Meal Assistance Virtual Game Reflective Questions

Jothika Logeswaran

1. Can you describe in one or two words how you felt after playing the virtual game?
Throughout the game, I experienced a range of emotions. When I successfully applied
safe feeding techniques and helped Greta eat independently, I felt proud of supporting her
progress. Seeing Greta respond positively to encouragement and make progress with her meal
made me feel happy and fulfilled. During moments where choking seemed possible, I felt a sense
of anxiety, wanting to ensure her safety. After successfully managing any difficult moments, like
when she cleared her airway, I felt relieved. As Greta became more independent, I felt
encouraged to continue building my skills and supporting her journey to recovery. These
emotions highlighted the importance of being attentive, supportive, and prepared when working
with clients who need specialized care.

2. Reflect on the sequencing you played the VGS and write down the order you
experienced it. What did you learn from the decisions you made?
II started by reviewing Greta’s background, her dysphagia diagnosis, and the
recommendations for her pureed diet and thickened fluids. I considered that her safety was a
priority and needed to ensure that her meal was appropriate, such as the coffee being thickened.
One mistake I made was offering to feed Greta after her affected arm was getting tired. I learned
that I should promote independence, and do so by encouraging Greta to use her unaffected hand
instead. Another mistake I made was offering encouragement and praise to Greta even though
she was using the incorrect swallowing technique. I should have guided her first by informing
her to take smaller bites and swallow twice with each bite.

3. What were you proud of? What went well for you during the game and why do you think
it went well?
During the game, I was proud of my ability to apply clinical reasoning skills effectively
to ensure Greta’s safety and comfort. My focus on monitoring her swallowing techniques,
positioning, and checking for signs of aspiration or choking showed my attentiveness to her
needs and understanding of dysphagia care. By taking the time to review the guidelines for
assisting clients with dysphagia, I felt more confident in my approach. My encouragement and
reassurance helped Greta feel supported, allowing her to focus on her meal without fear.

4. What was challenging for you during the game? What was the most difficult decision
point and why do you think it was difficult?
One of the most challenging aspects of the game was managing the delicate balance
between assisting Greta and allowing her to maintain her independence. The most difficult
decision point was determining when to intervene with hands-on support versus when to provide
verbal guidance and encouragement. I wanted to ensure her safety, but I was also aware of her
desire to be self-sufficient. This decision was difficult because overstepping could discourage her
and impact her confidence, while too little assistance could increase her risk of choking. This
decision was challenging because it required both careful observation and judgment, as well as a
deep understanding of Greta’s physical limitations and emotional needs. Striking this balance in
a risky situation, like meal assistance for a client with dysphagia, was complex and required
confidence in my clinical skills. As a student, I am still learning to trust my own assessments and
to note when it is appropriate to step in versus step back.

5. How could you create a social environment for a client during meal time, while
maintaining their safety?
I would start by discussing Greta’s preferences for social interaction during meals. For
example, I could ask if she enjoys having someone nearby for conversation or if she prefers to
focus quietly on her meal. Respecting her preferences allows me to personalize her experience
and make her feel more at ease. If Greta enjoys socializing, I would engage her in light
conversation, possibly discussing topics of interest to her. Keeping the conversation relaxed and
positive can help her feel more comfortable and enjoy her meal. Additionally, I would use
positive reinforcement, such as saying, “You’re doing great with your meal,” to boost her
confidence. I’d avoid talking too much or asking questions while she’s actively chewing or
swallowing, to minimize any risk of distraction that could lead to choking. I would ensure Greta
feels connected but remains focused on safe eating practices. For instance, I’d gently remind her
to take small bites, swallow thoroughly, and maintain an upright position without making her
feel pressured or rushed. I could also position myself at an angle where I can monitor her for
signs of difficulty, while still maintaining a warm and conversational demeanor.

6. How can you decrease the risk of choking and aspiration during meal assistance for a
client with dysphagia?
Ensuring the client is seated upright at a 90-degree angle is essential. This posture allows
gravity to aid swallowing and reduces the risk of food or liquids entering the airway. If the client
is in bed, I would adjust the bed to an upright position and support their head and neck for
stability. Conversation can also be distracting and may increase the risk of choking. I would
encourage the client to focus on each bite, and I would minimize conversation, only speaking as
necessary to provide guidance or reassurance. If the client initiates conversation, I would politely
suggest pausing while they’re chewing and swallowing. I would also observe the client closely
for any signs of difficulty swallowing, such as coughing, throat clearing, or changes in breathing.
Giving the client enough time to swallow fully before offering the next bite helps ensure that
each mouthful is safely cleared. I might also encourage double swallowing, where the client
swallows twice per bite, to ensure food moves fully down the esophagus. Clients with dysphagia
often need pureed foods and thickened liquids, as they are easier to control in the mouth and less
likely to cause aspiration. I would ensure Greta’s meal aligns with these dietary guidelines,
confirming her food consistency and using pre-thickened liquids or thickening agents as
recommended.

7. What do you believe caused the client to choke on her breakfast?

Engaging in conversation during meals can be a significant choking risk, especially for
clients with dysphagia. Talking requires coordination between breathing and swallowing, which
may be difficult for someone with weakened swallowing muscles. If Greta was distracted by
conversation, she may have unintentionally tried to swallow before her mouth was fully
prepared, increasing the risk of choking. Greta’s left-sided weakness due to her stroke may
contribute to difficulties with safe swallowing. This muscle weakness could make it harder for
her to control food in her mouth, leading to food “pocketing” or incomplete swallowing.
Additionally, if she was using her left hand, it might be challenging for her to manage the spoon,
resulting in larger or more difficult-to-control bites.Dysphagia often causes clients to require
more time to fully swallow each bite. If Greta’s previous spoonful was not entirely swallowed,
adding another bite could have compounded the difficulty, causing her airway to become
obstructed. Swallowing takes longer and requires extra care for someone with impaired function,
so rushing or taking successive bites can lead to choking.

8. How did you feel when Greta started to choke and how was that reflected in your
response?
When Greta started to choke, I felt a mix of concern and urgency. My primary feeling
was worry for her safety, and that sense of urgency likely heightened my focus on immediate
action. Choking is a serious incident, especially for a client with dysphagia, so my feelings of
concern directly impacted my response. I knew I needed to act quickly and carefully to prevent
further complications. My concern and increased sense of responsibility pushed me to respond
swiftly, making sure Greta felt supported and safe. However, I also had to manage my emotions
to avoid showing panic, as that could have increased Greta’s anxiety. By remaining calm
outwardly, I aimed to reassure her, even if I felt anxious internally. This balance helped me stay
focused on what needed to be done. While my emotions initially influenced me to act, I relied on
my training and understanding of aspiration protocols to guide my steps. For example, I
encouraged Greta to cough to help clear her airway, stayed by her side to monitor her, and
followed proper steps to assess her safety. Knowledge allowed me to act with confidence and
avoid panicked reactions that could have compromised her well-being.

9. Why do you think it is important to stay with the client when she began to choke?
The primary concern during a choking incident is the immediate safety of the client. By
remaining with her, you can quickly assess the severity of the choking and take appropriate
action, such as encouraging her to cough or, if necessary, performing choking first aid or calling
for emergency assistance. Ensuring her airway remains clear is vital for her health. Observing
Ms. Kasowski closely during this time allows you to notice any changes in her condition, such as
signs of distress, decreased consciousness, or changes in breathing patterns. This real-time
monitoring can help in making quick decisions about whether to escalate care or provide further
intervention. Choking can be a frightening experience, especially for someone who is already
adapting to the challenges of recovery from a stroke. By staying with her, you can offer
reassurance, help her remain calm, and provide emotional support. This can help reduce anxiety
and promote a sense of safety during a distressing situation.

10. Why do you think it is important to assess the client’s mouth and oral cavity after the
client’s choking incident?
Pocketing refers to the accumulation of food or liquids in the cheeks, gums, or teeth. If
food is not properly swallowed or cleared from the mouth, it can remain in pockets within the
oral cavity, increasing the risk of aspiration. After a choking incident, checking for pocketing
ensures that no food is left behind that could potentially block the airway or lead to further
choking. After a choking episode, it is critical to ensure that the client is not at risk for aspiration
(the inhalation of food or liquid into the lungs), which can lead to pneumonia or other respiratory
complications. By assessing the oral cavity for leftover food, you can help prevent aspiration by
ensuring that the mouth is clear and the swallowing process is functioning properly. This also
allows for the identification of any residual food that could be a source of further choking or
aspiration risk.

11. What would you do the same and what would you do differently if you were to
experience the same situation in clinical?
Ensuring Ms. Kasowski’s safety would remain my top priority. I would stay with her to
monitor her condition closely, assess the severity of the choking, and be ready to intervene
immediately if necessary. This action is essential for preventing further complications and
ensuring a quick response. Continuous monitoring during the choking episode would still be a
priority to ensure that the client’s condition does not worsen. I would be alert for signs of distress
or respiratory changes that may require escalation of care (such as calling for additional help or
emergency services). I would continue to reassure and comfort Ms. Kasowski, acknowledging
that choking can be a frightening experience. Offering reassurance helps the client stay calm and
feel supported, which can positively impact both her emotional well-being and the situation’s
outcome. After the choking episode, I would assess the client’s mouth for any food or liquids
that may have been left behind, as this is a potential risk for further choking or aspiration. This is
crucial for reducing the risk of complications.

12. What is the one skill regarding meal assistance that you would like to improve before
going to clinical?
One skill I would like to improve before going to clinical is assisting patients with
swallowing difficulties during meal times, particularly in a stroke recovery context. This
involves not only helping with physical feeding tasks but also ensuring the patient is positioned
safely and following any specific guidelines regarding food consistency and swallowing
techniques. I will study and practice techniques such as positioning (e.g., sitting upright at a 90-
degree angle) and the use of adaptive equipment (e.g., specialized utensils or cups). This will
help ensure safe feeding, especially for those who may have difficulty swallowing. I’ll study the
specific types of swallowing difficulties (dysphagia) common after a stroke and how to assist
patients based on their individual needs, including ensuring the consistency of food and liquids
matches the recommendations from the speech therapist (SLP).

13. How will you use what you have learned in the meal assistance game during your
clinical placement?
Each client has unique needs regarding feeding, swallowing, and nutritional intake. I will
assess their functional abilities, including swallowing capacity and specific recommendations
from the SLP or OT. For example, with Ms. Kasowski’s left-sided weakness and left-handed
dominance, I’ll tailor my assistance to maximize her independence while minimizing risks.
Positioning is key to preventing aspiration, so I’ll ensure she’s upright and properly aligned
during meals. I’ll follow the SLP’s guidance on food consistency (e.g., thickened liquids, soft
foods) to reduce aspiration risks. I’ll provide the right level of assistance, supporting her
independence but stepping in when necessary to prevent choking. After meals, I’ll monitor for
signs of aspiration, like coughing or difficulty breathing, and address any concerns promptly.