Managing ongoing swallow safety through information‐sharing: An ethnography of speech and language therapists and nurses at work on stroke units

Abstract

Background: Speech and language therapists and nurses need to work together to keep patients with swallowing difficulties safe throughout their acute stroke admission. Speech and language therapists make recommendations for safe swallowing following assessment and nurses put recommendations into practice and monitor how patients cope. There has been little research into the everyday realities of ongoing swallow safety management by these two disciplines. Patient safety research in other fields of healthcare indicates that safety can be enhanced through understanding the cultural context in which risk decisions are made. Aims: To generate new understanding for how speech and language therapists (SLTs) and nurses share information for ongoing management of swallows safety on stroke units. Methods & Procedures: An ethnographic methodology involving 40 weeks of fieldwork on three stroke wards in England between 2015 and 2017. Fieldwork observation (357 h) and interviews with 43 members of SLT and nursing staff. Observational and interview data were analysed iteratively using techniques from the constant comparative method to create a thematically organized explanation.Outcomes & Results: An explanation for how disciplinary differences in time and space influenced how SLT and nursing staff shared information for ongoing management of swallow safety, based around three themes: (1) SLTs and nurses were aligned in concern for swallow safety across all information-sharing routes; however, (2) ambiguity was introduced by the need for the information contained in swallowing recommendations to travel across time, creating dilemmas for nurses. Patients could improve or deteriorate after recommendations were made and nurses had competing demands on their time. Ambiguity hadThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Research trends and hotspots of post-stroke dysphagia rehabilitation: a bibliometric study and visualization analysis

“…Transcutaneous auricular electrical vagus nerve stimulation (ta-VNS) modulates swallowing function via bilateral extra-auricular stimulation of the vagus nerve, with few serious adverse events occurring during the intervention, which is safe and can be used as a novel non-invasive treatment strategy ( 84 ). Furthermore, the involvement of speech-language pathologists (SLPs) and nurses in the management of PSD rehabilitation is critical, and this co-management model can assist the rehabilitation team in consistently obtaining safety information about dysphagia and facilitating the implementation of the rehabilitation program; however, implementable options are needed to be explored further ( 85 ).…”