Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors

Abstract

To explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia.Method: A quantitative descriptive survey design, with non-probability, purposive sampling, was used. Twenty-one registered nurses and four doctors at a private South African hospital self-administered a questionnaire. Univariate analyses were completed by calculating frequency distributions of nurses' and doctors' identification and management practices.Results: Most (86%) did not use a formal screening tool. Indicators screened informally included: presence of drooling (84%) or gag reflex (76%), level of alertness (80%) and spontaneous saliva swallow (80%). Participants neglected important indicators like voluntary cough and vocal quality. Management provided included head of bed elevation (96%), speechlanguage therapist referrals (92%), nasogastric tube insertions (88%), intravenous fluids (84%) and positional adjustments (76%). Alternative management included total parenteral nutrition (52%), syringe feeding (48%), swallow muscle strengthening exercises (56%) and swallow manoeuvres (52%). Conclusion:Results indicated that doctors and registered nurses under-utilised important dysphagia indicators and used potentially harmful management practices like syringe feeding. Management practices further included out-of-scope methods like dysphagia rehabilitation exercises or manoeuvres. Recommendations include peer dysphagia screening training using formal tools and basic dysphagia management methods to better equip doctors and registered nurses when they clinically engage post-stroke patients.

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

“…The indwelling nasogastric tube can easily make the esophageal sphincter lose its integrity, increase the pharyngeal reflex threshold and reflux the contents of the gastroesophagus, thereby increasing the risk of aspiration (44). Studies (45,46) have shown that aspiration related pneumonia in stroke patients with dysphagia is mainly caused by aspiration, and aspiration pneumonia is closely associated with the death of stroke patients. The gastric tube is inserted intermittently to avoid long-term indwelling of the gastric tube, which can reduce the secretion of gastric acid and reflux of gastric contents, and prevent the bacteria in the stomach from migrating to the throat and inhaling the lower respiratory tract, thereby reducing the occurrence of aspiration pneumonia There are certain limitations in this study that should be concerned.…”

Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation

“…For perceived non-essential services such as speech therapy, these difficulties are often compounded because of their lack of priority when disseminating resources (Andrews & Pillay, 2017 ; Bright, Wallace, & Kuper, 2018 ; Rech, Hugo, Schmidt, Goulart, & Hilgert, 2019 ). As a result, according to Andrews and Pillay ( 2017 ), Pierpoint and Pillay ( 2020 ) and Modi and Ross ( 2000 ), many Speech-Language Therapists (SLTs) chose to alter their practice patterns to cope with the demands of the contexts in which they work, to allow for best possible practice within challenging conditions (Doeltgen et al, 2019 ; Saito et al, 2016 ).…”

Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management: A before-and-after study

“…Furthermore, following the clinical practice guidelines for dysphagia may reduce the death rate and chest infections in hospitalized patients, and consequently, improve patient prognosis [ 8 , 10 ]. However, despite the fact that multiple authoritative evidence-based guidelines are available and clearly recommend standard screening tools, treatment , and nursing care for dysphagia, there is a gap between clinical nursing practice and the best evidence, given that nurses underutilize important dysphagia indicators and use potentially harmful nursing practices such as syringe feeding [ 11 ]. Evidence-based interventions that have not been implemented require improvement.…”