Nurse-led dysphagia screening in acute stroke patients

Lees, Liz; Sharpe, Linda; Edwards, Amanda

doi:10.7748/ns2006.10.21.6.35.c6373

Cited by 24 publications

(9 citation statements)

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“…Increasing the knowledge of nursing staff on the detection of swallowing difficulties could have a direct impact on patient outcomes. Lees, Sharpe, and Edwards (2006) conducted a study involving nurse-led dysphagia screening in acute stroke patients. They investigated the outcomes of a systematic approach to training nurses who conduct dysphagia assessments.…”

Section: Identification Of Dysphagiamentioning

confidence: 99%

A Review of the Management of Dysphagia

Blackwell

Littlejohns

2010

Journal of Neuroscience Nursing

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Dysphagia is an impairment of swallowing associated with neurological diseases, including stroke. Identification is vitally important but can be difficult because stroke patients with dysphagia rarely perceive that they have a swallowing problem. Assessments of swallowing are not consistently carried out by medical or nursing staff, and often, there are unclear lines of responsibility as to which patients should be referred to a speech-language pathologist. This study measured the prevalence, assessment, and management of dysphagia in three private rehabilitation clinics in South Africa. Findings indicated a prevalence of dysphagia in 56% of patients following stroke, a number far exceeding previously reported statistics. This number may have been inflated due to conservative swallowing assessments given the subjective measures commonly utilized in South Africa, a product of the often-limited availability of imaging technology. All three clinics evidenced a strong multidisciplinary approach in the care and management of dysphagia patients. These findings highlight the need for increased education of collaboration between speech-language pathologists and nursing staff and support the need for future research in the field of poststroke dysphagia.

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Section: Identification Of Dysphagiamentioning

confidence: 99%

A Review of the Management of Dysphagia

Blackwell

Littlejohns

2010

Journal of Neuroscience Nursing

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“…A wet vocal quality after a swallow test indicates that the fluid has entered the airway and made contact with the vocal cords (Lees, Sharpe, & Edwards, 2006; Mann & Hankey, 2001; Ramsey, Smithard, & Kalra, 2003). Vocal quality was assessed by having the patient say “ah.” A cough may occur when weakness of the tongue allows fluid to fall over the base of the tongue into the unprotected airway or when a delay in the swallow reflex allows fluid to enter the airway (Lees et al; Mann & Hankey; Ramsey et al).…”

Section: Methodsmentioning

confidence: 99%

Accuracy of a Bedside Dysphagia Screening: A Comparison of Registered Nurses and Speech Therapists

Weinhardt

Hazelett²,

Barrett³

et al. 2008

Rehabilitation Nursing

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Evidence‐based guidelines suggest that stroke patients should be screened for dysphagia before oral intake. The purpose of this study was to validate a dysphagia screening tool comparing registered nurses (RNs) with speech therapists (STs). All stroke unit patients who received predetermined scores on specific items of the National Institutes of Health Stroke Scale were eligible for screening. The trial consisted of three parts (with swallow, cough, and vocal quality observed during each part): 1 teaspoon lemon ice, 1 teaspoon applesauce, and 1 teaspoon water. RNs performed five screenings that were compared with independent screenings performed on the same patient within 1 hour by a speech therapist (ST). Eighty‐three paired screenings were completed, with 94% agreement between the RNs and the STs. This screening identifies patients who are able to swallow and can eat from a safe menu until formally evaluated by an ST while maintaining nothing by mouth (NPO) status for those at risk for aspiration.

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“…A screening test such as the Standardized Swallowing Assessment 4 has been found to be both sensitive and specific to dysphagia and suitable for use by nurses. [5][6][7] The Standardized Swallowing Assessment may be an effective tool for facilities seeking to implement a dysphagia screening protocol. As voice changes after swallowing are significantly associated with dysphagia, 8-10 any dysphagia screening protocol selected should include this as a trigger for nursing assessment and further action.…”

Section: Identification Of Dysphagiamentioning

confidence: 99%

“…The presence of a formal dysphagia screening protocol of any kind is significantly associated with a reduced incidence of aspiration pneumonia 3 in stroke patients and therefore improved outcomes. A screening test such as the Standardized Swallowing Assessment 4 has been found to be both sensitive and specific to dysphagia and suitable for use by nurses 5–7 . The Standardized Swallowing Assessment may be an effective tool for facilities seeking to implement a dysphagia screening protocol.…”

Section: Translation To Practicementioning

confidence: 99%

Identification and nursing management of dysphagia in individuals with acute neurological impairment (update)

Hines

Wallace

Crowe

et al. 2011

International Journal of Evidence-Based Healthcare

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Forty-two quantitative studies were retrieved and, of these, 17 met the inclusion and quality criteria, representing a wide range of quantitative research methodologies. The evidence from this updated review indicates that nurses are well placed to conduct dysphagia screening and that there are several tools available that may be suitable for them to use. It is important that formal dysphagia screening protocols are in place and that nurses are trained to use them. If nurses screen patients with an acute neurological impairment within 24 h of admission, it may reduce the time that patients spend without appropriate methods of nutrition and hydration and improve clinical outcomes. Dysphagia screening by nurses does not replace assessment by other health professionals; instead it enhances the provision of care to patients at risk by allowing for early recognition and intervention to occur. Dysphagia screening by nurses is an important initial step in the care of patients with acute neurological impairment, but in order to achieve the best outcomes, it needs to be followed up with careful, consistent management of food and fluid intake.

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Nurse-led dysphagia screening in acute stroke patients

Cited by 24 publications

References 0 publications

A Review of the Management of Dysphagia

A Review of the Management of Dysphagia

Accuracy of a Bedside Dysphagia Screening: A Comparison of Registered Nurses and Speech Therapists

Identification and nursing management of dysphagia in individuals with acute neurological impairment (update)

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