Nurses' preferred items for dysphagia screening in acute stroke patients: A qualitative study
Background & Aim: Formal dysphagia screening protocols are not yet implemented in some hospitals although there is growing evidence that early dysphagia screening reduces pneumonia rates in stroke patients. Trained professionals are not often available outside weekdays working hours in stroke units, meaning that early screening is usually performed by nurses that use informal detection to screen dysphagia in acute stroke patients. The purpose of this study was to identify which items stroke nurses prioritize in their clinical practice to screen dysphagia in acute stroke patients.
Methods & Materials: A qualitative study was developed using a focus group technique in five stroke units with a total of 20 stroke nurses selected by purposive sampling in march 2019. Qualitative Data Analysis Software Miner Lite 4.0 was used to assist in content analysis.
Results: Two categories emerged: clinical data and swallowing and non-swallowing signs, each with a set of dimensions. In the category clinical data, relevance was noted for the dimension Glasgow Coma Scale and sex, identified as the most and least relevant, respectively, for dysphagia screening. In the category swallowing and non-swallowing signs no relevance evolved for preferred items. However, in this category, data suggest that nurses find less relevant in clinical practice speech disorders for dysphagia screening.
Conclusions: Results reinforce the importance of a standardized approach through the use of valid and reliable dysphagia screening protocols, arguing the need for clear guidance in acute stroke clinical pathways on procedures for dysphagia screening.
2. Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2019;8(5):439-58. http://dx.doi.org/10.1016/S1474-4422(19)30034-1.
3. Takizawa C, Gemmellm E, Kenworthym J, Speyer R. A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson’s Disease, Alzheimer’s Disease, Head Injury, and Pneumonia. Dysphagia. 2016;31(3):434-41. http://dx.doi.org/10.1007/s00455-016-9695-9.
4. Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, et al. Post-stroke dysphagia: A review and design considerations for future trials. International Journal of Stroke. 2016;11(4):399–411. http://dx.doi.org/10.1177/1747493016639057.
5. Al-Khaled M, Matthis C, Binder A, Mudter J, Schattschneider J, Pulkowski U, et al. Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes. Cerebrovascular Diseases. 2016;42(1-2):81-9. http://dx.doi.org/10.1159/000445299.
6. Jones E, Speyer R, Kertscher B, Denman D, Swan K, Cordier R. (2018). Health-Related Quality of Life and Oropharyngeal Dysphagia: A Systematic Review. Dysphagia. 2018;33(2):141-72. http://dx.doi.org/10.1007/s00455-17-9844-9.
7. Martino R, Beaton D, Diamant NE. Using different perspectives to generate items for a new scale measuring medical outcomes of dysphagia (MOD). Journal of Clinical Epidemiology. 2009;62(5):518-26. http://dx.doi.org/10.1016/j.jclinepi.2008.05.007.
8. Oliveira IJ, Mota LN, Freitas SV, Ferreira PL. Dysphagia screening tools for acute stroke patients available for nurses: A systematic review. Nursing Practice Today. 2019;6(3):103-15. http://dx.doi.org/10.18502/npt.v6i3.1253.
9. Bray BD, Smith CJ, Cloud GC, Enderby P, James M, Paley L, et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Journal of Neurology, Neurosurgery, and Psychiatry. 2017;88(1):25-30. http://dx.doi.org/10.1136/jnnp-2016-313356.
10. Daniels SK, Pathak S, Stach CB, Mohr TM, Morgan RO, Anderson JA. Speech Pathology Reliability for Stroke Swallowing Screening Items. Dysphagia. 2015;30(5):565-70. http://dx.doi.org/10.1007/s00455-015-9638-x.
11. Boaden E, Doran D, Burnell J, Burnell J, Dey P, Hurley M, et al. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database of Systematic Reviews. 2017;(6):13. http://dx.doi.org/10.1002/14651858.CD012679.
12. Altman KW, Takizawa C, Martino R, Speyer R, Derex L, Chevrou-Severac H, Altman R. Dysphagia screening, evaluation and treatment in stroke: implementation and integration with multiple concurrent clinical pathways. International Journal of Care Pathways. 2012;16(2):33. http://dx.doi.org/10.1258/jicp.2012.012m01.
13. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke.2019;50(12):e344–e418. http://dx.doi.org/10.1161/STR.0000000000000211.
14. Palli C, Fandler S, Doppelhofer K, Niederkorn K, Enzinger C, Vetta C, et al. Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study. Stroke. 2017;48(9):2583-5. http://dx.doi.org/10.1161/STROKEAHA.117.018157.
15. Middleton S, Coughlan K, Mnatzaganian G, Choy NL, Dale S, Jammali-Blasi A, et al. Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention: QASC Trial (Quality in Acute Stroke Care) Follow-Up. Stroke. 2017;48(5):1331-6. http://dx.doi.org/10.1161/STROKEAHA.116.016038.
16. Joundi RA, Martino R, Saposnik G, Giannakeas V, Fang J, Kapral MK, et al. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke. Stroke. 2017;48(4):900-6. http://dx.doi.org/10.1161/STROKEAHA.116.015332.
17. Dziewas R, Beck AB, Clave P, Hamdy S, Heppner HJ, Langmore SE, et al. Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century. Dysphagia.2017;32(1):78–82. http://dx.doi.org/10.1007/s00455-016-9746-2.
18. Portuguese Stroke Society (Internet). Porto: Guia das Unidades de AVC; 2017 (cited 2019 December 11). Available from: https://static.lvengine.net/spavc2013/Imgs/pages/uavc/GUIA%20AVC_site_28_11_17.pdf.
19. Silva IS, Veloso AL, Keating JB. Focus Group: considerações teóricas e metodológicas. Revista Lusófona de Educação. 2014;26(26):175-90. https://revistas.ulusofona.pt/index.php/rleducacao/article/view/4703
20. Bardin, L. Análise de conteúdo. Lisboa: Edições 70; 2008. P.288.
21. Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. Journal of Communication Disorders. 2013;46(3):238-48. http://dx.doi.org/10.1016/j.jcomdis.2013.04.001.
22. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, Diamant NE. The Toronto Bedside Swallowing Screening Test (TOR-BSST): Development and Validation of a Dysphagia Screening Tool for Patients with stroke. Stroke. 2009;40(2):555-61. http://dx.doi.org/10.1161/STROKEAHA.107.510370.
23. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, Brainin M. Dysphagia Bedside Screening for Acute-Stroke Patients: The Gugging Swallowing Screen. Stroke. 2007;38(11):2948-52. ttp://dx.doi.org/10.1161/STROKEAHA.107.483933.
24. Daniels SK, Anderson JA, Wilson PC. Valid Items for Screening Dysphagia Risk in Patients with Stroke: A Systematic Review. Stroke. 2012;43(3):892-7. http://dx.doi.org/10.1161/STROKEAHA.111.640946.
25. Sherman V, Flowers H, Kapral MK, Nicholson G, Silver F, Martino R. Screening for Dysphagia in Adult Patients with Stroke: Assessing the Accuracy of Informal Detection. Dysphagia.2018;33(5):662–9. http://dx.doi.org/10.1007/s00455-018-9885-8.
26. Smith EE, Kent DM, Bulsara KR, Leung LY, Lichtman JH, Reeves MJ, et al. Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke A Systematic Review for the 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke. 2018;49(3):e123-8. http://dx.doi.org/10.1161/STR.0000000000000159.
27. Donovan NJ, Daniels SK, Edmiaston J, Weinhart J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art. Invitational Conference Proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. Stroke. 2012;44(4):e24–e31. http://dx.doi.org/10.1161/STR.0b013e3182877f57.
28. Han JH, Lee GE, Jun JH, Lim YJ, Yoon, EJ, Kim YO. Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke. Korean Journal of Adult Nursing.2015;27(3):304-13. http://dx.doi.org/10.7475/kjan.2015.27.3.304.
29. Hines S, Kynoch K, Munday J. Nursing Interventions for Identifying and Managing Acute Dysphagia are Effective for Improving Patient Outcomes: A Systematic Review Update. The Journal of Neuroscience Nursing. 2016;48(4):215-23. http://dx.doi.org/10.1097/JNN.0000000000000200.
Copyright (c) 2020 Nursing Practice Today
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.