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

South African Journal of Communication Disorders

Field Value
Title Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors
Creator Pierpoint, Maggie Pillay, Mershen
Subject Health Sciences; Speech-Language Therapy stroke; dysphagia management; early identification; dysphagia intervention; doctors and registered nurses.
Description Background: South African speech-language therapists are the only health professionals charged with dysphagia rehabilitation. However, registered nurses and doctors are often initial healthcare contact points for post-stroke dysphagia. Notwithstanding service concerns, they do indeed identify and manage post-stroke dysphagia. However, little is known about specifically what they do during these initial clinical encounters.Objective: 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%), speech-language 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.
Publisher AOSIS
Date 2020-05-28
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Cross-sectional descriptive survey
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajcd.v67i1.625
Source South African Journal of Communication Disorders; Vol 67, No 1 (2020); 13 pages 2225-4765 0379-8046
Language eng
Coverage South Africa — —
Rights Copyright (c) 2020 Maggie Pierpoint, Mershen Pillay