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

Abstract

Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with neurological impairment. We conducted an update of a previous systematic review to examine the evidence regarding the nursing role in the recognition and management of dysphagia in adults with neurological impairment and the effectiveness of nursing interventions in the recognition and management of dysphagia. We conducted extensive database and internet searches and retrieved original quantitative research studies published between January 1998 and January 2008. Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Due to significant variability in study methodology, populations and interventions, no statistical meta-analysis was possible. 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.