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

Abstract

Background: Dysphagia, that is, difficulty in swallowing, is a serious and life-threatening condition that affects a significant number of individuals with acute neurological impairment. Objective: To find the best available evidence regarding: 1. The nursing role in the recognition and management of dysphagia in adults with acute neurological impairment. 2. The evidence on the effectiveness of nursing interventions in the recognition and management of dysphagia. Methods: In light of the new evidence we used Joanna Briggs Institute standard systematic review methods to update our previously published review. We included any quantitative research, published in English after 2008, focusing on the nursing role in the identification and nursing management of adults with neurogenic dysphagia. Results: Four new studies were added by this update. Dysphagia screening by nurses significantly reduces the number of chest infections in patients with stroke (OR 0.45, 95% CI 0.33 to 0.62, P < 0.00001). The presence of formal dysphagia care guidelines is effective for reducing inpatient death (OR 0.60, 95% CI 0.43 to 0.84, P = 0.003) and reducing chest infections (OR 0.68, 95% CI 0.51 to 0.90, P = 0.008). Formal dysphagia guidelines also increased the number of screens conducted and the number of screens within 24 hours of admission. Discussion: There is strong evidence to support the role of nurses in the detection and management of patients with neurogenic dysphagia. Suitable tools are available and there seems little reason for healthcare organisations not to have nurses trained in dysphagia screening. Conclusion: A considerable body of research now exists on this subject; however, some gaps still remain. High quality research is needed to provide evidence about the effect of nurse-initiated dysphagia screening on the number of days patients spend nil by mouth, the time patients wait for assessment, and the effect of nurse-initiated dysphagia screening on length of stay and discharge destination.