Abstract
BackgroundSouth 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.ObjectiveTo explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia.MethodA 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.ResultsMost (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%).ConclusionResults 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.
Highlights
~590 million people (8% of the world population) experience dysphagia (Cichero et al, 2017)
which could lead to the under-identification of dysphagia
which can potentially lead to higher infection rates and aspiration
Summary
~590 million people (8% of the world population) experience dysphagia (Cichero et al, 2017). It is important to disclaim that we refer to a bespoke South African reality about dysphagia practice in SA as reviewed by Andrews and Pillay (2017) They referred to a practice reality that, prior to a Speech-Language Therapist (SLT) assessment or diagnosis, it is highly likely that post-stroke dysphagics will be identified and managed by other healthcare professionals, usually nurses and medical doctors. In this light, the terms ‘identification’ and ‘management’ take on the uncommon usage of referring to what occurs before the more specialised SLT-led screening and management. Little is known about what they do during these initial clinical encounters
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