Speech-language pathologists’ experience with nursing initiated texture modified diets in health care settings

Abstract

BACKGROUND: Texture modified diets (TMDs) are among the most widely used compensatory measures for managing dysphagia. TMDs are associated with significant risks involving nutrition, hydration, and quality of life. Speech-language pathologists (SLPs) are trained to evaluate and treat people with dysphagia and to assess client-specific appropriateness of TMDs. However, patients are regularly placed on TMDs by nursing staff without formal training in dysphagia and without SLP consult (Gurevich et al., 2021). OBJECTIVE: This study explores the experience of SLPs in health care with respect to such nursing initiated TMDs with the goal of assessing the prevalence of this practice. METHOD: SLP students, clinical fellows, and practicing clinicians (N = 503) were surveyed regarding their exposure to the nursing initiated TMD practice. RESULTS: Overall, 78.9% of respondents have directly encountered the nursing initiated TMD practice, with an additional 10% having heard of it. The group most susceptible to this practice, the certified clinicians who work with dysphagia alongside nurses (n = 461), had a higher rate of directly encountering this practice (82.2%). Among these, the early career clinicians (n = 104) had an even higher direct encounter rate at 87.5%. CONCLUSIONS: Findings show that nursing initiated TMDs are pervasive in United States (U.S.) health care, and SLPs are shown to regularly face this issue in their work settings as soon as they enter the workforce. Given negative outcomes associated with TMDs, patient care would be best served if decisions to implement TMDs were made by personnel with training in dysphagia.