Nurse-led dysphagia screening in the intensive care unit - An implementation study.

Postextubation is common in the intensive care unit, and bedside screening by nurses is important to detect the condition and avoid aspiration to the airways. The objective of this study was to assess the implementation of nurse-led, systematic dysphagia screening in the intensive care unit and to identify barriers and facilitators for dysphagia screening. Design: pragmatic implementation study. Based on a programme theory, key behaviours were identified using the Behaviour Change Wheel framework. Implementation activities included education, e-learning, bedside peer support, feedback, and cues in the environment. Data sources included chart reviews, participant logs, implementation log and focus-group interviews. Participant logs showed 94% of nurses participated in educational sessions, less in e-learning (67%). Chart reviews showed very little use of nurse-led dysphagia screening. Only 19% of extubated patients followed screening protocol. Focus groups showed that nurses accepted the Yale Swallow Protocol as valid that new skills and understandings led to empowerment of nurses and aided decision making. Important barriers were keeping patients nil-per-mouth for intubation, lack of social support from other professionals, and difficulties with documentation. Facilitators were social support from colleagues. Implementation of nurse-led screening in intensive care was possible but challenged by external factors. Attention should be given to alterations of the screening protocol to avoid alteration of the instrument and easy documentation. Implementation of nurse-led dysphagia screening in intensive care may facilitate safe oral intake in patients and identify patients in need of specialised assessment. Implementation should aim to provide nurses with competences in screening patients swallowing function and allow contextualisation without altering the properties of the instrument.

Nielsen AH ，Winding R ，Busk BH ，Noe L ，Husted B ，Kristensen GJ ，Svenningsen H ，Ovesen T ... -  《Australian Critical Care》

Nursing adherence, barriers and facilitators to conduct post-stroke dysphagia screening and assessment: A study based on theoretical domain framework.

There are an increasing number of evidence-based recommendations for managing dysphagia in post-stroke patients. However, it is unclear whether nurses adopt these recommendations in their daily nursing practices. This study aimed to explore nurses' adherence, barriers, facilitators and views on dysphagia screening and assessment of post-stroke dysphagia. In this study, multiple methods were adopted. In Phase 1, a general information questionnaire and a knowledge-attitude-practice and barriers/facilitators questionnaire for dysphagia screening and assessment were distributed in 55 hospitals online. In Phase 2, semi-structured interviews were conducted to explore nurses' views on barriers. Descriptive and one-way variance analyses were used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. This study adheres to STROBE and COREQ guidelines. Nine hundred and forty-two completed questionnaires were collected. Only 36.52% of the nurses screened for swallow function in patients as a guideline. The biggest barrier was 'memory, attention and decision process', with an average score of 3.22 (.74). The different stages of implementation had various types and degrees of barriers (p < .001). Five themes were extracted after interviews, namely 'Inadequate environment and resource support', 'Increased workload', 'Professional value perception', 'Organisational culture', and 'Poor knowledge and skill'. Nurses' practice of dysphagia screening and assessment of patients with dysphagia after stroke were inadequate, and the barriers originated from patients, leadership and the nurses themselves. This research extracted five barriers of guidance adherence for post-stroke dysphagia screening and assessment and identified the different kinds and degrees of barriers in five implementation stages, providing a basis for nursing managers to break through the bottleneck of guideline implementation. The nurses recruited in this study completed validated questionnaires in the survey and suggestive answers in interviews.

Guo Y ，Guo L ，Dong X ，Yang C ，Wang M ，Gao H ，Lv P ，Ma K ... -  《-》

Validity and Reliability of the Turkish Version of the Postextubation Dysphagia Screening Tool.

Background and Purpose: Patients who have been intubated ≥48 hours are at risk of dysphagia. Evaluation of swallowing before starting oral feeding after extubation is necessary to prevent aspiration and the problems caused by aspiration. The Postextubation Dysphagia Screening tool is a validated and reliable tool used to evaluate extubation-induced dysphagia. This study was conducted to evaluate the validity and reliability of the Postextubation Dysphagia Screening Tool for the Turkish population. Methods: The study had a methodological design and was carried out with 50 patients followed in the intensive care unit of a public hospital. The study was carried out in four stages: (1) language validity, (2) content validity, (3) establishing interrater reliability by agreement with two observers (intensive care nurse and intensivist), and (4) establishing sensitivity and specificity with the intensive care nurse and intensivist. Results: The overall content validity index was 0.91, indicating content validity. Interrater reliability was established (Cohen's g = 0.93). The prevalence of postextubation dysphagia was 42%, and the sensitivity of the Postextubation Dysphagia Screening Tool was 82% and the specificity was 64%. Implications for Practice: The Turkish version of the Postextubation Dysphagia Screening Tool exhibited good evidence of validity and reliability and was determined important as it can help nurses evaluate postextubation dysphagia in intensive care patients. The use of this tool by a nurse reduces the risk of unsafe oral intake among patients after prolonged intubation. This tool allows accurate assessment of dysphagia and initiation of early and safe oral feeding in critical care patients.

Canbolat O ，Yuksel S ，Gorgulu U ，Cankar Dal H ，Kapucu S ... -  《Research and Theory for Nursing Practice》

Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol.

MacKinnon K ，Marcellus L ，Rivers J ，Gordon C ，Ryan M ，Butcher D ... -  《-》

Translation and adaption of the Yale Swallow Protocol for a Danish intensive care setting.

Dysphagia related to intubation affects almost one in five patients in the intensive care unit; it may vary due to fluctuations in cerebral status and fatigue and lead to pneumonia, re-intubation and increased mortality. Taking care of patients' nutritional needs is an integral part of nursing and nurses must therefore be able to assess risk of dysphagia at all hours. However, Danish validated methods for use in the critically ill patient population are lacking. To translate and adapt the Yale Swallow Protocol method for implementation in a Danish intensive care unit setting. Translation and adaption followed WHO's recommendations for translation and adaption of instruments. Face validity of the Danish version was evaluated in four group interviews. These were digitally recorded, transcribed and analysed using deductive content analysis. All interviewees gave informed consent. The translated version of the Yale Swallow Protocol was easy to understand, although nurses needed to have the method explained and needed training in using the method. In addition, the Yale Swallow Protocol must be adapted to local practice in terms of identifying patients at risk of dysphagia and deciding where to document results of the screening. The translated version of the Yale Swallow Protocol proved conceptually and culturally sound and acceptable to intensive care unit nurses. Implementation should be followed by theoretical and practical training to build a nursing vocabulary relating to dysphagia and strengthen nurses' sensitivity to clinical manifestations consistent with dysphagia.

Nielsen AH ，Gow ND ，Svenningsen H 《-》