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1.
J Clin Nurs ; 29(9-10): 1527-1538, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31970825

RESUMO

INTRODUCTION: Nurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost-effectiveness of these tests. METHODS: Following PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta-analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS-2. RESULTS: Twenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use. There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta-analysis, demonstrating high sensitivity; 96% (95% CI 0.90-0.99), but low specificity, 65% (95% CI 0.47-0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor. CONCLUSIONS: There is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost-effectiveness in acute stroke. RELEVANCE TO CLINICAL PRACTICE: Nurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke dysphagia. It is important to use a validated assessment tool that demonstrates good accuracy, clinical utility and cost-effectiveness.


Assuntos
Transtornos de Deglutição/diagnóstico , Programas de Rastreamento/métodos , Análise Custo-Benefício , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/enfermagem , Feminino , Humanos , Programas de Rastreamento/normas , Valor Preditivo dos Testes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem
2.
Soins Gerontol ; 24(137): 29-34, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31084806

RESUMO

In geriatrics, swallowing disorders are frequent, representing a daily source of anxiety for the nursing teams. Training in this area, aimed at caregivers in a long-stay care unit, has been developed based on an assessment of professional practices.


Assuntos
Transtornos de Deglutição/enfermagem , Avaliação Geriátrica , Enfermagem Geriátrica/educação , Idoso , Humanos
4.
Medsurg Nurs ; 26(2): 113-8, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-30304592

RESUMO

Impairment of cough and swallow is a potential consequence of neurological dysfunction that places affected patients at increased risk for respiratory compromise and death. Nurses are critical to early identification and frequent screening of airway defense mechanisms to reduce aspiration risk and improve clinical outcomes in patients with neurological impairment.


Assuntos
Tosse/complicações , Transtornos de Deglutição/enfermagem , Transtornos de Deglutição/fisiopatologia , Doenças do Sistema Nervoso/complicações , Pneumonia Aspirativa/enfermagem , Pneumonia Aspirativa/prevenção & controle , Insuficiência Respiratória/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Educação Continuada em Enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/educação , Fatores de Risco
5.
Br J Community Nurs ; 21(9): 476-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27594064

RESUMO

The clinical needs of patients can often be met by prescribing and administering a licensed medicine. District nurses will have some cases where a medicine cannot be used because the patient is unable to take it in its licensed form. In such situations, district nurses may be able to arrange for the patient to be supplied with an unlicensed medicine specifically made to meet that patient's special need. This article discusses the options available to district nurses to lawfully supply patients who have a special medication need due to, for example, an allergy to a particular ingredient or an inability to swallow solid oral medicines, such as tablets or capsules.


Assuntos
Enfermagem em Saúde Comunitária/legislação & jurisprudência , Enfermagem em Saúde Comunitária/normas , Transtornos de Deglutição/enfermagem , Prescrições de Medicamentos/enfermagem , Prescrições de Medicamentos/normas , Licenciamento/legislação & jurisprudência , Uso Off-Label/legislação & jurisprudência , Humanos , Uso Off-Label/normas , Reino Unido
6.
J Neurosci Nurs ; 48(2): 75-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26895569

RESUMO

Screening for dysphagia on stroke patient admissions in a timely manner, with early risk identification, and implementation of appropriate oral intake measures is a priority to reduce negative patient outcomes. Containing patient and facility costs, along with reducing length of stay, is a priority for all healthcare institutions. To ensure the provision of care at our facility was consistent with these priorities, we reviewed our processes and looked for opportunities for improvement. Assuring we had a reliable and valid nursing bedside screening tool for dysphagia was identified as a priority. We designed a study to answer the questions of validity and reliability. The findings suggest that our facility-developed Nursing Bedside Dysphagia Screen is a valid and reliable tool to help identify patients with stroke who are at risk for aspiration pneumonia.


Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/enfermagem , Diagnóstico de Enfermagem , Recursos Humanos de Enfermagem Hospitalar , Transtornos de Deglutição/economia , Feminino , Humanos , Masculino , Pneumonia Aspirativa/prevenção & controle , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações
7.
Community Pract ; 88(10): 32-5, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26596131

RESUMO

Swallowing problems are common and may occur in non neurological conditions. Swallowing problems are often insidious and ignored in older people; dysphagia should be recognized as a geriatric syndrome. It is important to identify this to ensure appropriate intervention and management is put into place. A Community Nurse is ideally placed to do this.


Assuntos
Enfermagem em Saúde Comunitária , Transtornos de Deglutição/enfermagem , Transtornos de Deglutição/epidemiologia , Humanos , Prevalência
8.
Br J Community Nurs ; Suppl Nutrition: S28-32, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26087205

RESUMO

Dysphagia impacts on the health and quality of life of individuals and contributes to the cost of health care. This paper summarises current literature regarding the nature, assessment and management of acquired oro-pharyngeal dysphagia in older adults. It examines the aetiology, prevalence and consequences of dysphagia, as well as issues regarding medication administration. Assessment of dysphagia is explored in terms of multidisciplinary screening, speech and language therapist clinical swallowing evaluation and instrumental assessment.


Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/enfermagem , Gerenciamento Clínico , Endoscopia , Feminino , Humanos , Masculino , Microscopia de Vídeo , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida
9.
J Clin Nurs ; 23(9-10): 1354-64, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24330351

RESUMO

AIMS AND OBJECTIVES: To evaluate the learning effect and resource use cost of workplace-based, blended e-learning about dysphagia for stroke rehabilitation nurses. BACKGROUND: Dysphagia is a potentially life-threatening problem that compromises quality of life. In many countries, nurses play a crucial role in supporting the management of patients with swallowing problems, yet the literature reports a need for training. DESIGN: A single-group, pre- and post-study with mixed methods. METHODS: Each blended e-learning session comprised a needs analysis, e-learning programmes, practical skills about modifying fluids and action planning to transfer learning into practice. Participants were the population of registered nurses (n = 22) and healthcare assistants (n = 10) on a stroke rehabilitation ward in a large, teaching hospital in England between August 2010-March 2011. Data collection comprised observation (34 hours), questionnaires administered at four time points to examine change in attitude, knowledge and practice, and estimating the resource use cost for the service. Nonparametric tests and content analysis were used to analyse the data. RESULTS: All participants achieved a nationally recognised level of competence. The learning effect was evident on the post- and follow-up measures, with some items of dysphagia knowledge and attitude achieving significance at the p ≤ 0·05 level. The most common self-reported changes in practice related to medicines management, thickening fluids and oral hygiene. The resource use cost was estimated at £2688 for 108 hours training. CONCLUSIONS: Workplace-based, blended e-learning was an acceptable, cost effective way of delivering essential clinical knowledge and skills about dysphagia. RELEVANCE TO CLINICAL PRACTICE: Dysphagia should be viewed as a patient safety issue because of the risks of malnutrition, dehydration and aspiration pneumonia. As such, it is pertinent to many members of the interdisciplinary team. Consideration should be given to including dysphagia management in initial education and continuing professional development programmes.


Assuntos
Transtornos de Deglutição/enfermagem , Educação Continuada em Enfermagem/economia , Internet , Processo de Enfermagem/economia , Idoso , Custos e Análise de Custo , Transtornos de Deglutição/reabilitação , Inglaterra , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , Local de Trabalho
10.
J Nurs Res ; 20(4): 272-80, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23154438

RESUMO

BACKGROUND: Impaired swallowing is common in elderly patients as well as those with neurological disorders and degenerative diseases. Convenient and accurate assessments should be available to community-dwelling older adults to diagnose and provide early management and care of swallowing difficulties, an important factor of influence on elderly life quality. PURPOSE: This study used convenient nonimaging methods to assess swallowing functions in community-dwelling older adults and estimated the prevalence of swallowing difficulties. METHODS: The study adopted a survey method and recruited 216 community-dwelling older adults over 65 years old in northern Taiwan. Researchers used tools including a swallowing test, questionnaire, water test, peripheral arterial pulse oximeter, and laryngeal S-EMG to assess participant swallowing functions and the prevalence of impaired swallowing. RESULTS: We found a 9.5% prevalence of impaired swallowing based on swallow questionnaire and water test results. Age correlated negatively with swallowing speed. A one-way ANOVA showed a significant difference in swallowing speed among the four age groups (F = 6.478, p < .00). A post hoc Scheffe comparison showed significant differences in swallowing time between the 60- to 69- and 70- to 79-year-old groups and 60- to 69- and 80- to 89-year-old groups. Multiple regression of impaired swallowing on various independent variables showed a significant standardized coefficient of 0.163 for age (t = 2.328, p = .021). Logistic regression showed a significant Wals test value for age (p = .007). The Kappa value was 0.307 for agreement analysis between impaired swallowing and SaO(2) value reduction of more than 2%. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Swallowing function deteriorates with age. Results of this study provide an assessment of the prevalence of impaired swallowing in community-dwelling older adults in Taiwan. Results can help guide clinical nurses to enhance their objective assessment of impaired swallowing to improve patient quality of life.


Assuntos
Transtornos de Deglutição/enfermagem , Avaliação Geriátrica/métodos , Enfermagem Geriátrica , Vida Independente , Avaliação em Enfermagem/métodos , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/epidemiologia , Feminino , Humanos , Masculino , Pesquisa Metodológica em Enfermagem , Inquéritos e Questionários , Taiwan/epidemiologia
11.
Can J Neurosci Nurs ; 33(1): 42-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21560885

RESUMO

Myotonic dystrophy (DM1) is the most prevalent muscular dystrophy occurring in adulthood. DM1 is a multi-systemic disorder resulting in early-onset cataracts, cardiac rhythm problems, muscle weakness, ptosis, and cognitive and psychiatric manifestations. Dysphagia is one of the most problematic symptoms of DM1 because it may cause weight loss, aspiration pneumonias or sudden death. The purpose of this review is to describe the characteristics of DM1 that make dysphagia management problematic, and to address the need for disease-specific guidelines and a clinical tool to aid in diagnosing and managing dysphagia in this population.


Assuntos
Transtornos de Deglutição , Avaliação em Enfermagem/normas , Guias de Prática Clínica como Assunto , Especialidades de Enfermagem/normas , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/enfermagem , Transtornos de Deglutição/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Distrofia Miotônica/complicações , Distrofia Miotônica/enfermagem , Distrofia Miotônica/terapia
12.
Br J Community Nurs ; 16(1): 6-10, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21278642

RESUMO

In the UK there is an increasing ageing population, bringing with it a host of degenerative conditions such as dementia. Dementia is a common condition among older people. In the UK there are estimated to be over 750 000 people with dementia and numbers are expected to double in the next 30 years (Comas-Herrera et al, 2007). The term 'dementia' is used to describe a syndrome which may be caused by a number of illnesses and is associated with ongoing decline of the brain and its abilities. There are many types of dementia, the most common are Alzheimer's disease, vascular dementia and dementia with Lewy bodies. The most common form of dementia is Alzheimer's which accounts for 62% of all cases. Vascular dementia either alone or co-existent with Alzheimer's, is the second most common subtype of dementia (Knapp et al, 2007). Dementia is associated with complex needs especially in the later stages, and can have a devastating effect on the individual, their family and friends. The care needs often challenge the skills and capacity of carers especially when normal every-day activities decline. Food and drink are fundamental to living. Consequently observing individuals struggling with eating and drinking not only poses difficulties for professionals but also raises emotional issues for the individual and their family.


Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/enfermagem , Demência/complicações , Doença Aguda , Idoso , Doença Crônica , Enfermagem em Saúde Comunitária , Transtornos de Deglutição/etiologia , Demência/epidemiologia , Avaliação Geriátrica , Necessidades e Demandas de Serviços de Saúde , Humanos , Planejamento de Cardápio , Avaliação em Enfermagem , Equipe de Assistência ao Paciente , Posicionamento do Paciente , Prevalência , Reino Unido/epidemiologia
13.
Palliat Med ; 25(3): 197-209, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21228087

RESUMO

Patients with advanced dementia often receive poor end-of-life care. We aimed to design and pilot a palliative care and advance care plan (ACP) intervention. Patients had undergone emergency hospital admission and had severe dementia. The intervention consisted of a palliative care patient assessment which informed an ACP discussion with the carer, who was offered the opportunity to write an ACP for the person with dementia. Carer-patient dyads were randomized to 'usual care' or the intervention. Carer-related outcome measures included the Kessler Distress Scale, Decision Satisfaction Inventory, Client Satisfaction Questionnaire and the Euroqol-5D, measured at baseline, six weeks, six months and three months after bereavement. The Satisfaction with End of Life Care in Dementia Scale was completed if the patient died. The 32 patient participants were physically frail and in the advanced stages of dementia: 62% had pressure damage to the skin, all needed feeding assistance and 95% were in pain. Nearly 50% died during the six-month follow-up period. Carers were difficult to recruit during acute admission; 33 patients and carers entered the study (22 intervention arm; 11 control arm). Only seven carers made ACPs. The care planning discussion was well received, but few carers wrote an ACP, despite intensive support from an experienced nurse specialist. Advance care planning is, in theory, a necessary intervention for people with severe dementia; the reluctance of carers to write plans needs to be explored further.


Assuntos
Planejamento Antecipado de Cuidados , Cuidadores , Demência/enfermagem , Cuidados Paliativos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/enfermagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/enfermagem , Seleção de Pacientes , Projetos Piloto , Qualidade de Vida , Inquéritos e Questionários
14.
Nurs Econ ; 28(2): 106-9, 113, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20446381

RESUMO

The purpose of this study was to evaluate the entire cost of nursing staff-prepared thickened liquids with Resource ThickenUp vs. utilizing commercially prepared thickened liquids in an acute care hospital. Time, cost, and effectiveness were studied in a 37-bed adult acute care neuroscience patient care unit in a large urban community hospital. Registered nurses and patient care technicians experienced in mixing thickened liquids for patients with dysphagia created liquids thickened to the consistency of nectar and honey from water, milk, and orange juice. Commercially prepared thickened liquids were 44% to 59% less expensive than the cost of manually creating the thickened liquids. Commercially prepared thickened liquids were more effective and of consistent viscosity than manually prepared thickened liquids due to variability in the skill of the preparer, alteration in the viscosity of the product based on acidity, protein, or sit-time from preparation to consumption.


Assuntos
Transtornos de Deglutição/terapia , Alimentos Formulados/economia , Custos Hospitalares , Acidente Vascular Cerebral/enfermagem , Adulto , Análise Custo-Benefício , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/enfermagem , Humanos , Acidente Vascular Cerebral/complicações , Estados Unidos
16.
Pflege Z ; 63(2): 102-7, 2010 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-20218168

RESUMO

This paper describes a study which was carried out within a project regarding the assessment of dysphagia for patients who had suffered a stroke. The aim of this investigation was to evaluate formatively the implementation of an assessment instrument for the care of patients with dysphagia. By means of a qualitative study semi-structured interviews with six nurses of a stroke unit were carried out. The interviews were analysed using content-analysis described by Mayring. The analysis illustrated that the interviewed nurses perceived the therapeutical value of nursing for patients with dysphagia. Furthermore the participants determined that a training course on the subject of caring for patients with dysphagia was important for the development of systematic knowledge which again added to the nurses' confidence of care for patients affected by dysphagia. However the utilisation of the assessment instrument developed by means of the project was problematic as described by the nurses participating in this study.


Assuntos
Transtornos de Deglutição/enfermagem , Avaliação em Enfermagem/métodos , Acidente Vascular Cerebral/enfermagem , Pesquisa em Enfermagem Clínica , Procedimentos Clínicos , Currículo , Transtornos de Deglutição/diagnóstico , Educação Continuada em Enfermagem , Humanos , Capacitação em Serviço , Acidente Vascular Cerebral/complicações
17.
J Gerontol Nurs ; 35(6): 20-7, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19537291

RESUMO

The Ottawa Model of Research Use guided the Hospital Elder Life Program nursing staff at a community hospital in promoting dysphagia assessment and management. The effect of an educational program and educational outreach on nurses' knowledge retention and nurse-initiated speech language pathology (SLP) referrals were assessed. The sample consisted of 122 nurses. Repeated measures analysis of variance demonstrated significant differences among the pretest and posttests immediately after and at 2 and 6 months later (F[3,70] = 10.126, p < 0.001). Nurses were more likely to initiate SLP referrals after the program. Improving practice requires stakeholder engagement and multiple strategies to sustain change.


Assuntos
Transtornos de Deglutição/diagnóstico , Enfermagem Baseada em Evidências , Avaliação em Enfermagem , Idoso , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/enfermagem , Humanos , Pessoa de Meia-Idade , Prevalência
19.
J Neurosci Nurs ; 37(4): 212-5, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16206547

RESUMO

Dysphagia is a major health problem associated with multiple neurological diseases such as stroke, multiple sclerosis, and Parkinson's disease, among others. Staff nurses lack a consistent approach to managing dysphagia patients. A dysphagia clinical nurse specialist (CNS) may facilitate a consistent approach. As a member of the interdisciplinary team, the dysphagia CNS carries a caseload and serves as a liaison between the interdisciplinary team and the nursing staff to oversee dysphagia nursing care.


Assuntos
Transtornos de Deglutição/enfermagem , Enfermeiros Clínicos/organização & administração , Papel do Profissional de Enfermagem , Competência Clínica , Comunicação , Consultores , Comportamento Cooperativo , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Necessidades e Demandas de Serviços de Saúde , Humanos , Relações Interprofissionais , Modelos de Enfermagem , Enfermeiros Clínicos/psicologia , Avaliação em Enfermagem , Pesquisa em Enfermagem/organização & administração , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto , Pneumonia Aspirativa/etiologia , Autonomia Profissional , Acidente Vascular Cerebral/complicações , Carga de Trabalho
20.
Int J Lang Commun Disord ; 36 Suppl: 369-74, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11340814

RESUMO

An inter-disciplinary approach to the assessment and management of dysphagia is essential. A partnership between speech and language therapists (SLT) and nurses combines in-depth experience of dysphagia with the holistic knowledge of the patient. Nurses in acute, rehabilitation and mental health settings are trained by SLTs to use a locally-developed screening tool. This allows the nurse to carry out a basic screening assessment when dysphagia is identified, start an interim feeding regime and monitor the patient's progress. Simple or short-term dysphagia can be managed by the dysphagia trained nurses (DTNs). Experience, qualitative and quantitative measurement has shown benefits. Audit results enable us to share our experiences and to plan for future development of the project including a formal validation of the tool.


Assuntos
Transtornos de Deglutição/terapia , Profissionais de Enfermagem/educação , Patologia da Fala e Linguagem , Transtornos de Deglutição/enfermagem , Humanos , Projetos Piloto
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