Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review.

BACKGROUND: Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS: A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS: A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION: Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.

Development of clinical items to identify dysphagia in patients with dementia-An e-Delphi study.

AIM: To identify clinical observable items that can be used to identify dysphagia while observing a typical eating situation. DESIGN: A three-round e-Delphi survey. METHODS: An expert panel consisting of five nurses, eight speech language therapists and five physicians participated in this three-round e-Delphi survey from November 2022 to January 2023. Round 1 presented the results of a literature research conducted in September 2022 and an open question to the participants. The answers were analysed using the content analysis method. In the following rounds, the results were presented back to the participants with a request to rate them for usefulness. Means, standard deviations, ANOVA and Fisher's exact test were used to demonstrate the panel's opinion, level of agreement, demographic characteristics of the participants as well as differences between the professional groups in regard of the rating of the items. Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES). RESULTS: The content analysis initially generated 36 items suggested by the expert panel. Seven additional items were incorporated from the literature review. In rounds 2 and 3, a 4-point Likert scale was used to rate each item and to calculate the level of agreement. The predetermined level of agreement exceeded 70% for 23 items. CONCLUSION: Based on the expert opinions, it is possible for nurses to identify dysphagia in patients with dementia by using the determined 23 items while observing a typical eating situation. PATIENT OR PUBLIC CONTRIBUTIONS: The expert panel contributed to the creation of this study by participating in the Delphi rounds. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The 23 items determined in this e-Delphi study enable nurses to make dietary adjustments or consult other members of the multidisciplinary team based on available evidence, enabling complications to be avoided. IMPACT: What problem did the study address? This study provides evidence regarding the identification of dysphagia in patients with dementia by nurses. What were the main findings? Twenty-three items were determined by an expert panel that can be used by nurses to identify dysphagia in patients with dementia while observing a typical eating situation. Where and on whom will the research have an impact? This research will have an impact on patients with dementia and the nurses caring for them. REPORTING METHOD: Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES) (Jünger et al., 2017), which promotes consistency and quality in conducting Delphi studies.

Speaking up about patient safety concerns: view of nursing students.

BACKGROUND: "Speaking up" is considered an important patient safety behaviour. The main idea is to voice patient safety concerns; however, several studies revealed that the organisational culture can be obstructive. In previous studies, we already identified barriers for doctors, nurses and medical students. In the current study, we explore how nursing students use "speaking up" during their internship in an academic teaching hospital. METHODS: Between 2019 and 2020, 212 nursing students were invited to take part in the survey. The validated Speaking Up about Patient Safety Questionnaire (SUPS-Q) was used to assess speaking up behaviours in nursing students. The SUPS-Q consisted of three behaviour related scales (11 items), three culture related scales (11 items), a question regarding barriers to speak up as well as a clinical vignette assessing a hypothetical speaking up situation. RESULTS: In total, 118 nursing students took part in the survey (response rate: 56%). Most of them noticed specific safety concerns, observed errors or rule violations. The vignette was seen as very realistic and harmful to the patient. However, the majority responded that they did not speak up and remained silent. They reported a rather discouraging environment and high levels of resignation towards speaking up. However, more advanced students were less likely to speak up than less advanced students (p = 0.027). Most relevant barriers were fear of negative reaction (64%), reaction not predictable (62%) and ineffectiveness (42%). CONCLUSIONS: Survey results of nursing students imply that speaking-up behaviours and remaining silent are common behaviours and coexist in the same individual. The clinical vignette and barriers to speaking up revealed that a hierarchical system does not support speaking-up behaviours. Organizational development is needed to foster professional teamwork, support attentive listening, encourage critical thinking, and problem-solving skills.

Mixed Reality Prototype of Multimodal Screening for Early Detection of Cognitive Impairments in Older Adults: Protocol Development and Usability Study.

BACKGROUND: The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project "Smart Cognition & Behaviour Screening powered by Augmented Reality" (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults. OBJECTIVE: This study established a protocol for the implementation and usability of a mixed reality (MR)-enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined. METHODS: This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods. RESULTS: This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023. CONCLUSIONS: The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39513.

Adaptation of Clinical Practice Guideline Recommendations in Hospitals for People Living With Dementia and Their Caregivers.

BACKGROUND: Dementia is common in older people in general hospitals. To improve the quality of their care, the use of nonpharmacological interventions based on the best evidence from clinical guidelines is recommended. Many international clinical guidelines exist, but their recommendations are often not used because they do not fit the local setting or the country. AIM: The aim of this study was to adapt the international clinical guidelines and their recommendations to the Austrian context regarding nonpharmacological interventions for people with dementia living in the general hospital setting. METHODS: The ADAPTE process was chosen as a method for the adaptation. A search for international clinical guidelines was conducted in seven databases within this process. The guidelines which met the inclusion and quality criteria were assessed with the AGREE II instrument by two independent reviewers. The recommendations of the guidelines were extracted. Those that did not fit the Austrian context were excluded, and recommendations with similar statements were summarized. The selected and modified recommendations were translated into German. RESULTS: Out of 206 guidelines, three met the inclusion criteria and two, the quality criteria. One hundred and fifty-two recommendations were extracted from these two guidelines, 42 of which were suitable for the Austrian setting and 20 of which had similar statements and could be summarized. Finally, 32 recommendations were identified that were applicable to the general hospital setting in Austria. LINKING EVIDENCE TO ACTION: The adaptation of clinical guidelines with the ADAPTE process generated seven topics with 32 recommendations. Many international guidelines exist, but they cannot be applied verbatim in every country due to the fact that some recommendations are not applicable with respect to the national and local context. Creating an adaption of international guidelines is an effective way to provide and link evidence from research to national nursing practice.

The effect of Therapeutic Touch on Back Pain in Adults on a Neurological Unit: An Experimental Pilot Study.

BACKGROUND: Chronic back pain affects many aspects of everyday life and is a common reason for medical visits, leading to high direct and indirect health care costs. Innovative and cost-effective nonpharmacologic pain management methods should be promoted to ensure adequate treatment. AIMS: The aim of this pilot study was to investigate the pain-relieving effect of Therapeutic Touch in adult neurologic patients with back pain. DESIGN: A pretest-post-test randomized controlled trial. SETTINGS: A university hospital in Austria. PARTICIPANTS/SUBJECTS: Patients with back pain diagnosis (N = 29) on hospital admission. METHODS: A pilot study was conducted for 3 months. The control group (n = 14) received the pharmacologic pain management recommended by the World Health Organization; patients in the intervention group (n = 15) received additionally four Therapeutic Touch treatments on 4 consecutive days. The Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale were used as outcome measures to evaluate activity domains affected by back pain and pain intensity. RESULTS: Pain improvement was found in the intervention group according to the mean score of the Quebec Back Pain Disability Scale (day 1: 72.53, standard deviation [SD] ± 14.10; day 4: 39.47, SD ± 8.77; p < .001). The Numerical Pain Rating Scale score averaged 4.33 points (SD ± 2.09) on the first day and 2.47 points (SD ± 1.12) on the fourth day. The long-term effect of Therapeutic Touch was significant and indicated a major effect (Pillai's trace = .641, F(3.12) = 7.1, p = .005, ηp2 = .641). CONCLUSIONS: Therapeutic Touch seems to be a noninvasive nursing intervention for back pain management to provide more professional patient care.

Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study.

BACKGROUND AND PURPOSE: Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment. METHODS: We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables. RESULTS: Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P=0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P=0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P=0.033). CONCLUSIONS: 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available.