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

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE Australian Critical Care Pub Date : 2025-01-01 DOI:10.1016/j.aucc.2024.07.081

Anne Højager Nielsen CCRN, MCN, PhD , Robert Winding MD , Bettina Hvas Busk , Lillian Noe , Birthe Husted CCRN, MHH , Gitte Juhl Kristensen CCRN , Helle Svenningsen CCRN, MCN, PhD , Therese Ovesen MD, DMSc

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Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

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重症监护病房护士主导的吞咽困难筛查--一项实施研究。

背景：拔管后是重症监护病房的常见病，护士进行床旁筛查对于发现这种情况并避免吸入气道非常重要：本研究旨在评估在重症监护病房实施由护士主导的系统性吞咽困难筛查的情况，并确定吞咽困难筛查的障碍和促进因素：设计：实用实施研究。基于计划理论，使用行为改变轮框架确定关键行为。实施活动包括教育、电子学习、床旁同伴支持、反馈和环境提示。数据来源包括病历审查、参与者日志、实施日志和焦点小组访谈：结果：参与者日志显示，94% 的护士参加了教育课程，参加电子学习的护士较少（67%）。病历审查显示，很少使用护士主导的吞咽困难筛查。只有 19% 的拔管患者遵循了筛查方案。焦点小组讨论显示，护士们认为耶鲁吞咽协议是有效的，新技能和新理解增强了护士的能力，有助于决策制定。重要的障碍是让患者保持无吞咽状态以便插管、缺乏来自其他专业人员的社会支持以及记录困难。同事的社会支持则是促进因素：结论：在重症监护中实施护士主导的筛查是可行的，但受到外部因素的挑战。应注意筛查方案的更改，以避免工具的更改和记录的不便。在重症监护中实施以护士为主导的吞咽困难筛查可促进患者的口腔摄入安全，并识别出需要专业评估的患者。实施的目的应是让护士具备筛查患者吞咽功能的能力，并允许在不改变工具特性的情况下根据具体情况进行筛查。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.