Hines Sonia, Wallace Karen, Crowe Linda, Finlayson Kathleen, Chang Anne, Pattie Moya
Masters of Applied Science-Research candidate Grad Dip Public Health, Masters of Applied Science-Research candidate 1. Nursing Research Centre, Mater Health Services; Queensland Centre for Evidence-based Nursing and Midwifery: A Collaborating Centre of the Joanna Briggs Institute 2. Nursing Research Centre, Mater Health Services; Mater Mothers' Research Centre; Queensland Centre for Evidence-based Nursing and Midwifery: A Collaborating Centre of the Joanna Briggs Institute 3. Institute of Health and Biomedical Innovation, Queensland University of Technology. Kelvin Grove, Brisbane, Australia 4. School of Nursing, QUT; Queensland Centre for Evidence Based Nursing & Midwifery; Nursing Research Centre, Mater Health Services 5. Moya Pattie Speech Pathology, Chapel Hill Qld 4069.
JBI Libr Syst Rev. 2010;8(6):255-301. doi: 10.11124/01938924-201008060-00001.
Dysphagia, or difficulty in swallowing, is a serious and life threatening medical condition that affects a significant number of individuals with neurological impairment. Nurses, who are available to patients 24 hours a day, are in the ideal position to identify individuals with swallowing difficulties and initiate interventions that may prevent further complications until a formal assessment can be undertaken. Appropriate assessment of swallowing function is essential to the accurate identification and diagnosis of deficits in swallowing and to the effective management of dysphagia.
What is the nursing role in the recognition and management of dysphagia in adults with neurological impairment?Is there evidence on the effectiveness of nursing interventions in the recognition and management of dysphagia?
Types of participants- Adult patients over the age of 18 years with neurogenic dysphagia secondary to acute neurological impairment were the chief population of interest; studies of nurses caring for these patients were also included.Types of interventions- This review included studies which used various interventions which focussed on the nursing role in recognition and nursing management of dysphagia; any formal observation of ability to swallow undertaken / documented by nurses; Clinical / Bedside Swallowing Assessment undertaken by nurses; and/or pulse oximetry monitoring.Types of outcomes- Early recognition by nurses of those with difficulty swallowingTypes of studies- Original quantitative research studies with a range of study designs such as randomised controlled trials, quasi-randomised trials, observational and descriptive studies.
Studies focussing solely on diagnostic procedures ordered or undertaken by either medical professionals or speech-language pathologist (such as videofluoroscopy/VFSS) were not of interest to this review.
A comprehensive search of a wide variety of published and unpublished sources was undertaken for the period between January 1998 and January 2008 using as main keywords: dysphagia (text word and MH) or gag reflex or swallow or "deglutition disorder" (text word and MH); problem or impair or difficult; neurological and impair or stroke or bedside swallowing assessment; MH "Brain Diseases+" or neurological and impair* or disorder* disease* or malfunction.
Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer.
The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.
Due to significant variability in study methodology, populations and interventions, no statistical meta-analysis was possible. Results are presented in narrative and tabular form instead.
Forty-two quantitative studies were retrieved and, of these, 17 met the inclusion and quality criteria, representing a wide range of quantitative research methodologies.
The evidence from this updated review indicates that nurses are well-placed to conduct dysphagia assessments and that there are several tools available that may be suitable for them to use. It is important that formal dysphagia screening protocols are in place and that nurses are trained to use them. If nurses screen patients with an acute neurological impairment within 24 hours of admission, it may reduce the time that patients spend without appropriate methods of nutrition and hydration and improve clinical outcomes. Dysphagia screening by nurses does not replace assessment by other health professionals; instead it enhances the provision of care to patients at risk allowing for early recognition and intervention to occur.
吞咽困难，即吞咽障碍，是一种严重且危及生命的医学状况，影响着大量有神经功能障碍的个体。护士一天24小时都在患者身边，处于识别吞咽困难个体并在进行正式评估之前启动可能预防进一步并发症的干预措施的理想位置。对吞咽功能进行适当评估对于准确识别和诊断吞咽缺陷以及有效管理吞咽困难至关重要。
护士在识别和管理有神经功能障碍的成人吞咽困难方面的作用是什么？是否有证据表明护理干预在识别和管理吞咽困难方面有效？
参与者类型——主要关注的人群是18岁以上继发于急性神经功能障碍的神经性吞咽困难成年患者；也包括对护理这些患者的护士的研究。干预类型——本综述纳入了使用各种干预措施的研究，这些措施侧重于护士在识别和护理管理吞咽困难方面的作用；护士进行/记录的对吞咽能力的任何正式观察；护士进行的临床/床边吞咽评估；和/或脉搏血氧饱和度监测。结果类型——护士对吞咽困难者的早期识别。研究类型——具有一系列研究设计的原始定量研究，如随机对照试验、半随机试验、观察性和描述性研究。
本综述不关注仅聚焦于医学专业人员或言语治疗师所进行的诊断程序（如电视荧光吞咽造影检查/VFSS）的研究。
在1998年1月至2008年1月期间，对各种已发表和未发表的来源进行了全面检索，主要关键词为：吞咽困难（文本词和医学主题词）或咽反射或吞咽或“吞咽障碍”（文本词和医学主题词）；问题或损害或困难；神经学和损害或中风或床边吞咽评估；医学主题词“脑部疾病+”或神经学和损害或障碍疾病*或功能障碍。
在纳入综述之前，由两位独立评审员对选定用于检索的定量论文进行方法学有效性评估。评审员之间出现的任何分歧通过讨论解决，或由第三位评审员解决。
提取的数据包括与综述问题和具体目标相关的关于干预措施、人群、研究方法和结果的具体细节。
由于研究方法、人群和干预措施存在显著差异，无法进行统计元分析。结果以叙述和表格形式呈现。
检索到42项定量研究，其中17项符合纳入和质量标准，代表了广泛的定量研究方法。
本次更新综述的证据表明，护士很适合进行吞咽困难评估，并且有几种工具可供他们使用。制定正式的吞咽困难筛查方案并培训护士使用这些方案很重要。如果护士在患者入院后24小时内对急性神经功能障碍患者进行筛查，可能会减少患者在没有适当营养和水合方法的情况下所花费的时间，并改善临床结果。护士进行的吞咽困难筛查不能替代其他健康专业人员的评估；相反，它加强了对有风险患者的护理，以便能够早期识别和干预。
