Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban.
S Afr J Commun Disord. 2020 May 28;67(1):e1-e13. doi: 10.4102/sajcd.v67i1.625.
South African speech-language therapists are the only health professionals charged with dysphagia rehabilitation. However, registered nurses and doctors are often initial healthcare contact points for post-stroke dysphagia. Notwithstanding service concerns, they do indeed identify and manage post-stroke dysphagia. However, little is known about specifically what they do during these initial clinical encounters.
To explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia.
A quantitative descriptive survey design, with non-probability, purposive sampling, was used. Twenty-one registered nurses and four doctors at a private South African hospital self-administered a questionnaire. Univariate analyses were completed by calculating frequency distributions of nurses' and doctors' identification and management practices.
Most (86%) did not use a formal screening tool. Indicators screened informally included: presence of drooling (84%) or gag reflex (76%), level of alertness (80%) and spontaneous saliva swallow (80%). Participants neglected important indicators like voluntary cough and vocal quality. Management provided included head of bed elevation (96%), speech-language therapist referrals (92%), nasogastric tube insertions (88%), intravenous fluids (84%) and positional adjustments (76%). Alternative management included total parenteral nutrition (52%), syringe feeding (48%), swallow muscle strengthening exercises (56%) and swallow manoeuvres (52%).
Results indicated that doctors and registered nurses under-utilised important dysphagia indicators and used potentially harmful management practices like syringe feeding. Management practices further included out-of-scope methods like dysphagia rehabilitation exercises or manoeuvres. Recommendations include peer dysphagia screening training using formal tools and basic dysphagia management methods to better equip doctors and registered nurses when they clinically engage post-stroke patients.
南非言语治疗师是唯一负责吞咽障碍康复的卫生专业人员。然而，注册护士和医生通常是中风后吞咽障碍的初始医疗接触点。尽管存在服务方面的担忧，但他们确实能够识别和管理中风后吞咽障碍。然而，对于他们在这些初始临床接触中具体做了什么，人们知之甚少。
探讨医生和注册护士在初次临床接触时如何识别和管理中风后吞咽障碍。
采用定量描述性调查设计，采用非概率、目的性抽样方法。21 名注册护士和 4 名医生在一家南非私立医院自行填写了一份问卷。通过计算护士和医生识别和管理实践的频率分布，完成单变量分析。
大多数（86%）没有使用正式的筛查工具。非正式筛查的指标包括：流口水（84%）或呛咳反射（76%）、警觉水平（80%）和自发性唾液吞咽（80%）。参与者忽略了一些重要的指标，如主动咳嗽和声音质量。提供的管理措施包括床头抬高（96%）、言语治疗师转诊（92%）、鼻胃管插入（88%）、静脉补液（84%）和体位调整（76%）。替代管理方法包括全胃肠外营养（52%）、注射器喂养（48%）、吞咽肌肉强化练习（56%）和吞咽手法（52%）。
结果表明，医生和注册护士没有充分利用重要的吞咽障碍指标，并且使用了可能有害的管理方法，如注射器喂养。管理措施还包括范围外的方法，如吞咽障碍康复练习或手法。建议包括使用正式工具对同行进行吞咽障碍筛查培训，以及基本的吞咽障碍管理方法，以便在临床接触中风后患者时，更好地为医生和注册护士提供帮助。
