Aerodigestive Research Core, University of Florida, Gainesville, FL, USA.
Department of Speech, College of Public Health, Health Professions, University of Florida, Gainesville, FL, USA.
J Clin Nurs. 2020 Dec;29(23-24):4573-4582. doi: 10.1111/jocn.15490. Epub 2020 Oct 2.
The current study surveyed nurse practice patterns for performing swallowing screens in an academic cardiac intensive care unit (ICU). It aimed to index: training and levels of confidence in conducting dysphagia screens; screening methods employed; timing and frequency of implement; and subsequent plan of care in identified high-risk patients.
Swallowing impairment (dysphagia) is common following cardiac surgery and associated with significant morbidity and mortality. Early and accurate detection of dysphagia is therefore critical to afford implementation of interventions to optimise patient care. Currently, no validated instruments or guidelines exist for nursing screening of dysphagia in this setting.
An anonymous and voluntary 10-item mixed-methods online survey was conducted using Qualtrics software. Nonprobability purposive sampling was utilised to recruit nurses working in an academic 24-bed cardiac ICU. Thematic analysis using operationally defined coding, SRQR checklist and descriptive statistics were employed.
Sixty-nine nurses completed the survey during a 1-month period, representing an 84% response rate. Formal training in performing swallowing screens was reported in 18.6% of nurses. In rank order, reported level of confidence was the following: "moderately" (49%); "somewhat" (35%); "not" (13%); and "very" (3%). The majority of nurses performed screens within 1 hr (40.6%) or between 1-4 hr (43.8%) of extubation. Fifteen different methods were utilised to screen swallowing function by nurses who reported a total of 31 different clinical signs indicative of dysphagia.
Survey data of practicing nurses in an academic cardiac ICU revealed limited formal training in swallowing screening methodology, a high degree of variability in screening methods employed and low levels of agreement for dysphagia signs.
Data highlight a knowledge gap and need for the development of formal education and validated rapid nursing dysphagia screening tools for standardised implementation in the cardiac surgery ICU setting.
本研究调查了在学术心脏重症监护病房（ICU）中护士进行吞咽筛查的实践模式。旨在确定：进行吞咽障碍筛查的培训和信心水平；使用的筛查方法；实施的时间和频率；以及在确定的高危患者中随后的护理计划。
心脏手术后吞咽障碍（吞咽困难）很常见，与显著的发病率和死亡率相关。因此，早期和准确地发现吞咽困难对于实施干预措施以优化患者护理至关重要。目前，在这种情况下，没有用于护理筛查吞咽困难的经过验证的工具或指南。
使用 Qualtrics 软件进行了一项匿名和自愿的 10 项混合方法在线调查。采用非概率目的性抽样方法招募在学术 24 床心脏 ICU 工作的护士。使用操作性定义编码、SRQR 清单和描述性统计进行主题分析。
在一个月的时间内，有 69 名护士完成了调查，应答率为 84%。18.6%的护士接受过进行吞咽筛查的正式培训。报告的信心水平依次为：“中度”（49%）；“有些”（35%）；“不”（13%）；和“非常”（3%）。大多数护士在拔管后 1 小时内（40.6%）或 1-4 小时内（43.8%）进行筛查。护士报告了 31 种不同的临床征象提示吞咽困难，共使用了 15 种不同的方法进行吞咽功能筛查。
在学术心脏 ICU 中进行的执业护士调查数据显示，在吞咽筛查方法学方面的正规培训有限，使用的筛查方法存在很大差异，对吞咽困难征象的一致性较低。
数据突出了知识差距，需要制定正式的教育和经过验证的快速护理吞咽筛查工具，以便在心脏手术 ICU 环境中进行标准化实施。
