The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Clin Nurs. 2023 Jul;32(13-14):3787-3796. doi: 10.1111/jocn.16623. Epub 2023 Jan 30.
There are an increasing number of evidence-based recommendations for managing dysphagia in post-stroke patients. However, it is unclear whether nurses adopt these recommendations in their daily nursing practices.
This study aimed to explore nurses' adherence, barriers, facilitators and views on dysphagia screening and assessment of post-stroke dysphagia.
In this study, multiple methods were adopted. In Phase 1, a general information questionnaire and a knowledge-attitude-practice and barriers/facilitators questionnaire for dysphagia screening and assessment were distributed in 55 hospitals online. In Phase 2, semi-structured interviews were conducted to explore nurses' views on barriers. Descriptive and one-way variance analyses were used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. This study adheres to STROBE and COREQ guidelines.
Nine hundred and forty-two completed questionnaires were collected. Only 36.52% of the nurses screened for swallow function in patients as a guideline. The biggest barrier was 'memory, attention and decision process', with an average score of 3.22 (.74). The different stages of implementation had various types and degrees of barriers (p < .001). Five themes were extracted after interviews, namely 'Inadequate environment and resource support', 'Increased workload', 'Professional value perception', 'Organisational culture', and 'Poor knowledge and skill'.
Nurses' practice of dysphagia screening and assessment of patients with dysphagia after stroke were inadequate, and the barriers originated from patients, leadership and the nurses themselves.
This research extracted five barriers of guidance adherence for post-stroke dysphagia screening and assessment and identified the different kinds and degrees of barriers in five implementation stages, providing a basis for nursing managers to break through the bottleneck of guideline implementation.
The nurses recruited in this study completed validated questionnaires in the survey and suggestive answers in interviews.
目前有越来越多基于证据的推荐意见可用于管理脑卒中后吞咽障碍患者，但尚不清楚护士是否将这些推荐意见应用于日常护理实践中。
本研究旨在探讨护士对脑卒中后吞咽障碍患者吞咽障碍筛查和评估的依从性、障碍因素、促进因素和看法。
本研究采用了多种方法。在第 1 阶段，通过在线方式在 55 家医院发放一般信息问卷和吞咽障碍筛查和评估的知识-态度-实践及障碍/促进因素问卷。在第 2 阶段，通过半结构式访谈探讨护士对障碍因素的看法。采用描述性和单因素方差分析对定量资料进行分析，采用内容分析法对定性资料进行分析。本研究遵循 STROBE 和 COREQ 指南。
共收集到 942 份完成的问卷。仅有 36.52%的护士按照指南对患者进行吞咽功能筛查。最大的障碍因素是“记忆、注意力和决策过程”，平均得分为 3.22（0.74）。不同实施阶段有不同类型和程度的障碍（p<0.001）。访谈后提取出 5 个主题，分别是“环境和资源支持不足”、“工作量增加”、“专业价值认知”、“组织文化”和“知识和技能欠缺”。
护士对脑卒中后吞咽障碍患者的吞咽障碍筛查和评估实践不足，障碍因素源自患者、领导和护士自身。
本研究提取出脑卒中后吞咽障碍筛查和评估指导依从性的 5 个障碍因素，并识别出 5 个实施阶段不同种类和程度的障碍，为护理管理者突破指南实施的瓶颈提供了依据。
本研究招募的护士在调查中完成了经过验证的问卷，并在访谈中提供了有建设性的答案。
