Nielsen Anne Højager, Winding Robert, Busk Bettina Hvas, Noe Lillian, Husted Birthe, Kristensen Gitte Juhl, Svenningsen Helle, Ovesen Therese
Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark(m); Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark(n).
Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, DK-7400 Herning, Denmark(m).
Aust Crit Care. 2025 Jan;38(1):101100. doi: 10.1016/j.aucc.2024.07.081. Epub 2024 Aug 29.
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.
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.
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.
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.
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.
拔管后情况在重症监护病房很常见，护士在床边进行筛查对于检测病情和避免气道误吸很重要。
本研究的目的是评估在重症监护病房由护士主导的系统性吞咽功能筛查的实施情况，并确定吞咽功能筛查的障碍和促进因素。
设计：务实的实施研究。基于一个项目理论，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、床边同伴支持、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。
参与者日志显示94%的护士参加了教育课程，参加电子学习的比例较低（67%）。病历审查显示护士主导的吞咽功能筛查使用很少。只有19%的拔管患者遵循筛查方案。焦点小组表明护士认可耶鲁吞咽方案有效，新技能和新认识增强了护士的能力并有助于决策。重要障碍包括为插管而让患者禁食、缺乏其他专业人员的社会支持以及记录困难。促进因素是同事的社会支持。
在重症监护病房实施护士主导的筛查是可行的，但受到外部因素的挑战。应注意筛查方案的调整，以避免仪器改变和便于记录。在重症监护病房实施护士主导的吞咽功能筛查可能有助于患者安全经口进食，并识别需要专业评估的患者。实施应旨在使护士具备筛查患者吞咽功能的能力，并允许根据具体情况进行调整而不改变仪器的特性。
