The research was conducted at a higher education institution in the Eastern Cape province, South Africa. The institution, recognised as historically disadvantaged, hosts an estimated 13 000 students, most from previously disadvantaged backgrounds. The nursing department at this institution began in 1984 as a joint agreement between the university and the Department of Health to educate and train nurses to increase the number of nurses to serve the homelands of Ciskei, as the lack thereof was extreme (Evertse, 1997). The setting is significant because it reflects a typical academic and clinical training environment where nursing students are prepared for the complex realities of healthcare delivery in a resource-constrained environment.

This study utilised a descriptive phenomenological qualitative design in which, in 2024, 12 registered final-year nursing students at the University of Fort Hare in the Eastern Cape, who met the study’s inclusion criteria, were recruited out of 27 students through purposive sampling to participate in semi-structured interviews about their experiences with dysphagia management (Fugard & Potts, 2015). Recruitment involved visiting the Nursing Department at the East London campus and personally inviting students to participate through word of mouth. The study explored experiences of final-year nursing students in the university who have received theoretical knowledge on dysphagia and were currently gaining clinical experience at the time in clinical settings such as acute stroke units, aged care facilities and neurology wards, where they are likely to encounter patients with dysphagia.

To ensure that the study participants were appropriate and could provide reliable and meaningful data relevant to the research question, specific inclusion and exclusion criteria were applied. The inclusion criteria required participants to be students registered at the University of Fort Hare in the 2024 academic year, pursuing a nursing degree, in their final year of study, and having encountered cases of dysphagia during their clinical practice. Conversely, participants were excluded if they were not currently registered at the University of Fort Hare, not enrolled in 2024, not pursuing a nursing degree, not in their final year of study or lacking clinical experience with dysphagia.

Data were gathered through semi-structured in-person interviews conducted in English, which lasted approximately 35 min – 45 min using interview guides developed by the researchers following an extensive literature search (DeJonckheere & Vaughn, 2019; Ruslin et al., 2022). A questionnaire (Appendix 1) with 10 open-ended questions served as the primary data collection tool, focused on confidence in theoretical knowledge, practical skills and formal training in dysphagia management, the number of dysphagic patients encountered, challenges faced and strategies used when caring for patients with dysphagia, as well as understanding their knowledge of the role of SLPs in dysphagia management. To ensure face and content validity, the interview guide was reviewed by two experienced speech therapists; no changes were made after the review. A pilot study was conducted with five nursing students. During this phase, researchers posed questions outlined in the interview guide to assess their appropriateness, which were conducted before data collection for the main study. The sessions were audio-recorded to ensure accuracy and to enable the interviewer to focus on active listening and building rapport rather than extensive note-taking. Thereafter, researchers consulted with the research supervisor to make necessary adjustments, as some questions were rephrased. Data from the pilot study were excluded from the primary analysis to maintain rigour. The interviews were conducted by researchers at the East London University Campus.

To ensure accuracy, interview recordings were transcribed verbatim and carefully checked against the audio files. The transcripts were anonymised by replacing names with participant numbers to maintain confidentiality. The data were analysed using thematic analysis following Braun and Clarke’s six-step framework: familiarisation with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes and producing the final report (Braun & Clarke, 2006; Clarke & Braun, 2013). Coding was developed collaboratively by the research team, and ATLAS.ti was used to organise, code and explore patterns in the data while ensuring that interpretive decisions were guided by the researchers rather than the software alone (Soratto et al., 2020).

Validity and reliability in qualitative research mean the extent to which the data are trustworthy and thus can be defended when challenged (Noble & Smith, 2015). As such, the data were returned to the participants of this study so that they could verify the accuracy of the recorded information (Birt et al., 2016) to ensure credibility. Transferability in this research was ensured by a thick description (Tayade & Lattie, 2021). Thick description entails providing a comprehensive narrative of field experiences, wherein the researcher explicitly outlines the cultural and social relationship patterns and contextualises those (Younas et al., 2023). In this research, dependability was ensured by an audit inquiry. An inquiry audit entails an external researcher, independent of both the data collection and analysis, reviewing the procedures of data collection, data analysis and the research study’s outcomes (De Kleijn & Van Leeuwen, 2018; McLeod, 2024.). In this research, the research supervisor was the one acting as an external researcher to review the research process. Confirmability in this research was ensured by an audit trail. An audit trail comprises clear and transparent documentation of the research process, starting from the initiation of the project through to the formulation and presentation of findings (De Kleijn & Van Leeuwen, 2018). The above criteria ensure that the results are trustworthy and thus valid and reliable, without any form of bias, thereby enhancing the overall integrity of the research findings.

Ethical approval for this study was obtained from the University of Fort Hare Health Research Ethics Committee (UFH HREC) (approval number: Ref #2024-09-18 HRECLVN11). Permission to conduct the study was also granted by the Head of the Nursing Department and relevant institutional gatekeepers. Written informed consent, including consent for audio recording, was obtained from all participants prior to data collection. To ensure confidentiality, participants were assigned identification numbers, and no personal identifying information was recorded.

The first theme of confidence and knowledge emerged in relation to participants’ experiences with dysphagia management, encompassing theoretical knowledge, practical skills and formal training (Table 1). Skills were reported to be developed through hands-on experiences and guidance from senior nurses, though one participant emphasised the challenge of not having access to speech, while 11 participants acknowledged feeling underprepared to manage patients with dysphagia:

This also reflected a strong awareness of the complexity of care and a motivation to improve. Six Participants described their current theoretical knowledge as ranging from low to moderate:

often shaped by brief and lecture-based instruction. However, this recognition highlighted a proactive desire for deeper learning. Nine participants expressed the need for dedicated modules, workshops and more comprehensive training that was consistent across participants, pointing to a constructive opportunity for curriculum development:

Overall, while gaps were identified, the findings underscore a clear commitment among learners to enhance their competencies and advocate for improved educational resources in dysphagia management.

In terms of practical skills, participants expressed varied levels of confidence and competence based on their experiences during clinical placements. Despite limited theoretical training, five participants felt confident in performing routine procedures, such as feeding through nasogastric (NG) tubes:

because these tasks were frequently encountered and practised in the wards. Practical therapists regularly. Similarly, participant 5 reported confidence in practical aspects like spoon-feeding patients but admitted their confidence was uncertain because of the lack of theoretical knowledge:

This limited theoretical exposure contributed to a lack of confidence in recognising and managing swallowing difficulties. Moreover, participants highlighted a scarcity of hands-on training opportunities, further impeding their ability to translate knowledge into clinical competence.

Under this theme, seven participants reported that their clinical exposure to dysphagia varied considerably depending on the ward or placement (Table 2):

Those assigned to stroke units, medical wards and the intensive care unit (ICU) encountered patients with swallowing difficulties more frequently:

In contrast, others, like the maternity ward, had minimal exposure. This inconsistency led to uneven opportunities for learning and skill development. In terms of challenges encountered, participants also described challenges in identifying early signs of dysphagia and uncertainty regarding intervention steps. Aspiration during feeding was reported to be a significant concern among the participants because they do not know what to do when a patient coughs while being fed:

Lastly, three participants noted limited supervision or mentorship related to dysphagia management during clinical placements, especially from speech therapists:

This noted gap in support contributed to their feelings of uncertainty and reduced confidence in practice. Table 2 provides an overview of this theme.

This theme encompasses sub-themes such as current strategies, role of SLPs and resource needs (Table 3). Twelve participants reported various strategies utilised in their clinical practice to support patients with dysphagia. Common approaches included (1) inserting a nasogastric tube:

and (2) the correct positioning of patients:

Of noteworthy is also the observed consistency in dysphagia management across clinical settings. Regarding the role of the SLP, while participants I acknowledged the vital role of SLPs, they frequently expressed uncertainty about when and how to refer patients:

A recurring theme among participants was the desire for structured learning opportunities to enhance their clinical skills in dysphagia management (Table 4). Five participants expressed interest in simulation-based training to practice assessment and intervention techniques in a safe environment before real patient encounters:

Factors such as collaboration between the speech therapy and nursing departments were brought up by participants in efforts to improve the management of dysphagia in patients (Bardien et al. 2020):

Participants also emphasised the need for accessible, clear management protocols to guide clinical decision-making:

Such resources were seen as essential to improve confidence, ensure consistency and promote evidence-based practice among nursing professionals.

The most striking finding is the mismatch between students’ awareness of the seriousness of dysphagia and their limited competence to manage it. Although many had performed routine tasks such as nasogastric feeding, they lacked a deeper understanding of dysphagia assessment and intervention. This combination of low theoretical knowledge and limited mentorship echoes global evidence that underprepared nurses are at risk of missing early signs of swallowing disorders (Hazelwood et al., 2025; Jeon et al., 2024; Jones & Porterfield, 2020; Olímpio et al., 2024). In settings where clinical supervision varies widely, such gaps can have serious consequences.

Dysphagia is a potentially life-threatening condition: malnutrition, dehydration, aspiration pneumonia and mortality are well-documented risks when management is inadequate (Dziewas et al., 2021; Eltringham et al., 2019). Students described uncertainty when patients coughed or choked during feeding and reported inconsistent guidance from mentors and SLPs. Without clear protocols or reliable supervision, bedside practice becomes variable and may raise ethical and medico-legal concerns. These findings, therefore, call for health-care institutions to implement accessible, standardised protocols and ensure that nurses receive ongoing support from experienced clinicians.

From an educational perspective, the study points to the need for a more integrated and clinically relevant approach to dysphagia training. Participants advocated simulation-based learning and structured opportunities to observe and practice under expert supervision. Evidence supports that simulation and guided practice strengthen competence and confidence in dysphagia care (Adams et al., 2024; Carless-Kane & Nowell, 2023a; Daneshfar & Karimi Moonaghi, 2025a; Hazelwood et al., 2025b). Early, repeated clinical exposure, reinforced by feedback, would enable students to translate theory into safe practice.

Interprofessional education is equally important (Bloom et al., 2022). Students’ uncertainty about when and how to refer patients to SLPs highlights the need for joint learning activities. Collaborative training with speech therapy departments would help nursing students understand SLP roles and foster effective referral pathways (Dondorf et al., 2015a; Khalili et al., 2022; Lal et al., 2024; Wilkinson et al., 2021). Nursing curricula should therefore embed dysphagia management as a core component and create formal opportunities for interprofessional collaboration.

These findings reinforce the central tenet of experiential learning theory that competence develops through structured observation, simulation and guided participation (Matlhaba, 2024). When students actively engage with real or simulated patients and receive timely feedback, they integrate theoretical knowledge with clinical judgement, building both confidence and professional identity. The results thus extend evidence that experiential learning approaches are particularly valuable in resource-limited contexts where clinical exposure is often inconsistent.

Future research should evaluate the long-term impact of simulation-based and interprofessional training on both student competence and patient outcomes. Studies in LMICs are especially needed to examine how such interventions can be adapted to settings with variable staffing and limited access to SLPs (Kathard & Pillay, 2013).