Original Research

Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors

Maggie Pierpoint, Mershen Pillay
South African Journal of Communication Disorders | Vol 67, No 1 | a625 | DOI: https://doi.org/10.4102/sajcd.v67i1.625 | © 2020 Maggie Pierpoint, Mershen Pillay | This work is licensed under CC Attribution 4.0
Submitted: 23 January 2019 | Published: 28 May 2020

About the author(s)

Maggie Pierpoint, Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Mershen Pillay, Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


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Abstract

Background: 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.

Objective: To explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia.

Method: 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.

Results: 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%).

Conclusion: 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.


Keywords

stroke; dysphagia management; early identification; dysphagia intervention; doctors and registered nurses.

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