Wednesday, July 11, 2007
This presentation is part of : Acute Care Studies
Evidence-Based Dysphagia Assessment and Management by Nurses
Sonia Sandhaus, MS, RN, CRNP1, Margarete Lieb Zalon, PhD, RN, APRN, BC2, Donna Valenti, RNC1, and Faith Harrell1. (1) Hospital Elder Life Program, Moses Taylor Hospital, Scranton, PA, USA, (2) Department of Nursing, University of Scranton, Scranton, PA, USA
Learning Objective #1: Describe the relationships among a needs assessment, evidence-based practice and an educational intervention in dysphagia management.
Learning Objective #2: Describe the outcomes of an educational program designed to improve dysphagia assessment and management by nurses.

              Dysphagia is a common problem in the elderly.  Dysphagia may be caused by neurological disorders, structural problems, chronic illness complications, medication side effects and age-related changes. It can have serious consequences including dehydration, inadequate nutrition, weight loss, aspiration pneumonia and airway obstruction which can lead to death (Palmer, Drennan & Baba, 2000). Nurses are not familiar with standards regarding dysphagia assessment and management (Werner, 2005). The need for dysphagia assessment and management improvement was identified when volunteers, who were part of a community hospital’s Hospital Elder Life Program (HELP), reported fears about feeding elderly patients.  The purpose is to investigate the effectiveness of an educational intervention in improving the knowledge of licensed nursing staff with regard to dysphagia.

             The sample consisted of 86 registered nurses and 36 licensed practical nurses from medical-surgical and critical care units. Nurses’ experience ranged from 1 month to 44 years (M = 13.3 years). A dysphagia educational intervention consisting of a brief interactive session utilizing a visual presentation created by HELP staff was provided within the context of the hospital’s annual competency-training fair. A 10-item pre-test and post-test were administered.  The pre-test mean was 8.63 (SD = 1.27) and for the post-test, it was 9.47 (SD = .80).  A paired t-test indicates the results of the second administration was significantly higher (N = 122, t = -7.134, p < .001).

             Nurses’ baseline dysphagia knowledge was strong and the educational intervention was effective in increasing knowledge, despite a less than ideal testing situation. Nurses need to be aware of the importance of dysphagia and the need to refer patients at risk to the speech pathologist.  Nurses need to be patient advocates as physicians may not be attuned to aspiration risks. Other issues include difficulties in capturing data related to speech pathologist referral and aspiration pneumonia prevention.