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Methods: This is a descriptive, exploratory, and cross-sectional study. The population consisted of 146 patients in the acute stage of stroke, who were admitted to a neuro-intensive care unit. The study was conducted from January to July 2014 in the city of Fortaleza, Brazil. Inclusion criteria were (1) age over 18 years; and (2) being alert and able to provide the necessary information, or being accompanied by a caregiver who was able to provide information on the patient’s health. Exclusion criteria included the presence of hemodynamic instability, risk of complications, or using an invasive ventilation. Ethical approval was received from the Federal University of Ceará Ethics Committee. A nurse who has been previously trained by the researchers conducted the data collection. Each patient was evaluated based on an instrument that was previously submitted to a face and content validation. This instrument contained questions about the socio-demographic profile (gender, age, marital status, education, and occupation), the patients’ current clinical condition (type, location, and number of episodes of stroke), the stroke severity evaluation based on the National Institutes of Health Stroke Scale - NIHSS (ranging from 0 to 21), and the functional capacity evaluation based on the Rankin scale (ranging from 0 to 6). For the Prevention of aspiration outcome evaluation, the nurse used an instrument containing a list of NOC indicators and their operational definitions. For each indicator, the nurse attributed a score ranging from 1 to 5. The higher the score, the better the health condition of the patient. For the presentation of descriptive statistics, data were compiled in Excel 8.0, and were analyzed in SPSS version 20.0.
Results: Patients were predominantly women (54.11%), living with a partner (64.38%), and unemployed (69.18%). The mean age was 60.97 years (SD=17.77), and the average years of education was 4.39 years (SD=4.38). Regarding the patients’ health status, 98.63% of the patients have had ischemic stroke, 28.77% have had totally compromised anterior cerebral circulation, 20.55% have had partially compromised anterior cerebral circulation, and 18.49% have had lacunar lesions. Regarding the number of stroke episodes, the average was 1.44 (SD=0.81), and the average length of hospital stay was 6.69 days (SD=6.71). Regarding the severity of the stroke, the average NIHSS score was 6.31 (SD=5.98). For the functional capacity, 35.86% of the patients have had moderately severe disability, 20% have had no significant disabilities, and 15.86% have had moderate disability. Regarding the Prevention of aspiration outcome, all NOC indicators were assessed. The indicators that were more compromised (scores below 4) were: Maintains oral hygiene (68.48%) and Remains upright for 30 minutes after eating (60.96%). The indicator Administers enteral tube feedings as recommended was assessed in only 39 patients and had good scores (4 and 5). The other indicators had high scores as follows: Identifies risk factors (3.94 ± 1.19); Positions self upright for eating and drinking (4.68 ± 0.86); Selects food and fluid of proper consistency (3.87 ± 1.67), and Uses suitable utensils to bring food to the mouth (4.81 ± 0.67).
Conclusion: The indicators Maintains oral hygiene, and Remains upright for 30 minutes after eating had the lower scores in patients during the acute stage of stroke. It is important for nurses to identify such situations and target early interventions. Thus, studies like this can be helpful to determine which outcomes are sensitive to nursing care, and which outcomes can contribute to the effectiveness of the interventions. Further studies with this nursing outcome are needed, especially with patients in the rehabilitation stage, as the consequences can be different in this context.