Dysphagia (difficulty in swallowing) is an eating and drinking disorder in which abnormalities may occur in the pre-oral, oral, pharyngeal or esophageal stages of the swallowing process (Roseving and Starke, 2005; Royal College of Speech and Language therapy, 2006 cited in Williams et al., 2010; Groher, 1997). Dysphagia is a common problem in patients with head and neck cancer but also in those with neurological conditions, such as stroke, Parkinson’s disease or Multiple Sclerosis. It is also familiar in children. Eating and drinking is a fundamental social activity and dysphagia can affect the quality of life of those living with this problem.
The diagnosis and management of dysphagia requires a multidisciplinary approach from all healthcare professionals, whether it is by nurses that carry out a basic swallow assessment; by speech and language therapists who develop a dysphagia plan; by health care support workers who provide assistance with meals; by physiotherapists assessing the ability for the patient to sit up right using the best equipment; by occupational therapists assessing the ability to use the cutlery; by pharmacists ensuring that patients have the medication that they can swallow safely and is adapted to their swallowing difficulties; by dietitians that ensure that patients have adequate nutritional intake; by psychologists working with people with challenging behaviours; or by doctors or GPs prescribing antibiotics for aspiration pneumonia.
The Interprofessional Dysphagia Framework (IDF) provides a strategy to healthcare professionals that need to develop their skills and knowledge in the diagnosis and management of people with dysphagia. It also identifies different levels of dysphagia practitioners: awareness, assistant dysphagia practitioner, foundation dysphagia practitioner, specialist dysphagia practitioner and consultant dysphagia practitioner.
Nurses working in stroke units have had the training to carry out a basic swallow screening within 4 hours of patients being admitted to hospital. They are either trained at assistant or foundation level. Also, across the UK, a few nurses have taken up the roles as specialist dysphagia practitioners. However, problems still persist in areas where nurses are unable to diagnose and manage patients with dysphagia due to lack of training combined with a lack of speech and language therapists. As a result, patients may be left nil by mouth for a significant amount of time, with intravenous fluids ensuring their hydration.
As a nurse and neuroscience nurse, I strongly believe that all undergraduate nurses should be trained in dysphagia. It is fundamental that nurses, irrespective of their area of practice, are able to understand the impact of dysphagia, identify signs and symptoms and implement dysphagia management plans. For example, a nurse working in an orthopaedic ward may have a patient with Chronic Obstructive Pulmonary Disease (COPD) admitted for a knee operation. Since dysphagia can also arise with COPD, the nurse needs to be able to understand not only the impact of dysphagia, but also identify any signs and symptoms of dysphagia and recognise when referral is needed to a more qualified dysphagia practitioner. Another example can be a nurse working in an Emergency Department who admits a patient with a history of stroke (and on modified texture diet) with sepsis.
I advocate that all undergraduates should be trained at a minimum of an assistant dysphagia practitioner level and all neuroscience nurses should be trained at a Foundation level. Dysphagia isn’t a problem that should only be managed by speech and language therapists. A multi-disciplinary approach is required to overcome the challenges we face every day.
© Ismalia de Sousa, 2016