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Management of dysphagia in stroke patients

Hughes, S.M. (2011). Management of Dysphagia in Stroke Patients.

Nursing Older People, 23(3), 21-24.

Student: Ying Liang

Student No: 822 913 679
Date Submitted: Feb 25th, 2014
NURS 260: Nursing Theory
Professor: Franklin Gorospe
Humber College ITAL

Management of Dysphagia in Stroke Patients

Introduction
Stroke can affect patients daily life in a most prompt manner by depriving people of

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Management of dysphagia in stroke patients

independence. In order to minimize the residual of stroke survivors, health care practitioners
are working cooperatively to obtain the best outcome. One of their most focus perspectives is
dysphagia which impairs swallowing ability of about 45 percent of patients admitted with
stroke (RCP, 2000). Common risk of aspiration or malnutrition may be caused by dysphasia.
Consequently, its management plays a crucial role in nursing practice involving stoke
patients.
In this paper, I am going to elaborate the coping strategies by exploring Hughes article
Management of dysphagia in stroke patients (Hughes, 2011). Hughes introduces the
pathophysiology of stroke, uses a case study to demonstrate the importance of holistic
assessment, the impact of a multidisciplinary team (MDT), and the effectiveness of solid nursing
skill. People suffer from dysphagia are at risk of morbidity and mortality because they are
particularly vulnerable to dehydration, malnutrition and aspiration pneumonia as well. I realized
nursing in this field is full of practical significance.
As far as I am concerned, this article is so impressive that it inspires my thought of how to
care post-stroke patients in my clinical work placement and future practice. I agree with Hughes
on the above three key points. The other article I want to discuss is Stroke: holistic care and
management Written by Mitchell and Moore. Their idea is consistent with Hughes and they
also consider the psychosocial caring for dysphagia patients. In this paper, I will review the
main idea of the two articles, discuss three implications for nursing practice, and elaborate the
meaning of psychosocial caring.
Three implications for nursing practice
Holistic assessment and nursing care are crucial for recovery.
Healthcare providers make care decisions based on the data obtained from holistic
assessment. The initial assessment of swallowing and nutritional screening should be carried out
within 24 hours of admission. After that, suitable diet is administrated to the patients according to

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Management of dysphagia in stroke patients

their swallowing capacity.

In addition, swallowing process depends on good oral hygiene and hydration (Hughes,
2011). If the patient has poor hygiene which might result in pain or infection, and thus his/her
nutritional intake would be reduced. The nurse should pay attention to oral inspection and
encourage the patients eat proper amount of food,
Finally, nutritional status is an important aspect that the nurses pay attention to when
performing everyday caring (Mitchell & Moore, 2004). Though the detailed report is done by
dietician, nurses are responsible for nutrition screening. MDT meeting is held to ensure the
continuity and effectiveness of the caring plan. Through carrying out the holistic personcentered care plan, nurses work cooperatively within the MDT and assist the team approach
to achieve therapeutic goal successfully.
Proper nursing skill can help to avoid stoke complications
It is very important for nurses to have solid nursing skill used to assist post-stroke
patients in our day-to-day practice. First of all, the nurses should have a sound knowledge of
swallowing and nutrition assessment. Being nursing students, we should learn how to observe
the clients diet, assess the status of nutrition and hydration, and monitor complication before
formal assessment by a speech and language therapist. In addition, we should always keep in
mind that the upright sitting position is the safest to protect the patients from choking
(Hughes, 2011). Simultaneously, the patient should be instructed to eat small bites of food to
the healthy side of the mouth. Moreover, great attention is supposed to be paid to the patients
when nurses do oral hygiene since dehydration and infection is easy to notice at the time
(Potter & Perry, 2010).
Nurse has an active role in multidisciplinary team (MDT)
MDT plays a vital role in achieving patients ideal rehabilitation. As Hughes(2011) points
out, providing effective dysphagia management needs a concerted efforts made by the physician,

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Management of dysphagia in stroke patients

nurse, OT, PT, SLT and etc. MDT meeting should be held at least one week to ensure the
effectiveness and continuity of in-hospital care (Hughes, 2011). Whats more, the caring plan
could have a chance to be modified in a timely manner. Being present 24 hours in the ward,
Nurses have access to get first-hand information and thus are responsible for commit an
initial and momentarily assessment. After reading the articles, I feel the role of nurse is much
more active than I think previously. I am aware that the assessment of swallow ability is not
only the task of SLTs, but also the responsibility and essential skill of nurses. Nursing job is
not just doing daily care. Instead, it is an important part of the health care team.
More importantly, emotional caring provided by nurses is very effective on stoke
patients. Mitchell and Moore state that nurses in some rehabilitation settings identify and
value their role in both emotional care giving and involving family care (Mitchell & Moore,
2004). Be aware of the patients physical and also psychological needs is part of good
nursing. Sometimes, it is necessary that the nurse expend their roles to understand the
patients situation.
Few patients and families achieve a positive adjustment to life after the onset of
stroke, most consider their original life 'gone', and 'changed forever' (Dowswell, et al.
2000).Inevitably, besides the physical discomfort, the post-stroke dysphagia patients would
be depressed, isolated, and feel the sense of rolelessness (Mitchell & Moore, 2004).These
negative mood would restrain them from recovery and sometimes worsen the situation. In my
opinion, I would first provide related information to patient and try to involve family
members into recovery. Besides that, I will give them more instruction about suitable diet and
living style. This will help them establish a positive attitude and build a therapeutic
relationship between nurse and patients. If so, the chances of refusing to eat will be decreased
and the patients are supposed to be more cooperative and active.
Conclusion

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Management of dysphagia in stroke patients

Based on the above discussion, it is clear that dysphagia management is critical to

stroke patients' rehabilitation. Holistic assessment, cooperative multidisciplinary teamwork,
professional and emotional nursing care are important aspects in dysphagia management. The
ultimate goal of MDT is achieve the best optimistic outcome and help the patients go back to the
society successfully in the near future. As a future nurse, I am greatly inspired by these two
articles. In clinical practice, I should not only have solid nursing skill to care the physical
discomfort, but also consider psychological and social needs of patients. At the same time, we
hope the above strategies of managing disphagia patients can help to improve their quality of
lives and gain the courage to fight against disease. After all, rehabilitation is a long process, and
this would be the best beginning for the patients and for us as well.

References:
College of Nurses of Ontario ( CNO). (2013). Practice from Standard: Therapeutic Nurse-Client
Relationship, Revised 2006. Retrieve from Http://www.cno.org/Global/docs/prac/41033Therapeutic.pdf
Dowswell, G., et al. (2000). Investigating recovery from stroke: a qualitative study. Journal of
Clinical Nursing. 9, 4, 507-515.
Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3),
21-24.
Mitchell, Elizabeth., Moore, Kevin. (2004). Stroke: holistic care and management.
Nursing Standard, 18(33), 43-52
Potter, P., Perry, A. G., Stockert, P. A., & Hall, A.M. (2014). Canadian fundamentals of nursing
(5thed). Toronto: Mosby, P. 1068.
RNAO Best Practice Guideline: Stroke Assessment Across the Continuum of Care (2006)
Http://rnao.ca/bpg/guidelines/stroke-assessment-adcross-continuum-care

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Management of dysphagia in stroke patients

Royal College of Physicians. (2000). National Clinical Guidelines for Stroke. London,
Intercollegiate Working Party for Stroke, RCP.