Academic journal article Online Journal of Issues in Nursing

Avoiding Negative Dysphagia Outcomes

Academic journal article Online Journal of Issues in Nursing

Avoiding Negative Dysphagia Outcomes

Article excerpt

The important role nurses play in avoiding negative dysphagia-management outcomes and potential malpractice lawsuits cannot be overstated. Broadly defined, dysphagia is the "impairment of the emotional, cognitive, sensory, and/or motor acts involved with transferring a substance from the mouth to stomach, resulting in failure to maintain hydration and nutrition, and posing a risk of choking and aspiration" (Tanner. 2007a, p. 3). Dysphagia can be lifethreatening, particularly in elderly patients (Altman. Gou-Pei. & Schaefer. 2010: Rov. Stemple. Merrill. & Thomas. 2007J. Chang etal. (2013) reviewed the death certificates of patients who were described as having died from a stroke; they reported that 5% had died as the result of aspiration pneumonia and 1% had died as the result of choking. In an earlier study, Schmidt, Holas, Halvorson, and Reding (1994) reported that the occurrence of pneumonia was more than 7.6 times greater in stroke patients who had aspirated than in those who had not aspirated. Dysphagia occurs in both pediatric and adult patients; treatment protocols for patients of different ages vary based on the patient's developmental, cognitive, and physiological status. This article will focus on the disorder as it occurs in adults.

In this article, we begin by considering the importance of informed consent in making decisions related to dysphagia. Next, we will discuss five strategies nurses can employ to promote positive dysphagia-management outcomes for adult patients who have, or are suspected of having, dysphagia. These recommendations, if followed, could prevent most negative dysphagia-management outcomes. These recommendations include:

* Considering the patient's diet and supported-nutrition status

* Understanding the speech-language pathologists' recommendations

* Developing a working familiarity with the goals, objectives, and procedures of dysphagia management

* Acting in response to instrumental dysphagia assessment recommendations

* Ensuring effective communication among members of the healthcare team

We will conclude by reiterating the important role of the nurse in managing dysphagia and avoiding negative dysphagia outcomes.

Informed Consent Related to Dysphagia Management

The need to preserve life through airway protection is sometimes in tension with the patient's desire to preserve a quality of life that is the same as it was before the onset of current health conditions. Consuming food and liquid includes the pleasures of smelling, tasting, and orally manipulating nutrients. For this reason nurses and their colleagues in speech-language pathology must consider both the safety of patients and their gustatory wishes. After due consultation, nurses and other providers need to respect the wishes of competent patients, their family members, and/or a patient surrogate if a patient is not competent (American Nurses Association. 2013). An informed consent document is then posted in the patient's care record.

It is essential that patients comprehend the dysphagia-management alternatives before signing informed consent documents. Brett and Rosenberg (2001) reviewed medical records relating to gastrostomy tube placements in a community teaching hospital; they reported that only 1 out of 154 patients' records documented a treatment-specific discussion regarding the tube placement. Patient consent needs to be obtained before implementation of any assessment or treatment procedures, particularly those which involve the possibility of radical, lifestyle alterations, such as those that may occur in cases of dysphagia. The most stringent level of consent, specifically that which includes signatures of patients or their surrogates on written documents, should be obtained before any dysphagia treatment is implemented. Refusal of dysphagia treatment should also be documented in writing. The mere lack of a refusal does not imply consent. It is a best practice for practitioners to ensure that patients and/or their surrogates fully understand the risks associated with dysphagia and the treatments for dysphagia. …

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