The Open Nursing Journal




ISSN: 1874-4346 ― Volume 13, 2019
REVIEW ARTICLE

Registered Nurse's Competency To Screen Dysphagia Among Stroke Patients: Literature Review



Hana M. Abu-Snieneh1, *, Mohammad Y.N. Saleh2
1 School of Nursing, The University of Jordan, Amman 11942, Jordan
2 Clinical Nursing Department, The University of Jordan, Faculty of Nursing, Amman-Jordan

Abstract

Background:

An increased number of elderly people in the world may lead to an increase in the incidence of stroke, which creates a burden on the country’s healthcare system. Dysphagia is the most common post stroke. Screening of dysphagia in stroke patients is serious to prevent complication linked to aspiration and inadequate hydration/nutrition.

Objective:

This literature review aimed to discuss registered nurses' competency to screen dysphagia among stroke patients.

Methods:

The keywords used were nurse's competency; dysphagia; dysphagia screening; and stroke. These keywords were entered into multiple electronic databases including CINAHL, Medline, Science Direct, Pro Quest, Pub Med, and Wiley Online Library. Aliterature search was conducted for the period2005 to 2016.Results:Seventeen studies were identified by a systematic search ofthe literature.Two parts created the body of this literature review. The first part covers the literature on the training nurses in screening dysphagia among stroke patients and benefits of screening. The second part covers nurse's competency in terms of knowledge and skills of screening dysphagia among stroke patients.

Conclusion:

Because the nurses have more contact with the patient, they are most likely to observe dysphagia. It is important that formal dysphagia screening protocols are routine nursing care that requires special training to practice. Trained nurses should assess their competency in terms of knowledge and skills via well-developed tool.

Keywords: Nurse's competency, Dysphagia, Dysphagia Screening, Stroke, WHO, Global population.


Article Information


Identifiers and Pagination:

Year: 2018
Volume: 12
First Page: 184
Last Page: 194
Publisher Id: TONURSJ-12-184
DOI: 10.2174/1874434601812010184

Article History:

Received Date: 13/4/2018
Revision Received Date: 30/06/2018
Acceptance Date: 15/07/2018
Electronic publication date: 31/08/2018
Collection year: 2018

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© 2018 Abu-Snieneh and Saleh.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence the author at the School of Nursing, The University of Jordan, Amman 11942, Jordan, Tel: (+962) 776442318; E-mail: abusnieneh13@hotmail.com




1. INTRODUCTION

The global population aged over 65 years is growing by 9 million a year, and by the year 2025 there will be more than 800 million people above 65 years of age in the world [1World Health Organization (WHO). The WHO STEP wise approach to stroke surveillance 2016 Available from: cited 2016 Aprilhttp://www.who.int/chp/steps/stroke/en/]. The World Health Organization (WHO) estimated that approximately one among six people will suffer a stroke at a time in their life [2Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2] ] According to WHO, around 17.5 million people died from cardiovascular diseases in 2012, representing 31% of overall global deaths. From these deaths, an estimate of 7.4 million was due to coronary heart diseases and 6.7 million were due to stroke [3World Health Organization (WHO). What can I do to avoid a heart attack or a stroke? Online Q&A 2015 [cited 2016 March]; Available from: from http://www.who.int/features/qa/27/en/].

A stroke is a rapidly developing clinical focal disorder of cerebral function through symptoms durable for twenty-four hours or longer and leading to death, with no obvious reason other than the vascular source [3World Health Organization (WHO). What can I do to avoid a heart attack or a stroke? Online Q&A 2015 [cited 2016 March]; Available from: from http://www.who.int/features/qa/27/en/]. The most common symptom after stroke is dysphagia in an approximately half of new onset stroke [4Teasell R, Foley N, Martino R, Richardson M, Bhogal S, Speechley M. Dysphagia and aspiration following stroke. cited 2016 April; Available from: wwwebrsrcom 2013.www.ebrsr.com]. Dysphagia is disruption of the bolus flow through the mouth and pharynx. As the function of swallowing is the safe delivery of a food bolus into the stomach, then the immediate complication of dysphagia is food entering the airway [5American Speech-Language-Hearing Association (ASHA). Swallowing disorders (Dysphagia) in adults 2016 Available from http://www.asha.org/public/speech/swallowing/ Swallowing-Disorders-in-Adults/]. Dysphagia as a deficiency of eating and drinking through any or all of the different phases of swallowing [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] ].

Dysphagia affects a vast number of acute stroke patients. An estimated 20% to 50% of patients who have suffered a stroke have identifiable signs and symptoms of dysphagia [7Ilott I, Bennett B, Gerrish K, Pownall S, Jones A, Garth A. Evaluating a novel approach to enhancing dysphagia management: Workplace-based, blended e-learning. J Clin Nurs 2014; 23(9-10): 1354-64.[http://dx.doi.org/10.1111/jocn.12409] [PMID: 24330351] ]. A higher percentage (30% to 67%) was reported in stroke patients [8Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care 2010; 19(4): 357-64.[http://dx.doi.org/10.4037/ajcc2009961] [PMID: 19875722] ]. Dysphagia interrupts half of acute stroke patients and carries three folds to seven folds amplified hazards of aspiration pneumonia [9Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J 2006; 82(968): 383-91.[http://dx.doi.org/10.1136/pgmj.2005.043281] [PMID: 16754707] ]. Up to 35% of deaths that may occur after a stroke are due to pneumonia [10Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36(9): 1972-6.[http://dx.doi.org/10.1161/01.STR.0000177529.86868.8d] [PMID: 16109909] ]. The frequency of dysphagia in patients who were classified as severe dysphagia was 52%, and 28% with a high risk of aspiration. At the hospital discharge, only 2.1% of patients still had severe dysphagia [11Mourão AM, Almeida EO, Lemos SMA, Vicente LCC, Teixeira AL. Evolution of swallowing in post-acute stroke: A descriptive study. Rev CEFAC 2016; 18(2): 417-25.[http://dx.doi.org/10.1590/1982-0216201618212315] ].

1.2. Background

The presence of dysphagia among stroke patients substantially leads to psychosocial, medical, and economic problems [12Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol 2015; 14(3): 119-24.http://ijnl.tums.ac.ir/index.php/ijnl/article/view/731[PMID: 26622975] -16Vesey S. Dysphagia and quality of life. Br J Community Nurs 2013. S14, S16, S18-S14, S16, S19[http://dx.doi.org/10.12968/bjcn.2013.18.Sup5.S14] ]. Aspiration pneumonia, dehydration, malnutrition, and noteworthy weight loss are examples of medical complications of dysphagia. Dysphagia not only escalates morbidity and mortality rate after stroke, but also significantly affects the quality of stroke patients’ life when it is impossible to share their meals with family and friends and may also increase the health care costs and patients’ hospital length of stay [2Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2] , 4Teasell R, Foley N, Martino R, Richardson M, Bhogal S, Speechley M. Dysphagia and aspiration following stroke. cited 2016 April; Available from: wwwebrsrcom 2013.www.ebrsr.com, 14Tanner DC, Culbertson WR. Avoiding Negative Dysphagia Outcomes. Online J Issues Nurs 2014; 19(2): 6.[http://dx.doi.org/10.3912/OJIN.Vol19No02PPT03] [PMID: 26812272] -24National Stroke Foundation. Clinical Guidelines for Stroke Management 2010.].

The Joint Commission's Disease-Specific Stroke Performance Measure [25Joint Commission. Dysphagia Screen. Q For which patients should the dysphagia screen be performed? 2009 Available from: cited 2016 Aprilhttp://www.jointcommission.org/ standards_information/jcfaqdetails.aspx?StandardsFaqId=88&ProgramId=47] stated “dysphagia screening should be performed on all ischemic and hemorrhagic stroke patients before being given anything by mouth, including food, fluids, or oral medications. Therefore, the patient must remain on NPO until a dysphagia screen has been completed” (p. 24). Initial screening of dysphagia is critical to prevent future health complications and should have a high priority in the health-care practices [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] , 26Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art: Invitational Conference Proceeding From the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. On behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke. Stroke 2013; 44: 24-31.http://stroke.ahajournals.org[http://dx.doi.org/10.1161/STR.0b013e3182877f57] , 27Martino R, Maki E, Diamant N. Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST©): Are 10 teaspoons of water necessary? Int J Speech-Language Pathol 2014; 16(3): 193-8.[http://dx.doi.org/10.3109/17549507.2014.902995] [PMID: 24833425] ].

Nurses play a critical role in supporting the management of patients with swallowing problems [28Ringleb PA, Bousser MG, Ford G, et al. Ischaemic stroke and transient ischemic attack. European Handbook Neurological Manage 2011; 1(2): 101-58.]. Nurses are the primary health care providers for the stroke patients with dysphagia, however, there is a need to train nurses to assess and recognize dysphagia in order to enhance stroke patients’ safety [5American Speech-Language-Hearing Association (ASHA). Swallowing disorders (Dysphagia) in adults 2016 Available from http://www.asha.org/public/speech/swallowing/ Swallowing-Disorders-in-Adults/-7Ilott I, Bennett B, Gerrish K, Pownall S, Jones A, Garth A. Evaluating a novel approach to enhancing dysphagia management: Workplace-based, blended e-learning. J Clin Nurs 2014; 23(9-10): 1354-64.[http://dx.doi.org/10.1111/jocn.12409] [PMID: 24330351] , 17Centers for disease control and prevention (CDC). About Stroke 2013., 29Ho YH, Liu HY, Huang ST. The prevalence and signs of Dysphagia among stroke patients in rehabilitation units. Hu Li Za Zhi 2014; 61(2): 54-62.[PMID: 24676952] ]. The Knowledge and skills about dysphagia disorder help nurses to identify the problem on time and refer the stroke patients for diagnosis and management to the specialist health care profession [30Mubeen R, Butt AK. Knowledge of dysphagia, It’s screening on nurses and awareness of role of speech and language pathologist in dysphagia. J Riphah College Rehab Sci 2014; 2(2): 38-41.]. If the nurses screen dysphagia within twenty-four hours of admission, it may reduce the time that patients waste without nutrition and hydration and increase good clinical outcomes for stroke patients [2Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2] ]. Nursing, specifically those who are trained in undertaking dysphagia screening have an important role in reducing adverse outcomes related to dysphagia [2Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2] ]. In addition, nurses are supposed to be competent to advise physicians and Speech Language Pathologist of the dysphagia symptoms [2Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2] , 20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20.]. Many literature reported the need for training the registered nurses on how to care for the stroke patients with dysphagia [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] , 10Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36(9): 1972-6.[http://dx.doi.org/10.1161/01.STR.0000177529.86868.8d] [PMID: 16109909] , 26Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art: Invitational Conference Proceeding From the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. On behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke. Stroke 2013; 44: 24-31.http://stroke.ahajournals.org[http://dx.doi.org/10.1161/STR.0b013e3182877f57] , 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] -35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] ].

1.3. Aim

This literature review aims to discuss registered nurses' competency to screen dysphagia among stroke patients.

2. METHODS

The literature search untile 2016. Additional studies were identified through the searches of literature reviews, as well as from the reference lists associated with these studies. The keywords were used in multiple combinations in order to conduct an extensive search of these databases. The keywords used were dysphagia; dysphagia screening nurse's competency; and stroke. These keywords were entered into multiple electronic databases including CINAHL, Medline, Science Direct, Pro Quest, Pub Med, and Wiley Online Library. The following are the inclusion criteria for the integrative research review:

  1. A research-based study.
  2. Quantitative, qualitative, mixed methods and systematic reviews.
  3. Written in English language.
  4. Focuses on nurses' screening of dysphagia among stroke patients.

3. RESULTS

The articles were obtained and reviewed based on the specific inclusion criteria established, then the authors restricted the searching strategy by selecting the full text only. The analysis of the methodological characteristics of the selected studies included the purpose, samples, study design, and the measurement. At the end of the literature search, 45 full-text articles were retrieved, the titles were screened for relevance and the abstracts were read carefully, twelve not relevant articles were removed. The remaining 33 papers were read in depth and considered to be reviewed to achieve the purpose of this study. After reviewing the titles, summaries, and fully reading the articles, 17 studies were chosen. Fig. (1) show PRISMA diagram for Literature Review.

The majority of the studies were published in 2010 through 2016. The type of all the selected studies were quantitative research except one which was a mixed method in single-group, pre- and post-study. Most of the selected studies were non-experimental quantitative descriptive studies (n = 8). Two studies were quasi-experimental and two were a literature review, while one study was a randomized clinical trial study. In addition, two study were implementation of project and one study was clinical evaluation. One article was a single-group, pre- and post-study with mixed methods.

Fig. (1)
Cross section of E-TCS.


Two parts created the body of this literature review. The first part covers the literature on the training nurses in screening dysphagia among stroke patients and benefits of screening. The second part of the literature review covers nurses competency in terms of knowledge and skills of screening dysphagia among stroke patients. Table 1 demonstrates themes of the studies reviewed.

Table 1
The themes of the studies reviewed.


3.1. Training Nurses in Screening Dysphagia Among Stroke Patients and Benefits of Screening

Several researchers have studied the benefits of training nurses in screening dysphagia that improve health care, reduces patient’s length of stay in the hospital, lower costs of health care, reduces patient’s medical complications, decreases the staff turnover; tensions and conflict on health caregivers, and most significantly, shrink mortality rates [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] , 12Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol 2015; 14(3): 119-24.http://ijnl.tums.ac.ir/index.php/ijnl/article/view/731[PMID: 26622975] , 18Cichero J A Y, Heaton S, Bassett L. Triaging dysphagia: Nurse screening for dysphagia in an acute hospital. J Clin Nurs 2009; 18(11): 1649-59.[http://dx.doi.org/10.1111/j.1365-2702.2009.02797.x] [PMID: 19490301] -20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20., 22Matesic E. Evaluation of testing and implementation of evidence-based RN bedside swallow screen for dysphagia: A clinical practice change. DNP practice inquiry projects 2010 Available from cited 2016 Aprilhttp://uknowledge.uky.edu/dnp_etds/9, 26Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art: Invitational Conference Proceeding From the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. On behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke. Stroke 2013; 44: 24-31.http://stroke.ahajournals.org[http://dx.doi.org/10.1161/STR.0b013e3182877f57] , 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] , 36Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis 2014; 23(4): 712-6.[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.030] [PMID: 23910514] ]. Randomized clinical trial study investiged the effects of swallowing therapy on recovery from dysphagia on sixty dysphagia patients, concluded that this stratgy prevent complications like aspiration [12Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol 2015; 14(3): 119-24.http://ijnl.tums.ac.ir/index.php/ijnl/article/view/731[PMID: 26622975] ].

Correspondingly, Rhoda and Pickel-Voight, (2015) reported that stroke patients commonly experience dysphagia post stroke and early diagnosis and management is an important prerequisite for recovery from stroke during the rehabilitation phase [35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] ], Edmiaston, Connor, Steger-May, Ford, (2014) also reported that there was no pneumonia incidence during implementation of the screening dysphagia [36Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis 2014; 23(4): 712-6.[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.030] [PMID: 23910514] ]. Consistently, Tanton, (2010) found that nearer identification of swallowing problems, leaded rapidly to start care pathway of dysphagia, consequently decrease risk of complication [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] ].

Chung, Chen, and Lee, (2013) implemented a project for nurses to enhance the accuracy and the level of understanding of the swallowing screening test and its implementation, their results reveal successfully raised the accuracy and the awareness level of swallowing screening to 100% and the occurrence of aspiration pneumonia reduced from 19% to 7% [32Chung HL, Chen IL, Lee HL. A program to improve accuracy rate of dysphagia screening for patients with stroke. Tzu Chi Nurs J 2013; 12(3): 89-101.]. Similar Hinchey, Shephard, Furie, Smith, Wang, amd Tonn, (2005) found that pneumonia was a weighty complication of stroke and increases mortality three-fold and they concluded that formal dysphagia screening was associated with a larger adherence rate to dysphagia screen and a considerably reduced risk of pneumonia and all formal stroke patients should be screened for dysphagia [10Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36(9): 1972-6.[http://dx.doi.org/10.1161/01.STR.0000177529.86868.8d] [PMID: 16109909] ]. Moreover, Cichero, Heaton, and Bassett, (2009) found that dysphagia screening reduces pneumonia threefold [18Cichero J A Y, Heaton S, Bassett L. Triaging dysphagia: Nurse screening for dysphagia in an acute hospital. J Clin Nurs 2009; 18(11): 1649-59.[http://dx.doi.org/10.1111/j.1365-2702.2009.02797.x] [PMID: 19490301] ]. Trained nurses showed more confidence in caring patients with dysphagia and offer more attention to the nutritional requirements of stroke patients [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] ].

Freeland, Pathak, Garrett, Anderson, and Daniels, (2016) in their study used medical mannequins to train 32 registered nurses in stroke swallowing screening, they found that this method can be used to train and evaluate nurses for acquirement and conservation of swallowing screening competency [37Freeland TR, Pathak S, Garrett RR, Anderson JA, Daniels SK. Using medical mannequins to train nurses in stroke swallowing screening. Dysphagia 2016; 31(1): 104-10.[http://dx.doi.org/10.1007/s00455-015-9666-6] [PMID: 26519043] ]. In addition, Ilott, Bennett, Gerrish, Pownall, Jones, and Garth, (2013) used a single-group, pre- and post-study with mixed methods to evaluating a novel approach (workplace-based, blended e-learning) for registered nurses and healthcare assistants, they found that this approach was an acceptable, cost effective way of delivering essential clinical knowledge and skills about dysphagia [7Ilott I, Bennett B, Gerrish K, Pownall S, Jones A, Garth A. Evaluating a novel approach to enhancing dysphagia management: Workplace-based, blended e-learning. J Clin Nurs 2014; 23(9-10): 1354-64.[http://dx.doi.org/10.1111/jocn.12409] [PMID: 24330351] ].

3.2. Nurses Competency in Terms of Knowledge and Skills of Screening Dysphagia

A competent health care provider should complete the dysphagia screening for every stroke patient with dysphagia before giving them anything by mouth, The competency of a nurse being able to perform the dysphagia screening independently leads to effectiveness for the stroke patient outcome [22Matesic E. Evaluation of testing and implementation of evidence-based RN bedside swallow screen for dysphagia: A clinical practice change. DNP practice inquiry projects 2010 Available from cited 2016 Aprilhttp://uknowledge.uky.edu/dnp_etds/9]. Competence in nursing is essential to provide safe and high-quality care for stroke patients, hence registered nurses are at the forefront of recognizing and responding to deviations in a patient’s condition which may be life-threatening. To provide a high standard care for stroke patients, nurses need new knowledge and skills through an orientation program and continual education [31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] ].

Several researchers have described registered nurses competency in term of knowledge and skills regarding screening dysphagia [30Mubeen R, Butt AK. Knowledge of dysphagia, It’s screening on nurses and awareness of role of speech and language pathologist in dysphagia. J Riphah College Rehab Sci 2014; 2(2): 38-41., 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] , 38Diendéré J, et al. Knowledge and practice concerning swallowing disorders in hemiplegic patients on nurses of Bobo–Dioulasso urban primary health care centers in Burkina Faso. e Neurological Sci 2016; 3: 48-53., 39McHale JM, Phipps MA, Horvath K, Schmelz J. Expert nursing knowledge in the care of patients at risk of impaired swallowing. Image J Nurs Sch 1998; 30(2): 137-41.[http://dx.doi.org/10.1111/j.1547-5069.1998.tb01268.x] [PMID: 9775554] ]. McHale, Phipps, Horvath, Schmelz, (1998) conducted a study to describe the practical knowledge of expert twelve nurses. Data were collected by interviews in which nurses deliberated the written narratives; nonparticipant observations and interviews; and patient chart review. By using interpretive phenomenology, they found that greatest nurse in the study did not accomplish a complete assessment of swallowing earlier in feeding patients, which was unexpected from expert nurses as they did not implement this essential assessment [39McHale JM, Phipps MA, Horvath K, Schmelz J. Expert nursing knowledge in the care of patients at risk of impaired swallowing. Image J Nurs Sch 1998; 30(2): 137-41.[http://dx.doi.org/10.1111/j.1547-5069.1998.tb01268.x] [PMID: 9775554] ].

Moreover, Albini, Soares, Wolf, Gonçalves, (2013) conducted a study to evaluate the knowledge about the care for dysphagia patients from the nurses through answering a structured questionnaire about dysphagia. They found that nurses had a satisfactory knowledge about the definition and complications of dysphagia, but they did not know about the stages, causes and specific care related to nutrition, medication, and hygiene in cases of dysphagia, the self-assessment reported deficiency of training in conducting some procedures to patients with dysphagia. Thus, they concluded the benefits of nurse’s continual training that focuses on screening dysphagia among stroke patients [31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] ].

Also, Diendéré et al, (2016) applied standardized survey in cross-section to determine nurse's knowledge and practices regarding swallowing disorders. They found that few nurses understood the importance of screening dysphagia [38Diendéré J, et al. Knowledge and practice concerning swallowing disorders in hemiplegic patients on nurses of Bobo–Dioulasso urban primary health care centers in Burkina Faso. e Neurological Sci 2016; 3: 48-53.]. In order to improve care among stroke patients, Diendéré, et al. suggested training for nurses on screening dysphagia. Similarly, Mubeen and Butt, (2014) conducted a survey to assess the knowledge of swallowing difficulties by using a self-constructed five point likert questionnaire. Their results indicated that the nurses do not have adequate knowledge of screening dysphagia and the role of the Speeach Language Pathologists [30Mubeen R, Butt AK. Knowledge of dysphagia, It’s screening on nurses and awareness of role of speech and language pathologist in dysphagia. J Riphah College Rehab Sci 2014; 2(2): 38-41.]. Futhermore, Rhoda and Pickel-Voight, (2015) focused on the nurses, who were the first health personnel to interact with a patient with stroke, because it is important that they are knowledgeable and skilled in the screening dysphagia. however, they found that the awareness of the nurses regarding dysphagia is weak and nurses have moderate knowledge of the signs, symptoms, and complications of dysphagia, but poor knowledge about its management by application a self-administered questionnaire with closed-ended questions [35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] ]. See Table 1 for more information.

4. DISCUSSION

Patients with stroke are at risk of dysphagia because they often have decreased the level of consciousness and poorer cranial nerve function followed by facial and oropharyngeal muscle weakness [14Tanner DC, Culbertson WR. Avoiding Negative Dysphagia Outcomes. Online J Issues Nurs 2014; 19(2): 6.[http://dx.doi.org/10.3912/OJIN.Vol19No02PPT03] [PMID: 26812272] , 28Ringleb PA, Bousser MG, Ford G, et al. Ischaemic stroke and transient ischemic attack. European Handbook Neurological Manage 2011; 1(2): 101-58.]. However, clinical signs and symptoms of dysphagia are not observable all the time and the existence of an intact gag reflex does not essentially rule out the opportunity of aspiration pneumonia [15Smallwood M. Using evidence-based practice to develop a swallow screen for stroke patients. J Neurosci Nurs 2012; 29(5): 325-9.]. The possibility of mortality was higher in patients with altered swallowing than in patients with no such alteration upon clinical evaluation [40Baroni A, Fábio S, Dantas RO. Risk factors for swallowing dynfunction in stroke patients. abr/jun 2012; 49(2): 118-24.]. Chang, et al. (2013) reviewed that the death certificates of patients who died with stroke were 5% due to aspiration pneumonia and 1% due to choking [41Chang CY, Cheng TJ, Lin CY, Chen JY, Lu TH, Kawachi I. Reporting of aspiration pneumonia or choking as a cause of death in patients who died with stroke. Stroke 2013; 44(4): 1182-5.[http://dx.doi.org/10.1161/STROKEAHA.111.000663] [PMID: 23449262] ].

Dysphagia screening is a marginally invasive, pass or fail tool for quick identification of patients who need a formal evaluation of swallowing administered by a trained professional [15Smallwood M. Using evidence-based practice to develop a swallow screen for stroke patients. J Neurosci Nurs 2012; 29(5): 325-9.]. Numerous clinical tools have varying sensitivity and specificity and several dysphagia screenings are available for nurses to administer among stroke patients and validate against the instrumental assessment. Although numerous dysphagia screening tools are present, no one has high sensitivity and reliability or applied quickly with minimal training [10Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36(9): 1972-6.[http://dx.doi.org/10.1161/01.STR.0000177529.86868.8d] [PMID: 16109909] ].

One of the main responsibilities of the registered nurses is screening dysphagia among stroke patients because they have better chances to contact with patients in clinical location and they must learn the accurate guidance of safe feeding of patients with dysphagia [37Freeland TR, Pathak S, Garrett RR, Anderson JA, Daniels SK. Using medical mannequins to train nurses in stroke swallowing screening. Dysphagia 2016; 31(1): 104-10.[http://dx.doi.org/10.1007/s00455-015-9666-6] [PMID: 26519043] ]. Additionally, nurses specifically trained in the acting screening dysphagia have a significant role in dropping adverse outcomes connected to dysphagia [4Teasell R, Foley N, Martino R, Richardson M, Bhogal S, Speechley M. Dysphagia and aspiration following stroke. cited 2016 April; Available from: wwwebrsrcom 2013.www.ebrsr.com, 6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] , 34Lees L, Sharpe L, Edwards A. Nurse-led dysphagia screening in acute stroke patients. Nurs Stand 2006; 21(6): 35-42.[http://dx.doi.org/10.7748/ns.21.6.35.s53] [PMID: 17069157] ]. However, dysphagia screening by nurses does not shift assessment by the Speech Language Pathologists; instead, it improves the care provided to patients at risk allowing for early detection and intervention [2Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2] , 6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] ].

Knowledge of swallowing disorders in terms of signs and symptoms is fundamental for nurses working in different hospital settings. A lack of knowledge about dysphagia can result in hazardous consequences and this can be fatal for the patient. Nurses conducted the swallowing screening test inconsistently and without a standard procedure, caused chiefly by the lack of knowledge and skills on dysphagia screening, and the absence of training programs [32Chung HL, Chen IL, Lee HL. A program to improve accuracy rate of dysphagia screening for patients with stroke. Tzu Chi Nurs J 2013; 12(3): 89-101.]. Several researchers emphasis on nurses for training the dysphagia screening [30Mubeen R, Butt AK. Knowledge of dysphagia, It’s screening on nurses and awareness of role of speech and language pathologist in dysphagia. J Riphah College Rehab Sci 2014; 2(2): 38-41., 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] , 33Barrere C, Delaney C, Peterson D, Hickey K. Primary Stroke Center education for nurses: Improving core measures. J Nurs Adm 2010; 40(12): 515-21.[http://dx.doi.org/10.1097/NNA.0b013e3181fc1a05] [PMID: 21084886] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] , 38Diendéré J, et al. Knowledge and practice concerning swallowing disorders in hemiplegic patients on nurses of Bobo–Dioulasso urban primary health care centers in Burkina Faso. e Neurological Sci 2016; 3: 48-53., 39McHale JM, Phipps MA, Horvath K, Schmelz J. Expert nursing knowledge in the care of patients at risk of impaired swallowing. Image J Nurs Sch 1998; 30(2): 137-41.[http://dx.doi.org/10.1111/j.1547-5069.1998.tb01268.x] [PMID: 9775554] ].

Training is a process by which someone has acquired the skills that are needed for a profession. Teaching enhances any knowledge and skills regarding the specific competency to improve one's capability and performance in order to increase productivity [42Merriam-Webster’s Learner’s Dictionary. Definition of Training. Available from: http://learnersdictionary.com/ definition/train]. The literature supports the need for screening of dysphagia because of frequent complications of post-stroke can be detected by nurses via applying the appropriate valid tool [26Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art: Invitational Conference Proceeding From the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. On behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke. Stroke 2013; 44: 24-31.http://stroke.ahajournals.org[http://dx.doi.org/10.1161/STR.0b013e3182877f57] , 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] , 33Barrere C, Delaney C, Peterson D, Hickey K. Primary Stroke Center education for nurses: Improving core measures. J Nurs Adm 2010; 40(12): 515-21.[http://dx.doi.org/10.1097/NNA.0b013e3181fc1a05] [PMID: 21084886] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] ]. There were medical, psychological, and economic benefits for screening dysphagia among stroke patients [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] , 12Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol 2015; 14(3): 119-24.http://ijnl.tums.ac.ir/index.php/ijnl/article/view/731[PMID: 26622975] , 18Cichero J A Y, Heaton S, Bassett L. Triaging dysphagia: Nurse screening for dysphagia in an acute hospital. J Clin Nurs 2009; 18(11): 1649-59.[http://dx.doi.org/10.1111/j.1365-2702.2009.02797.x] [PMID: 19490301] -20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20., 22Matesic E. Evaluation of testing and implementation of evidence-based RN bedside swallow screen for dysphagia: A clinical practice change. DNP practice inquiry projects 2010 Available from cited 2016 Aprilhttp://uknowledge.uky.edu/dnp_etds/9, 26Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art: Invitational Conference Proceeding From the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. On behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke. Stroke 2013; 44: 24-31.http://stroke.ahajournals.org[http://dx.doi.org/10.1161/STR.0b013e3182877f57] , 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] , 36Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis 2014; 23(4): 712-6.[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.030] [PMID: 23910514] ].

The patient needs come to be more complicated and nurses should attain essential competencies to deliver high-quality care. Care of patients with dysphagia is still a challenge because of the need for proper management of care and an interdisciplinary approach involving the Speech Language Pathologists, nurses, and medical experts [20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20., 25Joint Commission. Dysphagia Screen. Q For which patients should the dysphagia screen be performed? 2009 Available from: cited 2016 Aprilhttp://www.jointcommission.org/ standards_information/jcfaqdetails.aspx?StandardsFaqId=88&ProgramId=47]. To add more effects in the identification of dysphagia among stroke patients in order to decrease the consequence of dysphagia, nurses ought to assess their competency using the well-developed tool in identifying the level of expertise required by their anticipated role related to their job and should be trained to that level [43Boaden E, Davies S, Storey L, Watkins C. . Inter professional dysphagia framework. From the Royal College of Speech and Language Therapists 2006 Available from: cited 2016 Marchhttp:// www.uclan.ac.uk/facs/health/nursing/ research/groups/stroke].

Competency defined as the capability to do something efficiently and successfully [44Oxford dictionary. Definition of competency 2016 Available from: http://www.oxforddictionaries.com/definition/ english/competence]. Likewise, competency preferred outcome from an integration of knowledge, skills, abilities, judgment, and performing successfully at an expected level of nursing education and professional development [45Alspach J. From staff nurse to preceptor: A preceptor development program 2000.]. Although there is no universal definition of competency [46Donilon DM. Nurses Perceptions of their Competence in Managing Patient Situations in Acute Care. Open Access Available from: http://digitalcommons.uri.edu/cgi/ viewcontent.cgi?article=1015&context=oa_diss], registered nurses must continually reassess their competencies and identify needs for additional knowledge and skills. Measuring registered nurses competencies to determine if a nurse holds the ability to perform specific tasks on clinical skills, knowledge, education, and experience in the by competency assessment tools [47Gardulf A, Nilsson J, Florin J, et al. The Nurse Professional Competence (Npc) Scale: Self-Reported Competence on Nursing Students On The Point Of Graduation. Nurse Education Today 2015 ]. Accordingly, healthcare organizations are anticipated to assess and continue frequently registered nurses’ clinical competencies as quantity of work to achieve the top patient care.

In the acquisition and development of a skill, a nurse passes through five levels of proficiency: novice; advanced beginner; competent; proficient; and expert [48Benner P. From novice to expert. Am J Nurs 1982; 82(3): 402-7.[http://dx.doi.org/10.2307/3462928] [PMID: 6917683] ]. In 2006, an Inter-Professional Dysphagia Competence Framework [43Boaden E, Davies S, Storey L, Watkins C. . Inter professional dysphagia framework. From the Royal College of Speech and Language Therapists 2006 Available from: cited 2016 Marchhttp:// www.uclan.ac.uk/facs/health/nursing/ research/groups/stroke] was comprehensively planned for the nurses and other health care professionals to provide more effectiveness in the documentation of people with swallowing dysfunction to provide a steady approach in training and educating them. There are five levels of the Inter-Professional Dysphagia Competence Framework and their competences (Awareness; Assistant dysphagia practitioner; Foundation dysphagia practitioner; Specialist dysphagia practitioner; and Expert/consultant dysphagia practitioner) started from those who needed awareness on the presenting signs and symptoms of dysphagia and those associated with health risks to demonstrate skilled procedures with higher theoretical knowledge establishment on research/best practice. Low competence on registered nurse results spread the morbidity and mortality among stroke patients [47Gardulf A, Nilsson J, Florin J, et al. The Nurse Professional Competence (Npc) Scale: Self-Reported Competence on Nursing Students On The Point Of Graduation. Nurse Education Today 2015 ].

5. LITERATURE GAP

Dysphagia screening is a key process in the care of patients with post-stroke. All studies agreed the benefit of screening dysphagia among stroke patients. However, there was currently no agreement regarding the best approach to dysphagia screening [8Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care 2010; 19(4): 357-64.[http://dx.doi.org/10.4037/ajcc2009961] [PMID: 19875722] , 20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20.]. Disagreement exists regarding what tool should be used for screening and who should administer the screening [20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20.]. All studies addressed the benefits of training nurses in screening for dysphagia among stroke patients in this literature review. In addition, various studies have created different protocols for a nurse in order to conduct a dysphagia screening, but there was no one universally utilized dysphagia screening in the hospitals [20Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20.]. There are many screening methods, but all have limitations, especially when used with acutely ill patients [6Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230] ].

Publications about screening dysphagia among stroke patients started before 17 years and the methods used on the instruments were questionnaires and observation of patient’s clinical signs and symptoms [49Etges CL, Scheeren B, Gomes E, Barbosa LdeR. Screening tools for dysphagia: A systematic review. CoDAS 2014; 26(5): 343-9.[http://dx.doi.org/10.1590/2317-1782/20142014057] [PMID: 25388065] ]. Most of the studies described registered nurse competency in terms of knowledge and skills by descriptive exploratory design with purposive sampling to describe and assess knowledge about the care of the patients with dysphagia with small sample size [30Mubeen R, Butt AK. Knowledge of dysphagia, It’s screening on nurses and awareness of role of speech and language pathologist in dysphagia. J Riphah College Rehab Sci 2014; 2(2): 38-41., 31Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047] , 35Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081] ]. But little of them investigated the practice of nurses [37Freeland TR, Pathak S, Garrett RR, Anderson JA, Daniels SK. Using medical mannequins to train nurses in stroke swallowing screening. Dysphagia 2016; 31(1): 104-10.[http://dx.doi.org/10.1007/s00455-015-9666-6] [PMID: 26519043] -39McHale JM, Phipps MA, Horvath K, Schmelz J. Expert nursing knowledge in the care of patients at risk of impaired swallowing. Image J Nurs Sch 1998; 30(2): 137-41.[http://dx.doi.org/10.1111/j.1547-5069.1998.tb01268.x] [PMID: 9775554] ]. Minor studies used quazi-experimental [7Ilott I, Bennett B, Gerrish K, Pownall S, Jones A, Garth A. Evaluating a novel approach to enhancing dysphagia management: Workplace-based, blended e-learning. J Clin Nurs 2014; 23(9-10): 1354-64.[http://dx.doi.org/10.1111/jocn.12409] [PMID: 24330351] , 18Cichero J A Y, Heaton S, Bassett L. Triaging dysphagia: Nurse screening for dysphagia in an acute hospital. J Clin Nurs 2009; 18(11): 1649-59.[http://dx.doi.org/10.1111/j.1365-2702.2009.02797.x] [PMID: 19490301] , 37Freeland TR, Pathak S, Garrett RR, Anderson JA, Daniels SK. Using medical mannequins to train nurses in stroke swallowing screening. Dysphagia 2016; 31(1): 104-10.[http://dx.doi.org/10.1007/s00455-015-9666-6] [PMID: 26519043] ] and Randomized clinical trial study [12Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol 2015; 14(3): 119-24.http://ijnl.tums.ac.ir/index.php/ijnl/article/view/731[PMID: 26622975] ]. Most of the researchers concluded that nurses do not have adequate knowledge and practice in different aspects of dysphagia and screening dysphagia nurses should assess their competency in terms of knowledge and skills in well-developed tool and different evaluation tools exist. Most of the studies used self administered structured questionnaire to evaluate knowledge, while another study evaluated practical knowledge by written narratives; nonparticipant observations and interviews; and patient chart review [39McHale JM, Phipps MA, Horvath K, Schmelz J. Expert nursing knowledge in the care of patients at risk of impaired swallowing. Image J Nurs Sch 1998; 30(2): 137-41.[http://dx.doi.org/10.1111/j.1547-5069.1998.tb01268.x] [PMID: 9775554] ].

6. IMPLICATION

Competence in nursing is essential to provide safe and high quality care for stroke patients, hence registered nurses are at the forefront of recognizing and responding to deviations in patient condition which may be life- threatening. The outcomes of this review highlights the role of training in a clinical placement that may be an area of research to provide sufficient regular training for a registered nurse. Educational strategies that ease the development of nurses’ knowledge, skills, and competencies in managing patient are vital. Integration of theory and practice in nurse student's curricula is important for developing nurse competence.

The current review is unique and elicit for a new body of knowledge and evidence about screening dysphagia among stroke patients in the hospitals and inform health care providers and administrators of the importance of screening dysphagia prior to initiating the oral intake of fluids or food utilizing a simple valid reliable screening tool. In addition, this review may be a platform for future setup of policies and guidelines for the health care providers to screen dysphagia among stroke patients.

CONCLUSION

In stroke patients, dysphagia is frequent and present alarming symptom that needs urgent attention. Early screening of dysphagia is essential to prevent future health complications and should have a high priority in the health-care practices Nurses should be aware of the signs and symptoms of dysphagia to enable them recognized patients with dysphagia. Nurses, clinicians, and hospital administrators need to support teaching and training of nurses who take care of dysphagia stroke patients. Nurses need to develop their competencies on dysphagia screening based on evidence. Confirming competence in nursing practice should be a high priority for staff development departments in hospitals.

CONSENT FOR PUBLICATION

Not applicable.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

We would like to thank the Deanship for Scientific Research in the University of Jordan for funding this study.

REFERENCES

[1] World Health Organization (WHO). The WHO STEP wise approach to stroke surveillance 2016 Available from: cited 2016 Aprilhttp://www.who.int/chp/steps/stroke/en/
[2] Hines S, Kynoch K, Munday J. Identification and nursing management of dysphagia in individuals with acute neurological impairment: A systematic review protocol. JBI database of reviews and implementation reports 2014; 12(5): 195-236.[http://dx.doi.org/10.1097/01.XEB.0000455128.74875.d2]
[3] World Health Organization (WHO). What can I do to avoid a heart attack or a stroke? Online Q&A 2015 [cited 2016 March]; Available from: from http://www.who.int/features/qa/27/en/
[4] Teasell R, Foley N, Martino R, Richardson M, Bhogal S, Speechley M. Dysphagia and aspiration following stroke. cited 2016 April; Available from: wwwebrsrcom 2013.www.ebrsr.com
[5] American Speech-Language-Hearing Association (ASHA). Swallowing disorders (Dysphagia) in adults 2016 Available from http://www.asha.org/public/speech/swallowing/ Swallowing-Disorders-in-Adults/
[6] Tanton M. Developing a screening tool and training package to identify dysphagia in all settings. Nurs Times 2010; 106(15): 18-20.[PMID: 20481230]
[7] Ilott I, Bennett B, Gerrish K, Pownall S, Jones A, Garth A. Evaluating a novel approach to enhancing dysphagia management: Workplace-based, blended e-learning. J Clin Nurs 2014; 23(9-10): 1354-64.[http://dx.doi.org/10.1111/jocn.12409] [PMID: 24330351]
[8] Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care 2010; 19(4): 357-64.[http://dx.doi.org/10.4037/ajcc2009961] [PMID: 19875722]
[9] Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J 2006; 82(968): 383-91.[http://dx.doi.org/10.1136/pgmj.2005.043281] [PMID: 16754707]
[10] Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36(9): 1972-6.[http://dx.doi.org/10.1161/01.STR.0000177529.86868.8d] [PMID: 16109909]
[11] Mourão AM, Almeida EO, Lemos SMA, Vicente LCC, Teixeira AL. Evolution of swallowing in post-acute stroke: A descriptive study. Rev CEFAC 2016; 18(2): 417-25.[http://dx.doi.org/10.1590/1982-0216201618212315]
[12] Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol 2015; 14(3): 119-24.http://ijnl.tums.ac.ir/index.php/ijnl/article/view/731[PMID: 26622975]
[13] Li M, Wang Z, Han WJ, Lu SY, Fang ZY. Effect of feeding management on aspiration pneumonia in elderly patients with dysphagia. Clin Nurs Res 2015; 2l: 40-4.
[14] Tanner DC, Culbertson WR. Avoiding Negative Dysphagia Outcomes. Online J Issues Nurs 2014; 19(2): 6.[http://dx.doi.org/10.3912/OJIN.Vol19No02PPT03] [PMID: 26812272]
[15] Smallwood M. Using evidence-based practice to develop a swallow screen for stroke patients. J Neurosci Nurs 2012; 29(5): 325-9.
[16] Vesey S. Dysphagia and quality of life. Br J Community Nurs 2013. S14, S16, S18-S14, S16, S19[http://dx.doi.org/10.12968/bjcn.2013.18.Sup5.S14]
[17] Centers for disease control and prevention (CDC). About Stroke 2013.
[18] Cichero J A Y, Heaton S, Bassett L. Triaging dysphagia: Nurse screening for dysphagia in an acute hospital. J Clin Nurs 2009; 18(11): 1649-59.[http://dx.doi.org/10.1111/j.1365-2702.2009.02797.x] [PMID: 19490301]
[19] Cohen DL, Roffe C, Beavan J, et al. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke 2016; 11(4): 399-411.[http://dx.doi.org/10.1177/1747493016639057] [PMID: 27006423]
[20] Dondorf K, Fabus R, Ghassemi A E. The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. J of Nursing Education and Practice 2016; 6(4): 17-20.
[21] González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after Stroke: An Overview. Curr Phys Med Rehabil Rep 2013; 1(3): 187-96.[http://dx.doi.org/10.1007/s40141-013-0017-y] [PMID: 24977109]
[22] Matesic E. Evaluation of testing and implementation of evidence-based RN bedside swallow screen for dysphagia: A clinical practice change. DNP practice inquiry projects 2010 Available from cited 2016 Aprilhttp://uknowledge.uky.edu/dnp_etds/9
[23] National institutes of Health. What Is a Stroke? Available from 2016.http://www.nhlbi.nih.gov/health/health-topics/ topics/stroke
[24] National Stroke Foundation. Clinical Guidelines for Stroke Management 2010.
[25] Joint Commission. Dysphagia Screen. Q For which patients should the dysphagia screen be performed? 2009 Available from: cited 2016 Aprilhttp://www.jointcommission.org/ standards_information/jcfaqdetails.aspx?StandardsFaqId=88&ProgramId=47
[26] Donovan NJ, Daniels SK, Edmiaston J, Weinhardt J, Summers D, Mitchell PH. Dysphagia Screening: State of the Art: Invitational Conference Proceeding From the State-of-the-Art Nursing Symposium, International Stroke Conference 2012. On behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke. Stroke 2013; 44: 24-31.http://stroke.ahajournals.org[http://dx.doi.org/10.1161/STR.0b013e3182877f57]
[27] Martino R, Maki E, Diamant N. Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST©): Are 10 teaspoons of water necessary? Int J Speech-Language Pathol 2014; 16(3): 193-8.[http://dx.doi.org/10.3109/17549507.2014.902995] [PMID: 24833425]
[28] Ringleb PA, Bousser MG, Ford G, et al. Ischaemic stroke and transient ischemic attack. European Handbook Neurological Manage 2011; 1(2): 101-58.
[29] Ho YH, Liu HY, Huang ST. The prevalence and signs of Dysphagia among stroke patients in rehabilitation units. Hu Li Za Zhi 2014; 61(2): 54-62.[PMID: 24676952]
[30] Mubeen R, Butt AK. Knowledge of dysphagia, It’s screening on nurses and awareness of role of speech and language pathologist in dysphagia. J Riphah College Rehab Sci 2014; 2(2): 38-41.
[31] Albini RMN, Soares VMN, Wolf AE, Gonçalves CGO. Knowledge of Nursing Professionals about the Care to Dysphagic Patients in Intensive Care Units. CEFAC 2013; 15(6): 1512-24.[http://dx.doi.org/10.1590/S1516-18462013005000047]
[32] Chung HL, Chen IL, Lee HL. A program to improve accuracy rate of dysphagia screening for patients with stroke. Tzu Chi Nurs J 2013; 12(3): 89-101.
[33] Barrere C, Delaney C, Peterson D, Hickey K. Primary Stroke Center education for nurses: Improving core measures. J Nurs Adm 2010; 40(12): 515-21.[http://dx.doi.org/10.1097/NNA.0b013e3181fc1a05] [PMID: 21084886]
[34] Lees L, Sharpe L, Edwards A. Nurse-led dysphagia screening in acute stroke patients. Nurs Stand 2006; 21(6): 35-42.[http://dx.doi.org/10.7748/ns.21.6.35.s53] [PMID: 17069157]
[35] Rhoda A, Pickel-Voight A. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia. Curationis 2015; 38(2): 1564.[http://dx.doi.org/10.4102/curationis.v38i2.1564] [PMID: 26842081]
[36] Edmiaston J, Connor LT, Steger-May K, Ford AL. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. J Stroke Cerebrovasc Dis 2014; 23(4): 712-6.[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.030] [PMID: 23910514]
[37] Freeland TR, Pathak S, Garrett RR, Anderson JA, Daniels SK. Using medical mannequins to train nurses in stroke swallowing screening. Dysphagia 2016; 31(1): 104-10.[http://dx.doi.org/10.1007/s00455-015-9666-6] [PMID: 26519043]
[38] Diendéré J, et al. Knowledge and practice concerning swallowing disorders in hemiplegic patients on nurses of Bobo–Dioulasso urban primary health care centers in Burkina Faso. e Neurological Sci 2016; 3: 48-53.
[39] McHale JM, Phipps MA, Horvath K, Schmelz J. Expert nursing knowledge in the care of patients at risk of impaired swallowing. Image J Nurs Sch 1998; 30(2): 137-41.[http://dx.doi.org/10.1111/j.1547-5069.1998.tb01268.x] [PMID: 9775554]
[40] Baroni A, Fábio S, Dantas RO. Risk factors for swallowing dynfunction in stroke patients. abr/jun 2012; 49(2): 118-24.
[41] Chang CY, Cheng TJ, Lin CY, Chen JY, Lu TH, Kawachi I. Reporting of aspiration pneumonia or choking as a cause of death in patients who died with stroke. Stroke 2013; 44(4): 1182-5.[http://dx.doi.org/10.1161/STROKEAHA.111.000663] [PMID: 23449262]
[42] Merriam-Webster’s Learner’s Dictionary. Definition of Training. Available from: http://learnersdictionary.com/ definition/train
[43] Boaden E, Davies S, Storey L, Watkins C. . Inter professional dysphagia framework. From the Royal College of Speech and Language Therapists 2006 Available from: cited 2016 Marchhttp:// www.uclan.ac.uk/facs/health/nursing/ research/groups/stroke
[44] Oxford dictionary. Definition of competency 2016 Available from: http://www.oxforddictionaries.com/definition/ english/competence
[45] Alspach J. From staff nurse to preceptor: A preceptor development program 2000.
[46] Donilon DM. Nurses Perceptions of their Competence in Managing Patient Situations in Acute Care. Open Access Available from: http://digitalcommons.uri.edu/cgi/ viewcontent.cgi?article=1015&context=oa_diss
[47] Gardulf A, Nilsson J, Florin J, et al. The Nurse Professional Competence (Npc) Scale: Self-Reported Competence on Nursing Students On The Point Of Graduation. Nurse Education Today 2015
[48] Benner P. From novice to expert. Am J Nurs 1982; 82(3): 402-7.[http://dx.doi.org/10.2307/3462928] [PMID: 6917683]
[49] Etges CL, Scheeren B, Gomes E, Barbosa LdeR. Screening tools for dysphagia: A systematic review. CoDAS 2014; 26(5): 343-9.[http://dx.doi.org/10.1590/2317-1782/20142014057] [PMID: 25388065]

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