Swallowing Screening Practice Patterns for Nurses in the Cardiac Surgery Intensive Care Unit.

AIMS & OBJECTIVES The current study surveyed nurse practice patterns for performing swallowing screens in an academic cardiac Intensive Care Unit (ICU). It aimed to index: training and levels of confidence in conducting dysphagia screens; screening methods employed; timing and frequency of implement; and subsequent plan of care in identified high risk patients. BACKGROUND Swallowing impairment (dysphagia) is common following cardiac surgery and associated with significant morbidity and mortality. Early and accurate detection of dysphagia is therefore critical to afford implementation of interventions to optimize patient care. Currently, no validated instruments or guidelines exist for nursing screening of dysphagia in this setting. METHODS An anonymous and voluntary 10-item mixed-methods online survey was conducted using Qualtrics software. Nonprobability purposive sampling was utilized to recruit nurses working in an academic 24-bed cardiac ICU. Thematic analysi using operationally defined coding, SRQR checklist and descriptive statistics were employed. RESULTS Sixty-nine nurses completed the survey during a one-month period, representing an 84% response rate. Formal training in performing swallowing screens was reported in 18.6% of nurses. In rank order, reported level of confidence was: 'moderately' (49%); 'somewhat' (35%); 'not' (13%); and 'very' (3%). The majority of nurses performed screens within one-hour (40.6%) or between one and four hours (43.8%) of extubation. Fifteen different methods were utilized to screen swallowing function by nurses who reported a total of 31 different clinical signs indicative of dysphagia. CONCLUSIONS Survey data of practicing nurses in an academic cardiac ICU revealed limited formal training in swallowing screening methodology, a high degree of variability in screening methods employed, and low levels of agreement for dysphagia signs. Relevance to Clinical Practice Data highlight a knowledge gap and need for the development of formal education and validated rapid nursing dysphagia screening tools for standardized implementation in the cardiac surgery ICU setting.