NURS

150 Journal Article Review

Student ID: 823425053

Journal article review:

Hughes, S.M. (2011). Management of dysphagia in stroke patients. Nursing Older People.
Student: Kristina Milaniak
Student ID: 823425053
Date Submitted: March 2nd, 2015
NURS 150: Nursing Theory 2
Professor: Sylwia Wojtalik
Humber College ITAL

NURS 150 Journal Article Review

Student ID: 823425053

Journal article review managing symptoms of dysphagia in stroke patients

A stroke is a medical emergency termed as a sudden loss of brain functioning. It can occur
as an ischemic or hemorrhagic stroke, thus by blocking the flow of blood to the brain (i.e., blood
clot) or the rupture of blood vessels in the brain, respectively (Heart & Stroke Foundation, 2014).
Statistics Canada (2012) states that stroke is the third leading cause of death in Canada, with over
14,000 deaths occurring annually. The effects of suffering a stroke include paralysis, poor
mobility, anger, anxiety, depression, aphasia, and incontinence, to name a few. Sarah Hughes
(2011) case study article focuses on dysphagia (or difficulty swallowing), which is a common
impairment in patients affected by stroke. Its management is integral to stroke rehabilitation and
reducing the risks of mortality and morbidity. Since stroke rehabilitation includes physical,
psychosocial, and psychological aspects, the use of a multidisciplinary team is important to
consider when planning care. Effective communication amongst the multidisciplinary team must
be evident. The nurses role in rehabilitation of dysphagia and of other complications that stroke
patients present is central and pivotal to the plan of care. Gibbon et al. (2012), reinforces Hughes
view and states that the nurse role is multifaceted and is illustrated as containing three main
domains of care - provider, facilitator and manager. As a practical nursing student, being able to
fulfill the role and provide competent care to stroke patients will develop and enhance my practice.
This will be essential and beneficial to providing holistic, patient-centred care to stroke patients,
from the moment of initial admission to discharge and home/community care. As stroke incidence
is on the rise with the mean age of the population, the following paper will discuss the importance
of stroke rehabilitation knowledge and skills, primarily with dysphagia, within nursing care
amongst the multidisciplinary team.
When planning care for a person who has just suffered a stroke, it is imperative to
prioritize interventions. If following Maslows hierarchy of needs, physiological needs are
fundamental and are the foundation of what needs to be addressed initially when providing care
(Maslow, 1943). Physiological needs include breathing, food, water, sex, sleep, homeostasis, and
excretion. Upon initial admission of a stroke patient, a nutritional assessment needs to be
conducted within 24 hours, which informs the health care professional of the patients adequate

NURS 150 Journal Article Review

Student ID: 823425053

dietary and fluid intake. This includes having the ability to swallow. Maintaining proper
nutritional intake is a critical factor to any rehabilitation.
As seen in the case study with Mr. Smith, the stroke patient suffered from dysphagia, and
management of symptoms was addressed (Hughes, 2011). Through the initial days of care, as a
result of his stroke, Mr. Smith sustained left sided weakness and was seen pocketing food in his
cheek. This example provides evidence on how a proper nutritional assessment can indicate that
textured dietary requirements need to be reassessed. Modification of diet by changing the textures
of foods and fluids can be initiated by the nurse if the safety of client is in question. In this case,
thickened fluids were introduced into Mr. Smiths diet, to ease the swallowing process. Although
the swallowing assessment is conducted by the speech language therapist (SLT), the management
of dysphagia symptoms are a common practice and easy to implement by nursing staff awaiting
formal swallow assessment by an SLT (Hughes, 2011). The nurse is able to delegate this decision
under the practice standard of the College of Nurses of Ontario Decisions about Procedure and
Authority (CNO, 2014). In which, nurses take initiative and decide that a specified course of
action is required and commence that procedure in the absence of a direct order. This maintains
the quality of care given and safety of patients, similar to Mr. Smith.
By being able to identify the need to manage symptoms of dysphagia, the nurse upon
initial admission reduces the risks of the stroke patient experiencing malnutrition, weight loss, and/
or aspiration pneumonia. Aspiration pneumonia is where foods and fluids pass through the airway
and has a high mortality rate in stroke patients with dysphagia (Hughes, 2011). This is another
reason it is integral to identify any nutritional insufficiencies present on initial assessment and
throughout care, which may hinder the success of stroke rehabilitation. Therefore, as a practical
nursing student, knowing to prioritize the physiological needs in the plan of care is imperative to
patient rehabilitation and reducing the mortality rate that is evidently caused by stroke in Canada
and worldwide (Statistics Canada, 2012).
As stated already, stroke rehabilitation involves many healthcare professionals that
contribute to the care of a patient (Gibbon et al., 2012). It is made up of a multidisciplinary team
that can include physicians, nurses, physiotherapists and occupational therapists, massage

NURS 150 Journal Article Review

Student ID: 823425053

therapists, speech and language therapists. Hughes (2011) states that amongst the
multidisciplinary team, the nurses role is vital to ensuring that patients' dysphagia needs are met
and managed promptly and safely. The nurse follows the practice standard of therapeutic
communication by using a skill set of interpersonal and communicative strategies to appropriately
establish, and maintain the nurse-client relationship until discharge or transfer of accountability
(CNO, 2006). Effective therapeutic communication is important to promoting the successful
recovery or improved status of a patient because it involves client-centred care. The nurse interacts
with the patient on a daily basis and conducts the screening of the progression or regression of
patients status in day-to-day practice. Therefore, not only is communication important between
the nurse and patient, it is integral amongst the multidisciplinary team as well. The team must be
informed on the status of a stroke patients rehabilitation in order to provide efficient and
beneficial care from all fronts (physical, psychological, and/or psychosocial). Communicating
findings from initial screenings enables the multidisciplinary team to establish a baseline of needs
and regular reassessments done by the nurse need to be communicated in order to make changes to
meet those requirements.
Gibbon et al., (2012) reiterates the importance of the nurse in the management of common
problems that are present in individuals sustaining a stroke. A nurses role can be divided into
three domains provider, facilitator, and manager. All domains that encompass the nurse require
effective communication strategies to providing competent care. Gibbon et al., (2012) explains the
following. The nurse is the provider of care in aiding with nutrition, hydration, elimination, and
hygiene, which are all fundamental with the management of dysphagia in stroke patients. Along
with being a provider, the facilitator domain of a nurse includes maintaining and promoting the
emotional and social aspects of rehabilitation. This is done by the developing coping strategies that
encourage patients to carry out activities of daily living. Lastly, the manager role of a nurse
encompasses managing the multidisciplinary team by liaising, organizing, and mediating between
the patient and personal/professional caregivers. Thus, the nursing role is very complex and
requires constant critical thought (Gibbon et al., 2012). Therefore, as indicated by both authors, the
nursing role is very important and effective communication skills with the patient and

NURS 150 Journal Article Review

Student ID: 823425053

multidisciplinary team will be required in developing my clinical practice and maintaining

accountability within my care.
Providing holistic client-centred care involves including interventions that are catered to
the patients realistic goals. For most patients who suffered a stroke, a common goal is to resume
to independent daily living, such as providing hygiene, eating, returning to work, and/ or driving
(Gibbon et al., 2012). Mr. Smiths goals within the discussed case study, was to maintain adequate
nourishment, management of dysphagia symptoms and the outcome of the ability to feed without
assistance (Hughes, 2011). Successful rehabilitation should incorporate support for adaptation and
readjustment. The interventions that aid in the management of dysphagia symptoms primarily
include oral hygiene and maintaining adequate hydration. The provision of proper oral hygiene
assists in the swallowing process. Although baseline nutritional screening, as stated previously, is
important to planning care, weekly reassessments allows for readjustment and adaptation of
adequate interventions, such as oral hygiene and diet modifications. Screening tools such as
MUST, the five-stage screening process that classifies if patients are at risk of malnutrition,
indicates if relevant interventions should be made to meet patients' nutritional needs. Screening
tools like these are easy to understand and readily accessible to nurses (Hughes, 2011).
Interventions are the actions taken by healthcare professionals, which are incorporated within the
plan of care. Being able to identify what interventions are necessary and when modification is
needed will further enhance my knowledge in dealing with patients who have suffered a stroke. If
proper interventions are not met, the patients recovery may suffer. For example, poor oral hygiene
can cause damage to the psychosocial self, such as reduced social interaction or it can impair
nutritional health because of pain or infection in the oral cavity (Hughes, 2011). Familiarizing
myself with screening tools, such as MUST, will supplement my practice as a student nurse.
Effective interventions can move patients towards meaningful, realistic individual goals for
successful recovery.
With reviewing the nursing implications that are involved in management of post- stroke
impairments, especially dysphagia, there are many factors to consider. Hughes (2011) case study
article reviews the importance of creating a proper plan of care, by using the example of Mr.

NURS 150 Journal Article Review

Student ID: 823425053

Smiths diagnosis. As previously discussed, it is important to prioritize the patients needs based on
Maslows hierarchy (1943), with meeting physiological needs being a baseline. Maintaining an
open airway and breathing is the main goal with patients suffering from dysphagia, and preventing
aspiration pneumonia being at the forefront. Post-stroke symptoms are complex and usually
require a multidisciplinary healthcare team to result in successful stroke rehabilitation. The nurse
role stands pivotal amongst the healthcare professional team. Thus effective communication
strategies are a necessity throughout care, with the patient and with the multidisciplinary team.
Gibbon et al., (2012) views reinforce that the nurses role is imperative to stroke recovery and state
that the nurse functions as a provider, facilitator, and manager of care. Lastly, it is important to
provide appropriate interventions, such as oral hygiene for dysphagia patients, within the plan of
care that are focused towards the patients realistic goals. Throughout stroke rehabilitation,
reassessments allow for adaptation of patients needs, as they may change from initial assessment.
These nursing implications emphasize CNO (2006) practice standards and guidelines. Creating
and maintaining therapeutic communication allows for establishing holistic, patient-centred care in
the nurse-client relationship. The nurse also uses critical thought in day-to-day practice about
deciding which procedures and authority is necessary to sustain the safety of a patient (CNO,
2014). This holds the nurse accountable for all decisions made while the patient is in his/her care.
As a practical nursing student, the following review, discussion, and evident research of
stroke rehabilitation with management of symptoms, especially dysphagia, has broadened by
knowledge and enhanced my practice. I look forward to utilizing my knowledge of stroke
rehabilitation in a clinical setting, by being able to aim focus on the importance of the nutritional
assessment upon initial admission and throughout care. With stroke being the third leading cause
of death in Canada (Statistics Canada, 2012), as a student nurse, I can now identify the common
risk factors and create a proper plan of care for a stroke patient suffering from dysphagia, and
other common impairments. As stated previously, stroke incidence is on the rise with the mean age
of the population. As healthcare professionals, we should focus our efforts to primary and
secondary prevention techniques to decrease the incidence of stroke in the aging populations, and
make all stroke rehabilitation lead to successful recovery.

NURS 150 Journal Article Review

Student ID: 823425053

References

College of Nurses of Ontario. (2014). Practice standard: Decisions About procedures and
authority. Retrieved from http://www.cno.org/Global/docs/prac/41071_Decisions.pdf
College of Nurses of Ontario. (2006). Practice standard: Therapeutic nurse-client relationship.
Retrieved from http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
Gibbon, B., Gibson, J., Lightbody, C. E., & Radford, K. (2012, Nov). Promoting rehabilitation
for stroke survivors. Nursing Times, 108, 12-5. Retrieved from
http://search.proquest.com/docview/1239909933?accountid=11530
Heart and Stroke Foundation. (2014). Statistics and guidelines: Stroke. Retrieved from
http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483991/k.34A8/Statistics.htm#st
roke
Hughes, S. M. (2011). Management of dysphagia in stroke patients. Nursing Older People, 23(3),
21-4. Retrieved from http://search.proquest.com/docview/860038578?accountid=11530
Maslow, A. (1943). A theory of human motivation. Psychological Review. 50, 370396.
Statistics Canada. (2012, July). Mortality, summary list of causes 2009. Retrieved from
http://www.statcan.gc.ca/pub/84f0209x/84f0209x2009000-eng.pdf