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Can nurses assess patients with suspected swallowing problems or do they need a speech expert?

  • Comments (5)

Can nurses assess patients with suspected swallowing problems or do they have to be referred to a speech and language therapist? What do you think?

EXPERT COMMENT

“Nurses can and should assess the basic swallowing of their patients. Nurses should provide an environment suitable for a patient to consume fluid, this means ensuring they are upright, preferably in a seated position, with good upper balance. A patient should be tried with a small amount of water, and observations for coughing, gurgling, wet voice should be undertaken. If a nurse suspects a patient is having difficulty safely swallowing, many trust’s will provide a further nursing assessment, which has been supported by the SLT, this will enable you to carry out a further assessments. Referrals should only be made to a SLT once there is a validated concern relating to these initial assessments, for the specialist support.” 

Neil Wilson is a senior lecturer and admissions tutor in pre-registration adult nursing at Manchester Metropolitan University.

 

 

  • Comments (5)

Readers' comments (5)

  • Very true ... it's certainly how I was taught in practice.

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  • Anonymous

    agree with expert comment.

    but actually nowadays experts seem to be needed for everything and nurses only appear to be trained in the basics and to act as gatekeepers like gps. the need to make referrals to psychologists for psychological support, pharmacists for drug rounds, doctors to diagnose and evacuate impacted faeces, dieticians for feeding and hydration and use pampers and pads instead of carrying bedpans, computers to write their notes, etc. etc.
    I just wonder what they really do or still can do?

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  • Anonymous

    We, nurses, have been doing sucessful bedside swallowing assessments, after considerable consultation and training with speech and language therapists since 1994. However, we don't start with water, there is much to the assessment before we subject the patient to coughing, gurgling or wet voice. Correct positioning is vital before the process is even begun. Timing of the assessment, as soon as possible, with regular re-assessments, ensure adequate or alternative nutrition.

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  • I am a speech language pathologist specifically trained to diagnose and treat dysphagia.
    I would highly recommend that if a patient is suspected to have a swallowing problem that the nurse first take note of what type of problems the patient has on his/her current diet level since he/she is already approved to eat/drink/ take meds at a specific level (there are always exceptions to the rule, as in emergency situations or an individual in the process of dying).
    Here are some questions you can ask yourself to help identify a problem:
    Does the patient have problems with liquids alone or does the problem only occur when food is introduced into the mix? Does the patient demonstrate specific signs of penetration or aspiration (watery eyes, reddened face, coughing, throat clearing, gurgled voice, gurgled cough, etc)? Does head (chin parallel to the ground) or body positioning (e.g. sitting in a chair at a 90 degree angle) help to reduce the difficulty the patient is having? Is the patient taking any medication that is adversely affecting his/her swallowing? Is there something that the patient consumes that DOES NOT cause the problem? Does the patient cough/choke on his/her own saliva, another words, does the patient have as much difficulty BEFORE food/liquid/meds is even introduced to the oral cavity)? Is it behavioral (for example, does the patient eat too fast)?
    If there is not an SLP readily available, in the state of Florida, nursing may write an order for a downgraded liquid or food diet to ensure safety. In my state legally the only professionals who can upgrade the diet level of a patient is an SLP or a physician, and for good reason. Dysphagia is a very complex animal and without detailed training manifestations of the disorder are very difficult to piece out without specific training.
    Please do not diagnose or treat a swallowing disorder if you are not specifically trained to do so, as this is not within your scope of practice. Refer the patient to a speech language pathologist, and provide the details that you gained through your observation as your referral point. Your speech language pathologist would respect and appreciate your proactive and knowledgeable approach concerning your patients.


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  • I also am a Speech-Language Pathologist and work in Skilled Nursing. I am frustrated by the number of referrals of residents who are in an expected state of decline (by nature of their disease processes) who only need a downgrade of dietary texture, which can be legally done by nursing. In essence if nursing can provide the care necessary it is not considered "SKILLED" and should not be a billed service! If a resident (or patient) is a candidate for therapy to improve their swallowing, then SLP assessment is indicated, OR if compensatory strategies to improve function is needed, THEN an SLP would be indicated. But if a nurse or CNA already knows that the patient needs to be downgraded then the skills of an SLP are not needed. It is a grey area for certain, but the bottom line is that if the nurse is licensed to do something, then the skills of an SLP are not needed. IF the skills of an SLP are needed to change a situation then that is SKILLED.

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