Factors Promoting and Obstructing Dysphagia Nursing in Visiting Nursing

Abstract

[Purpose] The purpose of this study was to clarify the factors that promote and obstruct dysphagia nursing in nursing visits, and how it was influenced by the length of the visiting nursing experience.

[Methods] This study was approved by the ethics committee of our university. We conducted participant observation in visiting nursing and unstructured interviews of 7 visiting nurses. As a result, 25 categories were obtained as promoting factors and 37 categories were obtained as obstructing factors. Then we conducted a questionnaire about the 62 categories among 228 visiting nurses.

[Results] 1. Valid responses to the questionnaire were obtained from 159 visiting nurses. The average length of their visiting nursing experience was 4.2±2.9 years, and 67.9% had less than 5 years’ visiting nursing experience. 2. There were 10 promoting factors: visiting nurses “have a responsibility for dysphagia nursing,” “collect patient information by observing the patient and through cooperation with other medical staff members,” “predict patient’ s swallowing function at outcome,” “decide methods to ease the burden on the caregiver,” “avoid risks related to dysphagia,”“create an opportunity to acquire the knowledge,” “confirm patient’ s and caregiver’ s wishes,” “cooperate with doctors and nurses,” “cooperate with speech-language-hearing therapists (ST) and physical therapists (PT),” and “caregiver provides great care.” 3. There were 8 obstructing factors: visiting nurses have “insufficient knowledge about dysphagia and indirect therapy,” “difficulty assessing the swallowing function in a short time,” “difficulty predicting a patient’ s swallowing function at outcome,” “difficulty deciding care methods according to dysphagia,” “fear of risk related to dysphagia,” “patients with anticipatory stage problem,” “limited care time and no record systems for dysphagia nursing,” and “caregiver provide inadequate care.” 4. Compared with visiting nurses who have over 5 years of visiting nursing experience, dysphagia nursing practiced by those with under 5 years of experience was obstructed by “insufficient knowledge about dysphagia and indirect therapy,” and was promoted by “cooperating with ST and PT.”

[Conclusions] These results suggest that there is a need to promote the ability to make clinical judgments, and that record systems and a manual for dysphagia rehabilitation are needed for cooperation among many medical personnel to improve the quality of dysphagia nursing.