The Practices of Public Hospital Registered Nurses Regarding Post-Stroke Dysphagia, in China

Dysphagia is one of the most common complications in post-stroke patients, post-stroke medical disease management (eg, thrombectomy procedures) do have a huge influence on the long-term outcomes, with frontline clinical nurses serving as pivotal gatekeepers for early identification and management in post-stroke dysphagia (PSD). However, nurses, especially those in low- and middle-income countries, generally lack the ability to manage PSD, and the current state of Chinese public hospital registered nurses' relevant clinical practice remains unclear.

This study aims to evaluate how registered nurses, on initial clinical contact, screen and manage post-stroke dysphagia. A multi-center descriptive cross-sectional design was utilized.

From March 2 to April 18, 2024, 1010 nurses from 14 provinces in China completed an online questionnaire through convenient sampling. After applying inclusion and exclusion criteria, 943 valid questionnaires were included in the final analysis-the self-reported questionnaire collected data on knowledge of dysphagia, attitude and practices. Data were analyzed using descriptive statistics. This study adhered to the STROBE checklist guidelines.

The study involved 943 nurses, mostly from tertiary hospitals (71.05%) and stroke-related departments (68.93%). Only 2.86% were specialized dysphagia nurses. Dysphagia was identified using formal screening tools, with the 30-ml water swallowing test (87.8%) and repeated saliva swallowing test (77.2%) being most common. Screening was often conducted before the first intake of food, water, or medication (65.11%), and involved multiple personnel, including nurses (67.44%) and doctors (77.62%). Management strategies included nutritional support (83.46%), oral hygiene improvements (86.96%), rehabilitation exercises (86.96%), medication adjustments (75.4%), and referrals, primarily to doctors (71.58%), rehabilitation therapists (68.82%) and SLPs were referred after positive testing (44.54%).

This study reflects the current practices of Chinese nurses in screening and managing dysphagia, highlighting gaps between clinical practice and guidelines. The findings provide a theoretical foundation for policymakers to enhance training programs and workforce development, ultimately improving nursing practice quality.