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Implementing Dysphagia and Cognitive-Communication Disorder Care: Frontline Perspectives From Nurses in Skilled
Sundeep Venkatesan1, Rodney Gabel1, Stacey L Pavelko2
1Division of Speech-Language Pathology, Decker College of Nursing and Health Sciences, Binghamton University, State University of New York, Binghamton, New York, USA.
Aims And Objectives:
To examine how registered nurses (RNs) and licensed practical nurses (LPNs) working in skilled nursing and long-term care settings experience dysphagia and cognitive-communication disorder (CCD) care, with attention to barriers, facilitators and frontline adaptive strategies.
Background:
Nurses play a central role in implementing care for individuals with dysphagia and CCD; however, care delivery is often shaped by inconsistent training, limited interprofessional coordination and variable institutional support, contributing to gaps between evidence-based recommendations and practice.
Design:
Qualitative descriptive study.
Methods:
Semi-structured interviews were conducted with 19 nurses (9 RNs, 10 LPNs). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.
Results:
Three interrelated themes were identified describing: (1) the visibility gap between dysphagia and cognitive-communication disorders (CCD) in everyday nursing practice, (2) systemic and interprofessional barriers shaping care implementation and (3) the emotional and ethical burdens associated with frontline nursing care. Dysphagia was consistently prioritised as an immediate safety concern, whereas CCD remained less visible and was often managed through informal practices.
Conclusions:
Nurses play a central role in translating clinical recommendations into everyday care practice. Dysphagia was consistently prioritised as an immediate patient safety concern, whereas CCD appeared less visible and less systematically managed within routine nursing care. Variability in training, communication and institutional support contributes to inconsistencies in care delivery.
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