Akut inmeli hastalarda disfaji yönetiminde hemşirelere yönelik geliştirilen klinik rehber kullanımının aspirasyonun önlenmesi, beslenme ve memnuniyet durumu üzerine etkisi

Öz

Amaç: Çalışmada, inme sonrası disfaji yönetiminde hemşirelere yönelik geliştirilen kanıta dayalı rehber kullanımının hastada aspirasyonun önlenmesi, beslenme ve memnuniyet durumu üzerine etkisinin değerlendirilmesi amaçlanmıştır. Yöntem: Bu çalışma randomize olmayan kontrollü deneysel yöntem kullanılarak yapılmıştır. Hemşirelerin araştırmacılar tarafından geliştirilen kanıta dayalı klinik rehberi uygulayabilmesi için “Yakın İşbirliğine Dayalı İleri Araştırma ve Klinik Uygulama Modeli” kullanılmıştır. Araştırmanın örneklemini, bir devlet hastanesinin nöroloji kliniklerine akut inme tanısı ile başvuran 60 hasta (30 deney, 30 kontrol) oluşturmuştur. Örneklemin evreni temsil etme gücü %95 güvenirlik ve %5 yanılgı düzeyi ile güç analizi sonucu %80.7’dir. Veriler, Hasta Bilgi Formu, Yatak Başı Su İçme Değerlendirme Testi, Amerikan Ulusal Sağlık Enstitüsü İnme Skalası, Aspirasyonun Önlenmesi Hemşirelik Çıktıları Sınıflaması Ölçeği (NOC), Mini Nutrisyonel Değerlendirme (MND) Testi Kısa Formu, Newcastle Hemşirelik Bakımından Memnuniyet Ölçeği kullanılarak yüz yüze araştırmacı tarafından toplanmıştır. Bulgular: Deney grubundaki hastaların aspirasyonun önlenmesine yönelik NOC ölçeği puan ortalaması, kontrol grubuna göre yüksek bulunmuştur (p<0.05). Deney grubundaki hastaların MND puan ortalamaları, kontrol grubundaki hastalara göre düşüktür (p>0.05). Her iki grubun MND puanı ortalama puanın altında olup, malnütrisyon riskinin olduğunu göstermektedir. Deney grubundaki hastaların memnuniyet puan ortalamaları, kontrol grubundan yüksek olup, iki grubun puan ortalamaları arasındaki fark istatistiksel olarak anlamlı bulunmuştur (p< 0.05). Sonuç: İnme sonrası disfajinin yönetiminde kanıta dayalı rehber ile bakım verilmesi, aspirasyonun önlenmesinde ve hasta memnuniyet düzeyini artırmada etkili bulunmuştur.

Anahtar Kelimeler

• Disfaji
• kanıta dayalı rehber
• hemşirelik bakımı
• inme

The effect of using clinical guidelines developed for nurses in the management of post-stroke dysphagia on prevention of aspiration, nutritional status and patient satisfaction

Öz

Objective: To evaluate the effect of using an evidence-based clinical guidelines developed for nurses in the management of post-stroke dysphagia on prevention of aspiration, nutritional status and patient satisfaction. Method: This study was conducted using a non-randomized controlled experimental method. “Advanced Research and Clinical Practice Model Based on Close Collaboration” was used to enable nurses to apply the evidence-based clinical guideline developed by the researchers. The sample of the study consisted of 60 patients (30 experimental, 30 control) who applied to the neurology clinics of a state hospital with the diagnosis of acute stroke. The power of the sample to represent the universe was 80.7% as a result of power analysis with 95% confidence and 5% error level. The data of the study were collected by the researcher through face-to-face interviews using the Patient Information Form, Bedside Water Drinking Assessment Test, American National Institutes of Health Stroke Scale, Aspiration prevention scale (NOC), Mini Nutritional Assessment (MNA) Test Short Form, and Newcastle Nursing Satisfaction Scale. Results: The mean score of the NOC scale for aspiration prevention in the experimental group was found to be higher than the control group (p<0.05). The mean MNA scores of the patients in the experimental group were lower than the patients in the control group (p>0.05). The MNA scores of both groups were below the average score, indicating a risk of malnutrition. The mean satisfaction scores of the experimental group was higher than that of the control group, and the difference between the mean scores of the two groups was statistically significant (p<0.05). Conclusion: Providing care with evidence-based guidelines in the management of post-stroke dysphagia was found to be effective in preventing aspiration and increasing patient satisfaction levels.

Anahtar Kelimeler

• Dysphagia
• evidence-based guideline
• nursing care
• stroke

Kaynakça

1. Coupland AP, Thapar A, Qureshi MI, Jenkins H, Davies AH. The definition of stroke. J R Soc Med 2017; 110 (1):9-12. doi: 10.1177/0141076816680121.
2. Türkiye İstatistik Kurumu (TUİK). Ölüm ve Ölüm Nedeni İstatistikleri, 2019. https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2019. 2 Mart 2022’de erişildi.
3. World Health Organisation (WHO). The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. 2 Mart 2022’de erişildi.
4. Majersik JJ, Woo D. The enormous financial impact of stroke disability. Neurology 2020; 94 (9): 377-378. doi: 10.1212/WNL.000000000000903.
5. Boyraz, S. İnmeli bireylerde yutma ve beslenme. J Intern Med Nurs-Special Topics 2015;1(1):48-53. https://www.turkiyeklinikleri.com/article/en-inmeli-bireylerde-yutma-ve-beslenme-71398.html. 2 Mart 2022’de erişildi.
6. Arnold M, Liesirova K, Broeg-Morvay A, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PloS one 2016;11(2):e0148424. doi: 10.1371/journal.pone.0148424.
7. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36(12):2756-63. doi: 10.1161/01.STR.0000190056.76543.eb.
8. Hines S, Kynoch K, Munday J. Nursing interventions for identifying and managing acute dysphagia are effective for improving patient outcomes: a systematic review update. J Neurosci Nurs 2016; 48(4):215-23. doi:1097/JNN.0000000000000200.

9. Network SIGN. Management of patients with stroke: Identification and management of dysphagia. A national clinical guideline. 2010;119. http://library.nhsggc.org.uk/media/223794/sign119.pdf. 10 Mart 2017’de erişildi.
10. Elfetoh EEEA, Karaly SFM. Effect of swallowing training program on dysphagia following cerebrovascular stroke. Egypt Nurs J 2018;15(2):125. doi: 10.4103/ENJ.ENJ_10_18.
11. Yang F, Qiao H, Yan L, Lei Q, Cao X. Application of nursing intervention based on International Classification of Functioning, Disability and Health in the course of dysphagia for stroke patients. Chin J Pract Nurs 2017; 33(31): 2418-2422. doi: 10.3760/cma.j.issn.1672-7088.2017.31.005.
12. Gandolfi M, Smania N, Bisoffi G, Squaquara T, Zuccher P, Mazzucco S. Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study. Dysphagia 2014; 29(6):704-712. doi: 10.1007/s00455-014-9565-2.
13. Titsworth WL AJ, Fullerton A, Hester J, Guin P, Waters MF, et al. Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke. Stroke 2013; 44(11):3154-3160. doi: 10.1161/STROKEAHA.111.000204Stroke.
14. Smallwood M. Using evidence-based practice to develop a swallow screen for stroke patients. 2012; 29(5): 325-9. https://www.myamericannurse.com/using-evidence-based-practice-to-develop-a-swallow-screen-for-stroke-patients/. 10 Mart 2017’de erişildi.
15. Sorensen RT, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosci Nurs 2013;45(3):139-46. doi:10.1097/JNN.0b013e31828a412c.
16. Liu H, Shi Y, Shi Y, Hu R, Jiang H. Nursing management of post-stroke dysphagia in a tertiary hospital: a best practice implementation project. JBI Database System Rev Implement Rep 2016; 14(7):266-74. doi: 10.11124/JBISRIR-2016-002971.
17. Perry L, Hamilton S, Williams J, Jones S. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes. Worldviews Evid Based Nurs 2013;10(1):17-40. doi: 10.1111/j.1741-6787.2012.00255.x.
18. Savcı C, Acaroğlu R. İnmeli hastalarda yutma eğitimi ve izleminin disfaji ile ilişkili sorunlara etkisi. FNJN 2021; 29(2):137-149. doi: 10.5152/FNJN.2021.19007.
19. Brott T, Adams HP, Jr., Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20(7): 864-70. doi: 10.1161/01.str.20.7.864.
20. Oliveira AR, de Araujo TL, de Carvalho EC, Costa AG, Cavalcante TF, Lopes MV. Construction and validation of indicators and respective definitions for the nursing outcome swallowing status. Rev Lat Am Enfermagem 2015; 23(3): 450-457. doi: 10.1590/0104-1169.0377.2575.
21. Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009; 13(9): 782-8. doi: 10.1007/s12603-009-0214-7.
22. Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015;61(1):56-60. doi: 10.1016/j.archger.2015.04.006.
23. Akin S, Erdogan S. The Turkish version of the Newcastle Satisfaction with Nursing Care Scale used on medical and surgical patients. J Clin Nurs 2007;16(4):646-53. doi: 10.1111/j.1365-2702.2006.01583.x.
24. AGREE Araştırma Vakfı. Tani ve tedavi rehberlerini inceleme ve değerlendirme AGREE II Ölçeği. https://www.agreetrust.org/wp-content/uploads/2014/07/AGREE-II-Turkish-translation.pdf. 06 Mart 2017’de erişildi.
25. Rai N, Prasad K, Bhatia R, Vibha D, Singh MB, Rai VK, et al. Development and implementation of acute stroke care pathway in a tertiary care hospital in India: a cluster-randomized study. Neurol India 2016;64 Suppl:S39-45. doi: 10.4103/0028-3886.178038.
26. Hickson M, Bulpitt C, Nunes M, Peters R, Cooke J, Nicholl C, et al. Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in-patients? A randomised control trial. Clin Nutr 2004;23(1):69-77. doi: 10.1016/s0261-5614(03)00090-6.
27. Nijs KA, de Graaf C, Siebelink E, Blauw YH, Vanneste V, Kok FJ, et al. Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2006;61(9):935-42. doi: 10.1093/gerona/61.9.935.
28. Foley NC, Martin RE, Salter KL, Teasell RW. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med 2009; 41(9):707-13. doi: 10.2340/16501977-0415.
29. Reker DM, Duncan PW, Horner RD, Hoenig H, Samsa GP, Hamilton BB, et al. Postacute stroke guideline compliance is associated with greater patient satisfaction. Arch Phys Med Rehabil 2002; 83(6): 750-6. doi: 10.1053/apmr.2002.99736.
30. Babgohari KZ, Nouri JM, Khademolhoseini SM, Ebadi A. Effect of evidence-based nursing guidelines implementation on satisfaction of the patients hospitalized in cardiac care unit. Iran J Crit Care Nurs 2014; 7(1):23-30. http://ethic.jums.ac.ir/article-1-144-en.pdf. 06 Mart 2017’de erişildi.
31. Ertem G, Sevil Ü. The examination of the effect of nurse care to the quality of care and to the patient satisfaction which is given through the standards. Journal of Human Sciences 2007; 4(2). https://jhumansciences.com/ojs/index.php/IJHS/article/view/291. 06 Mart 2017’de erişildi.