| ObjectiveTo understand the status of dysohagia in stroke patients through a qualitative research and literature review.The study combined guidelines searching and Delphi method to construct a nursing intervention program for dysphagia in stroke patients and applied it to stroke patients with dysphagia to discuss the practical effect by comparing water swallow test's levels,therapeutic effect of dysphagia,one max mouthful of water volume,incidence of aspiration and pneumonia between the two groups.Methods1.Analysis of current situation10 stroke patients with dysphagia were selected for semi-structured in-depth interviews by using phenomenological approach.And Colaizzi data analysis principles were choosed to analyse data to investigate psychological experience and needs of patients with dysphagia after stroke.2.Construction of the nursing programRelevant guidelines on post-stroke dysphagia were searched on major guideline websites at home and abroad.Content analysis of the included guidelines were carried out after the selection of guidelines.After summarizing and grading the aggregated evidence,preliminary nursing intervention program was established by the research team.Then Delphi method conducted two rounds of expert consultation.The results of expert consultation were analyzed by using positive coefficient,coefficient of variation,coefficient of authority and other indicators.The program was modified according to the expert's opinion.The nursing intervention program for stroke patients with dysohagia was completed.3.Implementation of interventionA comparative study was conducted among 86 stroke patients with dysphagia who met the inclusion criteria by convenience sampling.The patients included in the control group from December 2017 to May 2018 and the intervention group from June 2018 to November 2018.The intervention group adopted the nursing intervention program of dysphagia after stroke,while the control group adopted the routine nursing method.The levels of water swallowing test,treatment effect of dysphagia,one max mouthful of water volume,incidence of aspiration and pneumonia were observed and compared.SPSS19.0 was used to analyze the data.When P < 0.05,the difference was statistically significant.Results1.Qualitative research4 themes were extracted:a shortage of the knowledge of dysphagia;negative emotions for daily eating and drinking;a strong desire to obtain health guidance for dysphagia;negative coping styles.2.Construction of nursing programA total of 10 relevant guides were included,including 2 Chinese guidelines and 8 English guidelines.From the content analysis,20 recommendations related to dysphagia in stroke were made in 7 aspects.15 experts were selected to take part in Delphi method.The positive coefficients of two rounds of expert consultation was 100%,the expert authority degree coefficient was 0.877,and the Kendall coordination coefficient of the indicators at all levels was 0.180,0.132 and 0.185(P < 0.05).The final intervention program includes four first-level indicators,14 second-level indicators and 20 third-level indicators,including the assessment of dysphagia,compensation methods,oral function and health guidance.3.Implementation of intervention(1)The baseline of the two groups was comparable,and there was no significant difference in gender,age,occupation,residence,education level,marital status,medical expenses,family monthly income,stroke type,stroke frequency,course of disease and types of chronic diseases(P > 0.05).(2)There was no significant difference in the level of water swallowing test between the two groups before intervention(P > 0.05).There was significant difference in the level of water swallowing test between the two groups after intervention(P < 0.05).(3)There was significant difference in the treatment effect of dysphagia between the two groups(P < 0.05).(4)There was no significant difference in one max mouthful of water volume between the two groups before intervention(P > 0.05).There was significant difference in one max mouthful of water volume between the two groups after intervention(P < 0.05).(5)There was no significant difference in the incidence of pneumonia between the two groups after intervention(P > 0.05).(6)The incidence of aspiration was significantly different between the two groups(P < 0.05).The incidence of cough was significantly different between the two groups(P < 0.05).There was no significant difference in the change of sound quality and the decrease of oxygen saturation(2%)(P > 0.05).ConclusionsThe study conducted a qualitative research and literature review to understand the true feelings and needs of stroke patients with dysphagia.In this study,we constructed a nursing intervention program for stroke patients with dysphagia through guideline search,content analysis and Delphi method.We applied this program to nursing practice and verified its clinical effect.The conclusions are as follows:1.The psychological experience of the patients with dysphagia after stroke is not good.Nurses should strengthen the identification and management of the dysphagia in stroke patients,guide the patients to understand and treat the dysphagia correctly,and take a positive coping style.It's necessary to construct the nursing intervention program for dysphagia in stroke patients.2.The nursing intervention program for dysphagia in stroke has certain scientific and clinical significance and is feasible in clinical nursing.3.The nursing intervention program for dysphagia in stroke can reduce the level of water swallowing test,increase one max mouthful of water volume,improve dysphagia effectively and improve swallowing function of stroke patients.4.The nursing intervention program for dysphagia in stroke can reduce the occurrence of cough,thereby reducing the incidence of aspiration. |
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