gms | German Medical Science

Background: ICU (Intensive Care Unit) acquired dysphagia may lead to severe consequences for patients including increased morbidity and mortality [1]. Dysphagia management depends on multi-professional collaboration; however international guidelines are lacking.

Objective: To explore and compare nurses’, physicians’ and occupational therapists' (OTs) views of dysphagia management in ICU.

Design and methods: We conducted six focus group interviews [2] with nurses (n=23), OTs (n=6) and intensivists (n=4). Data was analyzed using framework analysis [3] using a matrix developed from the first interview. Content from all interviews was added to the matrix, and subsequently condensed and refined.

Results: ICU dysphagia management depends on recognizing subtle signs of dysphagia in patients at risk. Assessment, methods of therapy and care differed between professional groups depending on their knowledge and clinical roles. Notably, nurses had little theoretical insight into dysphagia and relied primarily on experience. Moreover, collaboration between professional groups and responsibility for dysphagia management across the care continuum was determined by practical skills, knowledge and formal decision-making competence and resources. Dysphagia management was judged effective when based on mutual respect and recognition of health professionals' different perspectives.

Conclusion: Systematic inter-professional collaboration in ICU dysphagia management requires working toward a common goal of preventing aspiration and rehabilitating the patients' ability to swallow safely. Prerequisites are dysphagia assessment, using appropriate therapeutic interventions, sharing of knowledge and improving skills among professional groups. Nurses may need to improve their assessment skills and their understanding of dysphagia to increase their contribution to inter-professional dysphagia management.