Nurses' perceptions of barriers to care for patients with dysphagia and their information delivery preferences regarding dysphagia care

Robbertse, Andrea (2018-12)

Thesis (MSL&HT)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : The incidence and prevalence of non-communicable diseases are rising, leading to an increased occurrence of dysphagia, which can severely impact patient recovery. The goal of this study was to determine the perceived barriers to care that South African nurses experience when caring for patients with dysphagia, as well as nurses’ information preferences. A cross-sectional, mixed-methods approach was followed, making use of a questionnaire and Likert scale responses, as well as a non-scheduled structured interview. A total of 81 participants were obtained from two hospitals in the Western Cape and the Free State, by means of convenience sampling. Quantitative data was analysed by means of statistical analysis, including the Mann-Whitney U test and the Kruskall-Wallis H test. Qualitative data was analysed using an interpretative phenomenological approach, which was used to identify recurrent themes. This study relied on King’s Conceptual Systems (1971) to interpret findings. Several barriers to dysphagia care were identified in this study. Work environment-related barriers include staff shortages, time constraints, and overwhelming workloads. Reported patient-related barriers include perceptions of patients being uncooperative and patients disliking their modified diets. Lastly, several barriers regarding dysphagia knowledge and training were observed, such as unfamiliarity with the role of the speech-language therapist (SLT) in dysphagia management, unfamiliarity with SLT terminology, disagreement with the SLT’s recommendations, and inadequate training in dysphagia care. It was noted that barriers in various systems affect one another and often exacerbate existing problems. Various strategies to address these barriers are discussed in the study, with in-service training and more frequent interprofessional interaction and communication being the most likely solutions to these perceived barriers. A preference for written and verbal information, as well as personal contact during training was also observed in this study, which has implications for how nurses’ training should be conducted. This study highlights the homogenous experience of nurses in South Africa regarding dysphagia care and emphasise the need for improved dysphagia training, as well as the organisational changes needed for improved patient care.

AFRIKAANSE OPSOMMING : Die insidensie en prevalensie van nie-oordraagbare siektes neem toe, wat tot ‘n toename in die gevalle van disfagie lei. Hierdie toename kan die herstel van pasiënte ernstig benadeel. Die doel van hierdie studie was om die hindernisse wat Suid-Afrikaanse verpleegsters ten opsigte van pasiënte met disfagie ervaar, te verken, sowel as om verpleegsters se inligtingsvoorkeure te bepaal. ‘n Dwarssnit-, gemengde metode-benadering is gevolg, waar ‘n vraelys met Likert response, sowel as ‘n nie-geskeduleerde, gestruktureerde onderhoud, gebruik is. ‘n Gerieflikheidsteekproef van 81 deelnemers is bekom van tersiêre hospitale in beide die Wes-Kaap en die Vrystaat. Kwantitatiewe data is geanaliseer deur middel van statistiese analise, insluitend die Mann-Whitney U toets en die Kruskall-Wallis H toets. Kwalitatiewe data is geanaliseer deur middel van ‘n interpreterende fenomenologiese benadering, wat gebruik is om herhalende temas te identifiseer. Hierdie studie het op King se Konseptuale Sisteme (1971) staatgemaak om bevindinge te interpreteer. Verskeie hindernisse tot die sorg van pasiënte met disfagie is in hierdie studie geïdentifiseer. Werksomgewing-verwante hindernisse sluit ‘n tekort aan personeel in, sowel as ‘n tekort aan tyd en oorweldigende werksladings. Pasiënt-verwante hindernisse wat gerapporteer is sluit persepsies van disfagie pasiënte as onsamewerkend in, sowel as pasiënte wat nie van hul aangepaste diëte hou nie. Verskeie hindernisse met betrekking tot disfagie kennis en opleiding is waargeneem, insluitend onbekendheid met die rol van die spraak-taalterapeut (STT) in disfagie behandeling, onbekendheid met die STT se terminologie, meningsverskille oor die STT se aanbevelings, en onvoldoende opleiding in disfagie-sorg. Daar is opgemerk dat hindernisse in verskeie sisteme mekaar affekteer en dikwels bestaande probleme vererger. Verskeie strategieë om hierdie hindernisse aan te spreek word in hierdie studie bespreek – in-diensopleiding en meer gereelde interprofessionele interaksie en kommunikasie word as die mees waarskynlike oplossing tot hierdie hindernisse beskou. ‘n Voorkeur vir geskrewe en verbale inligting is in hierdie study opgemerk, sowel as persoonlike kontak tydens opleiding. Die voorkeure het implikasies vir die uitvoer van verpleegsters se opleidingsessies. Hierdie studie beklemtoon die homogene ervaring van verpleegsters in Suid-Afrika rakende disfagie-sorg, sowel as die behoefte aan beter disfagie-opleiding en die grootskaalse veranderinge wat nodig sal wees om pasiëntsorg te verbeter.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/104986
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