Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke

Jung-Hee Han; Gee-Eun Lee; Joo-Hyun Jun; Yoo-Jin Lim; Eun-Jin Yoon; Yeo-Ok Kim

doi:10.7469/kjan.2015.27.3.304

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Han, Lee, Jun, Lim, Yoon, and Kim: Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke

Original Article

Korean J Adult Nurs 2015;27(3):304-313.

Published online: NaN June 2015

DOI: https://doi.org/10.7469/kjan.2015.27.3.304

Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke

Jung-Hee Han, Gee-Eun Lee, Joo-Hyun Jun, Yoo-Jin Lim, Eun-Jin Yoon, Yeo-Ok Kim

Asan Medical Center, Seoul, Korea

Corresponding author: Han, Jung-Hee Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-6559, Fax: +82-2-474-4691, E-mail: hee972@naver.com

Received 23 March 20158 June 2015 Accepted 11 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Aspiration pneumonia (AP) is the major complication of dysphagia in patients with acute stroke. Nursing management for dysphagia influences on patients’ health outcomes. The purpose of this study was to develop and evaluate the effects of Dysphagia Nursing Protocol (DNP) for patients with acute stroke. We aimed to examine the incidence of AP and the dependency rate at the discharge.

Methods

We used a non-equivalent control group posttest only design in this study. DNP was developed with content validity index > 0.75 in all items. This protocol was composed of the evaluation, education, complication prevention, and checking phases. After training the staff nurses, we applied DNP protocol to the experimental group. The control group was enrolled from June to August 2013 (n=80), and the experimental group was June to August 2014 (n=64).

Results

The incidence of AP was 16.3% in control group while 4.7% in experimental group (p=.028), and the Odds Ratio (OR) was 0.26 (p=.045). The dependency ratio was 66.3% in control group while 43.8% in experimental group (p=.011), and the OR was 0.33 (p=.011).

Conclusion

DNP was beneficial for the reducing the risk of AP and the improved the functional status.

Keywords: Dysphagia, Stroke, Aspiration pneumonia, Dependency ratio, Nursing

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Figure 1.

Dysphagia nursing protocol.

Table 1.

Research Design of the Study

Groups	Pretest	Treatment	Posttest
Exp.		X	O₂
Cont.			O₂

Exp.=experimental group; Cont.=control group; X=dysphagia nursing protocol; O₂=Baseline characteristics, incidence of aspiration pneumonia, discharged modified ranken scale, dependency ratio.

Table 2.

The Demographic and Disease-related Characteristics at Baseline (N=144)

Characteristics	Categories	Cont. (n=80)	Exp. (n=64)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Age (year)		69.26±12.44	65.92±16.21	1.40	.163
Gender	Male	45 (56.3)	34 (53.2)	0.62	.575
Smoking	Never smoker	55 (69.0)	43 (67.0)	0.42	.811
	Ex-smoker	8 (10.0)	5 (8.0)
	Smoker	17 (21.0)	16 (25.0)
Initial NIHSS		7.78±5.32	6.75±4.53	1.26	.136
Initial MRS	0	0 (0.0)	1 (1.6)	4.61	.465
	1	4 (5.0)	7 (10.9)
	2	12 (15.0)	7 (10.9)
	3	14 (17.5)	15 (23.4)
	4	37 (46.3)	24 (37.5)
	5	13 (16.3)	10 (15.6)
TOAST	LAD	29 (36.3)	14 (21.9)	5.49	.240
	SVD	9 (11.3)	13 (20.3)
	CE	21 (26.3)	15 (23.4)
	Undertermined	9 (11.3)	11 (17.2)
	Others	12 (15.0)	11 (17.2)
Days of keeping dysphagia diet/tube feeding		10.14±6.80	8.77±5.10	1.34	.271
Discharge status	Home	28 (34.9)	21 (32.8)	2.33	.675
	Rehabilitation unit	33 (41.3)	24 (37.5)
	Other hospitals	19 (23.8)	19 (29.7)
Length of stay		10.75±6.70	8.97±5.15	2.33	.278

NIHSS=national institutes of health stroke scale; MRS=modified ranken scale; TOAST=trials of org 10172 in acute stroke; LAD=large artery disease; SVD=small vessel disease; CE=cardiac embolism.

Table 3.

Outcome Analysis (N=144)

Variables	Categories	Cont. (n=80)	Exp. (n=64)	x² or t	p	Predictors	Adjusted OR (95% CI)	p
		n (%) or	n (%) or
		M±SD	M±SD
Incidence of aspiration pneumonia^†		13 (16.3)	3 (4.7)	4.81	.028	DNP	0.26 (0.67~0.97)	.045
Discharged MRS	0	5 (6.3)	16 (25.0)	19.32	.002
	1	12 (15.0)	14 (2.9)
	2	10 (12.5)	6 (9.4)
	3	18 (22.5)	7 (10.9)
	4	21 (26.3)	19 (29.7)
	5	14 (18.0)	2 (3.1)
Dependency ratio (=MRS 3~5)^‡		53 (66.3)	28 (43.8)	7.31	.011	DNP	0.33 (0.14~0.78)	.011
						Initial NIHSS	1.18 (1.05~1.32)	.007

OR=odds ratio; CI=confidence interval; MRS=modified ranken scale; NIHSS=national institutes of health stroke scale; DNP=dysphagia nursing protocol;

^† Adjusted by age, gender, smoking, initial NIHSS, initial MRS, TOAST;

^‡ Adjusted by age, gender, smoking, initial MRS, TOAST.

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