Nurse Specialist Interventions in Rehabilitation Nursing for Patients with Impaired Swallowing: a Scoping Review
DOI:
https://doi.org/10.33194/rper.2025.40248Keywords:
Swallowing, Dysphagia, Rehabilitation NursingAbstract
Introduction: Swallowing is an essential process for nutrition and airway protection. When compromised, it poses significant biopsychosocial risks, being prevalent among institutionalized adults and elderly individuals. The Rehabilitation Nurse Specialist (RNS) possesses the knowledge and skills necessary to address this issue.
Objective: To map the most up-to-date scientific evidence on the intervention of RNS in patients with impaired swallowing in a hospital setting.
Methodology: A Scoping Review based on the Joanna Briggs Institute® methodology was conducted applying PCC eligibility criteria, with research conducted in EBSCOhost, Cochrane Database, Scopus, SciELO, and PubMed for literature published from 2018 to 2023. Six studies were included: two case studies, two quantitative studies, one integrative review of the literature, and one randomized controlled trial.
Results: The analysis of the six studies identified a set of RNS interventions for hospitalized patients with impaired swallowing: pre-oral feeding swallowing assessment, diet modification, oral hygiene, health education, motor functional rehabilitation, respiratory functional rehabilitation, and psychological intervention. These interventions contributed to reducing associated complications, improved cost-effectiveness, and decreased hospital length of stay.
Discussion: The findings highlight the relevance of the RNS role in managing patients with impaired swallowing, despite the scarcity of robust studies on the topic.
Conclusion: The RNS plays a fundamental role in achieving health gains for patients with impaired swallowing. Expanding research to systematize effective interventions is essential to promoting better health outcomes.
Protocol registration (Open Science Framework): osf.io/3vc2x; https://doi.org/10.17605/OSF.IO/BYJ56
Downloads
References
Branco C, Portinha S. Disfagia no adulto: da teoria à prática. Lisboa: Papa-Letras; 2017. ISBN: 9789898214621.
Dziewas R, Beck AM, Clavé P, et al. Recognizing the importance of dysphagia: stumbling blocks and stepping stones in the twenty-first century. Dysphagia. 2017;32(1):78-82. doi:10.1007/s00455-016-9746-2.
Malone JC, RAN. Anatomy, Head and Neck, Swallowing [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554405/
Hoeman SP. Enfermagem de Reabilitação - Prevenção, intervenção e resultados esperados. Loures: Lusodidacta; 2011. ISBN: 9789898075314.
Malagelada J, Bazzoli F, Boeckxstaens G, et al. World gastroenterology organisation global guidelines: dysphagia--global guidelines and cascades update September 2014. 2014. Available from: https://www.worldgastroenterology.org/guidelines/dysphagia/dysphagia-french
Braga R. Avaliação da função deglutição. In: Marques-Vieira C, Sousa L, editores. Cuidados de enfermagem de reabilitação à pessoa ao longo da vida. 1ª ed. Loures: Lusodidacta; 2016. p.181-8. ISBN: 978-989-8075-73-4.
Ordem dos Enfermeiros. Enfermagem de Reabilitação - Instrumentos de recolha de dados para a documentação dos Cuidados Especializados em Enfermagem de Reabilitação. Lisboa: Ordem dos Enfermeiros; 2016. Available from: https://www.ordemenfermeiros.pt/arquivo/colegios/Documents/2017/InstRecolhaDadosDocumentacaoCuidEnfReabilitacao_Final_2017.pdf
Oliveira I, Mota LAN, Freitas SV, Oliveira MIS, Ferreira PL. Dysphagia screening tools for acute stroke patients available for nurses: A systematic review. Nurs Pract Today. 2019;6(3):103-15. doi:10.18502/npt.v6i3.1253.
Feiteirona J. Intervenção do enfermeiro especialista em enfermagem de reabilitação no doente adulto/idoso com deglutição comprometida [dissertation]. Loures: ESS - Instituto Politécnico de Portalegre; 2020. Available from: http://hdl.handle.net/10400.26/33218
Adkins C, Takakura W, Spiegel BMR, et al. Prevalence and characteristics of dysphagia based on a population-based survey. Clin Gastroenterol Hepatol. 2020;18(8):1970-9. doi:10.1016/j.cgh.2019.10.029
Bhattacharyya N. The prevalence of dysphagia among adults in the United States. Otolaryngol Head Neck Surg. 2014;151(5):765-9. doi:10.1177/0194599814549156
Wirth R, Dziewas R, Beck AM, et al. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016;11:189-208. doi:10.2147/CIA.S97481
Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia. Arch Gerontol Geriatr. 2013;56(1):1-9. doi:10.1016/j.archger.2012.04.011
Minshall S, Pownall S. Management of swallowing problems in community settings. Br J Community Nurs. 2019;24(7):323-7. doi:10.12968/bjcn.2019.24.7.323.
Espinoza MKT, Samerón WAV, López LCS, Aquino PAB. Diagnóstico diferencial de la disfagia. Rev Cient Investig Mundo Cienc. 2019;3(1):587-617. doi:10.26820/reciamuc/3.(1).enero.2019.587-617.
Schwarz M, Coccetti A, Murdoch A, Cardell E. The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study. J Clin Nurs. 2018;27(1-2):e235-41. doi:10.1111/jocn.13922.
Regulamento n.º 392/2019 - Regulamento das competências específicas do enfermeiro especialista em Enfermagem de Reabilitação. Diário da República, II Série. 2019 May 3;n.º 85:13565-8. Available from: https://diariodarepublica.pt/dr/detalhe/regulamento/392-2019-122216893
Regulamento n.º 350/2015 - Regulamento dos Padrões de Qualidade dos Cuidados Especializados em Enfermagem em Enfermagem de Reabilitação. Diário da República, II Série. 2015 Jun 22;n.º 119:16655-60. Available from: https://diariodarepublica.pt/dr/detalhe/regulamento/350-2015-67552234
Paniagua DV, Ribeiro MPH, Correia AM, et al. Project K: Training for hospital-community safe transition. Rev Bras Enferm. 2018;71(Suppl 5):2264-71. doi:10.1590/0034-7167-2017-0549
Martins MM, Ribeiro O, Silva JV. O contributo dos enfermeiros especialistas em enfermagem de reabilitação para a qualidade dos cuidados. Rev Port Enferm Reabil. 2018;1(1):22-9. doi:10.33194/rper.2018.v1.n1.04.4386.
Joanna Briggs Institute. Manual for Evidence Synthesis. Aromataris E, Munn Z, editores. Adelaide: JBI; 2020. Available from: https://doi.org/10.46658/JBIMES-20-02
Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73. doi:10.7326/M18-0850
Silva PCL, Grilo EN. Deglutição Comprometida: Uma Abordagem de Enfermagem de Reabilitação. Rev Ibero-Am Saúde Envelhecimento. 2019;4(3):1498. doi:10.24902/r.riase.2018.4(3).1498
Feiteirona J, Grilo E. Cuidados de enfermagem ao doente adulto/idoso com deglutição comprometida: revisão integrativa de literatura. Rev Ibero-Am Saúde Envelhecimento. 2023;9(3):9-32. doi:10.60468/r.riase.2023.9(3).598.9-32
Zeng X, Li L, Wang W, Zhu L. Rehabilitation nursing intervention can improve dysphagia and quality of life of patients undergoing radiotherapy for esophageal cancer. J Oncol. 2021;2021:3711699. doi:10.1155/2021/3711699
Sá NMP, Oliveira FM, Sacramento CLG, Oliveira MIS, Almeida FLT. Programa de enfermagem de reabilitação na pessoa com deglutição comprometida em contexto de AVC: estudo exploratório. Rev Port Enferm Reabil. 2023;6(1):e265. doi:10.33194/rper.2023.265
Zhang R, Ju XM. Clinical improvement of nursing intervention in swallowing dysfunction of elderly stroke patients. Biomed Res. 2018;29(6):1099-102. Available from: https://www.alliedacademies.org/articles/clinical-improvement-of-nursing-interventionin-swallowing-dysfunction-of-elderly-stroke-patients.pdf
Silva PCL, Grilo EN. Reeducação funcional da pessoa com deglutição comprometida: estudo de caso. Rev Port Enferm Reabil. 2018;1(2):7-18. doi:10.33194/rper.2018.v1.n2.07.4387.
Ferreira AMS, Pierdevara L, Ventura IM, et al. Gugging Swallowing Screen: contributo para a validação cultural e linguística para o contexto português. Rev Enferm Referência. 2018;IV(16):85-94. doi:10.12707/RIV17090
Martino R, Silver F, Teasell R, et al. The Toronto bedside swallowing screening test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40(2):555-61. doi:10.1161/STROKEAHA.107.510370
Carrión S, Roca M, Costa A, et al. Nutritional status of older patients with oropharyngeal dysphagia in a chronic versus an acute clinical situation. Clin Nutr. 2017;36(4):1110-6. doi:10.1016/j.clnu.2016.07.009
Ortega O, Martín A, Clavé P. Diagnosis and management of oropharyngeal dysphagia among older persons, State of the Art. J Am Med Dir Assoc. 2017;18(7):576-82. doi:10.1016/j.jamda.2017.02.015
Smithard D, Westmark S, Melgaard D. Evaluation of the prevalence of screening for dysphagia among older people admitted to medical services - An international survey. OBM Geriatr. 2019;3(4):1904086. doi:10.21926/obm.geriatr.1904086
Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: A systematic review. BMC Health Serv Res. 2018;18:594. doi:10.1186/s12913-018-3376-3
Burgos R, Bretón I, Cereda E, et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018;37(1):354-96. doi:10.1016/j.clnu.2017.09.003
Stroke Foundation. Clinical guidelines for stroke management [Internet]. 2019 [cited 2024 Dec 13]. Available from: https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management
Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence-based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia - An updated clinical guideline. Clin Nutr. 2018;37(6):1980-91. doi:10.1016/j.clnu.2017.09.002
McCurtin A, Boland P, Kavanagh M, et al. Do stroke clinical practice guideline recommendations for the intervention of thickened liquids for aspiration support evidence-based decision making? A systematic review and narrative synthesis. J Eval Clin Pract. 2020;26(6):1744-60. doi:10.1111/jep.13372
Boulanger JM, Lindsay MP, Gubitz G, et al. Canadian stroke best practice recommendations for acute stroke management: Prehospital, emergency department, and acute inpatient stroke care, 6th Edition, update 2018. Int J Stroke. 2018;13(9):949-84. doi:10.1177/1747493018786616
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke - A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-110. doi:10.1161/STR.0000000000000158
Logemann J. Treatment of oral and pharyngeal dysphagia. Phys Med Rehabil Clin N Am. 2008;19(4):803-16. doi:10.1016/j.pmr.2008.06.003
Reyes A, Cruickshank T, Nosaka K, Ziman M. Respiratory muscle training on pulmonary and swallowing function in patients with Huntington's disease: a pilot randomised controlled trial. Clin Rehabil. 2015;29(10):961-73. doi:10.1177/0269215514564087
European Society for Swallowing Disorders. Position Statements and Meeting Abstracts Uniting Europe Against Dysphagia. Dysphagia. 2013;28(2):280-335. doi:10.1007/s00455-013-9455-z
Wirth R, Dziewas R, Beck AM, et al. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting. Clin Interv Aging. 2016;11:189-208. doi:10.2147/CIA.S97481
Easterling C. Management and treatment of patients with dysphagia. Curr Phys Med Rehabil Rep. 2018;6(4):213-9. doi:10.1007/s40141-018-0196-7
Easterling C. 25 anos de reabilitação da disfagia: o que fizemos, o que estamos fazendo e para onde vamos? Dysphagia. 2017;32(1):50-4. doi:10.1007/s00455-016-9769-8
Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil. 2016;43(5):364-72. doi:10.1111/joor.12382
Hegland KW, Davenport PW, Brandimore AE, Singletary FF, Troche MS. Rehabilitation of Swallowing and Cough Functions Following Stroke: An Expiratory Muscle Strength Training Trial. Arch Phys Med Rehabil. 2016;97(8):1345-51. doi:10.1016/j.apmr.2016.03.027
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Portuguese Rehabilitation Nursing Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
