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

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

Korean Journal of Adult Nursing 2015;27(3):304-313.
Published online: June 30, 2015

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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: March 23, 2015   • Accepted: June 11, 2015

Copyright © 2015 Korean Society of Adult Nursing

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.

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  • 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.
Figure 1.
Dysphagia nursing protocol.
kjan-27-304f1.jpg
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
n (%) or M±SD n (%) or M±SD
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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      Zeinab Hussein Ali, Marwa Abd-Elaziz, Amany Abdrbo
      Frontiers of Nursing.2023; 10(2): 213.     CrossRef

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    Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke
    Korean J Adult Nurs. 2015;27(3):304-313.   Published online June 30, 2015
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    Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke
    Korean J Adult Nurs. 2015;27(3):304-313.   Published online June 30, 2015
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    Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke
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    Figure 1. Dysphagia nursing protocol.
    Effects of a Dysphagia Nursing Protocol on Reducing Aspiration Pneumonia and Improving Daily Activity Dependency in Patients with Acute Stroke

    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.

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

    Characteristics Categories Cont. (n=80) Exp. (n=64) x2 or t p
    n (%) or M±SD n (%) or M±SD
    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.

    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.

    Table 1. Research Design of the Study

    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)

    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)

    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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