Nutritional support of pulmonary patients: a multidisciplinary approach

Expert nursing knowledge in the care of patients at risk of impaired swallowing

PURPOSE

To describe the practical knowledge of expert nurses when they assess and feed patients at risk of impaired swallowing. Observation uncovered a lack of well-developed nursing practices in assessing patients' swallowing and eating, and a wide range of interventions in the care of difficult-to-feed-patients. Finding little previous nursing research to guide practice for patients with impaired swallowing, the authors undertook a study to identify and describe the knowledge embedded in the everyday practice of nurses.

DESIGN

Descriptive, exploratory using purposive sampling. Twelve nurses were identified in 1994 as expert in the care of patients at risk of impaired swallowing in one Boston, Massachusetts teaching hospital.

METHODS

Data were collected using written narratives by each participant; group interviews in which nurses discussed the written narratives; nonparticipant observations and individual interviews of the expert nurses; and patients' chart review. Data were analyzed using interpretive phenomenology.

FINDINGS

Most nurses in the study did not perform a complete assessment of swallowing before feeding their patients. Yet, through feeding patients, they were able to describe several components of the swallowing assessment used in their practice.

CONCLUSIONS

The areas of assessment described by the nurses can serve as a template for the development of educational content and assessment tools for swallowing.

Central venous catheter-related infections: pathogenesis, predictors, and prevention

Central venous catheters are used widely for a variety of therapeutic purposes and have an increased incidence of infections related to their use. The purpose of this article is to address the issue of central venous catheter-related infections, including pathogenesis, predictors and diagnosis, and prevention.