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


METHODS
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.


RESULTS
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.
Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
J M
JM
McHale
M A
MA
Phipps
K
K
Horvath
J
J
Schmelz
D000328:Adult; D002983:Clinical Competence; D003680:Deglutition Disorders / Q000451:nursing* / Q000503:physiopathology; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009730:Nursing Assessment