Nurses' Perspectives of Dysphagia Screening Practices in Irish Residential Long-Term Care Settings: A Qualitative Descriptive Study.

Abstract

Objectives: To examine nurses’ perspectives on current dysphagia screening practices in Irish residential long-term care settings (RLTCS), and to investigate barriers and facilitators to nursing-led dysphagia screening within this healthcare context. Methods: This study employed a qualitative descriptive design and was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Participants were recruited through purposive sampling from RLTCS located in the northeast of the Republic of Ireland. Eleven in-person focus group interviews were conducted with thirty-four nurses working in clinical and managerial roles. A semi-structured interview guide was utilised, and the data were subsequently analysed using reflexive thematic analysis. Results: One central theme, comprising four subthemes, was developed. Nurses identified residents at risk of dysphagia through clinical judgement, drawing mainly on mealtime observations and residents’ self-reports of swallowing difficulties. Adequate training to screen for dysphagia and effective interprofessional communication were highlighted as key facilitators in identifying at-risk residents. Limited access to speech and language therapists (SLT), lack of dysphagia-specific guidelines and absence of validated swallow screening tests for this population were identified as major barriers. Conclusion: While nurses valued receiving in-service training in dysphagia, the practices employed to identify residents at risk often lack empirical support. Consequently, a substantial number of residents with dysphagia may remain undiagnosed. Limited access to SLT dysphagia services, combined with the absence of validated swallow screening tools for older adults in RLTCS, further impedes timely diagnosis and appropriate management of dysphagia.