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.