Perceived barriers to compliance with speech-language therapist dysphagia recommendations of South African nurses

BACKGROUND: Literature has shown that there is limited compliance amongst nurses with the dysphagia recommendations made by speech-language therapists (SLTs). Poor compliance could have a significant impact on the health outcomes of patients with dysphagia. OBJECTIVES: This study aimed to determine the specific barriers to compliance with dysphagia recommendations experienced by South African nurses, with the goal of identifying viable strategies to overcome these barriers. METHOD: This cross-sectional study made use of a self-administered questionnaire to obtain quantitative data on nurses’ perceptions of barriers to the implementation of SLT dysphagia recommendations. Eighty-one nurses were recruited from two tertiary hospitals in two South African provinces. Descriptive statistics were used to analyse the reported barriers to compliance. RESULTS: Three main barriers to compliance were identified, namely a lack of knowledge regarding dysphagia, patient-related barriers and workplace concerns. Knowledge barriers included poor familiarity with the role of the SLT in dysphagia management, lack of knowledge regarding SLT terminology, disagreement with dysphagia recommendations and insufficient dysphagia training. Workplace concerns included staff shortages, heavy workloads and time constraints. Poor patient cooperation was emphasised as a patient-related barrier. CONCLUSION: For dysphagia recommendations to be followed by nurses, SLTs need to be aware of the barriers experienced by nurses within the relevant facility. Speech-language therapists need to consider the provision of appropriate in-service dysphagia training and include nurses in the decision-making process when recommendations are made. Speech-language therapists need to consider their role in both clear communication with the nurses and the development of supporting material, such as glossaries and visual aids.