Clinical Validation of the Related Factors and Defining Characteristics of Impaired Swallowing for Patients with Stroke

腦中風患者吞嚥障礙相關因素和定義性特徵之臨床效度測定

鄭綺(Chii Jeng)；許寶鶯(Pao-Ying Sheu)；陳靜敏(Ching-Min Chen)；陳淑如(Su-Ru Chen)；曾櫻枝(Ing-Gy Tseng)

中風患者 ； 吞嚥障礙 ； 相關因素 ； 定義性特徵 ； stroke patient ； impaired swallowing ； related factor ； defining characteristic

The Journal of Nursing Research

9卷4期（2001 / 09 / 01）

105 - 115

英文

This exploratory study was conducted to examine the reliability and validity of related factors and defining characteristics of impaired swallowing for stroke patients. Sample of the study included (1) 12 nursing experts, (2) 52 nurses who work in neurological wards, and (3) 107 stroke patients who were divided into a BDST (Burks Dysphagia Screening Test)-positive group (n = 51) and a BDST-negative group (n = 56). Data were collected and validated based on expert validity, diagnostic content validity (DCV), construct validity, and discriminate validity. Results showed that the DCV scores of 17 related factors and 12 defining characteristics were all greater than 0.5. The internal consistency of the 12 defining characteristics was demonstrated by a Cronbach alpha coefficient of 0.89. Two factors were extracted from the 12 defining characteristics after factor analysis; these were “high risk of aspiration with speech disorder” and “ineffectiveness of swallowing”. Five major defining characteristics, i.e. pocketing of food, signs of acute aspiration, burning or tickling at the back of the throat, spitting food or food leaking from the mouth, and weak or hoarse cough, were determined by logistic regression. The findings of this study suggest that the 17 related factors and 12 defining characteristics are reliable and valid in diagnosing the problem of impaired swallowing for stroke patients.

This exploratory study was conducted to examine the reliability and validity of related factors and defining characteristics of impaired swallowing for stroke patients. Sample of the study included (1) 12 nursing experts, (2) 52 nurses who work in neurological wards, and (3) 107 stroke patients who were divided into a BDST (Burks Dysphagia Screening Test)-positive group (n = 51) and a BDST-negative group (n = 56). Data were collected and validated based on expert validity, diagnostic content validity (DCV), construct validity, and discriminate validity. Results showed that the DCV scores of 17 related factors and 12 defining characteristics were all greater than 0.5. The internal consistency of the 12 defining characteristics was demonstrated by a Cronbach alpha coefficient of 0.89. Two factors were extracted from the 12 defining characteristics after factor analysis; these were “high risk of aspiration with speech disorder” and “ineffectiveness of swallowing”. Five major defining characteristics, i.e. pocketing of food, signs of acute aspiration, burning or tickling at the back of the throat, spitting food or food leaking from the mouth, and weak or hoarse cough, were determined by logistic regression. The findings of this study suggest that the 17 related factors and 12 defining characteristics are reliable and valid in diagnosing the problem of impaired swallowing for stroke patients.

1. Axelsson, K., Norberg, A., Asplund, K.(1986).Relearning to eat late after a stroke by systematic nursing intervention: A case report.Journal of Advanced Nursing,11
2. Baker, D. M.(1993).Assessment and management of impairments in swallowing.Nursing Clinics of North America,28(4)
3. Carpenito, L. J.(1997).Nursing diagnosis: Application to clinical practice.Philadelphia:Lippincott.
4. Comrey, A. L.(1978).Common methodological problems in factor analysis studies.Journal of Consulting and Clinical Psychology,46
5. DePippo, K. L., Holas, M. A., Reding, M. H.(1994).The Burke Dysphagia Screening Test: Validation of its use in patients with stroke.Archives Physical Medicine ＆ Rehabilitation,75
6. Dilorio, C., Price, M. E.(1990).Swallowing: An assessment guide.American Journal of Nursing,90(7)
7. Emick-Herring, B., Wood, P.(1990).A team approach to neurologically based swallowing disorders.Rehabilitation Nursing,15(3)
8. Fehring, R. J.(1987).Methods to validate nursing diagnosis.Heart ＆ Lung,16(6)
9. Fehring, R. J.(1986).Validating diagnostic labels: Standardized methodology.Classification of nursing diagnosis: Proceedings of the sixth conference of nursing diagnosis,St. Louis, MO:
10. Gauwitz, D. F.(1995).How to protect the dysphagic stroke patient.American Journal of Nursing,95(8)
11. Gordon, M.(1994).Nursing diagnosis: Process and application.St. Louis, MO:Mosby.
12. Kim, M. J., McFarland, G. K., Mclane, A. M.(1995).Pocket guide to nursing diagnosis.St. Louis, MO:Mosby.
13. Lugger, K. E.(1994).Dysphagia in the elderly stroke patient.Journal of Neuroscience Nursing,26(2)
14. Maat, M. T., Tandy, L.(1991).Nursing diagnoses and interventions for the elderly.California:Addison-Wesley Nursing.
15. McCloskey, J. C., Bulechek, G. M.(1996).Iowa intervention project: Nursing intervention classification (NIC).St. Louis, MO:Mosby.
16. McFarland, G. K., McFarland, E. A.(1993).Nursing diagnosis intervention: Planning for patient care.St. Louis, MO:Mosby.
17. Teasell, R. W., Bach, D., McRae, M.(1994).Prevalence and recovery of aspiration poststroke: A retrospective analysis.Dysphagia,9
18. 行政院衛生署(1996)。中華民國八十四年衛生統計 Health and vital statistics Republic of China 1995。台北:行政院衛生署。
19. 陳麗華 Chen, Li-Hua(1994)。桃園，國防醫學院護理學研究所。
20. 盧志輝 Lu, Chih-Whei、 王亭貴 Wang, Tyng-Guey、 張允中 Chang, Yeun-Chung、 陳信水 Chen, Hsin-Shui、 謝富美 Hsieh, Fu-Mei、 賴金鑫 Lai, Jin-Shin、 連倚南 Lien, I-Nan(1996)。腦中風併吞嚥障礙患者造成吸入性肺炎及潛在性吸入之相關因子 The correlative factors of aspiration pneumonia and silent aspiration in stroke patients with dysphagia。慈濟醫學 Tzu Chi Medical Journal，8(4)
21. 戴金英(1996)。桃園，長庚大學護理學研究所。

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