Dealing With Dysphagia—Together In an interprofessional education program, nursing and speech-language pathology students pool their expertise for better training and patient care. Academic Edge
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Academic Edge  |   June 01, 2015
Dealing With Dysphagia—Together
Author Notes
  • Darla K. Hagge, PhD, CCC-SLP, is assistant professor and graduate coordinator in the Department of Speech-Language Pathology and Audiology at California State University-Sacramento. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. hagge@csus.edu
    Darla K. Hagge, PhD, CCC-SLP, is assistant professor and graduate coordinator in the Department of Speech-Language Pathology and Audiology at California State University-Sacramento. She is an affiliate of ASHA Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. hagge@csus.edu×
  • Nassrine Noureddine, RN, MSN, EdD, and Debra Brady, DNP, RN, CNS, of the CSUS Department of Nursing, and William Ofstad, PharmD, BCPS, of the California Northstate University College of Pharmacy, also contributed to this article.
    Nassrine Noureddine, RN, MSN, EdD, and Debra Brady, DNP, RN, CNS, of the CSUS Department of Nursing, and William Ofstad, PharmD, BCPS, of the California Northstate University College of Pharmacy, also contributed to this article.×
Article Information
Academic Edge
Academic Edge   |   June 01, 2015
Dealing With Dysphagia—Together
The ASHA Leader, June 2015, Vol. 20, 34-36. doi:10.1044/leader.AE.20062015.34
The ASHA Leader, June 2015, Vol. 20, 34-36. doi:10.1044/leader.AE.20062015.34
The scene is all too familiar to nurses and speech-language pathologists in health care facilities. An older patient is having difficulty swallowing after having a stroke, and his wife and daughter are at his bedside, frustrated, frightened and concerned. Why can’t he eat?
This patient’s room, however, is not in a hospital or skilled nursing facility, but in a lab at California State University-Sacramento. The “patient” is a retired teacher and the patient’s “family members” are undergraduate speech-language pathology students. The clinicians are speech-language pathology graduate and nursing undergraduate students demonstrating what they have learned in an interprofessional education program.
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A speech-language pathology graduate student performs a swallow evaluation on a “patient” (a retired educator who has aphasia) as the patient’s “daughter” (an undergraduate student) looks on.

The program is one response to national and international calls for interprofessional health care practice and education (including an Institute of Medicine report, see sources) to improve patient outcomes. About two years ago, CSU Sacramento nursing and communication sciences and disorders (CSD) faculty decided to collaborate on an interprofessional education program in swallowing screening and evaluation. Nursing training program managers realize the need to integrate swallowing and feeding issues into their curriculum, but few nursing faculty have formal education and training in those areas.
The program brings nursing undergraduate and CSD graduate students together in a progression of co-curricular learning opportunities that break down traditional learning silos and introduce students to interprofessional collaboration.
Lesson one: Introductions
In the first component, CSD graduate students introduce swallowing and feeding issues to nursing students. The students then break into small team-based groups, with the CSD students guiding the nursing students through the administration of a swallow screen.
The nursing students also learn to recognize clinical signs and symptoms that indicate the need for a full bedside swallowing evaluation and the role that SLPs play in the diagnosis and management of dysphagia. For many nursing students, this session is their first introduction to speech-language pathology and SLPs’ educational background, certification requirements, and health care roles and responsibilities.
Within two weeks after the interdisciplinary swallow screen, the nursing students begin their first clinical rotation at a skilled nursing facility. Historically, nursing education programs have relied on certified nursing assistants to teach nursing students about swallowing and feeding difficulties. The CSU-Sacramento model provides nursing students with enhanced swallowing education and training from future colleagues who specialize in dysphagia.
Lesson two: Problem-solving
In their second experience, students participate in a problem-based learning activity that integrates the interpretation of lab values with dysphagia management of a person who has recently had a stroke. The nursing professor and students teach CSD students about lab values—the patient’s blood chemistry, complete blood count and six vital signs (heart and respiratory rates, blood pressure, oxygen saturation, reported pain levels, temperature)—and their possible clinical implications.
Elevated temperature, elevated breathing and heart rates, decreased oxygen saturation, and pale or blue skin, for example, could indicate aspiration pneumonia. The condition might also cause anxiety, confusion or change in consciousness, especially in older patients.
Students then break into groups and review a case study involving a patient with a recent stroke. Led by nursing students, the CSD students practice identifying the patient’s abnormal lab values, determining possible implications and making informed clinical decisions relevant to dysphagia and cognitive-communication deficits.
The nursing professor and students teach CSD students about lab values—the patient’s blood chemistry, complete blood count and six vital signs (heart and respiratory rates, blood pressure, oxygen saturation, reported pain levels, temperature)—and their possible clinical implications.
Lesson three: Demonstrating skills
The culminating experience is a simulation, with retired educators who have stroke-related aphasia playing the role of patients. SLPs in community-based aphasia programs refer retired educators to the program; faculty recruit other volunteers from the university’s on-campus speech and hearing clinic. Undergraduate CSD students are trained to act as family members.
While waiting for their turn as participants, the students observe the simulation on a monitor in a separate room. Their experiences are twofold: as active participants and as observers.
The simulation takes place in a lab re-created to simulate a typical hospital patient room with an adjustable bed, linens, monitor, sink, bedside table and wall-mounted hand sanitizer. In the simulation, nursing students administer a swallow screen and CSD students then perform a bedside swallow evaluation. This experience communicating with a patient with aphasia is a first for many nursing students.
Faculty from both disciplines facilitate a post-simulation debriefing session with all participants: the nursing and CSD students, the undergraduate CSD students posing as family members, the retired educators with aphasia who play the patients, and the students who observed the simulation. Discussion includes the participants’ strengths as well as recommendations for improvement. Each student also completes demographic and outcome questionnaires.
The simulation, available online through the California Simulation Alliance, is the state’s first published simulation involving nursing and speech-language pathology students. Most nursing programs with simulation training subscribe to the alliance, and educators in those programs have free access to the simulations. Individual memberships are also available.

The simulation takes place in a lab re-created to simulate a typical hospital patient room with an adjustable bed, linens, monitor, sink, bedside table and wall-mounted hand sanitizer.

Outcomes
One goal of interprofessional education is interprofessional communication. In a recent survey of the nursing and CSD students, 96 percent reported that they enjoyed the opportunity to learn with students from other health professions, and 94 percent reported that learning with students from other health professions is likely to facilitate future interprofessional relationships.
The CSU-Sacramento speech-language pathology department hosts another interprofessional program, the Neuro Service Alliance. The alliance offers several Life Participation Approach programs for people with aphasia and other acquired neurogenic communication disorders. CSD students participate as trained communication partners in these interprofessional, experiential learning programs, which focus on conversation, using technology, art, books and other topics. Students from nursing and recreational therapy programs participate as guest communication partners. Plans are also underway for a collaboration integrating CSD and social work students in a counseling class.
Interprofessional education begins with a conversation among professionals from different disciplines about relevant clinical issues. From there, the professionals can re-create clinical circumstances for students from different fields to experience. As with all innovations, a new program needs to be evaluated, modified and expanded, and repeated each semester. Integrating interprofessional education into the curriculum is worth the potential for significant and measurable interprofessional learning outcomes, improved interdisciplinary teamwork and enhanced patient safety.
Sources
American Speech-Language-Hearing Association. (2015). Strategic Pathway to Excellence.
American Speech-Language-Hearing Association. (2015). Strategic Pathway to Excellence.×
Institute of Medicine (IOM), (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press. [PubMed] [PubMed]
Institute of Medicine (IOM), (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press. [PubMed] [PubMed]×
Interprofessional Education Collaborative. (2011). What Is Interprofessional Education (IPE)? Retrieved from https://ipecollaborative.org/About_IPEC.html.
Interprofessional Education Collaborative. (2011). What Is Interprofessional Education (IPE)? Retrieved from https://ipecollaborative.org/About_IPEC.html.×
National Center for Interprofessional Practice and Education. (2013). Learn about the Nexus. Retrieved from https://nexusipe.org.
National Center for Interprofessional Practice and Education. (2013). Learn about the Nexus. Retrieved from https://nexusipe.org.×
Noureddine, N., Hagge, D., & Brady, D. (2014). Middle Cerebral Artery CVA Speech Language Path. In California simulation alliance.
Noureddine, N., Hagge, D., & Brady, D. (2014). Middle Cerebral Artery CVA Speech Language Path. In California simulation alliance.×
The Joint Commission. (2008). Health care at the crossroads: Guiding principles for the development of the hospital of the future. Retrieved from www.jointcommission.org/assets/1/18/Hosptal_Future.pdf.
The Joint Commission. (2008). Health care at the crossroads: Guiding principles for the development of the hospital of the future. Retrieved from www.jointcommission.org/assets/1/18/Hosptal_Future.pdf.×
Reference this article as: Hagge, D., Noureddine, N., Brady, D., & Ofstad, W. (2015). Dealing with Dysphagia--Together. The ASHA Leader, 20(6), 34–36. doi. 10.1044.Leader.AE.20062015.34.
3 Comments
June 5, 2015
Christine Switzer
Well Done Darla!
Your program sounds amazing - good for you, very exciting.
June 25, 2015
Gloriajean Wallace
Comment on.."Dealing With Dysphagia Together" article
Very nice article about the innovative interdisciplinary collaborative program that has been developed (*and additional ideas about other similar programs mentioned at the end of the articles.."conversational partners," and additional pieces that will be added). A great teaching-learning experience..and what a great way to build interdisciplinary partnerships. Thank you so very much for sharing...and for the detail.
June 26, 2015
Darla Hagge
Additional information
Thank you so much, Christine and Gloriajean, for your kind words and supportive comments. If interested, additional publications and presentations regarding our interprofesional education collaboration may be found at: https://nexusipe.org/users/california-interprofessional-education-research-academy-ca-ipera. Thanks again!
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June 2015
Volume 20, Issue 6