Journal of Nursing Theory and Practice

[Nutritional Therapy in the Stroke Ward: Treatment of Dysphagia in Acute Care of Stroke Patients ]

SZABÓ Pál Tamás1,2, KOVÁCS Andrea1, HALÁSZ Tímea3, BÉRES-MOLNÁR Katalin Anna3, MOLNÁR Beatrix4, BALOGH Zoltán1,5, FOLYOVICH András1,6

DECEMBER 15, 2021

Journal of Nursing Theory and Practice - 2021;34(6)

[Background: Dysphagia can reach 50% among stroke patients and might cause serious complications. Proper treatment of the disorder and personalized nutritional therapy can help reduce negative outcomes. Aim: Based on existing guidelines and our own practical experience, we intended to provide a clear and practical summary that can help understand the specific aspects of nutrition in the care of stroke patients. Conclusion: The care and nutrition therapy for stroke patients requires teamwork and expertise. Early detection of a swallowing disorder and personalized nutritional therapy can reduce the serious complications that threaten stroke patients.]


  1. Semmelweis Egyetem Doktori Iskola
  2. Semmelweis Egyetem Egészségtudományi Kar Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Neurológiai Osztály – Stroke Centrum
  3. Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Neurológiai Osztály – Stroke Centrum
  4. Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Ápolási Igazgatóság
  5. Semmelweis Egyetem Egészségtudományi Kar
  6. Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő Neurológiai Osztály – Stroke Centrum



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BÁLINT Csaba, PAKAI Annamária, GRÓF Kinga, AHMANN Mercédesz Anna, VERZÁR Zsófia

[Various bloodstream infections are associated with high mortality, so early diagnosis is very important to reduce complications, with the gold standard procedure being blood culture and evaluation. Several databases were used to search for qualitative, relevant literatures (MEDLINE, PubMed, Ebsco). We selected national and international literature on the correct sampling of blood culture and sampling errors published between 2010 and 2020. The timing, method and location of blood culture sampling, the amount and frequency of sampling, the choice of haemoculture bottles, their storage and transport are all factors that influence the outcome. The choice of time can be independent of the clinical condition of the patient. Intravascular cannulation should be avoided if possible. Careful disinfection prior to haemoculture sampling and the use of chlorhexidine disinfection, which is already customary abroad, with the appropriate contact time, will both reduce contamination samples. Whether or not the patient is on antibiotic therapy is a key factor in the choice of blood culture bottle. To ensure optimal detection of pathogens, a quality control phase should be built into the pre-analytical processes. The solution to reduce the number of contaminated samples is to use sampling kits and to follow a mandatory blood culture sampling protocol.]

Journal of Nursing Theory and Practice

[Etymology for the word nurse]


[Auothors review the etymology and semantics of the Hungarian word for ’to nurse’ and ’nursing’. The Hungarian word ’ápol’ originally meant to kiss, to caress, from which it developed over time into meaning ’to care for in sickness or in distress’. It is maintained that the activity denoted by the word ’ápol’ [nurse] must always be characterised by gentle and affectionate attention and devotion.]

Journal of Nursing Theory and Practice

[A possible role of Advanced Practice Nurses in primary care - the possibility of screening for retinopathy in patients with diabetes]

TOKODI Attila Csaba, GALLOVICH Éva, RAJKI Veronika

[WHO data show that the prevalence of diabetes is constantly rising. The ocular complication of diabetes (Diabetic Retinopathy (DR)) is one of the leading causes of blindness worldwide. While the screening of the fundus is performed by ophthalmologists and optometrists in Hungary, internationally, the expertise of APN nurses is relied upon in primary care in many places. In Hungary, with modern methods, by integrating screening into primary care and at the same time by involving APN community nurses with master degree, the current screening rate of DR can be improved in the short term. In Hungary, the APN training leading to a university degree was launched in September 2017. The first APN community nurses with advanced competencies and master degree graduated in February 2019. In accordance with their qualifications, they have complex knowledge of the diagnosis of diabetes, the implementation of its screening, as well as the pharmacological and non-pharmacological therapy of the disease, and the tasks of nursing and patient education. They are able to independently evaluate the findings and decide on the modification, discontinuation of the required medication order, and the revision of the treatment plan. APN community nurses with a university degree are suitable for the care and follow-up of chronic patients in general practitioner practices and practice communities according to their level of competence.]

Journal of Nursing Theory and Practice

[Examination stress among BSc nursing students]


[To evaluate the stressors which affect students during their theoretical education and field clinical practices. We also examined their subjective health, physical activity, stress levels and the use of health-harming substances. During a quantitative research, we examined 133 first-, second-, third- and fourth-year, both full time and part-time nursing students at the Department of Nursing and Patient Care (BSc) with the help of an anonymous online self-completion questionnare. 49% of nursing students have considered discontinuing their nursing education program due to excessive stress. During their field clinical practice, contact with staff, fear of the unknown, making mistakes, and failure emerged as the most common stressors. The least common stressors included the quality of hospital equipment and the experience of dying/death. In all four years, lack of time, feeling overwhelmed, and difficult exams are the main sources of stress during the theoretical education. Undergraduate nursing students encounter a number of stressful stimuli during their academic years. Reducing or eliminating these stressors could reduce thoughts of discontinuing nursing education program, increase health status and last, the nursing profession could become more popular among higher educational health related students.]

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[Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose – The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study – 652 articles were found and were reduced to eight. We made a comparative analysis of these. The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.]

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[The new coronavirus, SARS-CoV-2, which causes the COVID-19 disease can lead to severe acute respiratory distress syndrome (ARDS). It poses a serious challenge to the health care system, especially intensive care. Neurological patients, usually of advanced age and with a myriad of comorbidities, are at particular risk through the impact of the new coronavirus on their condition and nutritional capacity. Stroke is a leader in morbidity and mortality data, with a focus on dysphagia and its complications due to COVID-19 disease and acute cerebrovascular accident. In the acute phase of stroke, 30-50% of patients suffer from dysphagia, which still shows a prevalence of 10% six months later. Dysphagia results in decreased or insufficient fluid and nutrient uptake, supp­lemented by inactivity, leading to malnutrition and sarcopenia, which worsens overall condition, outcome, and rehabilitation efficiency. Screening and early detection of swallowing disorders is a fundamental issue in order to develop a personalized and timely-initiated nutritional therapy strategy. Nutritional therapy plays a key role in frequent intensive care due to COVID-19 disease, where it increases the chances of recovery and reduces the length of stay in the intensive care unit and mortality. This is especially true in critically ill patients requiring prolonged ventilation. In COVID-19 diagnosed patients, screening for dysphagia, bedside assessment, and instrumental examination, followed by swallowing rehabilitation, are of paramount importance. Stroke can also be a complication of the COVID-19 infection. Care for cerebrovascular patients has also adapted to the pandemic, “triazination” has become systemic, and dysphagia screening for stroke patients and nutritional therapy adapted to it have also shed new light. ]

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