'Do Fever-Sugar-Swallow Protocols improve nurses' and physicians' satisfaction with the management of fever, hyperglycemia and dysphagia in stroke patients: A pre-and post-implementation survey of the “Quality in Acute Stroke Care” (QASC) Program‘

TL;DR

This study examines whether implementing Fever-Sugar-Swallow Protocols in German stroke units improves nurses' and physicians' satisfaction with managing fever, hyperglycemia, and dysphagia.

Contribution

The study evaluates the impact of FeSS Protocols on nurses' autonomy and physicians' satisfaction in stroke care within Germany's healthcare system.

Findings

Nurses reported significant improvements in autonomy and self-efficacy in managing fever, hyperglycemia, and dysphagia.

Physicians noted improved training activities for new colleagues on FeSS parameters and related clinical issues.

The study suggests FeSS Protocols could enhance the quality of stroke care and work environment in Germany.

Abstract

Nurses play a key role for delivery of high-quality patient care in the interprofessional stroke team. Nurses’ autonomy and advanced competencies are essential to a positive work environment, yet, are not well developed in Germany.

To assess whether using the Fever-Sugar-Swallow (FeSS) Protocols in stroke care improves: a) nurses’ satisfaction regarding their ability to autonomously manage fever, hyperglycemia, and dysphagia; and b) physicians’ satisfaction regarding the management of these parameters in German stroke units.

A pre-test/post-test survey administered to nursing and medical staff in eight stroke units was conducted prior to and following implementation of the FeSS Protocols.

An online survey, comprising items regarding global job satisfaction, the target parameters and control parameters, was distributed to participating stroke units. T-tests were calculated for significance between pre-post implementation, Cohen’s d was used to measure the effect size.

A total of 308 respondents (nurses n = 112 [pre], n = 65 [post]; physicians n = 82 [pre], n = 49 [post]) from 8 stroke units completed the survey (response rates: 49 % nurses; 53 % physicians). There were no significant differences regarding global job satisfaction, but nurses were significantly more likely to report improvements in autonomy regarding fever management (able to act autonomously (p = 0.006) and competently (p < 0.001)); perceived self-efficacy (p < 0.001), regarding blood glucose management (able to act timely (p = 0.002) and competently (p = 0.007); perceived self-efficacy (p < 0.001)), and dysphagia management (able to act autonomously (p = 0.005) and timely (p = 0.007)). In the medical profession, improvements were reported in training activities of new colleagues, not only regarding FeSS parameters fever (p < 0.001) and dysphagia (p < 0.001), but also regarding management of other clinical issues which were not the subject of our intervention (restlessness (p < 0.001), and sleep disorders (p < 0.001)).

Despite a tightly-regulated mandatory quality assurance system with well-established therapy guidelines, the implementation of the FeSS Protocols in German stroke units revealed potential for improvement by improving autonomy for nurses as a regular part of nurses’ work clinical practice, as it is common in other countries of the world. This would not only improve the quality of care, but could also contribute to increase attractiveness of work at the stroke unit.

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