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Table 3 The category, Awareness of risk assessments and risk factors for HAP

From: Registered nurses’ experiences of providing respiratory care in relation to hospital- acquired pneumonia at in-patient stroke units: a qualitative descriptive study

“We are always very particular so that no patient eats or drinks before we have assessed swallowing function, and then we have a schedule we use.” (Q1, RN/E)
“…Even if we should do [a swallow assessment], it might fail. We could be more meticulous and gain a higher level of competence.” (Q2, RN/F)
“Yeah, that one does not ventilate the lungs properly. Thus, one does not get the same ventilation [of the lungs] as when one is up and about. So, it becomes very likely that the lung collapses and, simultaneously, the patient maybe swallows some saliva or something, so it is very easy.” (Q3, RN/E)
“Some of our patients can pull on the nasogastric feeding tube, and it can then end up in the lungs [instead of the oesophagus], or if they are positioned flatly in bed, or [the feeding] goes too fast, and they are positioned on their left side, so the patient could also end up with some pneumonia if it goes wrong or if they aspirate.” (Q4, RN/D)
“… it is more if they have any other underlying diagnoses, but if they have asthma or COPD, then pneumonia arrives directly with the post man.” (Q5, RN/I)
“One could maybe identify patients at risk [for pneumonia] … and decide upon a goal for what those patients should do daily to minimise the risk. Just like in the way we identify those patients at risk for fall and pressure ulcers, so maybe one could identify those at risk to develop pneumonia…” (Q6, RN/E)
“If we consider our assessment measures, we think a lot about risk of falls and pressure ulcers and so on, and it is the first priority, but then one realises after a while, oh, there are maybe more risks, but the risk of attracting pneumonia is not the first thing on my mind when I receive the patient, no it is not.” (Q7, RN/G)
’Many years ago, it was mandatory to document in Riksstroke if the patient acquired pneumonia. It is not done anymore… it was an eye opener because we saw that we had a lot or… but an increased number got pneumonia, and we started to ransack ourselves. We became good at swallow assessments, and this was one way to raise awareness of the problem [of pneumonia]. We managed to decrease the numbers of pneumonia when we became aware of what we were doing’. (Q8, RN/F)
“… I have been where there is stroke-educated staff; it is much easier to discover and discuss and to initiate actions… it can always be done better.” (Q9, RN/H)