{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:15:04Z","timestamp":1790162104595,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004876","name":"Sheffield Hospitals Charity","doi-asserted-by":"publisher","award":["202112"],"award-info":[{"award-number":["202112"]}],"id":[{"id":"10.13039\/501100004876","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Dysphagia is associated with increased risk of stroke\u2010associated pneumonia (SAP). The multifactorial pathophysiology of SAP and the interplay of care processes make it challenging to unpack which components are associated with risk of SAP. The aim of the research was to capture contextual aspects of dysphagia management to build knowledge of care processes relevant to SAP.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The methodology was an ethnographic approach. The method was participant observation. Implementation of specialist swallow recommendations, positioning, and oral care processes of 10 stroke patients was observed around mealtimes during the first 72\u2010h of hospital admission. Data was analysed thematically. People affected by stroke were involved in the data analysis process and in the co\u2010generation of themes and implications for clinical practice.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Four themes were generated from the data: 1. Patient preparation for mealtimes and medications; 2. Variability in resources, knowledge and implementation of dysphagia care; 3. Swallowing and oral care are everyone's business; and 4. Communication about the person's dysphagia management plan and staff attitudes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This research enhances understanding of environmental barriers and facilitators that shape how dysphagia care is enacted in acute stroke settings, and how variability in everyday practice may influence circumstances relevant to SAP risk. The findings highlight the role of communication processes, patient and carer information needs, staff awareness of dysphagia diets, mealtime preparation, oral care practices, and access to resources in supporting the implementation of swallowing management plans within routine care.<\/jats:p>\n <\/jats:sec>\n \n WHAT THIS PAPER ADDS<\/jats:title>\n \n What is already known on the subject<\/jats:italic>\n \n \n The pathophysiology of stroke\u2010associated pneumonia (SAP) is multifactorial.<\/jats:p>\n <\/jats:list-item>\n \n Patients are most susceptible to SAP during their first 72\u00a0h post\u2010stroke.<\/jats:p>\n <\/jats:list-item>\n \n Preventative measures to identify dysphagia as early as possible, such as early dysphagia screening and a specialist swallowing assessment, are associated with reduced risk of SAP.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n \n What this paper adds to the existing knowledge<\/jats:italic>\n \n \n Increased understanding of how dysphagia care processes may impact on SAP.<\/jats:p>\n <\/jats:list-item>\n \n Identifies environmental barriers and facilitators to minimising potential risk of SAP, specifically relating to the implementation of the specialist swallowing assessment recommendations, positioning and oral care.<\/jats:p>\n <\/jats:list-item>\n \n Identifies areas for clinical improvement.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n \n What are the potential or clinical implications of this work?<\/jats:italic>\n \n \n Swallowing management plans are complex and often only partially enacted, with key elements beyond diet and fluid modification frequently overlooked.<\/jats:p>\n <\/jats:list-item>\n \n Dysphagia management requires a genuinely multidisciplinary and system\u2010wide approach, involving all ward staff and informed family and carers.<\/jats:p>\n <\/jats:list-item>\n \n Effective implementation depends on system\u2010level factors which include: clear, consistent and up\u2010to\u2010date sharing of swallowing plans across all channels; staff, patient and carer education; access to appropriate resources; and supportive ward practices and attitudes.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.70295","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T09:14:26Z","timestamp":1784970866000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dysphagia Care Processes on Acute Stroke Wards: An Ethnographic Study of Barriers and Facilitators Relevant to Stroke\u2010Associated Pneumonia"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0453-2456","authenticated-orcid":false,"given":"Sabrina A.","family":"Eltringham","sequence":"first","affiliation":[{"name":"Speech and Language Therapy Department Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"},{"name":"Centre for Applied Health & Social Care Research (CARe) Sheffield Hallam University Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Sciences Manchester Academic Health Science Centre University of Manchester Manchester UK"},{"name":"Manchester Centre for Clinical Neurosciences Geoffrey Jefferson Brain Research Centre Salford Royal Hospital Northern Care Alliance NHS Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Bray","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Richards","sequence":"additional","affiliation":[{"name":"Neurosciences Department Sheffield Teaching Hospitals, NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Burke","sequence":"additional","affiliation":[{"name":"Speech and Language Therapy Department Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"},{"name":"Combined Community and Acute Care Group (CCAG) Research Centre Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7108-8386","authenticated-orcid":false,"given":"Sue","family":"Pownall","sequence":"additional","affiliation":[{"name":"Speech and Language Therapy Department Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2017.1398482"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2021.1871785"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1460\u20106984.12725"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010021\u201001466\u20109"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.2307\/2088165"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp\u20102016\u2010313356"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000519903"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000492730"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010019\u201010061\u20106"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics4040067"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/geriatrics4040060"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.7208\/chicago\/9780226206868.001.0001"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000350199"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638280903556482"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/2049\u20106958\u20108\u201039"},{"key":"e_1_2_10_18_1","volume-title":"Disability and Health: ICF","author":"International Classification of Functioning","year":"2001"},{"key":"e_1_2_10_19_1","volume-title":"Quality Improvement Made Simple","author":"Jones B.","year":"2021"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2025.2563772"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.007843"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00009559"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000190056.76543.eb"},{"key":"e_1_2_10_24_1","unstructured":"NIHR.2024.Briefing Notes for Researchers: Public Involvement in NHS Health and Social Care Research. 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