CRN is live at Dell EMC World 2017 in Las Vegas. Get all of our coverage of the event, as well content from the Dell EMC World 2017 special issue of CRN, here.
Dell EMC World News
|
Dell EMC Bringing Mission-Critical Cloud Power Virtustream Into Channel Program Pat Gelsinger: VMware Opens Up Tech Partners To Expand Cloud Capabilities Virtustream Extends Mission-Critical Cloud Tech To Complex Health Care Applications Michael Dell To Partners: 'Enormous Cross-Selling Opportunities For You' Dell EMC's David Goulden: Modern, Automated Infrastructure Provides The First Step For Cloud Migration Dell EMC Rolls Out 'Flexible Consumption' Rebate For Partners Dell EMC Takes Aim At Cisco With New Open Networking Push |
Dell North America Sales Chief: 'Winning In Both Consumer And Commercial PCs' Is Key Dell EMC World: Michael Dell's 7 Keys To The Future Of Dell Technologies And The IT Industry Dell EMC World: Enterprise Sales Chief Scannell Says Partners Are Booting Competitors, Winning Big Deals Amid Huge Market Opportunity Michael Dell To Partners: 'Enormous Cross-Selling Opportunities For You' Partner Marketing Push: Dell EMC Arms Partners With New MDF Resources Dell EMC Gives Partners The Nod On Commercial PCs With Extension Of Partner-Led Strategy Dell EMC Launches All-Flash Storage Barrage 15 Hot Products Unleashed At Dell EMC World 2017 |
Dell EMC World Special Issue
Dell EMC World: Transformation Titans Map Out Dell EMC's Path To Growth
With the right pieces now in place, Dell EMC's complete-portfolio call to action is being heard loud and clear across the partner ecosystem.
Marius Haas On Why There's 'Zero Debate' About The Value Of Dell EMC's End-To-End Portfolio
Marius Haas believes that when it comes to determining which vendor partner is going to provide you with long-term value creation opportunities, there's no debate that it's Dell EMC.
John Byrne On Partners Pivoting Away From Cisco, HPE, Lenovo, And Selling The Entire Dell EMC Portfolio
John Byrne says that Dell EMC partners are rapidly moving away from competing vendors and aggressively pushing new business opportunities across the entire combined portfolio.
Dell EMC's Cheryl Cook On The Combined Partner Marketing Perspective
Dell EMC's global channel marketing chief Cheryl Cook talks to CRN about the importance of communication when combining the marketing efforts of two massive partner programs.
Chad Sakac On Dell EMC's Push To Turn Hyper-Converged Infrastructure Into A Utility
Dell EMC is putting the 'pedal to the medal' when it comes to hyper-converged infrastructure and is tasking Chad Sakac and his team with making customer transformation as simple as possible for partners.
Jeremy Burton On How Partners Can Take Advantage Of A Combined Dell, EMC
Ahead of Dell EMC World 2017, Jeremy Burton dug into the blockbuster acquisition and how it primes partners to take advantage of the new combined company.
Dell EMC's David Goulden On What It Means To Be The Biggest Player In Storage
Ahead of Dell EMC World 2017, David Goulden talks to CRN about the new combined storage powerhouse and why you won't heard anyone referred to as 'ex-Dell' or 'ex-EMC.'
© 2023 Fortune Media IP Limited. All Rights Reserved. Use of this site constitutes acceptance of our Terms of Use and Privacy Policy | CA Notice at Collection and Privacy Notice | Do Not Sell/Share My Personal Information | Ad Choices
FORTUNE is a trademark of Fortune Media IP Limited, registered in the U.S. and other countries. FORTUNE may receive compensation for some links to products and services on this website. Offers may be subject to change without notice.
S&P Index data is the property of Chicago Mercantile Exchange Inc. and its licensors. All rights reserved. Terms & Conditions. Powered and implemented by Interactive Data Managed Solutions.
Dell EMC is waging an all-out assault on the storage market, investing $2 billion in the effort, hiring 1,200 new storage sales specialists and offering new, robust, storage compensation incentives for its partners. A trio of executives leading the charge - Scott Millard, Joyce Mullen and Marius Haas - talked to CRN about how Dell EMC is putting the pieces in place to help its partners win big in storage.
'Refuse To Lose': Dell EMC Primes Its Partners For A Storage Revolution
Driving the company's storage sales offensive are new robust storage compensation incentives for solution providers and an influx of Dell EMC sales reps working side by side with those partners.
Dell EMC President Marius Haas On The Company's 'Refuse To Lose Approach' To The Storage Market
Dell EMC's Marius Haas on the Dell EMC's storage push and how channel partners are vital to Dell EMC's success.
Storage Boost: Dell Hires 1,200 Sales specialists To Drive Partner-Led Selling
By hiring 1,200 new storage sales specialists, Dell boosts its storage team by upward of 25 percent with an eye on skyrocketing storage revenue through its partners in 2018.
10 Hot Dell EMC Storage Products
CRN looks at 10 key products in the Dell EMC storage lineup, one that offers the broad capabilities to match the company's position as the world’s largest storage vendor.
Tech Tour: Behind The Scenes At Dell EMC's Storage Manufacturing Facility
CRN recently toured Dell EMC's storage manufacturing facility in Massachusetts which assembles, tests and ships converged and hyper-converged products throughout North America.
CRN Interview: Dell EMC Channel Chief Joyce Mullen On Driving More Storage Sales Through Partners And Her Channel Vision For 2018
Joyce Mullen, an 18-year Dell veteran who is now president of global channels, OEM and IoT Solutions, spoke with CRN about enabling partners to drive more storage sales, the potential integration of VMware into the Dell EMC Partner Program, and her channel vision for 2018.
Dell EMC Doubles Down On Storage Services, Unifying Portfolio
Dell EMC executives are making sure partners have the competencies they need to sell the Dell EMC portfolio as well as their own services.
Fistfuls Of Growth: Dell EMC's Expanded Product Portfolio Paves New Paths For Partners
Michael Dell has emphasized that customers want cutting-edge hybrid cloud tech and they want to buy it from fewer vendors. Here's how three solution providers backed up Dell's assertion with skyrocketing sales across Dell EMC's broad portfolio in 2017.
What Is a Personal Financial Specialist (PFS)?
A Personal Financial Specialist (PFS) is a certification for certified public accountants (CPAs) that allows them to expand their expertise and offerings to include financial planning and wealth management.
The American Institute of Certified Public Accountants (AICPA) established the Personal Financial Specialist (PFS) credential, which is reserved for CPAs, meaning holding a CPA is a prerequisite.
There are both educational and professional requirements that must be met before earning a PFS. However, the benefits of holding a PFS are numerous, which include expanded employment opportunities with corporations, consulting firms, and the ability to manage or own a wealth management practice.
Key Takeaways
- A Personal Financial Specialist (PFS) is a certification for certified public accountants (CPAs), allowing them to expand their expertise to include financial planning and wealth management.
- PFS applicants study estate planning, retirement planning, investing, insurance, and other areas of personal financial planning.
- Individuals with the PFS designation may work for accounting firms, consulting firms, or run their own wealth management practices.
- There are requirements to achieve a PFS designation, including a CPA license, education, a specified level of experience, and passing an examination.
- An added benefit to the PFS is that candidates know financial planning but also have extensive tax and corporate finance expertise as a CPA.
Understanding a Personal Financial Specialist (PFS)
A Personal Financial Specialist (PFS) certification is exclusively granted to CPAs. According to the AICPA, a PFS certification represents "a powerful combination of extensive tax expertise comprehensive knowledge of financial planning."
PFS applicants study estate planning, retirement planning, investing, insurance, and other areas of personal financial planning. Individuals with the PFS designation may work for accounting firms, consulting firms, or manage their own firm.
Earning the Personal Financial Specialist (PFS) means that individuals have earned the right to use the PFS designation with their names, which can Improve job opportunities, professional reputation, and pay.
Personal Financial Specialist (PFS) Requirements
There are four major requirements that are necessary to achieve a personal financial specialist designation, including a CPA license, education, a specified level of experience, and passing an examination. Some of those requirements are outlined below:
CPA License and AICPA Member
Candidates must obtain or hold an unrevoked and valid CPA certification that has been issued by a state. The candidate must also be a current Regular member of the AICPA.
Education and Experience Requirements
There are two pathways that candidates can choose from, depending on their level of experience.
The Standard and Certificate pathway has the following requirements:
- Possess at least two years of full-time teaching or business experience (or 3000 hours equivalent) in personal financial planning within the five years previous to applying for CPA/PFS
- Up to 1,000 hours of tax compliance experience can count towards the total experience required for the PFS
- A minimum of 75 hours of personal financial planning education in the five years preceding application for the PFS
The Experienced pathway has the following requirements:
- Possess five years of full-time experience (or 7,500 hours equivalent) in personal financial planning
- The AICPA states that up to 2,000 hours of tax compliance experience can count towards the total experience required for the PFS
- Earn a minimum of 105 hours of personal financial planning education within the seven-year period preceding the application date
According to the PFS credential handbook, regardless of the pathway, the education and experience must be in any of the 12 areas that make up the personal financial planning (PFP) Body of Knowledge. The AICPA offers educational courses for personal financial planning covering the courses within those 12 areas. However, certain approved courses from an accredited university or college may be accepted as substitutes.
PFP Body of Knowledge
The 12 areas that comprise the PFP Body of Knowledge for the education and experience requirements are listed below:
- Personal Financial Planning Process: Includes helping clients establish financial goals, gather data, and build client relationships
- Professional Responsibilities, Legislative, and Regulatory Compliance: Includes complying with any licensing requirements from state and federal authorities
- Fundamental Financial Planning Concepts: Includes budgeting, analyzing cash flow, income, and spending patterns
- Estate Planning: Includes establishing an estate financial plan to determine cash needs in the event of death and potential tax liabilities
- Charitable Planning: Involves determining the assets to be allocated for charitable giving and the various types of products available, such as trusts and life insurance
- Risk Management Planning: Includes determining a client's financial risks, including disability, illness, and property damage, as well as reviewing the available products to mitigate those risks
- Employee and Business Owner Planning: Includes executive compensation, options, the various benefits available for employees, and tax implications
- Investment Planning: Involves the review of a client's capital gains and losses, risk tolerance, and investment preferences to determine an appropriate investment strategy
- Retirement and Financial Planning: Includes determining a client's cash needs in retirement, financial goals, and the savings needed to meet those goals
- Elder and Chronic Illness Planning: Includes helping clients understand the various care and housing options while developing a plan for financial expenses
- Education Planning: Involves assisting clients with education planning and funding strategies
- Special Situations: Includes defining housing goals, income needs and determining the division of assets in the event of a divorce
Continuing Education
Also, every three years, PFS professionals must complete 60 hours of continuing professional education. Annually, they must pay a fee of several hundred dollars to continue using the designation.
A personal financial specialist (PFS) designation offers CPAs the ability to stand out from other financial planners while offering clients an expert who can develop a well-rounded financial strategy.
Personal Financial Specialist (PFS) Exam
The test requirement for the PFS is extensive, covering the financial planning process and professional responsibilities with courses such as tax, retirement, investments, insurance, and estate planning.
The PFS test consists of 160 questions, half of which are standalone multiple-choice, while the remainder includes case studies with accompanying multiple-choice questions. These include short scenarios followed by 2-5 multiple-choice questions and longer cases with 12-18 related multiple-choice questions.
The AICPA provides a brief video tutorial that features a mock test session. The test can be taken at one of the testing centers or online with a laptop or through a proctored test via webcam. Candidates are allocated five hours to complete it, as well as a 30-minute break.
Exempt from the PFS test are CPAs who have passed the Certified Financial Planner (CFP) or Chartered Financial Consultant (ChFC) exams. They are deemed to have met the test requirement.
Benefits of a Personal Financial Specialist (PFS)
Benefits exist for those who hold a PFS certification and clients looking for a financial professional to help them develop a financial plan for the long term.
Professionals have the ability to display their financial expertise by demonstrating their knowledge of financial planning, which can help attract new clients. The PFS certificate can enhance a professional's reputation and professional brand, thus improving career opportunities with the potential of boosting income. An added benefit to the PFS is that candidates have knowledge of financial planning, but they have extensive tax and corporate finance expertise as a CPA.
A CPA who holds a PFS can be particularly beneficial for clients who are looking to develop a financial plan that aligns with their long-term goals while also receiving the benefit of tax and accounting services. Another benefit to clients is that they gain access to a professional who is an expert in elder and estate planning and wealth preservation and retirement income.
PFS vs. CFP
Although the personal financial specialist and certified financial planner (CFP) have many similarities, there are distinct differences between the two designations. CPAs with a PFS certification have a well-rounded knowledge of accounting, tax, financial statements, and wealth management. However, a CFP is considered a type of financial advisor since it is given out by the Certified Planner Board of Standards, Inc.
As a result, there is a fiduciary responsibility that CFP's must adhere to, meaning they must provide financial advice that is in the best interest of their clients. CFPs must follow a strict code of ethics as outlined by the Certified Planner Board of Standard’s code of ethics.
Similar to a PFS designation, to earn a CFP, an individual must have 6,000 hours of professional experience and hold a bachelor’s degree from an accredited university. Also, both the CFP and PFS certifications allow candidates to waive some of the requirements if they hold a CFA. However, the CFP does not require candidates to have a prior certification, which contrasts with the PFS prerequisite of holding a CPA certification.
The benefits and employment opportunities of holding a CFP in PFS are numerous, and both certifications offer careers in personal financial planning, retirement, and tax planning. While a CFP allows an individual to offer investment planning, a PFS allows an individual to offer financial management at a corporate finance level due to the CPA certification.
Abstract and Introduction
Abstract
Dysphagia is a major health problem associated with multiple neurological diseases such as stroke, multiple sclerosis, and Parkinson's disease, among others. Staff nurses lack a consistent approach to managing dysphagia patients. A dysphagia clinical nurse specialist (CNS) may facilitate a consistent approach. As a member of the interdisciplinary team, the dysphagia CNS carries a caseload and serves as a liaison between the interdisciplinary team and the nursing staff to oversee dysphagia nursing care.
Introduction
Dysphagia is a widespread health problem that affects individuals of all ages, ethnic backgrounds, and socioeconomic statuses. Dysphagia management delays may lead to aspiration pneumonia, a life-threatening complication. Nurses have a key role to play in identifying, assessing, managing, and preventing complications related to dysphagia. Because hospitalization stays are shorter, early signs and symptoms of swallowing problems are more likely to go unnoticed by the healthcare team. A dysphagia clinical nurse specialist (CNS) can focus attention on this critical problem.
The role of the nurse in relation to dysphagia has been undefined and undeveloped. A dysphagia CNS role can provide a framework for standardized baseline knowledge in four subroles: expert practitioner, consultant, educator, and researcher. Evidence-based research is necessary to test the efficacy of bedside swallowing assessments and nursing interventions.
The dysphagia CNS collaborates with and participates as a member of the interdisciplinary team. A major outcome of this collaboration can be the development of practice guidelines and protocols that guide staff nurses at the bedside. Introducing the dysphagia CNS role is the first step toward a comprehensive and systematic approach for the nursing care of patients with dysphagia. Although this role has been developed in England, it has not been actualized in the United States. This article identifies the need for the role the dysphagia CNS and explores the potential impact of this role on early detection and the resulting reduction of dysphagia-related complications.
Without diverse input at the building stage, the outlook of any artificial intelligence can be very one dimensional – but DELL is helping such software systems see the bigger picture ...
TECHNOLOGICAL advances mean the world is changing so rapidly it’s a struggle to keep up.
One of the key issues is the ever-growing skills gap because, while it is commonly thought by the older generation that many young people all want to enter the technology sector, the reality is that not enough are studying STEM subjects to meet future needs.
For Dell Technologies the answer is a diverse and inclusive workforce that includes minority groups, females as well as men, and everyone from graduates to those re-entering the workforce at a later stage in life.
Diversity and inclusion is seen by Dell Technologies not just as a politically correct slogan but a business imperative - which is why the company has launched a range of programmes to attract and retain diverse talent.
Dell Technologies’ diversity and inclusion strategy is as important as its technology strategy because it is regarded as bringing business and social value to the company.
“We are in 180 countries and have 140,000 employees and what we want is to create a place where people can come to work and be themselves,” said Tricia Smyth, EMEA Diversity and Inclusion Lead for Dell Technologies.
“We want them to feel a sense of belonging so they do their best work rather than sit worrying about how they are perceived.
LEADING THE WAY: Tricia Smyth, EMEA Diversity and Inclusion Lead for Dell Technologies
That is a key part of our code of conduct. On the flip side we want customers to see we value these groups.”
Artificial intelligence (AI) is one area where homogeneity does not make good business sense.
“At the end of the day AI is programmed by a person and if you have a homogenous group programming it means there is just one dimension,” pointed out Smyth. “If we can apply diversity to that we are more likely to reflect what customers are looking for.
“As one of the largest technology companies in the world the onus is on us to use that position of privilege to make a difference.
“We are in a unique position to work on global challenges and we have built our agenda around sustainability, inclusion and transforming lives with technology.”
The seriousness of the skills gap can be seen in the fact that by 2024 in Europe and North America alone there are expected to be 600,000 unfilled computing jobs based on current graduation rates.
This is where programmes like STEMAspire comes in as it is aimed at encouraging females to study science, technology, engineering or mathematics and reverse the tendency for female students to drop out before they finish their studies.
This is Dell Technologies’ biggest programme in Scotland and has been so successful that the same model is being adopted by the company’s Pride employee resource group to encourage more of the LGBT community to enter the field. “We have just finished piloting this in Ireland and the feedback has been superb both from the mentors and mentees,” said Smyth.
“For mentors it is good to see they can cultivate talent and from the LGBT standpoint we are providing role models within Dell Technologies. Often LGBT students fail to make the transition from college or university into the industry as they are unsure of how they will be received.”
Dell Technologies also goes into secondary schools with its Digital Futures Programme to provide pupils an idea of what it is really like to work in the sector and the range of jobs available.
“This is working well too,” said Smyth. “At the start of one of my recent sessions I asked for a show of hands of those considering a career in the technology industry. Three out of 165 pupils put their hands up but at the end of the hour every single hand went up. We show how technology affects everything we do so that they can see all the different aspects of being a computer programmer.”
Another Dell Technologies programme centres on those who have taken a few years out of the workplace and would like to go back to work but are in need of new skills as well as a confidence boost.
Flexible working is also seen as key to encouraging people with family responsibilities to work for Dell Technologies and by 2020 it is expected that nearly 50 per cent of the workforce will have flexible work arrangements.
“We want to attract talent and make sure we create an environment where people can be themselves,” said Smyth.
“Dell Technologies is committed to that and is regularly voted one of the most ethical and most admired companies.
She added: “The core to all of this is addressing issues of bias. We all have biases and these affect how we make decisions so we need to be aware of them.”
In order to help employees recognise their biases the company has launched its Many Advocating Real Change (MARC) programme.
“We are not trying to change people but we need to eliminate bias from how we hire and recruit to make sure we build a diverse workforce,” said Smyth. “People tend to hire someone they like or someone like them so it is building awareness that someone unlike you does not always mean worse - it just means different.”
For more information go to https://corporate.delltechnologies.com/en-us/social-impact/cultivating-inclusion.htm
------------------------------------
Gender was on the agenda in Edinburgh
Dell Technologies are working collaboratively with Equate Scotland to help support and prepare the next generation of female STEM professionals entering today’s transforming work environment.
Scotland’s gender equality expert within STEM Equate Scotland, recently hosted their annual Student Network Conference and Awards Ceremony at the Edinburgh Centre for Carbon Innovation. Equate Scotland, established in 2006, is an organisation that actively promotes and encourages the advancement of women in science, technology, engineering and mathematics.
CAPITAL VENTURE: The Student Network Conference and Awards Ceremony
The event brought together female students from colleges and universities across Scotland, celebrating their passion for their chosen field. Students connected with inspiring female professionals from companies such as Dell Technologies, Data Lab, Ernst Young and Balfour Beatty, to help build on their network and enhance their career development.
The conference came about as part of Equate Scotland’s strategy to make tangible and sustainable change in Scotland, enabling the development of women studying and working within STEM industries by supporting their recruitment, retention and career progression.
Scotland’s STEM employment sector struggles with skills shortages which many expect will be exacerbated by Britain’s exit from the European Union. Studies suggest there are too few students coming through, particularly females, which jeopardises Scotland’s chance to be at the forefront of innovation.
Only 25% of women have a profession within the STEM sector and 70% of university students studying STEM will not progress onto a role within the industry. Dell Technologies attended the event and hosted an interactive workshop for students and employers. The workshop focused on effective communication and social media, providing students with tips and guidance on how to enhance and maintain a professional social media presence across platforms such as LinkedIn and Twitter.
Sarah O’Donnell, Executive Communications at Dell Technologies says: “The event was very much a celebration of super inspiring young women, bringing them together to connect with peers and other female professionals to help enhance their career development.
“Dell Technologies were delighted to support the event and I was particularly privileged to impart some of my knowledge on social media and communication skills in a super interactive workshop.”
Equate Scotland initially connected with Dell Technologies in 2017, providing support in the launch of their STEMAspire mentoring programme. The programme came about as part of
Dell Technologies wider social impact strategy to drive growth and innovation through advancing diversity and inclusion in the workplace.
The Dell Extended Technologies Complete (ETC) program delivers comprehensive, industry-leading, best-of-breed partner solutions that complement Dell Technologies servers, storage, and networking. Progress Software is one of the vendors in the program, having the “Strategic” highest level of partnership with Dell. The two vendors partner to deliver a robust joint offering for organizations seeking cost-effective yet highly functional load balancing solutions. The Progress® Kemp® LoadMaster® product offers the scalability, feature depth and security required to enable resilient delivery of a wide range of application workloads for organizations of all sizes and capabilities. Progress® Kemp® LoadMaster® simplifies Dell Elastic Cloud (ECS) Storage application delivery with easy management via web UI, API and Progress® Kemp® 360 Central® with a compelling TCO and outstanding customer support.
The benefits for Dell customers of using Progress Loadmaster are:
- Multinetwork Access
- ECS Optimized QoS (Quality of Service)
- Secure using TLS 1.3
- Concurrent IPv6 and IPv4
- SSL Offload
- Route based on DNS query source
- Seamless VDC failover
- Purpose built ECS S3 traffic steering
- ECS S3 Health Checking
- Hybrid path and host addressing
-Ends-
About EMT Distribution:
Emt Distribution is a leading technology distribution company based in Dubai, United Arab Emirates.
It specialized in providing leading IT Security, communications and virtualization solutions to the Middle East and Africa region. EMT Offers a wide range of products and solutions from various renowned technology vendors. We focus on cybersecurity solutions including endpoint protection, network security, data protection and threat intelligence.
About Progress :
Progress is a global software company that provides a range of products and solutions for application development, integration and deployment. Progress is the experienced, trusted provider of products designed with you, our customers, in mind. With Progress, you can build what you need, deploy where and how you want, empower your customers, then manage it all safely and securely. That way, you achieve growth even faster.
Media Contact:
Reshma Yesodharan
With support from Dell EMC, and in association with Intel and Microsoft, Dippy's Naturenauts offers a mobile-friendly interactive experience for children aged seven to eleven.
A fun activity that supports Dippy on Tour, Dippy and Fern the fox lead kids through a series of exploratory games that encourage them to venture outdoors and interact with the nature in their area while learning about science.
Through their generous support of Dippy on Tour and Dippy's Naturenauts, Dell EMC helped the Museum to help the next generation of scientists engage with the natural world through a leading a digital experience, guiding and engage them in scientific thinking.
Roles of the Dysphagia CNS
Healthcare professionals have been unsuccessful in identifying patients at high risk for aspiration pneumonia. Early screening and intervention is critical. Many available modalities can prevent dysphagia's life-threatening complications. According to Hansell and Heinemann (1996), nursing interventions may prevent dysphagia complications.
A dysphagia CNS can be a role model and resource for nursing practice. Developing the dysphagia CNS role requires careful planning. A clearly delineated job description will prevent an overwhelming workload for the dysphagia CNS; all members of the dysphagia team will benefit from this CNS's unique combination of knowledge, skills, and abilities.
Nurses have an important role in identifying dysphagia patients. According to Travers (1999), nurses are the professionals who most often are present at the bedside, particularly at mealtime, and are the first members of the healthcare team to observe signs and symptoms of dysphagia. By recognizing dysphagia early, nurses can help to prevent complications and decrease the number of deaths associated with dysphagia in those who have had a stroke (Travers, 1999). One of the most important functions of the dysphagia CNS is to train staff nurses to perform bedside swallowing assessments.
Odderson, Keaton, and McKenna (1995) found that nurses can perform bedside swallowing assessments. A swallow screen was performed on stroke patients within 24 hours after admission by a speech language pathologist or a certified nurse. The findings suggested that an initial swallow screen led to a significant reduction in aspiration pneumonia attributable to prompt dysphagia management. A nurse's complete swallowing assessment should include testing of the four phases of swallowing: the oral preparatory phase, the oral phase, the pharyngeal phase, and the esophageal phase (DiIorio & Price, 1990).
The role of the dysphagia CNS includes the subroles of expert practitioner, consultant, educator, and researcher (Hamric, Spross, & Hanson 1996). The ability to diagnose and manage dysphagia requires a consistent and logical interdisciplinary team approach (Travers, 1999). The dysphagia CNS should work with other members of the interdisciplinary team, including physicians, speech language pathologists, dietitians, nursing staff members, radiologists, and occupational therapists. She or he also should work with patients and their families.
Expert Practitioner Role
The dysphagia CNS's caseload should be determined by the severity of dysphagia among the patient population. An interdisciplinary team should meet regularly to determine this caseload. The dysphagia CNS would act as a liaison between the staff nurses and the dysphagia team to follow all identified and potential dysphagia patients. The nursing staff members would consult the CNS for initial identification, bedside swallowing assessment, and complication prevention and management.
Dysphagia management is another facet of the expert practitioner subrole. Many interventions that can be performed by a dysphagia CNS can be taught to nurses at the bedside. Nursing interventions are based on the Results of the bedside swallowing assessment and the modified barium swallow evaluation (MBSE).
Simple nursing interventions taught by the dysphagia CNS may effectively prevent dysphagia's most serious complications. Examples of these interventions include proper positioning, avoiding the use of beverages to wash food down, and avoiding the use of straws. These interventions must be used consistently. Patients with dysphagia must eat their meals in an environment that is free of distractions such as mealtime conversation and television (Galvan, 2001). The dysphagia CNS could coordinate the mealtime environment for dysphagia patients with other disciplines to arrange for uninterrupted blocks of time and train staff members to maintain adequate nutrition and reduce complication risk.
Consultant Role
The dysphagia CNS would be a recognized resource for nurses. Nursing assistants and staff nurses would be more likely to carry out the CNS recommendations with an improved understanding of the topic. Role perception also was identified as a possible factor that influenced noncompliance with recommendations made by speech and language pathologists (Colodny, 2001). Registered nurses (RNs) and certified nursing assistants (CNAs) share the task of feeding patients. Noncompliance among higher-status workers (e.g., RNs) may be the result of their belief that feeding patients is the job of CNAs. This belief may be behind their lack of information about procedures needed for the safe feeding of dysphagia patients.
The roles and the responsibilities of nurses who provide care for dysphagia patients remain unclear. How can RNs supervise CNAs if they lack the knowledge and skills to perform this difficult task? More research regarding nurses' perception of their role has been recommended (Colodny, 2001).
The dysphagia CNS working in a consultant role focuses on managing more severe or complex swallowing cases that have been problematic for staff nurses. The goal is to help staff nurses develop competencies and work independently when confronting similar clinical situations. Staff nurses could request a consultation to perform a bedside swallowing assessment and to develop a plan of care that nurses on all shifts could follow.
Dysphagia practice guidelines and protocols should be evidence-based (Perry & McLaren, 2003). Algorithms also can facilitate early swallowing assessment (Runions, Rodrigue, & White 2004). Dysphagia practice guidelines and protocols that are developed collaboratively by the interdisciplinary team can be clarified and implemented by the dysphagia CNS to provide individualized care. The dysphagia CNS can collaborate with the staff nurse to individualize guidelines, protocols, or algorithms based on the phase or phases of swallowing dysfunction. A template for a nursing plan of care and for documentation can be activated after the initial swallowing assessment has been performed.
Educator Role
A major role for the dysphagia CNS is that of educator. Inservices, dysphagia workshops, and individual instruction all are ways the dysphagia CNS can work with staff nurses. Colodny (2001) found that nurses were compliant with speech and language pathologists' (SLPs) feeding recommendations for dysphagia patients less than 50% of the time. RNs identified a lack of knowledge as the reason for noncompliance, not disagreement with SLP recommendations. By contrast, noncompliance with SLPs' recommendations among CNAs was due to disagreement with their recommendations, not a lack of knowledge. Feeding often becomes one of the first tasks nurses delegate to less-skilled personnel (McHale, Phipps, Horvath, & Schmelz, 1998). CNAs' disagreements may result from their belief that they are the feeding experts. RNs' lack of knowledge regarding feeding techniques for dysphagia patients could support this notion. Bedside swallowing assessments conducted by the dysphagia CNS can inform RNs, LPNs, and CNAs about feeding techniques in a way that creates consensus.
A dysphagia CNS can provide health teaching for dysphagia patients and their families, as well. Lin et al. (2003) conducted a study comparing 40 stroke patients who received swallowing training with a control group of 20 stroke patients who received no swallowing training in terms of direct and indirect therapy. Direct therapy includes positioning, diet textures, and environmental modification. Indirect therapies include thermal stimulation, lip, lingual, and laryngeal exercises. Choking frequency was significantly lower for the experimental group than the control group.
The dysphagia CNS role also would include handson training for nursing personnel at the bedside and didactic sessions in the classroom. Davies (2002) studied the practicality of specially trained nurses who screen patients for the initial signs of dysphagia. This training had three levels: dysphagia nurse 1, dysphagia nurse 2, and the dysphagia clinical specialist. Davies found several differences between the three levels of dysphagia nursing. A dysphagia nurse 1 performed a simple water screen and made referrals to speech and language pathologists for further evaluation. A dysphagia nurse 2 performed a dysphagia assessment using different textures of liquids. Dysphagia nurse specialists evaluated all patients who were found to have dysphagia by a dysphagia nurse 1 or 2. The dysphagia nurse specialist supervised the practice of all the dysphagia nurses and notified speech and language pathologists of any newly identified dysphagia patients and the interventions that currently were in use.
Research Role
The dysphagia CNS also can function as a researcher. Studies evaluating the efficacy of bedside swallowing assessments and management strategies would help bedside nurses recognize effective modalities. Nursing research is needed to explore the relationship between aspiration and pneumonia. Screening tools that have been tested on stroke patients should be modified, if necessary, and validated for patients with MS, Parkinson's disease, Alzheimer's disease, and other neurological conditions for evidence-based practice.
Oral care at mealtime is an area that should be studied. Langmore et al. (1998) identified dependence on others for oral care as a predictor of pneumonia. Wardh, Hallberg, Berggren, and Andersson (2000) found oral health care to be a low priority for nurses working with geriatric patients in nursing homes. A shift in focus among bedside nurses is necessary in light of current research suggesting that good oral health can prevent aspiration pneumonia in the elderly (Marik & Kaplan, 2003). According to Duffy (2002), both nursing-specific outcomes and the contributions that nurses make as members of multidisciplinary teams should be studied. Research should evaluate whether dysphagia is more frequently identified in institutions that employ dysphagia CNSs. The clinical outcome of aspiration pneumonia reduction should be studied in relation to early detection and management by CNSs.
Advertise With Us
We have various options to advertise with us including Events, Advertorials, Banners, Mailers, etc.
Download ETCIO App
Save your favourite articles with seamless studying experience
Get updates on your preferred social platform
Follow us for the latest news, insider access to events and more.
