Date of Completion


Embargo Period



Dysphagia, Swallow Screen, 3-ounce, Nursing, Nursing Administration

Major Advisor

Carl Coelho, Ph.D.

Associate Advisor

Rachel Theodore, Ph.D.

Associate Advisor

Steven Leder, Ph.D.

Field of Study

Communication Sciences


Doctor of Philosophy

Open Access

Open Access



Accurate and timely evaluation of swallowing is necessary to determine how to safely administer medications, maintain adequate nutrition and hydration, and avoid deleterious sequelae of prandial aspiration pneumonia. Use of a validated and reliable screening tool for determination of aspiration risk is a critical component of dysphagia management. The 3-ounce water swallow challenge (Suiter & Leder, 2008) is a validated and reliable screening tool that is well supported in the literature.

Statement of the Problem

While use of the 3-ounce water swallow challenge (Suiter & Leder 2008) administered by speech-language pathologists (SLPs) is supported by current research, who else should administer and interpret the challenge is not addressed. Therefore, health care professionals other than SLPs, i.e., registered nurses, should be involved in screening for aspiration risk (Bours et al., 2008). Deficiencies in current nurse administered screens are a barrier to this practice change.


There is a paucity of literature supporting nursing administration of validated screening tools for determining aspiration risk in hospitalized patients. Current practice involving administration of swallow screens by nurses is comprised of investigations that utilize largely non-evidenced based variables.

Research Purpose

This study investigated accuracy of a registered nurse administered 3-ounce water swallow challenge with hospitalized patients deemed at-risk for prandial aspiration compared with blinded ratings from speech-language pathology.


Patients were administered the 3-ounce water swallow challenge protocol by a SLP. The nurse then administered the screen to the same patient within 1 hour and independently recorded results and diet recommendations. Simultaneous with the nurse administered screen, a SLP re-rated the patient’s 3-ounce challenge for comparison with initial results as well as determined accuracy of the nurse administered screen.


Intra- and inter-rater agreements for the two speech-language pathologists were 100% (Cohen’s kappa of 1.0). Inter-rater agreement between registered nurses and speech-language pathologists was 98.01% (Cohen’s kappa of 0.95).


Results confirm the reliability and accuracy of a registered nurse administered swallow screen. The finding of 98% agreement (Cohen’s kappa 0.95) combined with previously reported 96.5% sensitivity, 97.9% negative predictive value, and ≤ 2% false negative rate support adoption of the 3-ounce challenge for the general hospital population.