Preferences, Barriers and Facilitators for Establishing Comprehensive Stroke Units

Strokes are caused by a block in the blood supply to the brain which causes a decrease in oxygen and delivery of other important supplies which facilitate proper functioning. Fifteen million cases are reported worldwide annually, although not all of these cases are mortalities, the large prevalence of strokes ranks it as the fourth leading cause of death in the United States. (Figueroa) Because of the time sensitivity associated with the lack of resources to the brain, strokes are considered a medical emergency and early recognition of symptoms can help decrease the amount of damage caused . Although strokes do not always cause death, strokes most often leave the individual with some physical and cognitive impairment.

In professional experience working at a comprehensive stroke center, early intervention in crucial in decreasing the amount of deficits stroke victims acquire. As I further my education and professional status in the field of Nurse Practitioner, I will be able to participate in in-depth research related to cerebrovascular accidents and quality patient outcomes.

According to the Centers for Disease Control and Prevention (CDC) (2015) every year there are 800,000 individuals who have strokes. There are 610,000 first time cases and 185,000 recurring stroke individuals. It is important for caregivers to note that the increased risk of another stroke is higher after the first (CDC, 2015). It is also critical for the caregiver to ask questions of the physician, such as what aspects physiologically and emotionally have been affected and treatments

Following the introduction, the authors continue into a review of literature in which the cited sources addressed relevance to the study’s variables. The review of literature consisted mainly of primary and current sources, with no citations preceding the article by five years. It is within this section of the article where the authors chose to further discuss the previous research conducted on the variables and how the variables have

Stroke survivors commonly experience medical complications during their rehabilitation stay. Depression, urinary tract infection, and limb pain have been reported as three of the most common complications experienced among stroke survivors (Doshi et al., 2003, McLean, 2004). The use of medical tubes (tracheostromies, enteral feeding tubes, and indwelling urinary catheters), and associated complications, are also on the increase in rehabilitation units (Roth and Lovell, 2003). (Ostwald, Sharon K., et al.,

Stroke is the third leading cause of death, and the leading cause of adult neurologic disability in Canada. After the age of 55, the risk of stroke is doubled every 10 years (Brunner & Day, 2010). Despite advances in stroke management post stroke complications occur. Nurses must focus on developing successful strategies to promote home and community based care for victims of completed stroke in order for them to resume their daily life as safely and independently as possible. Strategies must target prevention of future strokes, since a stroke survivor has a 20% chance of having another stroke within 2 years, and care management after the cerebrovascular accident. Effective strategies must be aimed at restoring patient’s independence by improving physical, mental and emotional functions. Three nursing strategies to promote this include: continuous patient education, patient and/or family goal setting, as well as providing psychosocial support to the patient’s family or primary caregiver(s). This paper will analyze why these three proposed strategies are crucial to promote home and community based care, as well as ways these strategies can be implemented in such settings in order to improve the outcome for post-stroke patients.

Article Summary: In the article “Early Identification, Rapid Response, and Effective Treatment of Acute Stroke: Utilizing Teleneurology to Ensure Optimal Clinical Outcomes” by Patricia Bowens, exhibits the concerns of acute stroke as a universal health issue. Not to mention, the article also introduces teleneurology being implemented in order to establish a conclusive attempt to minimize the condition. For instance, in the article Bowen’s had conducted an experimental analysis which statistically establish a significant disparity among sex, race, and economical conditions. As a result of her study, it appears that seven million Americans are diagnosed with acute stroke over the age of 20. Moreover, gender plays a pivotal role of acquiring this

In my current position as a registered nurse, I have identified improving patient compliance and stroke rehabilitation as an important phenomenon of interest. While researching cerebrovascular accident (CVA) articles, I have a strong desire to enter the field of neuroscience because I feel that there is a great need for reform in stroke awareness and treatment care in the cerebrovascular patients across the nation. In today’s society, Advanced Practice Nurses (APN) are not viewed as a rare commodity but as a representative to physicians across the nation, assisting in many health care needs. APNs are thoroughly accepted by both health care organizations and consumers and serve a vital role in the population overall well-being. Additionally, APNs will become essential as more individuals gain access to broader services through health care reform efforts, and they will serve as attributing members of a flourishing healthcare system. As I transition into my role as an APN, I plan to focus my efforts on managing and coordinating care for the clinically complex neurological and neurosurgical population. This paper will highlight the importance of following stroke guidelines presented by Joint Commission to help increase the health of the population through improved patient compliance and stroke rehabilitation.

To ensure the collaboration of the healthcare providers working with the stroke patients an interdisciplinary team (IDT) approach is utilized. As noted by Clarke & Forster (2015) in an IDT the team members collaborate in setting the patient goals and creating the individual plan of care for each patient. The IDT meets weekly to discuss the patient’s progress and adjusts the plan accordingly. In addition, each member of the IDT is accepting and knowledgeable of the other’s roles and appreciates the need to operate as equals (Clarke & Forster, 2015). The evidence presented and cited above was published in peer reviewed journals, is current and supported the need for the evidenced based plan of care described above.

We have greatly improved our stroke care in the last two years. The Neuro Critical Care has had limited growth except for stroke. Neuro Surgery has had little growth and struggle to cover Trauma at times.

Stroke is one of the leading causes of disability in the world and is increasingly causing more stress and burden on patients and families. After the acute stages of a cerebral vascular attack (CVA) or stroke, patients begin to realize their deficits which may sometimes leave them confused and afraid to go into the community. Rehabilitation is a key focus in recovery to help victims restore their physical function to their maximum potential, as well as develop their psychosocial confidence to be able to integrate into society with a disability. Patients can have an improved recovery from stroke by participating in rehabilitation services in the community and using their support system once discharged from the acute care setting. In this paper, it will be demonstrated that caregivers of stroke patients tend to influence recovery differently. Also, stroke survivors must integrate within their community to continue positive rehabilitation because stroke survivors need a stable environment to flourish in recovery.

Experience with the revascularization procedures emphasizes time is a primary factor for the prediction of clinical outcome. Organizing prehospitalization care is essential to minimize the delay of therapy initiation. Transport to the closest primary stroke center or comprehensive stroke center should be immediate and rapid. It may even involve air medical transport. Implementation of the guidelines for acute care organization shortens the course of procedures in the acute phase of stroke and may improve the patient’s outcome.52 In patients with moderate or severe clinical deficit (NIHSS > 8), performing of vascular intracerebral imaging is advocated to select the subjects with large-vessel occlusion. In such

Assessment will determine and influence the choice of interventions. Deterioration in neurological signs or failure to improve after initial insult may reflect decreased intracranial adaptive capacity requiring patient to be transferred to critical area for monitoring of ICP, other therapies. If the stroke is evolving, patient can deteriorate quickly and require repeated assessment and progressive treatment. If the stroke is “completed,” the neurological deficit is nonprogressive, and treatment is geared toward rehabilitation and preventing recurrence.

Stroke is seen as a major health concern and this is due to the fact that every year, as many as 110,000 individuals suffers from strokes making it a key issue. (NHS 2014)

The objective of this chapter is to describe the procedures used in the analysis of the data and present the main findings. It also presents the different tests performed to help choose the appropriate model for the study. The chapter concludes by providing thorough statistical interpretation of the findings.