Nurses' perceptions and experiences of initiating thrombolysis: a qualitative study.

Nurse-initiated thrombolysis has become established in some trusts for patients presenting to the accident and emergency department or coronary care unit with an acute myocardial infarction. A limited approach to the exploration of this multidimensional expansion in nursing practice is noted in the literature. The aims of this study were to explore the experiential dimensions of nurses who have initiated thrombolysis, if nurses perceive themselves prepared for the role, and whether they consider role expansion a positive or negative experience. A qualitative approach was used. The sample included 12 nurses organizationally sanctioned to autonomously administer a thrombolytic agent, who completed a self-administered, predominantly open-ended questionnaire. Data were analysed using the method described by Giorgi (1997). Two major themes emerged: 'perceived pressure to deliver best practice' and 'developing patient care within a holistic framework', these themes are discussed and underpinned with supporting narratives. Nurses initiating thrombolysis have a desire to engage with delivery of a treatment proven to have a positive impact on individual patient outcomes; they express an overwhelming desire 'to do good' for their patient. Despite struggling with the possibility of adverse patient outcomes, all the nurses felt that their experiences overall were positive and all supported this with examples of practice.

Establishment of stroke treatment plans: one hospital's experience.

Stroke remains one of the major causes of death and permanent disability in the United States, ranking as the third leading cause of death behind heart disease and cancer. It affects an estimated 700,000 persons each year; about two-thirds of those with a new or recurrent stroke survive. The aggregate cost of stroke in the United States is more than $40 billion per year, with an average cost per case of approximately $50,000. With the advent of recombinant tissue-type plasminogen activator (t-PA) for acute stroke, clinical pathways have been developed to provide efficient care to acute stroke patients. Efforts must be aimed at educating the public and all members of the healthcare team about proper stroke care. Surprisingly, only 20%-30% of all hospitals have stroke teams in place. To bring stroke care into the 21st century, this deficiency must be addressed and additional treatment agents such as neuroprotective medications need to be approved.