RESUMEN
Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.
Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.
ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.
Asunto(s)
Humanos , Terapia Trombolítica/enfermería , Accidente Cerebrovascular/enfermería , Atención de EnfermeríaRESUMEN
Objetivo: avaliar as habilidades dos enfermeiros, no uso terapêutico do Alteplase, como terapia fibrinolítica, em pacientes com diagnóstico de infarto agudo do miocárdio. Método: A pesquisa foi realizada por meio de um estudo descritivo transversal, quantitativo, realizado por meio de questionário como instrumento de coleta, contendo 10 questões de múltipla escolha elaboradas pelo autor. A amostra foi constituída por 24 enfermeiros. A coleta de dados foi realizada em julho de 2019, com CAAE n° 13159219.7.0000.5493. Os dados foram analisados e tratados por meio da análise descritiva. Resultado: Os resultados mostraram que os participantes da pesquisa possuem habilidades para o manuseio e aplicabilidade da terapia fibrinolítica, Alteplase, em pacientes acometidos por infarto agudo do miocárdio. Conclusão:Os resultados obtidos demonstram que os enfermeiros possuem habilidade para o manuseio, administração, aplicabilidade do Alteplase, bem como na avaliação dos sintomas e contraindicações do medicamento em pacientes acometidos por Infarto Agudo do Miocárdio. Entretanto, foi identificado uma porcentagem que apresentam dificuldades na execução de todas as atividades. Portanto, o estudo contribuirá na elaboração de protocolos aos profissionais da área da saúde envolvidos de modo direto ou indireto aos cuidados aos pacientes que necessitam desta intervenção farmacológica como tratamento.(AU)
Objective: to evaluate the abilities of nurses in the therapeutic use of Alteplase, as fibrinolytic therapy, in patients diagnosed with acute myocardial infarction. Method: The research was carried out by means of a transversal, quantitative descriptive study, carried out by means of a questionnaire as a collection instrument, containing 10 multiple choice questions elaborated by the author. The sample consisted of 24 nurses. The data collection was carried out in July 2019, with CAAE No. 13159219.7.0000.5493. The data were analyzed and treated through descriptive analysis. Result: The results showed that the research participants have skills for the handling and applicability of fibrinolytic therapy, Alteplase, in patients affected by acute myocardial infarction. Conclusion: The results show that the nurses have skills in the handling, administration and applicability of Alteplase, as well as in the evaluation of the symptoms and contraindications of the drug in patients affected by Acute Myocardial Infarction. However, it was identified a percentage that present difficulties in performing all activities. Therefore, the study will contribute in the elaboration of protocols to the professionals of the health area involved in a direct or indirect way to the care of patients who need this pharmacological intervention as treatment.(AU)
Objetivo: evaluar las capacidades de las enfermeras en el uso terapéutico de la Alteplasa, como terapia fibrinolítica, en pacientes diagnosticados con infarto agudo de miocardio. Material y método: La investigación se realizó mediante un estudio descriptivo cuantitativo transversal, realizado mediante un cuestionario como instrumento de recopilación, que contenía 10 preguntas de opción múltiple preparadas por el autor. La muestra constaba de 24 enfermeras. La recopilación de datos se llevó a cabo en julio de 2019, con el CAAE Nº 13159219.7.0000.5493. Los datos fueron analizados y tratados mediante un análisis descriptivo. Resultado: Los resultados mostraron que los participantes en la investigación tienen habilidades en el manejo y la aplicabilidad del tratamiento fibrinolítico, Alteplase, en pacientes afectados por un infarto agudo de miocardio. Conclusión: Los resultados muestran que las enfermeras tienen aptitudes para el manejo, la administración y la aplicabilidad del Alteplase, así como para la evaluación de los síntomas y las contraindicaciones del fármaco en los pacientes afectados por un infarto agudo de miocardio. Sin embargo, se identificó un porcentaje que presenta dificultades para realizar todas las actividades. Por lo tanto, el estudio contribuirá a la elaboración de protocolos para los profesionales de la salud que participan directa o indirectamente en la atención de los pacientes que necesitan esta intervención farmacológica como tratamiento.(AU)
Asunto(s)
Humanos , Terapéutica , Terapia Trombolítica/enfermería , Activador de Tejido Plasminógeno , Infarto del Miocardio , Enfermería de Urgencia , Servicios Médicos de UrgenciaRESUMEN
The first priority telemedicine programme focused, from 2011, on five areas, with the aim of guaranteeing equal access to care to everybody across a healthcare region. Experiments were financed by public authorities. These practices are now integrated into the organisation of healthcare.
Asunto(s)
Pautas de la Práctica en Enfermería/normas , Telemedicina/normas , Enfermedad Crónica/enfermería , Diagnóstico por Imagen/enfermería , Diagnóstico por Imagen/normas , Humanos , Monitoreo Fisiológico/enfermería , Monitoreo Fisiológico/normas , Pautas de la Práctica en Enfermería/organización & administración , Calidad de la Atención de Salud/organización & administración , Calidad de la Atención de Salud/normas , Telemedicina/organización & administración , Terapia Trombolítica/métodos , Terapia Trombolítica/enfermería , Terapia Trombolítica/normas , Recursos HumanosRESUMEN
BACKGROUND: Stroke centers with limited on-site neurovascular physician coverage may experience delays in acute stroke treatment. We sought to assess the impact of providing 24/7 neurocritical care acute care nurse practitioner (ACNP) "stroke code" first responder coverage on treatment delays in acute stroke patients who received tissue plasminogen activator (tPA). METHODS: Consecutive acute ischemic stroke patients treated with intravenous tPA at a primary stroke center on Oahu between 2009 and 2014were retrospectively studied. 24/7 ACNP stroke code coverage (intervention) was introduced on July 1, 2011. The tPA utilization, door-to-needle (DTN) time, imaging-to-needle (ITN) time, and independent ambulation at hospital discharge were compared between the preintervention period (24 months) and the postintervention period (33 months). RESULTS: We studied 166 stroke code patients who were treated with intravenous tPA, 44 of whom were treated during the preintervention period and 122 of whom were treated during the postintervention period. After the intervention, the median DTN time was reduced from 53 minutes (interquartile range [IQR] 45-73) to 45 minutes (IQR 35-58) (P = .001), and the median ITN time was reduced from 36 minutes (IQR 28-64) to 21 minutes (IQR 16-31) (P < .0001). Compliance with the 60-minute target DTN improved from 61.4% (27 of 44 patients) in the preintervention period to 81.2% (99 of 122 patients) in the postintervention period (P = .004). The tPA treatment rates were similar between the preintervention and postintervention periods (P = .60). CONCLUSIONS: Addition of 24/7 on-site neurocritical care ACNP first responder coverage for acute stroke code significantly reduced the DTN time among acute stroke patients treated with tPA.
Asunto(s)
Atención Posterior , Enfermería de Cuidados Críticos , Fibrinolíticos/administración & dosificación , Enfermeras Practicantes , Admisión y Programación de Personal , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica/enfermería , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Anciano de 80 o más Años , Femenino , Hawaii , Humanos , Infusiones Intravenosas , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Evaluación de Programas y Proyectos de Salud , Recuperación de la Función , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Remoción de Dispositivos/instrumentación , Remoción de Dispositivos/enfermería , Embolectomía/instrumentación , Embolectomía/enfermería , Stents , Accidente Cerebrovascular/enfermería , Trombectomía/instrumentación , Trombectomía/enfermería , Terapia Trombolítica/instrumentación , Terapia Trombolítica/enfermería , Diseño de Equipo , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Atrial fibrillation (AF) is a frequent cause of acute ischemic stroke that results in severe neurological disability and death despite treatment with intravenous thrombolysis (intravenous recombinant tissue plasminogen activator [rtPA]). We performed a retrospective review of a single-center registry of patients treated with intravenous rtPA for stroke. The purposes of this study were to compare intravenous rtPA treated patients with stroke with and without AF to examine independent predictors of poor hospital discharge outcome (in-hospital death or hospital discharge to a skilled nursing facility, long-term acute care facility, or hospice care). A univariate analysis was performed on 144 patients receiving intravenous rtPA for stroke secondary to AF and 190 patients without AF. Characteristics that were significantly different between the two groups were age, initial National Institutes of Health Stroke Scale score, length of hospital stay, gender, hypertension, hyperlipidemia, smoking status, presence of large cerebral infarct, and hospital discharge outcome. Bivariate logistic regression analysis indicated that patients with stroke secondary to AF with a poor hospital discharge outcome had a greater likelihood of older age, higher initial National Institutes of Health Stroke Scale scores, longer length of hospital stay, intubation, and presence of large cerebral infarct compared with those with good hospital discharge outcome (discharged to home or inpatient rehabilitation or signed oneself out against medical advice). A multivariate logistic regression analysis showed that older age, longer length of hospital stay, and presence of large cerebral infarct were independent predictors of poor hospital discharge outcome. These predictors can guide nursing interventions, aid the multidisciplinary treating team with treatment decisions, and suggest future directions for research.
Asunto(s)
Fibrilación Atrial/enfermería , Infarto Cerebral/enfermería , Alta del Paciente , Evaluación del Resultado de la Atención al Paciente , Terapia Trombolítica/enfermería , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/mortalidad , Infarto Cerebral/etiología , Infarto Cerebral/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Evaluación en Enfermería , Casas de Salud , Transferencia de Pacientes , Proteínas Recombinantes/administración & dosificación , Estudios Retrospectivos , Medición de RiesgoRESUMEN
Delay seeking medical assistance for acute ischemic stroke remains a barrier to the provision of optimal care, including the administration of tissue plasminogen activator. Although women report greater knowledge of stroke symptoms and stroke risk factors than men, earlier hospital arrival in women has not been consistently reported. The purposes of this study were to examine women's interpretation of stroke symptoms and compare cognitive and behavioral responses between women who arrived at the hospital within 3 hours of symptom onset and women who arrived after 3 hours. More than half of the participants arrived at the hospital greater than 3 hours after first noticing symptoms. Most women did not recognize the cause of symptoms. Knowledge about a treatment of stroke was limited, and a minority of the women knew they were at risk for stroke despite having known risk factors. Maladaptive responses to symptoms were reported more frequently by women with hospital arrival greater than 3 hours after symptom onset than by women with earlier arrival. Efforts are needed to reduce maladaptive responses to stroke onset that may contribute to delay seeking medical assistance for the symptoms of acute ischemic stroke.
Asunto(s)
Actitud Frente a la Salud , Concienciación , Infarto Cerebral/enfermería , Infarto Cerebral/psicología , Diagnóstico Precoz , Intervención Médica Temprana , Identidad de Género , Alfabetización en Salud , Adaptación Psicológica , Anciano , Infarto Cerebral/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Educación del Paciente como Asunto , Proyectos Piloto , Recurrencia , Encuestas y Cuestionarios , Terapia Trombolítica/enfermería , Terapia Trombolítica/psicologíaRESUMEN
No instruments are currently available to help health systems identify target areas for reducing door-to-needle times for the administration of intravenous tissue plasminogen activator to eligible patients with ischemic stroke. A 67-item Likert-scale survey was administered by telephone to stroke personnel at 252 U.S. hospitals participating in the "Get With The Guidelines-Stroke" quality improvement program. Factor analysis was used to refine the instrument to a four-factor 29-item instrument that can be used by hospitals to assess their readiness to administer intravenous tissue plasminogen activator within 60 minutes of patient hospital arrival.
Asunto(s)
Infarto Cerebral/enfermería , Intervención Médica Temprana/organización & administración , Adhesión a Directriz , Terapia Trombolítica/enfermería , Activador de Tejido Plasminógeno/administración & dosificación , Infarto Cerebral/terapia , Eficiencia Organizacional , Humanos , Infusiones Intravenosas , Admisión del Paciente , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad , Estudios de Tiempo y Movimiento , Flujo de TrabajoRESUMEN
BACKGROUND: Patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) are at risk of early death. This may be reduced by timely assessment and treatment. OBJECTIVES: The purpose of this study was to evaluate if Nurse-led Early Triage (NET) in the coronary care unit (CCU) can improve time to assessment and management of NSTE-ACS patients. METHODS: Data on 79 consecutive chest pain patients admitted pre-NET to the acute admissions unit (AAU) and on 103 patients admitted in the first six months of the NET service in CCU, was re-examined and compared to subsequent data obtained on 92 patients admitted via NET five years later, in order to re-evaluate the service. RESULTS: NET resulted in significant improvements in: the number of patients with chest pain who had their 12-lead electrocardiogram (ECG) performed within 10 min of admission (94% vs 32%, p<0.001); the number of high-risk NSTE-ACS patients prescribed clopidogrel (72% vs 42%, p<0.01); and the number being managed in CCU (82% vs 34%, p<0.01). Comparison of the NET service at five years with the pre-NET service demonstrated measurable benefits were sustained (p<0.01) for the same comparative end points. There were no significant differences in these end-points of time to ECG, clopidogrel prescription nor management in CCU for high-risk patients between the NET groups at six months and five years, demonstrating that current triage is as effective as when first introduced. CONCLUSIONS: This study demonstrated the positive impact of nurse-led early triage for NSTE-ACS patients and that initial benefits have been sustained.
Asunto(s)
Síndrome Coronario Agudo/enfermería , Enfermería Cardiovascular/organización & administración , Unidades de Cuidados Coronarios/organización & administración , Triaje/organización & administración , Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/mortalidad , Anciano , Anciano de 80 o más Años , Enfermería Cardiovascular/métodos , Dolor en el Pecho/tratamiento farmacológico , Dolor en el Pecho/mortalidad , Dolor en el Pecho/enfermería , Vías Clínicas/organización & administración , Electrocardiografía , Práctica Clínica Basada en la Evidencia/métodos , Práctica Clínica Basada en la Evidencia/organización & administración , Femenino , Mortalidad Hospitalaria , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Infarto del Miocardio/enfermería , Evaluación en Enfermería/métodos , Evaluación en Enfermería/organización & administración , Factores de Riesgo , Terapia Trombolítica/enfermería , Triaje/métodosRESUMEN
INTRODUCTION: Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is the standard of care for patients exhibiting signs of acute ischemic stroke. IV rt-PA uses weight-based dosing, and often an estimated weight is used. The clinical effects of using estimated weight in dosing IV rt-PA remain unclear. The goal of this descriptive study was to determine if there was a significant difference in estimated versus actual weight dosing of rt-PA. METHODS: A retrospective chart review was performed to compare estimated versus actual patient weight. The sample consisted of patients from the hospital database who received IV rt-PA during June 2009-June 2010. Patients were included if they presented to the emergency department with stroke symptoms, received IV rt-PA, and had documented estimated and actual weights. Recorded (prescribed) dosing of IV rt-PA was compared with the suggested dosing using the admission weight. The differences between the weights and doses were calculated, analyzed, and categorized as being underdosed or overdosed. RESULTS: Twenty-six charts met the inclusion criteria. Using descriptive statistics and tests of difference, the mean estimated weight was 79.9 kg (±3.92 kg) and the mean actual weight was 78.5 kg (±3.86 kg); four patients had an estimated weight discrepancy of ≥5 kg. Six had correct estimated dosing; however, all of these patients were greater than 100 kg and received the maximum dose of 90 mg. Eleven patients' estimated weights were underestimated, resulting in underdosing of IV rt-PA. Nine estimated weights were overestimated, leading to overdosing of the medication, but none of the dosing overages exceeded 10%. No statistical significance was found between the two groups' estimated weights or dosing errors, t(26) = 0.69, p = .79. DISCUSSION: Results from this study found documented estimated weights were not significantly different from actual weights and the precision of estimated weight were similar to weights obtained using a scale. Despite these results, methods for obtaining actual weights in the emergency department for high-risk patients should be explored.
Asunto(s)
Peso Corporal , Enfermería de Urgencia/métodos , Proteínas Recombinantes/administración & dosificación , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/enfermería , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Terapia Trombolítica/métodos , Terapia Trombolítica/enfermeríaAsunto(s)
Terapia Trombolítica , Arteriopatías Oclusivas/tratamiento farmacológico , Arteriopatías Oclusivas/etiología , Circulación Sanguínea/efectos de los fármacos , Fibrinolíticos/administración & dosificación , Humanos , Infarto del Miocardio/complicaciones , Estreptoquinasa/administración & dosificación , Terapia Trombolítica/clasificación , Terapia Trombolítica/enfermería , Activador de Tejido Plasminógeno/administración & dosificaciónRESUMEN
A isquemia aguda de membros pode se manifestar, embora de forma incomum, como consequência à vasculite associada ao vírus da imunodeficiência humana (HIV). O presente caso descreve a evolução de uma paciente soropositiva para o HIV, que apresentou quadro de isquemia distal bilateral, com diminuição da temperatura de terço distal das pernas e pés, dor intensa, cianose fixa de pododátilos e ausência de pulsos distais. Submetida ao tratamento com terapia trombolítica, apresentou sinais de lesões decorrentes da isquemia e lesão tecidual de reperfusão com perda tecidual em regiões distais dos dedos, porém com melhora dos sinais e sintomas dos membros inferiores. Trata-se de um caso raro na literatura em função da associação da vasculite com o HIV e do acometimento dos vasos distais nos membros inferiores. Entretanto, o conhecimento desta associação é de extrema importância devido à repercussão na vida dos pacientes acometidos.
The acute limb ischemia may manifest itself, albeit unusual, as a consequence of vasculitis associated with human immunodeficiency virus (HIV). This case report described a patient seropositive for HIV who developed bilateral distal ischemia with temperature decrease of distal legs and feet, severe pain, cyanosis of fixed toes, and absence of distal pulses. She underwent treatment with thrombolytic therapy, showed signs of injury resulting from ischemia and reperfusion tissue injury with tissue loss in the distal regions of the fingers, but with improvement of the signs and symptoms of lower limbs. It is a rare case in literature due to the association of vasculitis with HIV and to the torment of distal vases of the lower limbs. Despite of that, the knowledge of the pathology is extremely important because of the repercussion in the patients' lives.
Asunto(s)
Humanos , VIH , Isquemia/sangre , Isquemia/terapia , Terapia Trombolítica/enfermería , Vasculitis/complicaciones , Extremidad InferiorRESUMEN
Stroke is currently the 3rd leading cause of death in the United States and is the leading cause of severe, long-term disability. With the advent of recombinant tissue plasminogen activator/alteplase, there is a treatment option for ischemic stroke. Unfortunately, only a small number of eligible patients receive this treatment. Whereas much research has been performed on barriers to treatment related to prehospital delays, less research has been performed on in-hospital delays related to hospital staff's perceptions of stroke patients. In this qualitative exploratory study, focus group interviews were conducted to examine emergency nurses' experiences in caring for stroke patients. A convenience sample was recruited using flyers distributed in the emergency department. Three groups of emergency nurses were interviewed in a private location within the facility. The 30-minute, semistructured interviews included 2 to 4 emergency nurses and were moderated by the investigator. Individual transcripts were analyzed for trends, patterns, and recurring themes. Three major themes regarding barriers to and facilitators of stroke care emerged: (a) nurses' comfort with assessment of stroke patients, (b) feedback regarding nurse performance and patient outcomes; and (c) environmental issues such as staffing, competing priorities, and patient and family needs. Despite the various challenges facing emergency nurses, all groups verbalized a desire to provide excellent care to these patients. Further research is recommended to address these challenges and to explore potential solutions identified in this study to improve the care of stroke patients.
Asunto(s)
Actitud del Personal de Salud , Infarto Cerebral/enfermería , Enfermería de Urgencia , Accesibilidad a los Servicios de Salud , Accidente Cerebrovascular/enfermería , Terapia Trombolítica/enfermería , Adulto , Retroalimentación , Femenino , Grupos Focales , Alemania , Hemiplejía/enfermería , Humanos , Entrevista Psicológica , Persona de Mediana Edad , Evaluación en Enfermería , Resultado del TratamientoRESUMEN
Acute stroke can result in neurological impairment or death. The Colorado Stroke Alliance and the Colorado Stroke Registry have made progress toward improving stroke care through their statewide quality improvement efforts. This report is a follow-up to a previous publication in the Journal of Neuroscience Nursing. The previous report focused on the organization and structure of the Colorado Stroke Alliance. The present report describes some of the successes and insights that have been achieved, including adherence to stroke quality indicators, gender disparities, process times for intravenous recombinant tissue plasminogen activator/alteplase, the impact of emergency medical services, and the role that nurses continue to have as agents of change in improving hospital care.
Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administración , Sistema de Registros , Planes Estatales de Salud/organización & administración , Accidente Cerebrovascular/enfermería , Colorado , Conducta Cooperativa , Medicina Basada en la Evidencia , Fibrinolíticos/uso terapéutico , Adhesión a Directriz , Disparidades en Atención de Salud , Humanos , Comunicación Interdisciplinaria , Evaluación de Resultado en la Atención de Salud , Guías de Práctica Clínica como Asunto , Accidente Cerebrovascular/mortalidad , Análisis de Supervivencia , Terapia Trombolítica/enfermería , Activador de Tejido Plasminógeno/uso terapéuticoAsunto(s)
Conducta Cooperativa , Hospitales Especializados/organización & administración , Comunicación Interdisciplinaria , Grupo de Atención al Paciente/organización & administración , Accidente Cerebrovascular/enfermería , Enfermería de Urgencia , Medicina Basada en la Evidencia/organización & administración , Georgia , Implementación de Plan de Salud/organización & administración , Humanos , Capacitación en Servicio/organización & administración , Unidades de Cuidados Intensivos , Mejoramiento de la Calidad/organización & administración , Terapia Trombolítica/enfermeríaRESUMEN
Stroke is a frequent emergency faced by Emergency Department (ED) staff. Evidence produced from significant trials has led to the introduction of stroke thrombolysis across the world. Campaigns to increase public awareness that 'stroke is a medical emergency,' have led to emergency departments facing necessary adjustment, re-allocation of resources and education of staff. From a review of the associated literature, barriers to implementation of the service include; non-recognition of stroke, inappropriate triage of these patients by both ED staff and ambulance personnel, delays in obtaining neuro-imaging, and inefficient processes of in-hospital emergency stroke care. Further study is required to review the educational needs and resource management, as well as the efficacy of the public education in stroke.
Asunto(s)
Difusión de Innovaciones , Servicio de Urgencia en Hospital , Tratamiento de Urgencia , Necesidades y Demandas de Servicios de Salud/organización & administración , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Eficiencia Organizacional , Enfermería de Urgencia , Servicio de Urgencia en Hospital/organización & administración , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/enfermería , Tratamiento de Urgencia/estadística & datos numéricos , Medicina de Emergencia Basada en la Evidencia , Educación en Salud , Humanos , Selección de Paciente , Personal de Hospital/educación , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Terapia Trombolítica/métodos , Terapia Trombolítica/enfermería , Terapia Trombolítica/estadística & datos numéricos , Factores de Tiempo , Triaje , Reino Unido/epidemiologíaRESUMEN
Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease, myocardial infarction and cardiovascular death. Management of patients with CKD presenting with acute coronary syndromes is more complex than in the general population, due to greater diagnostic uncertainty and the lack of direct evidence for therapeutic interventions in this specific population, coupled with concerns about therapy-related adverse effects. However, these patients potentially have much to gain from conventional revascularisation strategies used in the general population. This review summarises the current evidence regarding the treatment of patients with CKD presenting with acute coronary syndromes, in particular with respect to coronary revascularisation strategies.
Asunto(s)
Síndrome Coronario Agudo/enfermería , Síndrome Coronario Agudo/terapia , Angioplastia Coronaria con Balón/enfermería , Fallo Renal Crónico/enfermería , Fallo Renal Crónico/fisiopatología , Revascularización Miocárdica/enfermería , Stents , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Tasa de Filtración Glomerular/fisiología , Mortalidad Hospitalaria , Humanos , Fallo Renal Crónico/mortalidad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/enfermería , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Tasa de Supervivencia , Terapia Trombolítica/enfermeríaRESUMEN
Despite stroke being the third leading cause of death and a leading cause of disability in the United States, less than 7% of stroke survivors receive tissue plasminogen activator (tPA) in the treatment of acute stroke. The purpose of this review was to determine what research is available on barriers to tPA use and to determine gaps in the literature. A search of the literature was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed. Keywords were stroke, emergency, nursing, thrombolytics, cerebrovascular accident, ischemia, intervention, tPA, and barriers. Pertinent references from articles obtained were searched as well. The search yielded 45 articles for review. Barriers to tPA use were found in both prehospital and in-hospital settings. Prehospital delays were related to contacting primary care physicians, mode of arrival to the hospital, and survivors' lack of knowledge regarding stroke. Sources of in-hospital delays included non-stroke center status, lack of training of emergency department staff, delays in computed tomography scans, and poor understanding regarding priority stroke treatment (e.g., mild or improving symptoms and disparities related to age, gender, and race). Future research to evaluate the impact of nursing care and attitudes toward stroke patients on the administration of tPA is recommended.