Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

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.

Assessing care dependence status and associated influencing factors among middle-aged hemiplegic stroke patients during the post-acute rehabilitation phase: A correlational study.

AIMS: To comprehensively examine the prevailing condition of care dependence among middle-aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post-acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon. DESIGN: A single-centre, cross-sectional study design. METHODS: During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease-related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods. RESULTS: The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke. CONCLUSION: The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice. RELEVANCE TO CLINICAL PRACTICE: The incidence of care dependence in middle-aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post-acute rehabilitation period and improve the quality of life of hemiplegia patients. REPORTING METHOD: Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies (see Table S1). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Interventions for improving psychosocial well-being after stroke: A systematic review.

BACKGROUND: Up to one third of all stroke patients suffer from one or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocial well-being after stroke. Currently it is not known which interventions are effective and what aspects of these interventions are most effective to improve psychosocial well-being after stroke. OBJECTIVE: To identify potentially effective interventions - and intervention components - which can be delivered by nurses to improve patients' psychosocial well-being after stroke. METHODS: A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019-April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data. RESULTS: In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, and medication management. Active information and physical exercise were identified as effective methods of delivery. DISCUSSION: The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being. FUNDING AND REGISTRATION: This study was supported by the Taskforce for Applied Research SIA (RAAK.PUB04.010). This review was not registered.

Reabilitação cognitiva à pessoa com acidente vascular cerebral: intervenção do enfermeiro especialista em enfermagem de reabilitação / Cognitive rehabilitation for people with stroke: intervention by the rehabilitation nurse

A mortalidade por Acidente Vascular Cerebral (AVC) no mundo e em Portugal, encontra-se em decréscimo nas últimas décadas. Contudo, a taxa de incidência tem apresentado um comportamento contrário. Do AVC decorrem alterações neurológicas, constituindo-se como um acontecimento crítico que despoleta no indivíduo/família, um processo de transição. As alterações da função cognitiva, apresentam impacto na funcionalidade, autonomia e qualidade de vida: provocam uma redução na eficiência do funcionamento, diminuição da performance nas Atividades da Vida Diária (AVD) e dificuldade de adaptação. A reabilitação cognitiva baseia-se na neuroplasticidade, ou seja, promove processos de reestruturação, investindo na capacidade do Sistema Nervoso Central em modificar-se e reorganizar-se a nível estrutural e funcional. Os cuidados do Enfermeiro Especialista em Enfermagem de Reabilitação (EEER) à pessoa com AVC, iniciam-se com uma avaliação neurológica sistematizada e criteriosa, para mensuração dos défices e dos ganhos em saúde obtidos através da implementação de programas de reabilitação que incluam a dimensão cognitiva. Estes planos de cuidados contemplam a execução de tarefas terapêuticas exercitadas repetidamente, relacionadas com o autocuidado e/ou direcionadas para o treino da função lesada. As estratégias de intervenção do EEER podem ser de reestruturação ou compensatórias e é a sua mobilização conjugada que torna o programa de reabilitação mais efetivo. Sobre a reabilitação cognitiva, não existem estudos que comprovem inequivocamente as vantagens e os ganhos em saúde e da funcionalidade da pessoa. No entanto, por não existir impacto negativo, devem ser implementados estes programas de reabilitação, porque haverá maior probabilidade de trazer algum benefício comparativamente com a não atuação. O Relatório de Estágio constitui-se como um instrumento metodológico, que sintetiza as aprendizagens e demonstra o desenvolvimento de competências comuns e específicas do EEER, através da descrição, análise e reflexão das atividades realizadas durante o Ensino Clínico, que decorreu em contexto hospitalar e comunitário.

Mortality from Stroke in the world and in Portugal has been decreasing in recent decades. However, the incidence rate has shown an opposite behavior. A stroke results in neurological changes, constituting a critical event that triggers a transition process in the individual/family. Changes in cognitive function have an impact on functionality, autonomy, and quality of life: it causes a reduction in functioning efficiency, decreased performance in Activities of Daily Living (ADL) and difficulty in adapting. Cognitive rehabilitation is based on neuroplasticity, which promotes restructuring processes, investing in the ability of the Central Nervous System to modify and reorganize itself at a structural and functional level. The care provided by the Nurse Specialist in Rehabilitation Nursing (EEER) to the person with stroke begins with a systematic and careful neurological assessment, to measure the deficits and health gains obtained through the implementation of rehabilitation programs that include the cognitive dimension. These care plans contemplate the execution of therapeutic tasks exercised repeatedly, related to self-care and/or directed to the training of the injured function. The EEER intervention strategies can be restructuring or compensatory and it is their combined mobilization that makes the rehabilitation program more effective. About cognitive rehabilitation, there are no studies that unequivocally prove the advantages and gains in health and functionality of the person. However, as there is no negative impact, these rehabilitation programs should be implemented, as they will be more likely to bring some benefit compared to not acting. This report is a methodological instrument, which summarizes the learning and demonstrates the development of common and specific competences of the RNS, through the description, analysis and reflection of the activities carried out during the internships, which took place in a hospital and community context.

The effect of nursing and rehabilitation measures on quality of life and expression of Bax/Bcl2 genes in patients with stroke.

Stroke is the leading cause of neurological problems and the third leading cause of death globally, leading to various neurological defects. Due to the importance of applying nursing and rehabilitation measures to reduce complications in these patients, a study was conducted to determine the effect of nursing and rehabilitation measures on the quality of life of patients with stroke. This two-stage experimental study (before and after) was performed on 20 patients with stroke admitted to the internal medicine department. Patients were selected by sampling method, which had inclusion criteria. Data were collected using a questionnaire based on the quality of life in four areas of physical, mental, general health, and social functioning before and after the intervention. Real-Time PCR measured the expression of Bcl2 / Bax genes. Descriptive and inferential statistics analyzed the data. The results showed that the mean quality of life scores in physical function, psychological, social position, and general health after nursing and rehabilitation measures increased significantly (p = .05). Also, the quality of life score after these measures had a significant increase compared to before (p = .05). Also, a significant increase was observed in the expression ratio of the Bcl2 / Bax genes in the study group compared to the control group, which indicates the effect of nursing and rehabilitation measures on cerebral ischemia. The findings showed that the application of nursing and rehabilitation measures positively affects various aspects of patients' quality of life with stroke. These programs should be provided while educating patients and their families to help them achieve greater independence in the future.

When interactions are interruptions: an ethnographic study of information-sharing by speech and language therapists and nurses on stroke units.

PURPOSE: To explore how the information-sharing context influences how speech and language therapy (SLT) and nursing staff interact on stroke units and what they discuss. METHODS: Ethnographic methodology was used, with data collected during 40 weeks of fieldwork across three inner city stroke units in the UK. Data comprised field notes collected during 357 h of participant observation and 43 interviews. Interviews were conducted with 14 SLTs, 1 SLT assistant, 24 registered nurses and 4 nursing assistants. RESULTS: This paper is focused on informal information-sharing. SLTs and nurses had different experiences of time and space (the temporal-spatial context) with respect to ward presence and proximity to patients, influencing how they interacted, the content of their talk and their relationships. Most interactions had the quality of interruptions, in which SLTs seized moments in between nursing tasks. Conditions were less suited to sharing information about communication than swallowing and SLTs felt more allied to other therapists than nurses. CONCLUSION: The temporal-spatial context impeded information-sharing, particularly about patients' communication needs. Consideration should be given to developing relationships between SLTs and nurses as key partners for patient care and raising the profile of communication information in ways that are relevant and useful to nursing work.Implications for rehabilitationStrategic waiting for opportunities to interrupt nurses and gain their attention is central to how speech and language therapists manage their need to share information informally with nurses.The small "windows in time" available for interaction influence information-sharing, with a limiting effect on information about patients' communication.There is potential to improve information-sharing between speech and language therapists and nurses by considering how the relevance of information for patient care could be made clearer.

Cuidando en el hogar a una persona con enfermedad cerebrovascular:del desconocimiento a la satisfacción / Cuidando de uma pessoa com doença cerebrovascular em casa: da ignorância àsatisfação / Caring a Person with Cerebrovascular disease at home: from the lack knowledge to satisfaction

Introduction: cerebrovascular diseases generate disability and dependence. It is the familycaregiver who assumes responsibility for the daily care of the patient with sequelae of this disease.Assuming this new role is not an easy activity and requires preparation and accompaniment.295Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62Objective: to know the experience of the family caregiver when they first take care of a personwith sequelae of a stroke at home. Methodology: qualitative study with a grounded theoryapproach. 16 family caregivers participated. The information was collected through semistructured interviews. The data analysis was done with initial, focused, axial and theoreticalcoding. Results: five categories were identified: Taking care of my family: a new experience,Changing the environment: making the experience easier, Support from others: feeling companyin care, Feeling satisfaction: the result of care well done and Living care: between fear, faith andlove. The central category was called Caring at home: from lack of knowledge to satisfaction.Conclusions: the experience of caring for the first time represents a challenge for the familycaregiver to create new strategies that favor caring for the person. Nursing professionals have theresponsibility of designing nursing interventions that meet the specific needs of this population.

Introducción: las enfermedades cerebrovasculares generan discapacidad y dependencia. Es elcuidador familiar quien asume la responsabilidad del cuidado diario de la persona con secuelasde esta enfermedad. El asumir este nuevo rol no es una actividad sencilla y requiere de preparacióny acompañamiento. Objetivo: comprender la experiencia del cuidador familiar cuando asume porprimera vez el cuidado en el hogar de una persona con secuelas de un accidente cerebrovascular.Metodología: estudio cualitativo con enfoque de teoría fundamentada. Participaron 16 cuidadoresfamiliares. Se recolectó la información por entrevistas semiestructuradas. El análisis de los datosse hizo con codificación inicial, focalizada, axial y teórica. Resultados: se identificaron cincocategorías: Asumiendo el cuidado de mi familiar: una nueva experiencia, Cambiando el entorno:haciendo más fácil la experiencia, El apoyo de otros: sintiendo compañía en el cuidado, Sintiendosatisfacción: el resultado de un cuidado bien hecho y Viviendo el cuidado: entre el miedo, la fe yel amor. La categoría central se denominó Cuidando en el hogar: desde la falta de conocimientoa la satisfacción. Conclusiones: la experiencia de cuidar por primera vez representa para elcuidador familiar un reto para crear nuevas estrategias que favorezcan el cuidado de la persona.Los profesionales de enfermería tienen la responsabilidad de diseñar intervenciones de enfermeríaque atiendan las necesidades específicas de esta población.

Introdução: as doenças cerebrovasculares geram incapacidade e dependência. É ocuidador familiar que assume a responsabilidade pelo cuidado diário ao pessoa comsequelas desta doença. Assumir este novo papel não é uma atividade fácil e requerpreparação e acompanhamento. Objetivo: conhecer a vivência do cuidador familiar aocuidar pela primeira vez de uma pessoa com sequela de AVE no domicílio. Metodologia:estudo qualitativo com abordagem teórica fundamentada. Participaram 16 cuidadoresfamiliares. As informações foram coletadas por meio de entrevistas semiestruturadas. A análisedos dados foi realizada com codificação inicial, focada, axial e teórica. Resultados: foramidentificadas cinco categorias: Cuidar do meu familiar: uma nova experiência, Mudar o ambiente:296Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62tornar a experiência mais fácil, O apoio dos outros: sentir-se companhia no cuidado, Sentir-sesatisfeito: o resultado de um cuidado bem feito , Viver o cuidado: entre o medo, a fé e o amor.Conclusões: a experiência de cuidar pela primeira vez representa um desafio para o cuidadorfamiliar criar novas estratégias que favoreçam o cuidar da pessoa. Os profissionais deenfermagem têm a responsabilidade de projetar intervenções de enfermagem que atendam àsnecessidades específicas desta população.

Nursing's Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community.

Facilitating successful care transitions across settings is a key nursing competency. Although we have achieved improvements in acute stroke care, similar advances in stroke care transitions in the postacute and return to community phases have lagged far behind. In the current delivery system, care transitions are often ineffective and inefficient resulting in unmet needs and high rates of unnecessary complications and avoidable hospital readmissions. Nurses must use evidence-based approaches to prepare stroke survivors and their family caregivers for postdischarge self-management, rehabilitation, and recovery. The purpose of this article is to provide evidence on the important nursing roles in stroke care and transition management across the care continuum, discuss cross-setting issues in stroke care, and provide recommendations to leverage nursing's impact in optimizing outcomes for stroke survivors and their family unit across the continuum. To optimize nursing's influence in facilitating safe, effective, and efficient care transitions for stroke survivors and their family caregivers across the continuum we have the following recommendations (1) establish a system of coordinated and seamless comprehensive stroke care across the continuum and into the community; (2) implement a stroke nurse liaison role that provides consultant case management for the episode of care across all settings/services for improved consistency, communication and follow-up care; (3) implement a validated caregiver assessment tool to systematically assess gaps in caregiver preparedness and develop a tailored caregiver/family care plan that can be implemented to improve caregiver preparedness; (4) use evidence-based teaching and communication methods to optimize stroke survivor/caregiver learning; and (5) use technology to advance stroke nursing care. Nurses must leverage their substantial influence over the health care delivery system to achieve these improvements in stroke care delivery to improve the health and lives of stroke survivors and their families.

Exploring community-dwelling stroke survivors' experiences of receiving a nurse-led theory-based stroke self-management programme: A qualitative study.

ABSTRACT: International evidence-based guidelines recommend self-management support for stroke survivors to improve their health outcomes. We developed a 4-week nurse-led stroke self-management programme (SSMP) and conducted a randomised controlled trial to assess its effects. This paper reports the findings of a qualitative study nested within the randomised controlled trial to explore stroke survivors' experiences of SSMP participation. Semi-structured interviews were conducted with all adult participants who were clinically diagnosed with a first or recurrent ischaemic or haemorrhagic stroke, residing at home, communicable in Cantonese, had a Montreal Cognitive Assessment score below the second percentile, and participated in at least 1 SSMP session. All interviews were conducted in Cantonese, lasted approximately 45 minutes, and were audio-recorded. Interview data were transcribed verbatim and analysed thematically. Sixty-four stroke survivors (mean age 66.33 years, SD 12.34) were recruited, and 59 were interviewed via phone immediately after completion of SSMP. Three themes were derived. Overall, participants were satisfied with the SSMP. Their understanding of self-management was improved, and they recognised its importance in recovery. Their confidence in self-management was also enhanced through the use of multifaceted strategies. Suggestions were made to enhance their participation experiences, including increased home visits and group sessions, making group session attendance optional and arranging them more accessibly, meeting the survivors who shared their survival experiences in the videos, and access to the videos online. This study concurred that the SSMP enhanced stroke survivors' self-efficacy in self-management. Rearrangement of the programme format and enhancements in accessibility could be further examined to enable more effective stroke self-management.

The application value of continuous nursing intervention on quality of life in patients with stroke: A protocol for systematic review and meta-analysis.

BACKGROUND: Individual characteristics, physical function disability, emotional, as well as cognitive symptoms, along with the general health discernment might be associated or impact the quality of life of patients suffering from stroke directly or indirectly. Appropriate continuous nursing intervention is required to enhance the quality of life of patients with stroke. Therefore, the present study will be conducted to systematically investigate the application value of continuous nursing intervention for improving the quality of life of patients experiencing stroke. METHODS: We will conduct a comprehensive search of electronic databases such as MEDLINE, Cochrane Library, CINAHL, EMBASE, Scopus, Chinese National Knowledge Infrastructure, and WanFang databases to identify relevant publications. We will only include studies published in English or Chinese languages. Accordingly, randomized controlled trials evaluating the application value of continuous nursing intervention for improving the quality of life of patients suffering from stroke will be included. We will use 2 independent authors to conduct study selection, extract data, and evaluate the quality of the included studies. In case of any discrepancies, they will be addressed by consensus. Also, we will use RevMan 5.3 software to carry out the statistical analysis. RESULTS: The current study will summarize high-quality evidence to systematically explore application value of continuous nursing intervention for improving the quality of life in patients with stroke. CONCLUSION: The present study will summarize the direct and indirect pieces of evidence to ascertain whether continuous nursing intervention can improve the quality of life in patients with stroke. ETHICS AND DISSEMINATION: Ethical approval will not be required. REGISTRATION NUMBER: April 25, 2021.osf.io/xnrzt/ (https://osf.io/xnrzt/).

Phone-Based Intervention under Nurse Guidance after Stroke (PINGS II) Study: Protocol for a Phase III Randomized Clinical Trial.

OBJECTIVES: The Sub-Saharan African (SSA) region now has the highest estimated effect size of hypertension for stroke causation worldwide. An urgent priority for countries in SSA is to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. Thus the overall objective of the Phone-based Intervention under Nurse Guidance after Stroke II study (PINGS-2) is to deploy a hybrid study design to assess the efficacy of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to improve longer term blood pressure (BP) control among stroke survivors. MATERIALS AND METHODS: A phase III randomized controlled trial involving 500 recent stroke survivors to be enrolled across 10 Ghanaian hospitals. Using a computer-generated sequence, patients will be randomly assigned 1:1 into the intervention or usual care arms. The intervention comprises of (i) home BP monitoring at least once weekly with nurse navigation for high domiciliary BP readings; (2) medication reminders using mobile phone alerts and (3) education on hypertension and stroke delivered once weekly via audio messages in preferred local dialects. The intervention will last for 12 months. The control group will receive usual care as determined by local guidelines. The primary outcome is the proportion of patients with systolic BP <140 mm Hg at 12 months. Secondary outcomes will include medication adherence, self-management of hypertension, major adverse cardiovascular events, health related quality of life and implementation outcomes. CONCLUSION: An effective PINGS intervention can potentially be scaled up and disseminated across healthcare systems in low-and-middle income countries challenged with resource constraints to reduce poor outcomes among stroke survivors.

BE FAST to recognize stroke.

ABSTRACT: An easy-to-use acronym, BE FAST (Balance, Eyes, Face, Arms, Speech, Time), is gaining in popularity for rapid screening of patients for signs and symptoms of stroke that would otherwise be missed by using the more familiar FAST (Face, Arms, Speech, Time) acronym alone. This article describes the BE FAST tool and discusses how to integrate it into nursing practice.

Effect of traditional Chinese medicine emotional therapy on post-stroke depression: A protocol for systematic review and meta-analysis.

BACKGROUND: Post-stroke depression has seriously affected the rehabilitation and quality of life of patients, and there is no reliable treatment plan at present. Nursing plays an important role in the recovery of patients, some studies have pointed out that traditional Chinese medicine emotional therapy has advantages in improving post-stroke depression and promoting rehabilitation, but it is lack of evidence-based basis. The purpose of this study is to systematically evaluate the effect of traditional Chinese medicine emotional therapy on the improvement of post-stroke depression. METHOD: We will search CNKI, Wanfang, VIP and CBM, PubMed, Embase, Web of Science and the Cochrane Library database, and search the randomized controlled trial on traditional Chinese medicine emotional therapy in patients with post-stroke depression from the establishment of the database to February 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers. And meta-analysis is performed on the included literature using RevMan5.3 software. RESULT: In this study, the effect of traditional Chinese medicine emotional therapy on the improvement of post-stroke depression is evaluated by patient psychiatric scale score, compliance evaluation, quality of life evaluation and other indicators. CONCLUSION: This study will provide reliable evidence-based basis for establishing a reasonable and effective nursing scheme for patients with post-stroke depression. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/KA7G3.

[Perspectives offered by advanced nursing practice with stroke victims in France in 2021]. / Perspectives offertes par la pratique avancée infirmière auprès des victimes d'AVC.

30% more strokes are expected by 2030. To face this incoming huge public health challenge, large-scale projects for primary, secondary and tertiary prevention of neurovascular risk have to be developed. French new advanced nursing practices will be most promising if they are based on the timeliness of pathology follow-up but also on leadership in training, research and innovation in the care pathway for stroke victims.

Measuring organizational context in Australian emergency departments and its impact on stroke care and patient outcomes.

BACKGROUND: Emergency departments (ED) are challenging environments but critical for early management of patients with stroke. PURPOSE: To identify how context affects the provision of stroke care in 26 Australian EDs. METHOD: Nurses perceptions of ED context was assessed with the Alberta Context Tool. Medical records were audited for quality of stroke care and patient outcomes. FINDINGS: Collectively, emergency nurses (n = 558) rated context positively with several nurse and hospital characteristics impacting these ratings. Despite these positive ratings, regression analysis showed no significant differences in the quality of stroke care (n = 1591 patients) and death or dependency (n = 1165 patients) for patients in EDs with high or low rated context. DISCUSSION: Future assessments of ED context may need to examine contextual factors beyond the scope of the Alberta Context Tool which may play an important role for the understanding of stroke care and patient outcomes in EDs.

The Caregiver Experience After Stroke in a COVID-19 Environment: A Qualitative Study in Inpatient Rehabilitation.

BACKGROUND AND PURPOSE: Stroke is the leading cause of disability in the United States. Two-thirds of stroke survivors will require caregiver assistance. Evidence suggests the mental health of caregivers is closely related to patients' health outcomes. The timing of this study intersected with the beginning of the coronavirus disease-2019 (COVID-19) pandemic that required strict social distancing and hospital visitor policy changes. This study aims to answer the primary research question: What is the level and nature of stress experienced by caregivers of persons with newly-acquired stroke in the inpatient rehabilitation setting and how has the COVID-19 pandemic impacted the caregiver experience? METHODS: Recruitment occurred from a single inpatient rehabilitation facility. Participants were administered the Perceived Stress Scale and then completed qualitative semistructured interviews. The investigators used a phenomenological, iterative approach to collect and analyze qualitative data. The data were independently coded and categorized before consolidated into primary themes and subthemes. RESULTS: Eleven informal caregivers' perspectives generated 13 subthemes across 4 primary thematic categories: COVID-19 impact, concerns of the caregiver, coping strategies, and important aspects of the caregiver experience. COVID-19 social distancing necessitated new visitor policies, which presented additional challenges for caregivers. DISCUSSION AND CONCLUSIONS: Caregiver attendance at therapy sessions and frequent, direct communication between staff and caregivers improved caregiver readiness for family member discharge following inpatient rehabilitation. This study shared perspectives from a distinctive time during the COVID-19 pandemic. If visitation for multiple therapy sessions is prohibited, we recommend taking alternative measures to keep the caregiver involved in the plan of care.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A326).

Utilization of Advanced Practice Providers in Advanced Practice Provider-Led Stroke Clinic to Expand Outpatient Stroke Follow-up Care.

Stroke follow-up care with neurology specialty advanced practice providers is critical to focus on stroke prevention. The need for which is underscored by results of a recent study noting that many stroke survivors of first-ever strokes were not receiving stroke standard-of-care prevention measures including consistent antiplatelet therapies and regular exercise. Study findings further note the rates of usage for stroke prevention interventions (daily anti-platelet therapy, smoking cessation, regular exercise, hypertension control) were between 50% and 70%. Clinical nurse specialists along with nurse practitioner and physician assistant advanced practice providers are uniquely suited to manage outpatient ischemic stroke care to reduce the recurrence of stroke and improve patient outcomes.

Cuidado de si: representações sociais de cuidadores familiares de pacientes com AVC / Caring for oneself: social representations of stroke patients' family caregivers / Cuidado de sí mismos: representaciones sociales de los cuidadores de pacientes con familiares accidente cerebrovascular

Objetivo: Analisar as representações sociais de cuidadores familiares de pacientes acometidos por AVC, sobre o cuidado de si. Método: Estudo descritivo, no qual foi utilizado como aporte teórico as representações sociais. Foram investigados 20 cuidadores que frequentavam duas clinicas especializadas em Belém do Pará. Os dados foram coletados por meio de entrevistas semiestruturadas e organizados pela técnica de análise temática indutiva. Resultados:O cuidado de si foi representado pelos cuidadores como de difícil agregação às suas atividades de cuidar do adoecido pelo AVC devido à sobrecarga de trabalho, a qual gerou estresse e frustração. Alguns cuidadores conseguiram transformar esse estresse em uma representação pertencente a complexidade da sua vivência e da realidade do cuidado. Conclusão:Foi possível acessar o seu imaginário social e consequentemente a produção de significados atrelados as ações dos cuidadores, comportamentos e componentes cognitivos envolvidos na realidade do cuidar

Objective:The study's main goal has been to investigate the social representations of stroke patients' family caregivers by focusing on self-care. Methods: It is a descriptive study, which used the theoretical approach of social representations. There were investigated 20 caregivers who attended two specialized clinics in Belém city, Pará State, Brazil. Data were collected through semi-structured interviews and processed by the inductive thematic analysis technique. Results: Self-care was represented by caregivers as difficult to combine to their activities of caring for the person suffering from stroke due to work overload, which generated stress and frustration. Some caregivers were able to transform this stress into a representation belonging to a complexity of their experience and the care reality. Conclusion: It was possible to access their social imagery and, consequently, the production of linked meanings as caregivers' actions, behaviors and cognitive components involved in the care reality

Objetivo: Analizar las representaciones sociales de los cuidadores de pacientes con accidente cerebrovascular de la familia en el auto cuidado.Método: Estudio descriptivo, que se utilizó como las representaciones sociales teóricas. Investigaron 20 cuidadores que asisten a dos clínicas especializadas en Belem. Los datos fueron recolectados a través de entrevistas semi-estructuradas y organizadas por la técnica de análisis temático inductivo. Resultados: El cuidado de sí estuvo representada por los cuidadores como difíciles de agregar sus actividades para atender a los enfermos por accidente cerebrovascular debido a la sobrecarga de trabajo, lo que causó el estrés y la frustración. Algunos cuidadores fueron capaces de convertir ese estrés en una representación que pertenece a la complejidad de su experiencia y la realidad cuidado. Conclusión: Fue posible acceder a los imaginarios sociales y por lo tanto la producción de significados vinculado las acciones de los cuidadores, el comportamiento y los componentes cognitivos implicados en la realidad de la atención

Caracterização de pacientes com classificação de risco vermelha em uma unidade hospitalar filantrópica / Characterization of patients with red risk classification in a philanthropic hospital unit / Caracterización de pacientes con clasificación de riesgo roja en una unidad hospitalaria filantrópica

Objetivo: caracterizar o perfil epidemiológico e clínico dos pacientes com classificação de risco vermelha (prioridade zero) em um hospital filantrópico. Método: estudo documental, quantitativo, realizado em um hospital filantrópico com 109 prontuários de pacientes com classificação de risco vermelha que adentraram a emergência ao longo de oito meses. Realizou-se a análise estatística descritiva. Resultados: verificou-se que 33,9% da amostra tinha idade entre 61 e 80 anos; 67,7% eram mulheres; 61,4% não fumavam; 62,4% não eram etilistas; 42,2% eram hipertensos; 16,5% apresentou rebaixamento do sensório. Percebeu-se que 37,6% dos prontuários não tinham a hipótese diagnóstica registrada e que 56,9% tiveram alta hospitalar. Conclusão: constatou-se que a maioria dos pacientes com classificação de risco vermelha era idosa, hipertensa, tinha 2º grau completo, não fumava ou era etilista. A principal queixa referida foi rebaixamento do sensório. A principal hipótese diagnóstica foi acidente vascular encefálico. A maioria dos pacientes evoluiu para alta hospitalar

Objective: To characterize the epidemiological and clinical profile of patients with red risk classification (priority zero) in a philanthropic hospital. Method: A quantitative documentary study carried out in a philanthropic hospital with 109 charts of patients with red risk classification who entered the emergency room during eight months. The descriptive statistical analysis was performed. Results: It was verified that 33.9% of the sample was aged between 61 and 80 years; 67.7% were women; 61.4% did not smoke; 62.4% were non-alcoholic; 42.2% were hypertensive; 16.5% presented lowering of the sensorium. It was noticed that 37.6% of the medical records did not have the diagnostic hypothesis registered and that 56.9% were discharged from hospital. Conclusion: It was found that the majority of the DOI: 10.9789/2175-5361.rpcfo.v13.8072Caracterização de pacientes com classificação de risco vermelha...ISSN 2175-5361Pontes TO, Oliveira BSB, Joventino ES165R. pesq.: cuid. fundam. online 2021 jan/dez 13: 164-169patients with red risk classification were elderly, hypertensive, had a full second degree, did not smoke or were an alcoholic. The main complaint reported was lowering of the sensorium. The main diagnostic hypothesis was stroke. Most of the patients evolved to hospital discharge

Objetivo: Caracterizar el perfil epidemiológico y clínico de los pacientes con clasificación de riesgo rojo (prioridad cero) en un hospital filantrópico. Método: Estudio documental, cuantitativo, realizado en un hospital filantrópico con 109 prontuarios de pacientes con clasificación de riesgo roja que adentraron la emergencia a lo largo de ocho meses. Se realizó el análisis estadístico descriptivo. Resultados: Se verificó que el 33,9% de la muestra tenía edad entre 61 y 80 años; El 67,7% eran mujeres; 61,4% no fumaban; El 62,4% no eran etilistas; El 42,2% eran hipertensos; El 16,5% presentó descenso del sensorio. Se percibió que el 37,6% de los prontuarios no tenían la hipótesis diagnóstica registrada y que el 56,9% tuvo alta hospitalaria. Conclusión: Se constató que la mayoría de los pacientes con clasificación de riesgo rojo era anciana, hipertensa, tenía 2º grado completo, no fumaba o era etilista. La principal queja referida fue descenso del sensorio. La principal hipótesis diagnóstica fue accidente vascular encefálico. La mayoría de los pacientes evolucionaron a alta hospitalaria