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1.
Braz J Med Biol Res ; 52(9): e8533, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31483000

RESUMO

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.


Assuntos
Transtornos de Ansiedade/prevenção & controle , Ansiedade/prevenção & controle , Cuidadores , Disfunção Cognitiva/prevenção & controle , Transtorno Depressivo/prevenção & controle , Educação em Saúde/métodos , Acidente Vascular Cerebral/enfermagem , Adulto , Ansiedade/etiologia , Transtornos de Ansiedade/etiologia , Estudos de Casos e Controles , Disfunção Cognitiva/etiologia , Transtorno Depressivo/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral
2.
Rev Infirm ; 68(248): 42-43, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30955542

RESUMO

In the context of teaching unit UE2.3, student nurses in Alsace organised a round table on the theme of strokes. The aim was to improve their knowledge of this pathology and make them players in the inter-professional dimension of their future practice.


Assuntos
Equipe de Assistência ao Paciente , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/enfermagem
4.
Nurse Pract ; 44(4): 50-54, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30889110

RESUMO

Preeclampsia is a complication of pregnancy that affects approximately 4% of pregnancies. Preeclampsia is defined as new-onset hypertension after 20 weeks gestation often accompanied by new-onset proteinuria. Women who experience preeclampsia during pregnancy are at an increased risk for hypertension and stroke later in life. Healthcare providers should screen women appropriately to minimize risk.


Assuntos
Profissionais de Enfermagem , Pré-Eclâmpsia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/enfermagem , Feminino , Previsões , Humanos , Programas de Rastreamento/enfermagem , Gravidez , Fatores de Risco
5.
J Neurosci Nurs ; 51(1): 54-59, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30614936

RESUMO

In this retrospective, nonexperimental, comparative descriptive design using convenience sampling, the timeliness of care delivered by 11 Stroke Certified Registered Nurses (SCRNs) to 95 hyperacute stroke patients (last known well of 4.5 hours or less) on the acute stroke protocol set by Target: Stroke Phase II Campaign Manual was compared with that of 13 non-SCRNs in a small, rural, level III stroke facility in the southwestern region of the United States. There was statistical significance in the total timeliness of care delivered by SCRNs to hyperacute stroke patients as compared with the non-SCRNs (t = -4.109, P = .001) and acute stroke protocol goal times for door to stroke team activation (t = -3.291, P = .001), door to computed tomography (t = -4.020, P < .001), door to teleneurology initiation (t = -4.020, P < .001), and door to alteplase administration (t = -3.367, P = .004). Limitations included sample size, nursing documentation, and nurses studying for the SCRN examination. It was concluded that, at this facility, SCRNs had a statistically significant difference in the timeliness of care delivered to hyperacute stroke patients on meeting protocol time goals. The SCRNs also met all protocol goals, and the non-SCRNs did not meet the door-to-teleneurology initiation and door-to-alteplase administration goals. Future studies should include a larger sample size and stroke patient outcomes.


Assuntos
Enfermagem em Neurociência/normas , Enfermeiras e Enfermeiros/normas , Acidente Vascular Cerebral/enfermagem , Adulto , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Melhoria de Qualidade , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X
6.
Home Healthc Now ; 37(1): 23-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30608464

RESUMO

STROKE is sudden and often traumatic with results that affect both the patient and family members who provide care. Approximately 40% of individuals caring for family members/friends are male. Transitioning from the noncaregiver role to caregiver can be unsettling. Guided by Friedemann's framework of systemic organization, this secondary data analysis examined problems reported by men caring for spouses in the first year after stroke. Using a mixed methods design, 73 caregivers (CGs) participated in bimonthly telephone interviews for 1 year. For this analysis, only the males caring for spouses (n = 12 married and n = 1 unmarried partner) were examined. These data were analyzed using Colaizzi's rigorous method of content analysis. Five problem themes emerged: 1) adjusting to multitasking in everyday living (Friedemann's system maintenance and individuation), 2) recognizing physical and mental disabilities (coherence), 3) dealing with outside forces and limited resources (individuation), 4) struggling to return to normal (system maintenance), and 5) feeling physically, mentally, and emotionally exhausted (system maintenance). These problem themes demonstrated incongruence as the men sought to maintain their prior lives.Theory-based themes of male stroke CGs' problems were uncovered that can be used to target interventions to help them achieve balance between incongruence and congruence in their lives.


Assuntos
Cuidadores/psicologia , Qualidade de Vida/psicologia , Cônjuges/psicologia , Reabilitação do Acidente Vascular Cerebral/enfermagem , Reabilitação do Acidente Vascular Cerebral/psicologia , Adaptação Psicológica , Adulto , Idoso , Empatia , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/psicologia
7.
Trials ; 20(1): 52, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30646948

RESUMO

BACKGROUND: The objective of this study was to analyze the impact of two forms of secondary preventive follow-up on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA). METHODS: We included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based age-independent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12 months after hospital discharge in relation to education level (low, ≤10 years; high, >10 years) separately for the intervention and control groups. RESULTS: Among controls, systolic BP (SBP) decreased only among the highly educated (-2.5 mm Hg, 95% confidence interval (CI) -0.2 to -4.8), whereas LDL-C increased in the low-education group (0.2 mmol/L, 95% CI 0.1 to 0.3). At 12 months, controls with low education not more than 70 years of age had higher SBP than controls of the same age with high education (5.8 mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (-0.3 mmol/L, 95% CI -0.2 to -0.4) and, in the subgroup not more than 70 years old, low-educated participants had lower LDL-C at 12 months than those with high education (0.3 mmol/L, 95% CI 0.1 to 0.5). CONCLUSIONS: Nurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education. TRIAL REGISTRATION: ISRCTN Registry ISRCTN23868518 , June 19, 2012 - Retrospectively registered.


Assuntos
Escolaridade , Ataque Isquêmico Transitório/enfermagem , Papel do Profissional de Enfermagem , Educação de Pacientes como Assunto/métodos , Prevenção Secundária/métodos , Acidente Vascular Cerebral/enfermagem , Telefone , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea , LDL-Colesterol/sangue , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipolipemiantes/uso terapêutico , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/fisiopatologia , Ataque Isquêmico Transitório/psicologia , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Fatores de Risco , Comportamento de Redução do Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Suécia , Fatores de Tempo , Resultado do Tratamento
8.
J Emerg Nurs ; 45(3): 242-248, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30195862

RESUMO

INTRODUCTION: Despite the increasing incidence of acute ischemic stroke in the United States, many health care facilities remain unprepared to manage patients with acute stroke, including the administration of intravenous alteplase (recombinant tissue plasminogen activator [rTPA]). This has led to an opportunity for telemedicine systems to facilitate these evaluations and acute medical stroke treatment decisions. However, even telemedicine systems can fail to provide timely evaluation and management of the patient with acute stroke. The purpose of this retrospective study was to compare stroke outcome metrics pre- and postimplementation of a hybrid, local nurse-led "stroke-responder" telemedicine system. METHODS: A retrospective chart review was performed on 21 patients at a regional community hospital between the years of 2014 and 2016. Data were collected pre- and postimplementation of a local stroke-responder system. Outcomes obtained included door-to-alert time, door-to-computerized tomography (CT) time, door-to-rtPA order time, and door-to-rtPA bolus dose administration time. Outcomes were compared among years. RESULTS: Between 2014 and 2016, 21 charts were reviewed. Decreased mean times were observed for all metrics. The mean time for door-to-alert decreased from 21.19 to 5.84 minutes (P = 0.021), door-to-CT from 29.9 to 12.2 minutes (P = 0.022), door-to-rtPA order 88.4 to 53 minutes (P = 0.021), and door-to-rtPA administration from 106.94 to 64.65 minutes (P = 0.001). CONCLUSION: In an acute stroke telemedicine system, implementation of a local nurse-led "stroke responder" system resulted in significantly decreased acute stroke metrics for a community hospital within a regional hospital system.


Assuntos
Acidente Vascular Cerebral/enfermagem , Telemedicina/métodos , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/administração & dosagem , Tomografia Computadorizada por Raios X
9.
J Clin Nurs ; 28(1-2): 300-309, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29989233

RESUMO

AIMS AND OBJECTIVES: To examine emotional support given by nurses to family members in the acute phase after a working-aged patient's stroke based on nurses' and family members' experiences. BACKGROUND: The number of patients with stroke is increasing globally. There is a lack of knowledge about the emotional support of family members during the acute phase of working-aged stroke victims. To be able to provide high-quality nursing care during this phase, we need information about emotional support from family members' and nurses' perspective. METHOD: Using a Glaserian grounded theory approach, the study was conducted using open interviews with family members and group interviews with nurses. Data were collected between 2012-2013. RESULTS: In this study, emotional support is identified as Caring Interaction. The changed life situation and diverse feelings aroused by the stroke are the starting point of providing emotional support to family members. It is important that the nurses notice family members' need for support at the right time, use their intuition and respond appropriately. CONCLUSIONS: The patient's family members are important when providing holistic nursing care for the whole family. As well as providing emotional support, high-quality nursing interventions enhance the care of family members. This study provides an explanation of the interaction process between family members and nurses. It helps family members and nurses to better understand each other. Although the data were collected 5 years ago, it is assumed that the interaction between family members and nurses has not changed during these years remarkably. RELEVANCE TO CLINICAL PRACTICE: According to the experiences of family members and nurses who participated in this research, emotional support manifests in Caring Interaction. Being aware of body language and behaviour of family members, nurses can better interact with them.


Assuntos
Família/psicologia , Relações Profissional-Paciente , Acidente Vascular Cerebral/enfermagem , Sobreviventes , Adulto , Empatia , Feminino , Teoria Fundamentada , Humanos , Masculino
10.
Int J Nurs Stud ; 89: 72-79, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30342326

RESUMO

BACKGROUND: The Quality in Acute Stroke Care Trial implemented nurse-initiated protocols to manage fever, hyperglycaemia and swallowing (Fever, Sugar, Swallow clinical protocols) achieving a 16% absolute improvement in death and dependency 90-day post-stroke. OBJECTIVE: To examine associations between 90-day death and dependency, and monitoring and treatment processes of in-hospital nursing stroke care targeted in the trial. DESIGN: Secondary data analysis from a single-blind cluster randomised control trial. SETTING: 19 acute stroke units in New South Wales, Australia. PARTICIPANTS: English-speakers ≥18 years with ischaemic stroke or intracerebral haemorrhage arriving at participating stroke units <48 h of stroke onset, excluding those for palliation and without a telephone. METHOD: Data from patients in the 10 intervention hospitals and the nine control hospitals in the QASC trial post-intervention cohort, who had both hospital process of care data and 90-day outcome data were included. Associations between independence at 90-day (modified Rankin Score ≤1) and processes of care for fever, hyperglycaemia, and dysphagia screening were examined using multiple logistic regression adjusting for treatment group, sex, age group, premorbid modified Rankin scale, marital status, education, stroke severity and correlation within hospitals. RESULTS: Of 1126 patients in the post-intervention cohort (intervention or control), 970 had both in-hospital processes of care data and 90-day outcome data. Patients had significantly lower odds of 90-day independence if, within the first 72 h of stroke unit admission, they had one or more: febrile event (≥37.5 °C) (OR 0.47; 95%CI:0.35-0.61; P < 0.0001), higher mean temperature (OR:0.25; 95%CI:0.14-0.45; P < 0.0001), finger-prick blood glucose reading ≥11 mmol/L (OR:0.61; 95%CI:0.47-0.79; P = 0.0002), higher mean blood glucose (OR 0.89; 95%CI:0.84-0.95; P = 0.0006), or failed the swallowing screen (OR 0.35; 95%CI:0.22-0.56; P < 0.0001). Patients had greater odds of independence when: venous blood glucose was taken on admission to hospital or within 2 h of stroke unit admission (OR 1.4; 95%CI:1.01-1.83; P = 0.04); finger-prick blood glucose was measured within 72 h of stroke unit admission (OR 1.3; 95%CI:1.02-1.55; P = 0.03); or when swallowing screening or assessment was performed within 24 h of stroke unit admission (OR 1.8; 95%CI:1.29-2.55; P = 0.0006). CONCLUSION: We have provided robust evidence of the importance of monitoring patients' temperature, blood glucose and swallowing status to improve 90-day stroke outcomes. Routine nursing care can result in significant reduction in death and dependency post-stroke.


Assuntos
Transtornos de Deglutição/diagnóstico , Febre/diagnóstico , Hiperglicemia/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Sinais Vitais , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , New South Wales , Método Simples-Cego , Acidente Vascular Cerebral/enfermagem
11.
Int J Nurs Pract ; 25(2): e12719, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30561838

RESUMO

AIM: The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this. BACKGROUND: Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time. DESIGN: This was a prospective longitudinal study. METHODS: A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants. RESULTS: Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self-rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden. CONCLUSION: Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers.


Assuntos
Cuidadores/psicologia , Hemorragias Intracranianas/enfermagem , Estresse Psicológico , Acidente Vascular Cerebral/enfermagem , Adaptação Psicológica , Adulto , China , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Sobreviventes
12.
Jpn J Nurs Sci ; 16(2): 202-211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30203546

RESUMO

AIM: This study aimed to investigate the effect of progressive muscle relaxation on the caregiver burden and level of depression among the caregivers of older patients with a stroke. METHODS: This randomized, controlled experimental study was conducted between December, 2015 and July, 2017 with the caregivers of older patients with a stroke who had been admitted to the home care unit of a state hospital. The caregivers were randomly assigned to intervention (n = 23) and control (n = 21) groups, based on the study's inclusion criteria. The caregivers in the intervention group practiced progressive muscle relaxation exercises at home 3 days per week for 8 weeks. The control group had no intervention. RESULTS: The mean age of the older patients with a stroke was 80.15 ± 9.86 years and the mean duration of the disease was 39.07 ± 44.69 months. The mean age of the caregivers was 50.29 ± 12.62 years, 84.1% of whom were female, 38.6% were elementary school graduates, and 86.4% were married. It was found that there was a statistically significant decrease in the mean Zarit Caregiver Burden Scale and Beck Depression Scale scores of the caregivers in the intervention group after practicing progressive muscle relaxation, but this decrease was not statistically significant when the intervention and control groups were compared. CONCLUSION: This study showed that there was a statistically significant decrease in the caregiver burden and level of depression among the caregivers in the intervention group after progressive muscle relaxation exercises, but that there was no statistically significant difference when the intervention and control groups were compared.


Assuntos
Treinamento Autógeno , Cuidadores/psicologia , Depressão/prevenção & controle , Depressão/terapia , Terapia de Relaxamento , Estresse Psicológico , Acidente Vascular Cerebral/enfermagem , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Assistência Domiciliar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Turquia
13.
Interv Neuroradiol ; 25(2): 234-238, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30269668

RESUMO

Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse practitioners have taken on highly specialized roles. Neurointerventional care has rapidly evolved similarly to interventional cardiac care, in that nurse practitioners are successfully being incorporated as procedural assistants in catheterization laboratories. Similar utilization of nurse practitioners in interventional neuroradiology holds the capacity to decrease physician workload, mitigate stresses contributing to burn-out, and reallocate more physician time to procedures. Nurse practitioner practice faces procedural, clinical, legal and interpersonal barriers. Despite calls for expanded practice by the Institutes of Medicine, a paucity of nurse practitioner training opportunities exists. Fragmented privileging processes contribute to environments where nurse practitioners must navigate hurdles without established interventional neuroradiology-specific precedent. Increased nurse practitioner mentorship, fluoroscopy law standardization, physician support surrounding nurse practitioner autonomy, and role consistency is imperative for optimal nurse practitioner utilization. Nurse practitioners are uniquely equipped to bridge evolving gaps through the provision of safe, efficacious care, and generating revenue at lower costs. Discussion surrounding nurse practitioner use to bridge workflow gaps is an exciting opportunity for future practice development.


Assuntos
Procedimentos Endovasculares , Neurorradiografia , Profissionais de Enfermagem , Papel do Profissional de Enfermagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/cirurgia , Trombectomia , Angiografia Cerebral , Humanos , Estados Unidos
14.
Stroke ; 49(9): 2155-2162, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30354982

RESUMO

Background and Purpose- Well-organized stroke care is associated with better patient outcomes, but the most important organizational factors are unknown. Methods- Data were extracted from the Sentinel Stroke National Audit Programme of adults with acute stroke treated in stroke hospitals in England and Wales between April 2013 and March 2015. Multilevel models with random intercepts for hospitals were used to estimate the association of each variable with 30-day mortality to estimate the impact of admission to differently organized hospitals. Results- Of the 143 578 patients with acute stroke admitted to 154 hospitals, 14.4% died within 30 days of admission. In adjusted analyses, admission to hospitals with higher ratios of nurses trained in swallow screening was associated with reduced odds of death ( P=0.004), and admission to hospitals with daily physician ward rounds was associated with 10% lower odds of mortality compared with less-frequent ward rounds (95% CI, 0.82-0.98; P=0.013). Number of stroke admissions and overall ratio of registered nurses on duty at weekends were not found to be independently associated with mortality after adjustment for other factors. Conclusions- If these associations are causal, an extra 1332 deaths annually in England and Wales could be saved by hospitals providing care associated with a ratio of nurses trained in swallow screening of at least 3 per 10 beds and daily stroke physician ward rounds.


Assuntos
Unidades Hospitalares/organização & administração , Enfermeiras Especialistas/estatística & dados numéricos , Sistema de Registros , Acidente Vascular Cerebral/mortalidade , Visitas com Preceptor/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Unidades Hospitalares/estatística & dados numéricos , Hospitalização , Humanos , Modelos Logísticos , Masculino , Mortalidade , Análise Multinível , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/terapia , País de Gales
15.
Soins ; 63(828): 36-40, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30213314

RESUMO

Intravenous thrombolysis is one of two emergency procedures for ischaemic stroke. Its implementation requires fine coordination of the healthcare team and must be adapted to the local context of each hospital and sector. International good clinical practice guidelines are available to support team organisation.


Assuntos
Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/enfermagem , Terapia Trombolítica , Humanos , Unidades de Terapia Intensiva , Equipe de Assistência ao Paciente
16.
Soins ; 63(828): 41-42, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30213315

RESUMO

Since its inception in 2015, thrombectomy has revolutionised the emergency management of ischaemic stroke with large vessel occlusion. Indeed, early endovascular extraction of the thrombus considerably improves the prognosis. Different medical teams are involved in the critically urgent management of these very fragile patients.


Assuntos
Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/cirurgia , Trombectomia , Humanos
17.
Diabet Med ; 35(8): 1027-1036, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30152589

RESUMO

This paper is an abridged and modified version of guidelines produced by the Joint British Diabetes Societies for inpatient care on glycaemic management during the enteral feeding of people with stroke and diabetes. These were revised in 2017 and have been adapted specifically for Diabetic Medicine. The full version can be found at: www.diabetes.org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Many people have both diabetes and an acute stroke, and a stanv dard approach to the management of people with stroke is the provision of adequate nutrition. Frequently, this involves a period of enteral feeding if there is impaired ability to swallow food safely. There is currently considerable variability in the management of people with diabetes fed enterally after a stroke, and the evidence base guiding diabetes management in this clinical situation is very weak, although poor glycaemic outcomes in people receiving enteral feeding after stroke may worsen recovery and cause harm. The aim of this document is to provide sensible clinical guidance in this area, written by a multidisciplinary team; this guideline had input from diabetes specialist nurses, diabetologists, dietitians, stroke physicians and pharmacists with expertise in this area, and from UK professional organizations. It is aimed at multidisciplinary teams managing people with stroke and diabetes who require enteral feeding. We recognize that there is limited clinical evidence in this area.


Assuntos
Glicemia/metabolismo , Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Nutrição Enteral/normas , Hospitalização , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Complicações do Diabetes/sangue , Complicações do Diabetes/enfermagem , Diabetes Mellitus/sangue , Diabetes Mellitus/enfermagem , Nutrição Enteral/métodos , Nutrição Enteral/enfermagem , Humanos , Pacientes Internados , Monitorização Fisiológica/enfermagem , Monitorização Fisiológica/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/enfermagem , Reino Unido
18.
J Hosp Palliat Nurs ; 20(4): 358-367, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30063629

RESUMO

Stroke survivors often experience life-altering functional and cognitive changes and burdensome symptoms. Palliative care could provide additional support to improve outcomes of stroke patients and their families. The purpose of this review was to describe how palliative care is conceptualized and implemented within stroke care.An integrative review of the literature published between 1990 and 2016 using the terms "palliative care," "stroke," or "acute stroke" was conducted. Of the 363 articles identified, 44 were screened, 21 met inclusion criteria, and 2 additional articles were identified through reference list review, resulting in a final sample of 23 articles.Palliative care was predominantly understood as end-of-life care and was most commonly offered in acute stages when patients were expected to die. Patients, families, and providers reported challenges surrounding decision making, uncertainty regarding transitions to palliative care, and needs related to communication and physical and psychosocial support. The quality of the research was moderate to good but was limited by retrospective designs, reliability of data collection procedures and tools, recall bias, and generalizability.This review highlights gaps in access to palliative care throughout the illness trajectory and underscores the need for study of models that integrate palliative care into stroke care.


Assuntos
Tomada de Decisões , Cuidados Paliativos/métodos , Acidente Vascular Cerebral/enfermagem , Humanos , Cuidados Paliativos/tendências , Qualidade de Vida , Acidente Vascular Cerebral/psicologia
19.
J Adv Nurs ; 74(12): 2882-2893, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30019422

RESUMO

AIM: To explore the feasibility of the Post-Stroke Depression toolkit in terms of fidelity and acceptability in daily nursing practice. BACKGROUND: Depression after stroke is common and influences patients' recovery significantly. Although stroke guidelines recommend early depression screening and treatment, depressive symptoms remain unrecognized. To enhance adoption of evidence into the context of the daily practice of stroke treatment, we developed the Post-Stroke Depression toolkit, an evidence-based nurse-led intervention for the early management of depressive symptoms after a stroke for use in the hospital setting. DESIGN: An explanatory mixed-methods before-and-after study design. METHODS: Data were collected continuously from March 2012 - June 2013 during three phases: pre-implementation, the implementation phase (where implementation strategies guided the implementation) and the sustainability phase (executed without the implementation strategies) and involved patient chart audits and surveys and individual and focus group interviews with nurses. RESULTS: A total of 775 patient charts were audited to examine fidelity. Implementation of the Post-Stroke Depression toolkit during the implementation phase resulted in an increase in depression screening (+72.9%) and more patients receiving nursing interventions (+11.1%). During the sustainability phase, screening for depression decreased (-16.3%), while the application of the nursing interventions remained unchanged (+0.6%). The acceptability of the toolkit was judged to be good. CONCLUSIONS: The Post-Stroke Depression toolkit was found to be feasible in terms of fidelity and acceptability, improving structural screening for depressive symptoms as well as the application of nursing interventions in case of a positive screening. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03500250.


Assuntos
Transtorno Depressivo/enfermagem , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Países Baixos , Acidente Vascular Cerebral/enfermagem , Inquéritos e Questionários
20.
Top Stroke Rehabil ; 25(6): 397-402, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30028654

RESUMO

BACKGROUND: Stroke is a life-changing event for both stroke survivors and their family caregivers. After receiving acute care at the hospital, family members are expected to take care of stroke survivors at home and to continue treatment and rehabilitation. The new role of "informal caregiver" is a challenge that creates many difficulties for family caregivers that are not explicit in the Sri Lankan context. OBJECTIVES: This study aimed at exploring family caregivers' experiences of providing informal care for dependent stroke survivors. METHODS: The sample was chosen by purposive sampling with a maximum variation by age, ethnicity, religion, educational level, relationship, and monthly income. Ten informal family caregivers to stroke survivors with hemiplegia who had been treated at the National Hospital of Sri Lanka participated in in-depth interviews analyzed using conventional content analysis. RESULTS: Qualitative content analysis of data resulted in an overriding theme, "Caring with love, against all odds," along with four categories, "Life alterations," "Lack of resources," "Compassionate care," and "Coping strategies." Although the increased workload, restricted social life, physical problems, and knowledge and financial deficits were challenging for the family caregivers, self-strength and supportive social networks helped them to compassionately care for their stroke survivor. CONCLUSIONS: The phenomenon of family caregivers providing informal care for stroke survivors was explicated as compassionate care, notwithstanding numerous difficulties. The findings motivate further research and strategies to minimize family caregivers' burden and facilitate the positive aspects of caregiving to promote the health and well-being of both stroke survivors and their families.


Assuntos
Cuidadores/psicologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/enfermagem , Adolescente , Adulto , Idoso , Climatério/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sri Lanka/epidemiologia , Acidente Vascular Cerebral/mortalidade , Sobrevida , Adulto Jovem
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