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Patient Management in the Telemetry/Cardiac Step-Down Unit: A Case-Based Approach

Chapter 7:  10 Real Cases on Transient Ischemic Attack and Stroke: Diagnosis, Management, and Follow-Up

Jeirym Miranda; Fareeha S. Alavi; Muhammad Saad

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Case review, case discussion, clinical symptoms.

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Case 1: Management of Acute Thrombotic Cerebrovascular Accident Post Recombinant Tissue Plasminogen Activator Therapy

A 59-year-old Hispanic man presented with right upper and lower extremity weakness, associated with facial drop and slurred speech starting 2 hours before the presentation. He denied visual disturbance, headache, chest pain, palpitations, dyspnea, dysphagia, fever, dizziness, loss of consciousness, bowel or urinary incontinence, or trauma. His medical history was significant for uncontrolled type 2 diabetes mellitus, hypertension, hyperlipidemia, and benign prostatic hypertrophy. Social history included cigarette smoking (1 pack per day for 20 years) and alcohol intake of 3 to 4 beers daily. Family history was not significant, and he did not remember his medications. In the emergency department, his vital signs were stable. His physical examination was remarkable for right-sided facial droop, dysarthria, and right-sided hemiplegia. The rest of the examination findings were insignificant. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. The neurology team was consulted, and intravenous recombinant tissue plasminogen activator (t-PA) was administered along with high-intensity statin therapy. The patient was admitted to the intensive care unit where his hemodynamics were monitored for 24 hours and later transferred to the telemetry unit. MRI of the head revealed an acute 1.7-cm infarct of the left periventricular white matter and posterior left basal ganglia. How would you manage this case?

This case scenario presents a patient with acute ischemic cerebrovascular accident (CVA) requiring intravenous t-PA. Diagnosis was based on clinical neurologic symptoms and an NIHSS score of 7 and was later confirmed by neuroimaging. He had multiple comorbidities, including hypertension, diabetes, dyslipidemia, and smoking history, which put him at a higher risk for developing cardiovascular disease. Because his symptoms started within 4.5 hours of presentation, he was deemed to be a candidate for thrombolytics. The eligibility time line is estimated either by self-report or last witness of baseline status.

Ischemic strokes are caused by an obstruction of a blood vessel, which irrigates the brain mainly secondary to the development of atherosclerotic changes, leading to cerebral thrombosis and embolism. Diagnosis is made based on presenting symptoms and CT/MRI of the head, and the treatment is focused on cerebral reperfusion based on eligibility criteria and timing of presentation.

Symptoms include alteration of sensorium, numbness, decreased motor strength, facial drop, dysarthria, ataxia, visual disturbance, dizziness, and headache.

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Amani Baidwan, Kendyl Egizi and Alysha Payne

Darrell Jackson, 81 year old male, came to the Emergency Department at Los Robles Hospital by ambulance after he collapsed in a coffee shop. Upon arrival he presented with left sided weakness, facial drooping, and aphasia. He was diagnosed with an ischemic stroke, right humerus head fracture, and right wrist fracture. The priority of care upon initial presentation to the Emergency Department included a CT scan, frequent monitoring of vital signs, starting a peripheral IV, drawing labs, assessing blood glucose, and an EKG. The nurse in the Emergency Department continuously monitored Mr. Jackson’s neurological status, changes in level of consciousness and signs and symptoms of complications.

After much discussion with the family, consent was given for tissue plasminogen activator (tPA). After tPA was given, Mr. Jackson converted to a hemorrhagic stroke, which is one of many risks associated with administration of tPA. He was His computed tomographic scans (CT) revealed intraparenchymal hematoma in both cerebral hemispheres and a large hemorrhage in the left parietal lobe. In the Intensive care Unit, Mr. Jackson was on  a ventilator, had a RASS score of -5 and was only responsive to noxious stimuli. Priority in plan of care included airway management and a CPAP trial to begin weaning protocols. The CPAP trial failed, and a tracheostomy was placed. Mr.Jackson was then transferred to the Progressive Care Unit to continue treatment where the NG tube was removed and a PEG tube was inserted. Mr. Jackson has no known allergies and has a history of hypertension, dementia, Parkinson’s disease, stroke, diabetes, GERD, BPH, hypophosphatemia and anemia.

Collaborative interventions are necessary from all healthcare providers, such as physicians, nurses, physical therapy, occupational therapy, speech therapy, case management and social work, to adequate;y care for Mr. Jackson. Case management has been working closely with the family to provide necessary resources to continue care for Mr. Jackson after discharge from the hospital. Mr. Jackson was discharged home with home health after 3 weeks in the hospital. His condition prior to discharge was as follows: A/O x 3 with mild cognitive deficits, speech impairment and left sided weakness.

Discussion Questions

  • What is the difference between an ischemic stroke and hemorrhagic stroke?
  • What are some of the risk associated with tissue plasminogen activator (tPA) that the nurse would need to assess for and educate the patient about?
  • What are some of the psychological needs the nurse should anticipate for a patient who has experienced a stroke?

Nursing Case Studies by and for Student Nurses Copyright © by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Ischemic stroke: A case study

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  • Rudolf Cymorr Kirby P. Martinez, PhD, MA, RN, CAA, LMT, CSTP, FRIN
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This presents an analysis of a case of Ischemic stroke in terms of possible etiology, pathophysiology, drug analysis and nursing care

Clinical Focus: Adult Medical/Surgical

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Stroke Case Study (45 min)

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Mrs. Blossom is a 57-year-old female who presented to the Emergency Room with new onset Atrial Fibrillation with Rapid Ventricular Response (RVR). She is admitted to the cardiac telemetry unit after being converted to normal sinus rhythm with a calcium channel blocker (diltiazem). When you enter the room to assess Mrs. Blossom, her daughter looks at you concerned and says “mom’s acting kinda funny.”

What nursing assessments should be completed at this time?

  • Full set of vital signs (Temp, HR, BP, RR, SpO2)
  • Should probably get a 12-lead EKG
  • Assess symptoms using PQRST or OLDCARTS

You assess Mrs. Blossom to find she has a left sided facial droop, slurred speech, and is unable to hold her left arm up for more than 3 seconds.

What is/are your priority nursing action(s) at this time?

  • Call a Code Stroke (or whatever the equivalent is at your facility) to initiate response of the neurologist or Stroke team.
  • Notify the charge nurse to help you obtain emergency equipment if you don’t already have it at the bedside to be prepared in case of emergency

What may be occurring in Mrs. Blossom?

  • She may be having a stroke

You call a Code Stroke and notify the charge nurse for help. You obtain suction to have at bedside just in case. The neurologist arrives at bedside within 7 minutes to assess Mrs. Blossom. He notes her NIH Stroke Scale score is 32. He orders a STAT CT scan, which shows there is no obvious bleed in the brain.

What are the possible interventions for Mrs. Blossom at this time?

  • Since there is no bleed evident on scan, Mrs. Blossom would qualify for a thrombolytic like tPA (alteplase) or for surgical intervention, as long as there are no contraindications

What are the contraindications for thrombolytics like tPA (alteplase)?

  • Recent surgery, current or recent GI bleed within the last 3 months, excessive hypertension, evidence of cerebral hemorrhage

You administer tPA per protocol, initiate q15min vital signs and neuro checks. You stay with the patient to continue to monitor her symptoms.

What are possible complications of tPA administration? What should you monitor for?

  • Bleeding, especially into the brain or a GI bleed
  • She may bruise easily or bleed from IV sites or her gums
  • Monitor for s/s bleeding or worsening stroke symptoms, which may indicate a hemorrhagic stroke has developed.

After 2 hours, Mrs. Blossom is showing signs of improvement. She is able to speak more clearly, though with a slight slur. She is still slightly weak on the left side, but is able to hold her arm up for 10 seconds now. Her NIHSS is now 6. Mrs. Blossom’s daughter asks you why this happened.

What would you explain has happened to Mrs. Blossom physiologically?

  • Because of her new onset atrial fibrillation, the blood was likely pooling in her atria because they were just quivering and not contracting. When blood pools, it clots. When she was converted back into a normal rhythm and her atria began contracting again, that likely dislodged a clot, which went to her brain.
  • The clot in her brain caused brain tissue to die → ischemic stroke.

Two days later, Mrs. Blossom has recovered fully. She will be discharged today on Clopidogrel and Aspirin, plus a calcium channel blocker,  with a follow up appointment in 1 week to see the neurologist.

What education topics should be included in the discharge teaching for Mrs. Blossom and her family?

  • Anticoagulant therapy is imperative to prevent further clots from forming within Mrs. Blossom’s atria if she stays in Atrial Fibrillation.
  • They should be taught the signs of a stroke (FAST) and call 911 if they notice them.
  • They should be taught signs of Atrial Fibrillation with RVR and be sure to go to the hospital if this occurs – the patient is at higher risk for stroke.
  • Medication instructions for calcium channel blockers and anticoagulants.

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Nursing Case Studies

Jon Haws

This nursing case study course is designed to help nursing students build critical thinking.  Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process.  To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy  to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs.  If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding.  In the end, that is what nursing case studies are all about – growing in your clinical judgement.

Nursing Case Studies Introduction

Cardiac nursing case studies.

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Pediatrics Nursing Case Studies

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Metabolic/Endocrine Nursing Case Studies

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Case report

Clinical course of a 66-year-old man with an acute ischaemic stroke in the setting of a covid-19 infection, saajan basi.

1 Department of Stroke and Acute Medicine, King's Mill Hospital, Sutton-in-Ashfield, UK

2 Department of Acute Medicine, University Hospitals of Derby and Burton, Derby, UK

Mohammad Hamdan

Shuja punekar.

A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater oxygen requirement, alongside reduced levels of consciousness. A positive COVID-19 throat swab, in addition to bilateral pneumonia on chest X-ray and lymphopaenia in his blood tests, confirmed a diagnosis of COVID-19 pneumonia. A proactive decision was made involving the patients’ family, ward and intensive care healthcare staff, to not escalate care above a ward-based ceiling of care. The patient died 5 days following admission under the palliative care provided by the medical team.

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is a new strain of coronavirus that is thought to have originated in December 2019 in Wuhan, China. In a matter of months, it has erupted from non-existence to perhaps the greatest challenge to healthcare in modern times, grinding most societies globally to a sudden halt. Consequently, the study and research into SARS-CoV-2 is invaluable. Although coronaviruses are common, SARS-CoV-2 appears to be considerably more contagious. The WHO figures into the 2003 SARS-CoV-1 outbreak, from November 2002 to July 2003, indicate a total of 8439 confirmed cases globally. 1 In comparison, during a period of 4 months from December 2019 to July 2020, the number of global cases of COVID-19 reached 10 357 662, increasing exponentially, illustrating how much more contagious SARS-CoV-2 has been. 2

Previous literature has indicated infections, and influenza-like illness have been associated with an overall increase in the odds of stroke development. 3 There appears to be a growing correlation between COVID-19 positive patients presenting to hospital with ischaemic stroke; however, studies investigating this are in progress, with new data emerging daily. This patient report comments on and further characterises the link between COVID-19 pneumonia and the development of ischaemic stroke. At the time of this patients’ admission, there were 95 positive cases from 604 COVID-19 tests conducted in the local community, with a predicted population of 108 000. 4 Only 4 days later, when this patient died, the figure increased to 172 positive cases (81% increase), illustrating the rapid escalation towards the peak of the pandemic, and widespread transmission within the local community ( figure 1 ). As more cases of ischaemic stroke in COVID-19 pneumonia patients arise, the recognition and understanding of its presentation and aetiology can be deciphered. Considering the virulence of SARS-CoV-2 it is crucial as a global healthcare community, we develop this understanding, in order to intervene and reduce significant morbidity and mortality in stroke patients.

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A graph showing the number of patients with COVID-19 in the hospital and in the community over time.

Case presentation

A 66-year-old man presented to the hospital with signs of left-sided weakness. The patient had a background of chronic obstructive pulmonary disease (COPD), atrial fibrillation and had one previous ischaemic stroke, producing left-sided haemiparesis, which had completely resolved. He was a non-smoker and lived in a house. The patient was found slumped over on the sofa at home on 1 April 2020, by a relative at approximately 01:00, having been seen to have no acute medical illness at 22:00. The patients’ relative initially described disorientation and agitation with weakness noted in the left upper limb and dysarthria. At the time of presentation, neither the patient nor his relative identified any history of fever, cough, shortness of breath, loss of taste, smell or any other symptoms; however, the patient did have a prior admission 9 days earlier with shortness of breath.

The vague nature of symptoms, entwined with considerable concern over approaching the hospital, due to the risk of contracting COVID-19, created a delay in the patients’ attendance to the accident and emergency department. His primary survey conducted at 09:20 on 1 April 2020 demonstrated a patent airway, with spontaneous breathing and good perfusion. His Glasgow Coma Scale (GCS) score was 15 (a score of 15 is the highest level of consciousness), his blood glucose was 7.2, and he did not exhibit any signs of trauma. His abbreviated mental test score was 7 out of 10, indicating a degree of altered cognition. An ECG demonstrated atrial fibrillation with a normal heart rate. His admission weight measured 107 kg. At 09:57 the patient required 2 L of nasal cannula oxygen to maintain his oxygen saturations between 88% and 92%. He started to develop agitation associated with an increased respiratory rate at 36 breaths per minute. On auscultation of his chest, he demonstrated widespread coarse crepitation and bilateral wheeze. Throughout he was haemodynamically stable, with a systolic blood pressure between 143 mm Hg and 144 mm Hg and heart rate between 86 beats/min and 95 beats/min. From a neurological standpoint, he had a mild left facial droop, 2/5 power in both lower limbs, 2/5 power in his left upper limb and 5/5 power in his right upper limb. Tone in his left upper limb had increased. This patient was suspected of having COVID-19 pneumonia alongside an ischaemic stroke.

Investigations

A CT of his brain conducted at 11:38 on 1 April 2020 ( figure 2 ) illustrated an ill-defined hypodensity in the right frontal lobe medially, with sulcal effacement and loss of grey-white matter. This was highly likely to represent acute anterior cerebral artery territory infarction. Furthermore an oval low-density area in the right cerebellar hemisphere, that was also suspicious of an acute infarction. These vascular territories did not entirely correlate with his clinical picture, as limb weakness is not as prominent in anterior cerebral artery territory ischaemia. Therefore this left-sided weakness may have been an amalgamation of residual weakness from his previous stroke, in addition to his acute cerebral infarction. An erect AP chest X-ray with portable equipment ( figure 3 ) conducted on the same day demonstrated patchy peripheral consolidation bilaterally, with no evidence of significant pleural effusion. The pattern of lung involvement raised suspicion of COVID-19 infection, which at this stage was thought to have provoked the acute cerebral infarct. Clinically significant blood results from 1 April 2020 demonstrated a raised C-reactive protein (CRP) at 215 mg/L (normal 0–5 mg/L) and lymphopaenia at 0.5×10 9 (normal 1×10 9 to 3×10 9 ). Other routine blood results are provided in table 1 .

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Object name is bcr-2020-235920f02.jpg

CT imaging of this patients’ brain demonstrating a wedge-shaped infarction of the anterior cerebral artery territory.

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Object name is bcr-2020-235920f03.jpg

Chest X-ray demonstrating the bilateral COVID-19 pneumonia of this patient on admission.

Clinical biochemistry and haematology blood results of the patient

APTT, activated partial thromboplastin time; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; Hb, haemoglobin; INR, international normalised ratio; MCV, mean corpuscular volume; PT, prothrombin time; WCC, white cell count.

Interestingly the patient, in this case, was clinically assessed in the accident and emergency department on 23 March 2020, 9 days prior to admission, with symptoms of shortness of breath. His blood results from this day showed a CRP of 22 mg/L and a greater lymphopaenia at 0.3×10 9 . He had a chest X-ray ( figure 4 ), which indicated mild radiopacification in the left mid zone. He was initially treated with intravenous co-amoxiclav and ciprofloxacin. The following day he had minimal symptoms (CURB 65 score 1 for being over 65 years). Given improving blood results (declining CRP), he was discharged home with a course of oral amoxicillin and clarithromycin. As national governmental restrictions due to COVID-19 had not been formally announced until 23 March 2020, and inconsistencies regarding personal protective equipment training and usage existed during the earlier stages of this rapidly evolving pandemic, it is possible that this patient contracted COVID-19 within the local community, or during his prior hospital admission. It could be argued that the patient had early COVID-19 signs and symptoms, having presented with shortness of breath, lymphopaenia, and having had subtle infective chest X-ray changes. The patient explained he developed a stagnant productive cough, which began 5 days prior to his attendance to hospital on 23 March 2020. He responded to antibiotics, making a full recovery following 7 days of treatment. This information does not assimilate with the typical features of a COVID-19 infection. A diagnosis of community-acquired pneumonia or infective exacerbation of COPD seem more likely. However, given the high incidence of COVID-19 infections during this patients’ illness, an exposure and early COVID-19 illness, prior to the 23 March 2020, cannot be completely ruled out.

An external file that holds a picture, illustration, etc.
Object name is bcr-2020-235920f04.jpg

Chest X-ray conducted on prior admission illustrating mild radiopacification in the left mid zone.

On the current admission, this patient was managed with nasal cannula oxygen at 2 L. By the end of the day, this had progressed to a venturi mask, requiring 8 L of oxygen to maintain oxygen saturation. He had also become increasingly drowsy and confused, his GCS declined from 15 to 12. However, the patient was still haemodynamically stable, as he had been in the morning. An arterial blood gas demonstrated a respiratory alkalosis (pH 7.55, pCO 2 3.1, pO 2 6.7 and HCO 3 24.9, lactate 1.8, base excess 0.5). He was commenced on intravenous co-amoxiclav and ciprofloxacin, to treat a potential exacerbation of COPD. This patient had a COVID-19 throat swab on 1 April 2020. Before the result of this swab, an early discussion was held with the intensive care unit staff, who decided at 17:00 on 1 April 2020 that given the patients presentation, rapid deterioration, comorbidities and likely COVID-19 diagnosis he would not be for escalation to the intensive care unit, and if he were to deteriorate further the end of life pathway would be most appropriate. The discussion was reiterated to the patients’ family, who were in agreement with this. Although he had evidence of an ischaemic stroke on CT of his brain, it was agreed by all clinicians that intervention for this was not as much of a priority as providing optimal palliative care, therefore, a minimally invasive method of treatment was advocated by the stroke team. The patient was given 300 mg of aspirin and was not a candidate for fibrinolysis.

Outcome and follow-up

The following day, before the throat swab result, had appeared the patient deteriorated further, requiring 15 L of oxygen through a non-rebreather face mask at 60% FiO 2 to maintain his oxygen saturation, at a maximum of 88% overnight. At this point, he was unresponsive to voice, with a GCS of 5. Although, he was still haemodynamically stable, with a blood pressure of 126/74 mm Hg and a heart rate of 98 beats/min. His respiratory rate was 30 breaths/min. His worsening respiratory condition, combined with his declining level of consciousness made it impossible to clinically assess progression of the neurological deficit generated by his cerebral infarction. Moreover, the patient was declining sharply while receiving the maximal ward-based treatment available. The senior respiratory physician overseeing the patients’ care decided that a palliative approach was in this his best interest, which was agreed on by all parties. The respiratory team completed the ‘recognising dying’ documentation, which signified that priorities of care had shifted from curative treatment to palliative care. Although the palliative team was not formally involved in the care of the patient, the patient received comfort measures without further attempts at supporting oxygenation, or conduction of regular clinical observations. The COVID-19 throat swab confirmed a positive result on 2 April 2020. The patient was treated by the medical team under jurisdiction of the hospital palliative care team. This included the prescribing of anticipatory medications and a syringe driver, which was established on 3 April 2020. His antibiotic treatment, non-essential medication and intravenous fluid treatment were discontinued. His comatose condition persisted throughout the admission. Once the patients’ GCS was 5, it did not improve. The patient was pronounced dead by doctors at 08:40 on 5 April 2020.

SARS-CoV-2 is a type of coronavirus that was first reported to have caused pneumonia-like infection in humans on 3 December 2019. 5 As a group, coronaviruses are a common cause of upper and lower respiratory tract infections (especially in children) and have been researched extensively since they were first characterised in the 1960s. 6 To date, there are seven coronaviruses that are known to cause infection in humans, including SARS-CoV-1, the first known zoonotic coronavirus outbreak in November 2002. 7 Coronavirus infections pass through communities during the winter months, causing small outbreaks in local communities, that do not cause significant mortality or morbidity.

SARS-CoV-2 strain of coronavirus is classed as a zoonotic coronavirus, meaning the virus pathogen is transmitted from non-humans to cause disease in humans. However the rapid spread of SARS-CoV-2 indicates human to human transmission is present. From previous research on the transmission of coronaviruses and that of SARS-CoV-2 it can be inferred that SARS-CoV-2 spreads via respiratory droplets, either from direct inhalation, or indirectly touching surfaces with the virus and exposing the eyes, nose or mouth. 8 Common signs and symptoms of the COVID-19 infection identified in patients include high fevers, severe fatigue, dry cough, acute breathing difficulties, bilateral pneumonia on radiological imaging and lymphopaenia. 9 Most of these features were identified in this case study. The significance of COVID-19 is illustrated by the speed of its global spread and the potential to cause severe clinical presentations, which as of April 2020 can only be treated symptomatically. In Italy, as of mid-March 2020, it was reported that 12% of the entire COVID-19 positive population and 16% of all hospitalised patients had an admission to the intensive care unit. 10

The patient, in this case, illustrates the clinical relevance of understanding COVID-19, as he presented with an ischaemic stroke underlined by minimal respiratory symptoms, which progressed expeditiously, resulting in acute respiratory distress syndrome and subsequent death.

Our case is an example of a new and ever-evolving clinical correlation, between patients who present with a radiological confirmed ischaemic stroke and severe COVID-19 pneumonia. As of April 2020, no comprehensive data of the relationship between ischaemic stroke and COVID-19 has been published, however early retrospective case series from three hospitals in Wuhan, China have indicated that up to 36% of COVID-19 patients had neurological manifestations, including stroke. 11 These studies have not yet undergone peer review, but they tell us a great deal about the relationship between COVID-19 and ischaemic stroke, and have been used to influence the American Heart Associations ‘Temporary Emergency Guidance to US Stroke Centres During the COVID-19 Pandemic’. 12

The relationship between similar coronaviruses and other viruses, such as influenza in the development of ischaemic stroke has previously been researched and provide a basis for further investigation, into the prominence of COVID-19 and its relation to ischaemic stroke. 3 Studies of SARS-CoV-2 indicate its receptor-binding region for entry into the host cell is the same as ACE2, which is present on endothelial cells throughout the body. It may be the case that SARS-CoV-2 alters the conventional ability of ACE2 to protect endothelial function in blood vessels, promoting atherosclerotic plaque displacement by producing an inflammatory response, thus increasing the risk of ischaemic stroke development. 13

Other hypothesised reasons for stroke development in COVID-19 patients are the development of hypercoagulability, as a result of critical illness or new onset of arrhythmias, caused by severe infection. Some case studies in Wuhan described immense inflammatory responses to COVID-19, including elevated acute phase reactants, such as CRP and D-dimer. Raised D-dimers are a non-specific marker of a prothrombotic state and have been associated with greater morbidity and mortality relating to stroke and other neurological features. 14

Arrhythmias such as atrial fibrillation had been identified in 17% of 138 COVID-19 patients, in a study conducted in Wuhan, China. 15 In this report, the patient was known to have atrial fibrillation and was treated with rivaroxaban. The acute inflammatory state COVID-19 is known to produce had the potential to create a prothrombotic environment, culminating in an ischaemic stroke.

Some early case studies produced in Wuhan describe patients in the sixth decade of life that had not been previously noted to have antiphospholipid antibodies, contain the antibodies in blood results. They are antibodies signify antiphospholipid syndrome; a prothrombotic condition. 16 This raises the hypothesis concerning the ability of COVID-19 to evoke the creation of these antibodies and potentiate thrombotic events, such as ischaemic stroke.

No peer-reviewed studies on the effects of COVID-19 and mechanism of stroke are published as of April 2020; therefore, it is difficult to evidence a specific reason as to why COVID-19 patients are developing neurological signs. It is suspected that a mixture of the factors mentioned above influence the development of ischaemic stroke.

If we delve further into this patients’ comorbid state exclusive to COVID-19 infection, it can be argued that this patient was already at a relatively higher risk of stroke development compared with the general population. The fact this patient had previously had an ischaemic stroke illustrates a prior susceptibility. This patient had a known background of hypertension and atrial fibrillation, which as mentioned previously, can influence blood clot or plaque propagation in the development of an acute ischaemic event. 15 Although the patient was prescribed rivaroxaban as an anticoagulant, true consistent compliance to rivaroxaban or other medications such as amlodipine, clopidogrel, candesartan and atorvastatin cannot be confirmed; all of which can contribute to the reduction of influential factors in the development of ischaemic stroke. Furthermore, the fear of contracting COVID-19, in addition to his vague symptoms, unlike his prior ischaemic stroke, which demonstrated dense left-sided haemiparesis, led to a delay in presentation to hospital. This made treatment options like fibrinolysis unachievable, although it can be argued that if he was already infected with COVID-19, he would have still developed life-threatening COVID-19 pneumonia, regardless of whether he underwent fibrinolysis. It is therefore important to consider that if this patient did not contract COVID-19 pneumonia, he still had many risk factors that made him prone to ischaemic stroke formation. Thus, we must consider whether similar patients would suffer from ischaemic stroke, regardless of COVID-19 infection and whether COVID-19 impacts on the severity of the stroke as an entity.

Having said this, the management of these patients is dependent on the likelihood of a positive outcome from the COVID-19 infection. Establishing the ceiling of care is crucial, as it prevents incredibly unwell or unfit patients’ from going through futile treatments, ensuring respect and dignity in death, if this is the likely outcome. It also allows for the provision of limited or intensive resources, such as intensive care beds or endotracheal intubation during the COVID-19 pandemic, to those who are assessed by the multidisciplinary team to benefit the most from their use. The way to establish this ceiling of care is through an early multidisciplinary discussion. In this case, the patient did not convey his wishes regarding his care to the medical team or his family; therefore it was decided among intensive care specialists, respiratory physicians, stroke physicians and the patients’ relatives. The patient was discussed with the intensive care team, who decided that as the patient sustained two acute life-threatening illnesses simultaneously and had rapidly deteriorated, ward-based care with a view to palliate if the further deterioration was in the patients’ best interests. These decisions were not easy to make, especially as it was on the first day of presentation. This decision was made in the context of the patients’ comorbidities, including COPD, the patients’ age, and the availability of intensive care beds during the steep rise in intensive care admissions, in the midst of the COVID-19 pandemic ( figure 1 ). Furthermore, the patients’ rapid and permanent decline in GCS, entwined with the severe stroke on CT imaging of the brain made it more unlikely that significant and permanent recovery could be achieved from mechanical intubation, especially as the damage caused by the stroke could not be significantly reversed. As hospitals manage patients with COVID-19 in many parts of the world, there may be tension between the need to provide higher levels of care for an individual patient and the need to preserve finite resources to maximise the benefits for most patients. This patient presented during a steep rise in intensive care admissions, which may have influenced the early decision not to treat the patient in an intensive care setting. Retrospective studies from Wuhan investigating mortality in patients with multiple organ failure, in the setting of COVID-19, requiring intubation have demonstrated mortality can be up to 61.5%. 17 The mortality risk is even higher in those over 65 years of age with respiratory comorbidities, indicating why this patient was unlikely to survive an admission to the intensive care unit. 18

Regularly updating the patients’ family ensured cooperation, empathy and sympathy. The patients’ stroke was not seen as a priority given the severity of his COVID-19 pneumonia, therefore the least invasive, but most appropriate treatment was provided for his stroke. The British Association of Stroke Physicians advocate this approach and also request the notification to their organisation of COVID-19-related stroke cases, in the UK. 19

Learning points

  • SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is one of seven known coronaviruses that commonly cause upper and lower respiratory tract infections. It is the cause of the 2019–2020 global coronavirus pandemic.
  • The significance of COVID-19 is illustrated by the rapid speed of its spread globally and the potential to cause severe clinical presentations, such as ischaemic stroke.
  • Early retrospective data has indicated that up to 36% of COVID-19 patients had neurological manifestations, including stroke.
  • Potential mechanisms behind stroke in COVID-19 patients include a plethora of hypercoagulability secondary to critical illness and systemic inflammation, the development of arrhythmia, alteration to the vascular endothelium resulting in atherosclerotic plaque displacement and dehydration.
  • It is vital that effective, open communication between the multidisciplinary team, patient and patients relatives is conducted early in order to firmly establish the most appropriate ceiling of care for the patient.

Contributors: SB was involved in the collecting of information for the case, the initial written draft of the case and researching existing data on acute stroke and COVID-19. He also edited drafts of the report. MH was involved in reviewing and editing drafts of the report and contributing new data. SP oversaw the conduction of the project and contributed addition research papers.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient consent for publication: Next of kin consent obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

sample case study stroke patient

A sample case study: Mrs Brown

On this page, social work report, social work report: background, social work report: social history, social work report: current function, social work report: the current risks, social work report: attempts to trial least restrictive options, social work report: recommendation, medical report, medical report: background information, medical report: financial and legal affairs, medical report: general living circumstances.

This is a fictitious case that has been designed for educative purposes.

Mrs Beryl Brown URN102030 20 Hume Road, Melbourne, 3000 DOB: 01/11/33

Date of application: 20 August 2019

Mrs Beryl Brown (01/11/33) is an 85 year old woman who was admitted to the Hume Hospital by ambulance after being found by her youngest daughter lying in front of her toilet. Her daughter estimates that she may have been on the ground overnight. On admission, Mrs Brown was diagnosed with a right sided stroke, which has left her with moderate weakness in her left arm and leg. A diagnosis of vascular dementia was also made, which is overlaid on a pre-existing diagnosis of Alzheimer’s disease (2016). Please refer to the attached medical report for further details.

I understand that Mrs Brown has been residing in her own home, a two-story terrace house in Melbourne, for almost 60 years. She has lived alone since her husband died two years ago following a cardiac arrest. She has two daughters. The youngest daughter Jean has lived with her for the past year, after she lost her job. The eldest daughter Catherine lives on the Gold Coast with her family. Mrs Brown is a retired school teacher and she and both daughters describe her as a very private woman who has never enjoyed having visitors in her home. Mrs Brown took much encouragement to accept cleaning and shopping assistance once a week after her most recent admission; however, she does not agree to increase service provision. Jean has Enduring Power of Attorney (EPOA) paperwork that indicates that Mrs Brown appointed her under an EPOA two years ago. She does not appear to have appointed a medical treatment decision maker or any other decision-supporter.

I also understand from conversations with her daughters that Jean and Mrs Brown have always been very close and that there is a history of long-standing conflict between Catherine and Jean. This was exacerbated by the death of their father. Both daughters state they understand the impact of the stroke on their mother’s physical and cognitive functioning, but they do not agree on a discharge destination. Mrs Brown lacks insight into her care needs and says she will be fine once she gets back into her own home. Repeated attempts to discuss options with all parties in the same room have not resulted in a decision that is agreeable to all parties.

Mrs Brown has a history of Alzheimer’s disease; type II diabetes – insulin dependent; hypertension; high cholesterol and osteoarthritis. She has had two recent admissions to hospital for a urinary tract infection and a fall in the context of low blood sugars. She is currently requiring one to two people to assist her into and out of bed and one person with managing tasks associated with post-toilet hygiene. She can walk slowly for short distances with a four-wheel frame with one person to supervise. She benefits from prompting to use her frame; she needs someone to cut her food and to set her up to eat and drink regularly and to manage her medication routine. She requires one person to assist her to manage her insulin twice daily.

The team believe that Mrs Brown’s capacity for functional improvement has plateaued in the last ten days. They recommend that it is in her best interests to be discharged to a residential care setting due to her need for one to two people to provide assistance with the core tasks associated with daily living. Mrs Brown is adamant that she wants to return home to live with Jean who she states can look after her. Jean, who has a history of chronic back pain, has required several admissions to hospital over the past five years, and states she wants to be able to care for her mother at home. Jean states she is reluctant to agree to extra services as her mother would not want this. Her sister Catherine is concerned that Jean has not been coping and states that given this is the third admission to hospital in a period of few months, believes it is now time for her mother to enter residential care. Catherine states that she is very opposed to her mother being discharged home.

Mrs Brown is at high risk of experiencing falls. She has reduced awareness of the left side of her body and her ability to plan and process information has been affected by her stroke. She is now requiring one to two people to assist with all her tasks of daily living and she lacks insight into these deficits. Mrs Brown is also at risk of further significant functional decline which may exacerbate Jean’s back pain. Jean has stated she is very worried about where she will live if her mother is to enter residential care.

We have convened two family meetings with Mrs Brown, both her daughters and several members of the multi-disciplinary team. The outcome of the first meeting saw all parties agree for the ward to provide personalised carer training to Jean with the aim of trialling a discharge home. During this training Jean reported significant pain when transferring her mother from the bed and stated she would prefer to leave her mother in bed until she was well enough to get out with less support.

The team provided education to both Jean and Catherine about the progressive impact of their mother’s multiple conditions on her functioning. The occupational therapist completed a home visit and recommended that the downstairs shower be modified so that a commode can be placed in it safely and the existing dining room be converted into a bedroom for Mrs Brown. Mrs Brown stated she would not pay for these modifications and Jean stated she did not wish to go against her mother’s wishes. The team encouraged Mrs Brown to consider developing a back-up plan and explore residential care options close to her home so that Jean could visit often if the discharge home failed. Mrs Brown and Jean refused to consent to proceed with an Aged Care Assessment that would enable Catherine to waitlist her mother’s name at suitable aged care facilities. We proceeded with organising a trial overnight visit. Unfortunately, this visit was not successful as Jean and Catherine, who remained in Melbourne to provide assistance, found it very difficult to provide care without the use of an accessible bathroom. Mrs Brown remains adamant that she will remain at home. The team is continuing to work with the family to maximise Mrs Brown’s independence, but they believe that it is unlikely this will improve. I have spent time with Jean to explore her adjustment to the situation, and provided her with information on community support services and residential care services. I have provided her with information on the Transition Care Program which can assist families to work through all the logistics. I have provided her with more information on where she could access further counselling to explore her concerns. I have sought advice on the process and legislative requirements from the Office of the Public Advocate’s Advice Service. I discussed this process with the treating team and we decided that it was time to lodge an application for guardianship to VCAT.

The treating team believe they have exhausted all least restrictive alternatives and that a guardianship order is required to make a decision on Mrs Brown’s discharge destination and access to services. The team recommend that the Public Advocate be appointed as Mrs Brown’s guardian of last resort. We believe that this is the most suitable arrangement as her daughters are not in agreement about what is in their mother’s best interests. We also believe that there is a potential conflict of interest as Jean has expressed significant concern that her mother’s relocation to residential care will have an impact on her own living arrangements.

Mrs Brown’s medical history includes Alzheimer’s disease; type II diabetes; hypertension; high cholesterol and osteoarthritis. She was admitted to Hume Hospital on 3 March 2019 following a stroke that resulted in moderate left arm and leg weakness. This admission was the third hospital admission in the past year. Other admissions have been for a urinary tract infection, and a fall in the context hypoglycaemia (low blood sugars), both of which were complicated by episodes of delirium.

She was transferred to the subacute site under my care, a week post her admission, for slow-stream rehabilitation, cognitive assessment and discharge planning.

Mrs Brown was diagnosed with Alzheimer’s disease by Dr Joanne Winters, Geriatrician, in April 2016. At that time, Mrs Brown scored 21/30 on the Standardised Mini-Mental State Examination (SMMSE). During this admission, Mrs Brown scored 15/30. I have undertaken cognitive assessment and agree with the diagnosis; further cognitive decline has occurred in the context of the recent stroke. There are global cognitive deficits, but primarily affecting memory, attention and executive function (planning, problem solving, mental flexibility and abstract reasoning). The most recent CT-Brain scan shows generalised atrophy along with evidence of the new stroke affecting the right frontal lobe. My assessments suggest moderate to severe mixed Alzheimer’s and vascular dementia.

While able to recall some key aspects of her financial affairs, including the general monetary value of her pension and regular expenses, Mrs Brown was unable to account for recent expenditure (for repairs to her home) or provide an estimate of its value, and had difficulty describing her investments. In addition, I consider that she would be unable to make complex financial decisions due to her level of cognitive impairment. Accordingly, I am of the view that Mrs Brown now lacks capacity to make financial decisions.

Mrs Brown states that she previously made an Enduring Power of Attorney (EPOA) but could no longer recall aspects of the EPOA, such as when it would commence and the nature of the attorney’s powers. Moreover, she confused the EPOA with her will. Her understanding of these matters did not improve with education, and therefore I consider that she no longer has capacity to execute or revoke an EPOA.

Mrs Brown acknowledges that she needs some assistance but lacks insight into the type of assistance that she requires, apart from home help for cleaning and shopping. She does not appreciate her risk of falling. She is unable to get in and out of bed without at least one person assisting her. She frequently forgets to use her gait aid when mobilising and is not able to describe how she would seek help in the event of falling. She is not able to identify or describe how she would manage her blood sugar levels, and this has not improved with education. Accordingly, I consider that she lacks capacity to make decisions about accommodation arrangements and services.

Mrs Brown does not agree with the treating team’s recommendation to move into residential care and maintains her preference to return home. This is in spite of a failed overnight trial at home with both her daughters assisting her. Unfortunately, she was unable to get out of bed to get to the toilet and required two people to assist her to do so in the morning. In light of these matters, and in the context of family disagreement regarding the matter, the team recommends that the Office of the Public Advocate be appointed as a guardian of last resort.

Reviewed 22 July 2022

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  • Open access
  • Published: 02 February 2024

The impact of education/training on nurses caring for patients with stroke: a scoping review

  • Yanjie Zhao 1 , 2 ,
  • Yuezhen Xu 2 ,
  • Dongfei Ma 1 ,
  • Shuyan Fang 1 ,
  • Shengze Zhi 1 ,
  • Meng He 1 ,
  • Xiangning Zhu 1 ,
  • Yueyang Dong 1 ,
  • DongPo Song 1 ,
  • Atigu Yiming 1 &
  • Jiao Sun 1  

BMC Nursing volume  23 , Article number:  90 ( 2024 ) Cite this article

457 Accesses

Metrics details

Stroke survivors have complex needs that necessitate the expertise and skill of well-trained healthcare professionals to provide effective rehabilitation and long-term support. Limited knowledge exists regarding the availability of specialized education and training programs specifically designed for nurses caring for stroke patients.

This review aims to assess the content and methods of training for nurses caring for stroke patients, examine its impact on both nurses and patients, and identify key facilitators and barriers to its implementation.

We conducted a comprehensive scoping review by reviewing multiple databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, Google Scholar, and Cochrane databases. Data extraction and narrative synthesis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

Seventeen articles were included in this review. We found that education/training not only enhanced patients' self-care abilities, nursing outcomes, and satisfaction, but also had a positive impact on the knowledge, skills, and practices of nurses. The obstacles to education/training included feasibility and cost-effectiveness, while the driving factors were management support and participation, professional education/training, and controlled environment creation.

Conclusions

This review highlights the crucial role of education/training in enhancing stroke care provided by nurses. Effective education/training integrates various educational methods and management support to overcome implementation barriers and optimize clinical practice benefits. These findings indicate the necessity of universal and consistent stroke education/training for nurses to further improve patient outcomes in stroke care.

Peer Review reports

Introduction

Stroke is a primary cause of mortality and disability worldwide, and prompt medical management by specialists can improve the cure rate and minimize the disability, mortality, and recurrence rates [ 1 ]. The provision of care in stroke units is widely recognized for its positive impact on the prognosis of stroke patients [ 2 ]. This can be attributed to the presence of multidisciplinary teams equipped with extensive expertise, skills, and experience in stroke management. According to the Guidelines for Stroke Management, healthcare professionals involved in stroke care should possess a strong sense of service, expertise, and effective communication skills. Additionally, professional education and training should be offered to staff lacking the necessary knowledge or competencies [ 3 ]. Nurses play a crucial role as stakeholders and team members in the comprehensive stroke care system, influencing all aspects of care, from initial assessments and symptom recognition to treatment, rehabilitation exercises, early warning monitoring, psychological support, and end-of-life care [ 4 , 5 ]. Consequently, stroke nursing staff require comprehensive training and education to ensure their capacity to deliver high-quality care to stroke patients. The development and implementation of stroke education and training programs for nurses are paramount in achieving high-quality stroke care and fostering positive patient prognosis [ 6 ].

Currently, the limited number of nurses worldwide who have received stroke education and training poses challenges in delivering high-quality care for individuals with stroke. In response to this issue, several developed countries, such as the UK with its National Stroke Strategy, have recognized the importance of nationally recognized, quality-assured, and replicable stroke education and training programs for healthcare professionals to ensure their proficiency and expertise [ 7 ]. Consequently, a Stroke-Specific Education Framework was established [ 8 ]. In developing countries like China, where stroke has a high prevalence, effective prevention and treatment of stroke have become crucial objectives for the overall population health. Consequently, in line with the decision-making and implementation of initiatives like the "Healthy China 2030 Plan" and "Action Plan for Implementing Healthy China," it is recommended that large healthcare institutions establish a "Brain Heart Health Manager Training Course" instructed by stroke experts [ 9 ]. This training should cover a comprehensive range of stroke management approaches at different stages. These strategies serve as valuable benchmarks and training guidelines for the development of stroke education programs for nurses.

The education and training of stroke caregivers pose significant challenges. These challenges arise due to the constantly changing conditions of individuals with stroke, as well as the presence of physical dysfunction, cognitive impairment, and psychosocial problems [ 10 , 11 ]. Notably, cognitive impairment can be difficult to detect in the early stages [ 12 ]. Current education and training for nurses who care for stroke patients primarily consist of in-service training and continuing education courses [ 13 ]. However, there are notable issues with this approach, including limited educational resources such as inadequate materials, training programs, and support systems. Additionally, there is a need for the integration of existing educational methods to maximize their effectiveness and equip nurses with the necessary knowledge and skills for effectively managing stroke patients [ 14 ]. Research suggests that the effectiveness of education and training for stroke nursing staff can be enhanced through evidence-based guidelines, interactive curricula, and increased opportunities for nurses to practice [ 15 , 16 , 17 ]. Conversely, barriers to effective education and training may include a lack of time and financial support, as well as nurses' resistance to updating their knowledge and skills [ 18 , 19 ].

The significant role of nursing care in stroke management is widely recognized, yet it has not received sufficient research attention. The results of one integrative review only confirmed the potential and feasibility of education/training for all stroke healthcare professionals, including doctors, neurologists, physiotherapists, paramedics, nurses, and dispatchers [ 20 ]. Nurses play a different role in stroke care than other healthcare professionals. Professional education/training can better address the professional development needs of nurses in these fields. At present, there has been no scope review on the education/training programs for nurses involved in stroke care. The impact of these education/training programs on nurses and the patients cared for by trained nurses has not been reported. Therefore, this review adopts a scoping review approach to summarize the existing scientific literature, examine the effects of stroke education and training on nurses involved in stroke care and their patients, and identify the factors that facilitate or hinder stroke education and training. Our findings may provide evidence for improving the quality of nurses caring for people with stroke.

Materials and methods

This review employed a scoping review methodology [ 21 ] based on the Joanna Briggs Institute (JBI) method [ 22 , 23 , 24 ]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist [ 25 ] and the 2020 PRISMA flow diagram were utilized. The following research questions were addressed: 1) What types of education/training programs have been developed for nurses involved in stroke patient care? 2) What are the effects of the education/training on nurses? 3) What are the effects of the education/training on patients? 4) What are the facilitators and barriers encountered in the implementation of the education/training?

Search strategy

The research team developed a retrieval strategy based on the research purpose and content, and two members of the research team (ZYJ and MDF) independently conducted searches according to the retrieval strategy. The research team resolved the differences and ultimately determined the retrieval results. A comprehensive search was conducted across a range of databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, Google Scholar, and Cochrane Library. The details of the search strategy, including those of the grey literature, are outlined in Additional file 1 :  Appendix A. A hand-search of reference lists of all included studies was also performed to identify any additional articles that were not captured through database searches.

Study eligibility

The JBI Participants Concept Context framework used to define the scoping review search strategy is described in Table  1 .

Inclusion criteria for this review included:

Nurses working in the community or clinical settings with no age limitations;

Study on education and training provided to nurses;

Information on stroke patient care in various nursing settings;

Reviews of the data, with no restrictions on information sources or study type. The study type included descriptive research, analytical research, trial research, thesis dissertations, and organizational reports;

All studies on the impact of education/training on nurses involved in stroke care from publication to February 2023.

Publications in English.

Exclusion criteria for this review included:

The primary focus of education/training was not on nurses;

Participants of nursing educators, nursing college instructors, nursing students, or graduate nurses;

Reviews (e.g., integrative, systematic, and scoping reviews).

All retrieved records were imported into EndNote X9 to eliminate duplicate studies. Throughout the initial review and abstract screening, an iterative approach was utilized to further refine the inclusion/exclusion criteria to align the screening process with the focus of this review. We included peer-reviewed academic research articles that reported original data sources and employed diverse research methodologies. Grey literature resources included master's and doctoral dissertations found in ProQuest papers and degree databases, as well as reports obtained from relevant organizational websites, such as Google Scholar. The target participants comprised full-time nurses, part-time nurses, casual registered practical nurses, registered nurses, registered practical nurses, and permanent nurses. If the education/training participants primarily focused on nurses, it also encompassed healthcare assistants, nurse assistants, and other community health workers. Education/training reviews mainly involving nursing educators, nursing college instructors, nursing students, or graduate nurses working in medical environments (e.g., hospitals, clinical settings, nursing homes, and patient homes) and educational settings (e.g., nursing schools, colleges, and universities) were excluded. The articles on the impact of education/training on nurses other than nurses caring for stroke patients, as well as the impact of educated and trained nurses on the stroke patients they care for were excluded. Literature reviews (e.g., integrative, systematic, and scoping reviews) were excluded. Two members of the research team (XYZ and FSY) independently screen titles and abstracts from literature searches. The full texts of the articles with potentially relevant titles and abstracts were further screened by two independent researchers for articles that met the predefined inclusion criteria for the review. In case of disagreements or discrepancies between the two researchers regarding the inclusion of certain studies, they resolved them through discussion with the involvement of a third researcher (ZSZ).

Data extraction

Based on previous literature and the research content of this review, the research team created a data extraction template, which included the author, year, country, review design, characteristics of staff participants (including nursing department, years of nursing practice, and completion of training/activities), characteristics of patient participants (including mean patient age, female/male ratio, and completion of training/activities), content of education and training programs, delivery format, delivery method, education and training providers, program frequency and duration, guiding theories, and main outcome measures. A pilot test was conducted in two papers. After confirming the efficacy of the template in extracting the required data for the review, the research team utilized it to extract data from all other relevant studies. The main consensuses of data extraction included the importance of ensuring data accuracy during extraction. Years of nursing practice refers to the overall duration of a nurse's participation in nursing work, rather than just focusing on stroke patient care. The number of staff participants, completion of training/activity, patient participants, mean patient age and patient sex must be strictly extracted according to the study's description. Data extraction included all essential data points to prevent loss and ensure the representation of complete information in this review. Didactic activities of education/training mainly involved lectures, brochures, demonstrations, self-directed e-learning, and videos. Interactive activities of education/training mainly involved simulation exercises, seminars, group discussions, and clinical practices. The main outcome measure was divided into two categories: nurse and quality of care. Nurse mainly refers to the impact of educational/training activities on nursing staff, encompassing their skills, job satisfaction, etc. Quality of care refers to the impact of education/training activities on patients, including their disease outcomes and satisfaction with care. Two researchers (HM and A·Y) independently extracted key data from eligible studies. If there are disagreements, they resolve them through discussion with the third researcher (SJ).

Data analysis, synthesis, and charting of findings

The research characteristics and the scope and properties of available research are presented in the form of a numerical analysis table. To synthesize the research results, especially those related to the education/training of stroke nurses, as well as the role of stroke patients cared for by these educated and trained nurses, we identified a descriptive exploratory study published by Thompson et al. [ 26 ]. In their study, they identified the elements of education and training as follows: "Educates and supports staff to deliver safety, high-quality care, and make a valid contribution to ward patient safety," providing a useful framework for synthesizing these findings. Because of the focus of this review on exploring and participating in the education/training of nurses in the care of stroke patients, the research team also combined the three separate sections (i.e., essential requirements, knowledge and understanding, skills and ability) of the Stroke-Specific Education Framework [ 8 ]. Several crucial aspects and considerations of education and training in the nursing field were identified, encompassing the fundamental professional knowledge of nurses, nurses' clinical practice skills, impact on nurses, patient self-care abilities, care outcomes, patient satisfaction, barriers and facilitators to education and training, guiding the research team to synthesize findings on the impact of comprehensive education and training interventions on nurses participating in stroke care. The data was independently integrated by two researchers (ZXN and DYY). Any disagreements can be resolved through discussion or by a decision made by a third researcher (SDP).

As per the scoping review requirements, the quality assessment of the included articles is neither mandatory nor within the scope of the scoping review [ 24 , 25 ]. Nevertheless, this paper adopted a critical perspective on the included literature due to the limitations of the overall paper evaluation approach.

Search results

As shown in the PRISMA chart (Fig.  1 ), a total of 11,990 records were identified through databases and 2805 records were identified from ProQuest Dissertations and Theses, Google Scholar. After removing the duplicates ( n  = 1527), a total of 13,268 records were screened for the title and abstract, resulting in the exclusion of 13,239 records. The remaining 29 records and 3 additional full-text papers retrieved from reference lists were further assessed for eligibility. Ultimately, 17 records were included in this review.

figure 1

PRISMA flow chart illustrating the identification of literature for the scoping review

Basic characteristics of the studies

The records included in this review are presented in Table  2 . Out of the 17 included studies, the majority ( n  = 14) were published in Western countries. Among these, five were from the United Kingdom [ 27 , 28 , 29 , 30 , 31 ] and four were from the United States [ 32 , 33 , 34 , 35 ]. The remaining studies were from Australia ( n  = 2) [ 36 , 37 ], Switzerland ( n  = 2) [ 38 , 39 ], Canada ( n  = 1) [ 40 ], and Asian countries with larger population bases and more developed healthcare systems, such as China ( n  = 1) [ 41 ], India ( n  = 1) [ 42 ], and Japan ( n  = 1) [ 43 ].

Five studies utilized randomized trial designs, including two randomized controlled trials [ 34 , 39 ] and three cluster randomized controlled trials [ 30 , 36 , 42 ]. One study followed a cohort study design [ 38 ], while another utilized a mixed-method design [ 33 ]. The remaining studies employed quasi-experimental designs: seven used pretest–posttest [ 27 , 29 , 32 , 35 , 37 , 40 , 41 ], one used a non-equivalent group [ 28 ], one conducted a Cross-Sectional Web-Based Questionnaire Survey [ 43 ], and one utilized knowledge introduction [ 31 ].

All studies included in this review considered nurses involved in stroke care as the primary participants for education/training. However, due to the necessity of program development, a small number of studies also included educated or trained healthcare assistants [ 27 , 30 ], nurse assistants, and other community health workers [ 33 ].

Only five studies did not disclose the number of nurses involved in the education and training programs [ 30 , 31 , 32 , 36 , 42 ]. However, the remaining 12 studies provided information about the number of participating nurses. In total, approximately 1662 nurses took part in the education and training programs within the included studies The majority of these nurses were registered nurses or registered practical nurses (94.12%). Some studies also included permanent nurses [ 37 ], full-time nurses, part-time or casual nurses [ 40 ], health care assistants [ 27 , 30 ], nurse assistants [ 33 ], and community health workers [ 42 ]. A few studies mentioned the number of years of nursing practice among the participating nurses, which varied from 2 to 35 years. Junior nurses represented the majority, accounting for 69.07% of the total. Furthermore, the completion rate of the education and training programs was consistently high for all nurses, ranging from 64.7% to 100%.

Out of the 17 studies included in this analysis, 15 implemented education and training interventions aimed at improving stroke patient care among nurses involved in stroke care. Eight of these studies specifically targeted nurses working in stroke rehabilitation [ 28 , 29 , 30 , 32 , 33 , 37 , 38 , 40 ], while the remaining seven focused on nurses working in general wards [ 27 ], acute stroke units [ 36 ], medical centers [ 34 ], neurological ICUs [ 35 ], neurological wards [ 41 ], the community [ 42 ], and emergency medical services [ 39 ]. The other two studies had distinct focuses: one examined nurses' awareness and actual stroke care nursing practices through a web-based cross-sectional questionnaire in acute stroke units [ 43 ], and the other summarized knowledge gained from simulation training completed by nurses in hyperacute stroke units [ 31 ].

Nine studies reported information on selected patient characteristics [ 27 , 28 , 29 , 30 , 34 , 36 , 38 , 40 , 42 ]. The known outcome analyses included a larger number of male than female patients (777 males and 563 females). One study did not impose an age restriction on stroke patients [ 36 ], while the remaining studies comprised patients aged between 59 and 78 years, who had experienced strokes and were admitted to diverse departments, including rehabilitation units, neurology units, stroke units, and various other departments.

The education/training programs focused on imparting the latest professional knowledge and addressing practical clinical care issues. To ensure accessibility to knowledge, the study developed the program. The education/training program commenced by providing an overview of stroke, covering its definition, etiology, influencing factors, treatment, general care, and rehabilitation. This was done to establish a foundational understanding of stroke-related nursing knowledge among the participating nurses [ 27 , 28 , 29 , 30 ]. Subsequently, specialized nursing knowledge on individuals with stroke was covered, including the administration of tissue-type plasminogen activator [ 35 ], cardiac monitoring [ 35 , 37 ], and neurological assessment [ 31 , 35 , 39 , 41 ]. Additionally, the education/training program was tailored to the specific characteristics of each nursing department to address practical clinical care concerns. Examples of such tailored training included management of blood glucose in stroke patients with diabetes mellitus [ 36 ]; rehabilitation of stroke patients with dysphagia [ 33 , 34 , 35 , 36 ]; rehabilitation of patients with urinary incontinence [ 38 ]; reducing physical restraints for stroke patients at risk of falls [ 32 ]; physiotherapy and secondary prevention [ 42 ]; stroke care; and interprofessional communication training for stroke unit doctors, dieticians, physiotherapists, and specialist nurses [ 31 , 35 , 40 ]. The relevance of these educational/training objectives was instrumental in their effectiveness.

Eight education/training methods were used across all the included studies, which were categorized into five formats: classroom lectures (face-to-face), book reading (learning manuals), simulation training (scenario-based and virtual simulations), demonstration teaching (presentations), and seminars (on-site, telephone/internet, and group/collective seminars). Most of the studies utilized multiple education/training methods, as there was no single method prevalent. Out of the included studies, eleven employed three or more types of education/training methods that positively influenced either the trained nurses or the quality of care [ 27 , 28 , 29 , 30 , 31 , 33 , 35 , 36 , 37 , 40 , 41 ]. Only two studies utilized a single education/training method, either face-to-face lectures [ 32 ] or demonstrations [ 34 ]. Additionally, one study primarily utilized online courses, providing flexibility for nurses to complete the education/training programs at their convenience [ 39 ]. The duration and frequency of the education/training programs were reported in these studies. Each education/training session ranged from 30 min to 2 h in length and from 1 working day to 15 months in duration. Most education/training programs were delivered multiple times. The education/training providers were predominantly clinical care specialists ( n  = 8) [ 27 , 30 , 32 , 33 , 35 , 37 , 40 , 42 ], followed by physicians and occupational therapists ( n  = 6) [ 28 , 29 , 31 , 34 , 40 , 41 ]. In addition, online education/training was provided by platform developers [ 39 ]. However, the providers in the remaining three studies were not specified [ 36 , 38 , 43 ].

Nine studies in this review examined education and training theories. Among them, four studies utilized rehabilitation guidelines, including the 2012 AHA Guidelines for Stroke Rehabilitation [ 35 ], the Australian National Clinical Guidelines for Stroke [ 36 ], and the International Consultation on Incontinence (ICI) guidelines [ 38 ], to enhance education and training in managing neurological incontinence in frail older individuals. Some of the studies used not only practice guidelines but also hospital fall prevention protocols to optimize the content of the education/training program [ 32 ]. Theoretical frameworks were used in three studies, such as the education/training program for nurses working in stroke rehabilitation units, where the content of the program applied the theory of complex interventions and a behavior change framework to enhance the practices of nurses [ 33 ]. Additionally, in the education/training of nurses working in stroke rehabilitation units, the content framework for the workshops was developed using the Aphasia Framework for Outcome Measurement and the person-centered education theory REAP (Relating well, Environmental manipulation. Ability-focused care and Personhood), to enhance experiential learning [ 40 ]. In addition, the education/training was based on social constructivism and cognitive constructivism concerning stroke disease. There was one treatment method category, which aims to guide the limb rehabilitation of people with stroke based on Bobath's method [ 28 ].

Description of the impact of education/training measures on nurses

Adequately trained nurses have an improved ability to understand and apply their acquired knowledge and skills, resulting in more effective management and coordination of patient care, and ultimately enhancing their professional standing. The data are presented in Table  3 .

A research team conducted education and training sessions to instruct nurses on the proper positioning of the unaffected limb to facilitate the recovery of limb function in stroke patients. The sessions began with a face-to-face lecture, addressing the definition and etiology of stroke, factors influencing recovery, the multidisciplinary team's role in rehabilitation, and the impact of ergonomics on movement and positioning. The nurses in both the intervention and non-intervention groups completed a questionnaire, revealing significantly higher knowledge scores among the nurses who received the intervention [ 27 ]. The education/training enhanced the nurses' fundamental professional knowledge. Furthermore, the nurses' knowledge has been expanded through various education and training programs. One such example is the restraint reduction program, aimed at preventing falls in stroke patients. The program equipped nurses with knowledge of risk factors for falls, policies regarding restraint and seclusion, and hospital philosophies on restraint use, and provided them with hands-on training on fall prevention [ 32 ].

In the education/training of nurses on clinical practice skills, the studies opted for more experiential methods rather than the traditional and monotonous training and assessment methods, aiming to enhance their clinical practice skills. For example, in the education/training on morning care activities [ 29 ], neurological assessment [ 39 , 41 ], and cardiac monitoring [ 37 ] for patients with stroke, the studies used scenario simulation. This involved developing a series of nursing scenarios that closely resembled real-life situations, in which nurses were educated and trained to handle various nursing issues that may arise in a simulated work setting. This not only addressed the problem of the disconnect between theory and practice but also improved nurses' clinical practice adaptability and proficiency. Additionally, to identify and address any issues in the clinical practice of the educated/trained nurses, the studies also provided practical workshops in the education/training program, thereby bridging any gaps and enhancing the clinical practice skills of the nurses through repeated training [ 29 , 30 , 34 , 36 ].

Furthermore, the interactive nature of the education/training program enabled nurses to refine their nonclinical skills, such as communication, leadership, and emergency management, through learning and practice [ 31 , 40 ]. For example, in stroke rehabilitation, nurses who had received education/training were capable of employing suitable communication strategies to meet the needs of patients with communication difficulties, consequently mitigating their levels of frustration and agitation.

While the studies were highly specific in developing the education/training program, the involvement of the multidisciplinary team resulted in a detailed and well-thought-out education/training program. The education/training program resulted in the enhancement of the nurses' knowledge and skills, ultimately improving their self-confidence [ 27 , 28 , 37 , 40 ]. As the training progressed, the nurses' attitudes and job satisfaction improved over time [ 27 , 33 , 37 , 40 , 41 ].

Description of the impact of education/training measures on patients

Nine studies assessed the quality of care. Among these, seven studies demonstrated that education and training had a positive impact on improving the quality of care. It is important to note that the quality of care indicators evaluated in these studies varied significantly, leading to the categorization of assessment results into three main categories.

Patients with stroke cared for by nurses who had received a 3-month education/training can correctly position their limbs during daily self-care activities [ 27 ]. The Stroke Patient Restraint Reduction Program resulted in decreased use of physical restraints and lower fall rates among high-risk patients [ 32 ]. This positive outcome was achieved by providing education/training to nurses and closely monitoring their implementation of the care plan in their daily work.

The study results provided compelling evidence that better management of fever, hyperglycemia, and dysphagia in acute stroke patients during the first 72 h after admission had significant benefits for individuals with both mild and severe strokes [ 36 , 38 ]. This improved management reduced mortality, improved physical function, and optimized the care process. Furthermore, integrating education/training with good ideas in an interactive and highly practical educational program was more likely to increase motivation and improve care outcomes. Additionally, integrating education/training with good concepts was more likely to motivate nurses to learn, thereby overcoming barriers to education/training and making programs more effective, thus improving care outcomes [ 37 ]. However, contradicting results were observed with a physiotherapist-led training program and a teaching intervention aimed at improving the posture of stroke patients. These interventions showed no effect on patient outcomes [ 29 , 30 ].

The trained nurses not only improved their communication skills but also their handling of complex situations [ 33 ]. The trained nurses exhibited competence in prioritizing the physical and psychological needs of stroke patients, thus facilitating improved communication between patients and nurses [ 28 ]. As a result, this increased the acceptability of the nursing care plan and the overall satisfaction of patients with the nursing service [ 33 ].

Description of the facilitators and barriers encountered in the implementation of education/training

As illustrated in Table  4 , some of the education and training programs did not adequately consider the limited availability of nursing staff [ 38 ]. Additionally, they did not address the high volume of nursing tasks. For instance, in the consultation component of the education and training program aimed at reducing restraints and preventing falls in individuals with stroke, the clinical nurse specialist's check-ins with the nurses increased from once every two weeks to once a week. However, this increase in workload resulted in resistance from the trained nurses towards implementing the program. Resistance towards implementing the education and training program was observed [ 32 ]. A few nurses provided excuses for missing the education and training sessions, including illness, leave, and personal reasons [ 30 , 36 ].

Two studies examined the cost-effectiveness of developing education/training programs. Managers who thoroughly assess the costs of human and financial resources, as well as equipment, before developing an education/training program, often encounter barriers to implementation. These barriers may arise due to the cost–benefit imbalance or the inability to replicate the program in other areas [ 35 , 41 ].

Facilitators of education and training

The review identified key facilitators for implementing the education/training programs, including the support and participation of management, the need for specialized education and training, and the establishment of a controlled environment.

The support and involvement of managers were considered crucial in facilitating the implementation of education/training programs [ 34 ]. These education/training programs were achieved with limited staffing and without any additional resources and can be replicated in most district general hospitals [ 29 , 36 ]. Replicating an education/training program can reduce work hours, better optimize care resources, reduce time wastage, and increase efficiency, thus facilitating hospital managers to actively support and explore stroke education/training programs.

Interviews identified a strong desire for specialized education/training among stroke nurses, while a questionnaire on their stroke knowledge revealed that all nurses obtained low scores [ 27 , 28 , 33 , 34 ]. Furthermore, a subset of surveyed nurses emphasized the importance of providing education/training specifically tailored to the needs of stroke nurses to improve the efficiency of care. The lack of skills in stroke rehabilitation and the overwhelming of stroke nurses often result in limited nursing hours [ 31 ].

Simulation training is a paramount method utilized to train stroke nurses. Its purpose is to design a lifelike setting where nurses can hone their skills without jeopardizing patient safety. According to the nurses, certain practical exercises like assessing swallowing skills needed to be repeatedly practiced within a secure educational/training environment – a place that was benign for patients and free from the apprehension of repetition [ 31 , 34 ]. Additionally, the nurses expressed a desire for instruction within a safe and regulated atmosphere, to acquire non-technical coping skills [ 31 ].

This review examines the impact of education/training on nurses involved in stroke care, as well as the barriers and facilitators in the education and training process. It specifically focuses on studies conducted in developing countries in both Western and Eastern regions. Education/training measures developed for nurses involved in stroke care were classified into five categories and yielded better educational outcomes when ≥ 3 categories of education/training methods were implemented. Management support and involvement played a key role in facilitating stroke education/training programs.

A key issue surrounding the implementation of stroke education/training programs is how to effectively translate the theoretical knowledge acquired by trained nurses into clinical practice. In this review, eleven studies employed three or more types of education/training methods that positively influenced either the trained nurses or the quality of care.With the increasing demand for education and training, and the advancements in technology, several different approaches have been developed. These methods cater to diverse groups of individuals with varying needs, resulting in different outcomes and costs. To date, face-to-face lectures remain the most popular method [ 44 ]. Despite being more traditional, they serve as the foundation for education and training programs [ 45 , 46 ]. The advantages of face-to-face lectures include set learning times, systematic knowledge transfer, and opportunities for direct interaction [ 47 ]. The disadvantage of lecture-based education/training methods is that trainees are unable to actively participate and can only passively absorb information from the lecturer's presentation. This limitation hinders their thinking and absorption capabilities. Some researchers have suggested that while lecture-based methods can still be found in both face-to-face and online courses, they should only be used sparingly in hybrid courses [ 44 ]. Simulation training methods, on the other hand, offer a solution to these limitations. They involve more scenario-based teaching methods as opposed to traditional classroom-based methods, which stimulate trainees' interest in learning. Simulation training also allows trainees to gain perceptual knowledge and deepen their impressions. Moreover, it enables trainees to connect theoretical knowledge with practical knowledge, facilitating the development of deep and accurate concepts. Currently, scenario-based and virtual simulations are the most commonly utilized methods of simulation training in medical education/training [ 48 , 49 , 50 ]. While scenario-based simulations can be used when time and personnel constraints are not a concern [ 51 , 52 ], the combination of simulation training and virtual simulations can improve the time and cost-effectiveness of education/training. However, the adoption of virtual simulation education/training platforms requires careful consideration of technological and platform-related issues [ 44 , 53 , 54 , 55 ]. On the other hand, the discussion method focuses on developing trainees' problem-solving skills and analytical judgment, but it demands a high level of trainer experience and skill [ 54 ]. In the context of stroke education and training, a comprehensive approach, combining classroom lectures, simulation training, and discussion methods, is recommended to ensure a better translation of theoretical knowledge of stroke management into clinical practice in future education and training programs.

In addition, stroke survivors frequently experience sudden fluctuations in their condition, which makes their situation highly unpredictable. They require close medical monitoring and often suffer from physical dysfunction, cognitive impairment, and psychiatric issues. As a result, the content of stroke caregiver education/training programs needs to be highly specialized and complex [ 10 , 11 , 12 ]. To achieve optimal outcomes, it is essential to base stroke education/training on relevant theories. Currently, stroke education/training programs are undergoing development. Likely, a combination of theoretical models and guidelines for stroke care management will serve as the theoretical foundation for future stroke education/training. This approach aims to enhance the quality of stroke caregiver education and training.

This review provides further validation that education/training has a positive impact on the clinical practices of nurses. The findings indicate that well-trained nurses demonstrate improved abilities in recognizing and managing patients' conditions promptly, responding effectively to unexpected situations including cardiac arrest, respiratory failure, and shock [ 56 ], and experiencing a lower incidence of medical errors [ 57 ]. In addition, adequately trained nurses exhibit enhanced job satisfaction, and their patients report higher satisfaction levels with the nursing care they receive. This can be attributed to the increased capability of nurses to communicate effectively with patients and deliver personalized care tailored to their individual needs and preferences. Such personalized care fosters trust and support among patients, resulting in greater adherence to treatment plans and care management [ 58 ].

The primary objective of stroke education/training is to enhance the clinical outcomes of trained nurses, thereby improving the quality of care they provide to their patients. The findings of this review indicate that stroke education/training contributes to increased patient self-care, improved outcomes, and greater acceptance and satisfaction with the care program. These results not only underscore the feasibility and effectiveness of the existing stroke education/training models but also highlight the distinctive role of nurses in the management of stroke patients. However, only seven of the studies provided information on the patients attended to by the trained nurses, and there was a lack of standardized and comprehensive measures to evaluate the quality of care. These findings suggest that the current design of stroke education/training programs may have some limitations in assessing their effectiveness in clinical practice. In clinical research, it has become increasingly common to utilize measures of patients' attitudes toward their disease symptoms and their impact on their daily lives as a tool to evaluate outcomes and determine treatment and care options. Patient-reported outcomes are now recognized as the most direct measure of effectiveness in clinical practice. They provide a powerful reference for doctors in diagnosing and treating patients and are of great importance to clinical practice [ 59 , 60 , 61 ]. For future studies, it is recommended that researchers standardize the effectiveness of stroke education/training according to patient-reported outcomes.

This review highlights the significance of managerial support and involvement in promoting the implementation of stroke management education/training programs. One crucial aspect is the establishment of effective evaluation and monitoring mechanisms by governmental and healthcare institutions. These mechanisms ensure that the training programs and courses adhere to specific standards and quality requirements. Furthermore, they assess the knowledge and skills of professionals and initiate timely actions to address deficiencies and enhance overall standards [ 62 ]. Another critical point is that complex education/training necessitates efficient organizational management [ 63 ]. As stroke treatment technology advances and patient demand grows, education/training will continue to play a vital role. Therefore, governments and healthcare organizations should invest in improving the education/training of stroke professionals to deliver higher-quality care [ 64 ]. Simultaneously, professional and not-for-profit organizations should actively contribute by providing more training and educational resources for professionals, fostering continuous improvement in stroke treatment and care.

Limitations

This is the first scoping review of the literature on the impact of education/training on nurses involved in stroke care. Nevertheless, this review does have certain limitations. Firstly, we solely included literature published in English, possibly excluding significant studies, thereby constraining the scope of the findings. Secondly, a few studies failed to provide information on the number, age, and years of experience of the participating nurses, which somewhat hinders the generalizability of the results. Lastly, some studies encompassed in this review were over a decade old, rendering the results less contemporaneous.

This review comprehensively examines the potential impact of education and training on nurses caring for stroke patients, the challenges they may face, and the key success factors. The results of the study reveal several exciting findings. Firstly, systematic education and continuous training undeniably enhance nurses' knowledge and clinical skills in stroke care. Well-trained nurses not only gain deeper insights and apply their knowledge and skills, but also translate these abilities into tangible improvements in patient care and care processes, thereby enhancing their professional development. Secondly, the effectiveness of education and training boosts nurses' confidence and job satisfaction. This enables them to empathize with patients and provide personalized care addressing their physical and emotional needs. Subsequently, this leads to a significant increase in patients' recognition and overall satisfaction with nursing services. Additionally, management support and involvement are crucial for the success of the education and training program. Simultaneously, the establishment of a comprehensive evaluation and monitoring system is crucial for maintaining high standards and quality in nursing education and training. Despite the positive impact of current education and training mechanisms on nurses' professional practice, there are still limitations in evaluating their effectiveness in clinical practice. Hence, future research should focus on developing more objective, standardized, and comprehensive evaluation strategies to thoroughly assess the effectiveness of education and training programs.

Availability of data and materials

No underlying data was collected or produced in this review.

Abbreviations

Preferred Reporting Items for Systematic reviews and Meta-Analyses

Healthcare assistants

Registered nurses

Registered practical nurses

Interactive computer-assisted instruction

Instructor-led videotape learning program

Intensive Care Unit

No statement

International Consultation on Incontinence

Relating well, Environmental manipulation, Ability-focused care, and Personhood

Patient-reported outcomes

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This review was supported by the Natural Science Foundation of Xinjiang Uygur Autonomous Region, China (grant 2022D01C440) and the Undergraduate Teaching Reform Research Project of Jilin University, China (grant 2023XZD100).

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Zhao, Y., Xu, Y., Ma, D. et al. The impact of education/training on nurses caring for patients with stroke: a scoping review. BMC Nurs 23 , 90 (2024). https://doi.org/10.1186/s12912-024-01754-x

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sample case study stroke patient

Clinical Trials

Displaying 76 studies

The purpose of this study is to test the feasibility of providing a mindfulness based stress management intervention, the Resilient Living Program,to stroke survivors and their family caregivers. The Resilient Living Program consists of an introduction and 4 online modules, each completed  2 weeks apart. Stroke survivors and their caregivers will practice the strategies taught in the modules using a journal to record. Questionnaires to gauge the impact of the intervention will be completed at baseline, 5, 9, and 12 weeks.

The purpose of this study is to determine whether the application of compression to the distal aspect of the upper extremity of a person with stroke will increase range of motion of the wrist.

The Stroke Hyperglycemia Insulin Network Effort (SHINE) Trial is a multicenter, randomized, controlled clinical trial of 1400 patients that will include approximately 60 enrolling sites. The study hypotheses are that treatment of hyperglycemic acute ischemic stroke patients with targeted glucose concentration (80mg/dL - 130 mg/dL) will be safe and result in improved 3 month outcome after stroke. Eligible subjects must be within 12 hours of stroke symptom onset and have diabetes and glucose concentrations of over 110 mg/dL on initial evaluation. The enrolling sites will include the Neurological Emergencies Treatment Trials (NETT) sites as well as non NETT sites from ...

The purpose of this study is to develop a computer vision based software program to better understand upper extremity movements after stroke.

The purpose of this pilot study is to examine the feasibility of methods to assess and describe the presence of symptoms and their characteristics in young adult stroke survivors.  

The purpose of this study is to assess the effectiveness of the Better Mobile Health App for use by patients after hospital discharge for a stroke by using satisfaction survey ratings and hospital readmission rates. The Better App provides a personal health assistant who assists in coordination of care. The app is provided in addition to standard care and compared to the use of standard care alone.

The purpose of this study is comparing physician empathy, as perceived by the patient, during acute stroke consultation among patients seen remotely by telemedicine consult to those who received an in-person consult.

Stroke is the second leading cause of death worldwide. Traditional stroke risk factors explain about half of the risk for stroke. The remaining half may be partially explained by sleep duration and disturbances, which are prospectively related to incident stroke across multiple populations. Although these relationships have been identified, at present, essentially nothing is known regarding the modifiable, sleep-inhibiting behaviors that determine sleep duration and disruption; these are probable targets of stroke prevention. The study proposed here is intended to fill this void by determining the relation between sleep-inhibiting behaviors, self-reported sleep duration and disruption, and stroke amongst acute stroke ...

The purpose of this study is to assess if patient outcomes are improved when the Comprehensive Stroke Center/Primary Stroke Center (CSC/PSC) system is supplemented with an Integrated Stroke Practice Unit (ISPU) system of care, a patient-centric model of care involving the patient and caregiver/family that coordinates care from the acute management through the rehabilitation and recovery of the patient.

This is a randomized, double-blind, placebo-controlled parallel group outpatient study that will utilize standard stroke rehabilitation outcome measures, as well as fMRI techniques in a subset of subjects, to evaluate the effect of HT-3951 on motor recovery and behavior in medically stable subjects following ischemic stroke.

The purpose of this study is to to explain the mechanisms of brain resilience and susceptibility to post-stroke cognitive impairment and dementia (PSCID) in diverse U.S. populations based on the complex interplay among vascular risk factors, pre-existing disease burden, acute stroke lesion location, and genomic and epigenomic variations.

For stroke, interval times, such as door-to-imaging (DTI), door-to-needle (DTN), door-to-groin puncture (DTG), and door-to-reperfusion (DTR) times, are used to evaluate workflow efficiency. We hypothesize that by introducing case review feedback forms for each treated stroke case at our institution, individual members of the stroke team will develop a better estimation of their personal treatment times, and this will lead to an overall reduction in interval times after one year.

The primary objectives of this study are to determine whether treatment of OSA with positive airway pressure starting shortly after acute ischemic stroke or high risk TIA reduces recurrent stroke, acute coronary syndrome, and all-cause mortality 6 months after the event, and improves stroke outcomes at 3 months in patients who experienced an ischemic stroke.

The purpose of this registry is to assess outcomes associated with the use of devices intended to restore blood flow in patients experiencing acute ischemic stroke.

This is a study to evaluate the hypothesis that FDA cleared thrombectomy devices plus medical management leads to superior clinical outcomes in acute ischemic stroke patients at 90 days when compared to medical management alone in appropriately selected subjects with the Target mismatch profile and an MCA (M1 segment) or ICA occlusion who can be randomized and have endovascular treatment initiated between 6-16 hours after last seen well.

The aims of this study are to assess the feasibility of and satisfaction with providing a tele-rehabilitation service directed at language disorders in individuals with stroke and measure the change in language function.

This is a pivotal phase study of up to 120 subjects and 15 clinical sites. All subjects are implanted with the Vivistim System® and then randomized to either study treatment or active-control treatment. The randomization will be stratified by age (<30, >30) and baseline FMA UE (20 to <35; >35 to 50). Study treatment is vagus nerve stimulation (VNS) delivered during rehabilitation. Active control treatment is rehabilitation (standard-of-care treatment) with only a minimal amount of VNS at the start of each session intended to support blinding.

The purpose of this study is to evaluate a tele-rehabilitation service directed at treating upper limb weakness due to stroke to see if it is feasible to provide at Mayo Clinic, and also to assess if the stroke patients and clinicians are satisfied with the process.

The purpose of this study is to determine whether a wristband that detects your pulse can detect your heart rate and rhythm similar to electrocardiograms (ECG).

This is a study in patients who recently had a brain attack (stroke) and in whom no clear cause of the stroke could be identified. These strokes are likely due to a blood clot and therefore, can be called embolic stroke of undetermined source. The abbreviation is ESUS. The study will compare 2 blood thinners. Patients will be randomly assigned to either Rivaroxaban 15 mg or Aspirin 100 mg and the study is intended to show, if patients given rivaroxaban have fewer blood clots in the brain (stroke) or in other blood vessels.

The purposes of this study are to investigate the level of correspondence between the most severe and most bothersome symptoms, and to examine discordant responses to determine which symptoms are reported as the most bothersome despite not being the most severe. A secondary aim is to examine the relationship between specific symptoms and time since stroke.

The purpose of this study is to assess the safety, performance and effectiveness of thrombus removal in subjects presenting with acute ischemic stroke with the NeVa stent retrievers.

The purpose of this study is to find out what kinds of therapy equipment are most effective in improving walking and balance after a stroke.

The primary purpose of this study is to report the composite endpoint of survival to transplant, recovery, or LVAD support free of debilitating stroke (Modified Rankin Score > 3) or reoperation to replace the pump at 5-years post-implant in subjects who were implanted with the HM3 or HMII LVAS in the MOMENTUM 3 IDE trial and are ongoing at the 2-year follow-up.

The purpose of this study is to assess whether a novel therapy approach (repetitive facilitative exercise (RFE)) is more effective than conventional rehabilitation in facilitating the recovery of upper extremity function following stroke.

The primary purpose of this study is to monitor patients with acute ischemic strokes who receive reperfusion therapies (tissue plasminogen activator, mechanical thrombectomy or both) with non-invasive cerebral oximetry to (rScO2) assess if changes in rScO2 can predict  changes in clinical neurologic examination.

This is a randomized, placebo-controlled, phase 3 clinical trial to evaluate the efficacy and safety of transcranial ultrasound (US) as an adjunctive therapy to tissue plasminogen activator (tPA) treatment in subjects with acute ischemic stroke.

The objective of this project is to evaluate a treatment decision aid for patients with atrial fibrillation.

VICTORY AF is an IDE, prospective global, multi-center, single arm, controlled, unblinded, investigational clinical study. The purpose of this clinical study is to evaluate the risk of procedure and/or device related strokes in subjects with persistent or long-standing persistent atrial fibrillation (AF) undergoing ablation with the Phased RF System.

A pivotal, prospective, multi-center, randomized, controlled, double-blinded study combining active Nexstim NBS-guided 1Hz rTMS or sham-rTMS targeting the healthy hemisphere with standardized task oriented rehabilitation will be conducted in patients with post-stroke motor impairment. The therapy will be provided for 6 weeks and primary outcome assessed 6 months later.

This is a prospective, randomized, controlled, unblinded, multi-center evaluation of the stroke incidence in patients implanted with a HeartWare HVAD who receive optimal blood pressure management. The study compares results of stroke incidence in a new cohort of subjects receiving optimal blood pressure management to a reference stroke incidence observed in the original IDE clinical trial (HW004) that did not specify optimal blood pressure management. In addition, a secondary endpoint will evaluate non-inferiority of stroke-free success on the originally implanted device to a control group (i.e. any FDA-approved LVAD for destination therapy). Subjects will be randomized to HeartWare HVAD or ...

The purpose of this study is to determine if cerebral perfusion imaging can identify a subset of patients who are most likely to have a favorable outcome after thrombectomy treatment. We hypothesize that patients with a favorable Critical Area Perfusion Score (CAPS≤3) on cerebral perfusion imaging will have a favorable response to revascularization by thrombectomy and that patients with a CAPS>3 will not.

The purpose of this study is to examine the gait in patients with hemiplegia following a stroke, when wearing an ankle foot orthosis and without wearing an ankle foot orthosis.

The specific aims of this study are to:

  • Definitively determine the therapeutic benefit of the intensive treatment relative to the standard treatment in the proportion of patients with death and disability (mRS 4-6) at 3 months among subjects with ICH who are treated within 4.5 hours of symptom onset.
  • Evaluate the therapeutic benefit of the intensive treatment relative to the standard treatment in the subjects' quality of life as measured by EuroQol at 3 months.
  • Evaluate the therapeutic benefit of the intensive treatment relative to the standard treatment in the proportion of hematoma expansion (defined as increase from baseline hematoma volume of > ...

The purpose of this observational study is to describe how the human endocannabinoid system (ECS) responds to an ischemic stroke or transient ischemic attack and explore whether modulation of the ECS holds potential to serve as a therapeutic target for neuroprotective therapies.     

The objective of this study is to determine the mechanisms of stroke in patients with Intracranial Atherosclerotic Disease (IAD) by specifically evaluating limitations of antegrade flow through the stenotic artery, distal tissue perfusion to the affected territory, and artery-to-artery embolism. The hypothesis is that non-invasive imaging biomarkers that stratify stroke risk and distinguish mechanisms of IAD. This prospective multicenter study will enroll 175 patients with recently symptomatic high-grade IAD. Patients will be studied within 21 days of the index event (allowing appropriate time to arrange for diverse imaging modalities), with the following advanced neuroimaging techniques to elucidate mechanisms of recurrent ...

The purpose of this study is to compare edoxaban (investigational drug) with warfarin and enoxaparin, to see if it is safe and effective in preventing stroke and other blood clot complications in subjects with atrial fibrillation whose doctors plan to treat them with an electrical cardioversion. It is expected that 284 sites will recruit 2200 subjects from North America, EU, Russia, Ukraine and Israel. Participants will be randomly allocated to receive either treatment with edoxaban, or treatment with warfarin, plus enoxaparin if required. Participants will have an equal chance of receiving either treatment. Participants will be in the study for ...

The purpose of this research study is to examine how certain genes and lifetime and ongoing stress may impact rehabilitation and recovery after stroke.

The purpose of this study is to screen high-risk subjects with annual prolonged cardiac monitoring to determine the rate of subclinical atrial fibrillation detection.  

The purpose of this study is to compare the post-procedure treatment differences in stroke risk between those randomized to revascularization and intensive medical management (IMM) and those randomized to IMM alone.

Objectives - Primary: To test the hypothesis that apixaban is superior to aspirin for the prevention of recurrent stroke in patients with cryptogenic ischemic stroke and atrial cardiopathy. - Secondary: To test the hypothesis that the relative efficacy of apixaban over aspirin increases with the severity of atrial cardiopathy.

The purpose of this study is to describe in detail the smoking history in a population of acute or prior cerebrovasculqar accident (CVA) patients and identify those who qualify for lung cancer screening by criteria outlined by three separate organizations.

Carotid revascularization for primary prevention of stroke (CREST-2) is two independent multicenter, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis. One trial will randomize patients in a 1:1 ratio to endarterectomy versus no endarterectomy and another will randomize patients in a 1:1 ratio to carotid stenting with embolic protection versus no stenting. Medical management will be uniform for all randomized treatment groups and will be centrally directed.

We aim to determine whether cognitive impairment attributable to cerebral hemodynamic impairment in patients with high-grade asymptomatic carotid artery stenosis is reversible with restoration of flow. To accomplish this aim CREST-H will add on to the NINDS-sponsored CREST-2 trial (parallel, outcome-blinded Phase 3 clinical trials for patients with asymptomatic high-grade carotid artery stenosis which will compare carotid endarterectomy plus intensive medical management (IMM) versus IMM alone (n=1,240), and carotid artery stenting plus IMM versus IMM alone (n=1,240) to prevent stroke and death). CREST-H addresses the intriguing question of whether cognitive impairment can be reversed when it arises from abnormal cerebral ...

The purpose of this study is to determine if an atrial fibillation (AF) detection intervention in men and women at least 70 years of age with undiagnosed AF or atrial flutter (AFL) reduces the person-years incidence rate of stroke compared to usual care (no AF detection intervention).

The primary purpose of this study is to test the theory that Eliquis (apixaban) is superior to aspirin for the prevention of recurrent stroke in patients with cryptogenic ischemic stroke and atrial cardiopathy.

The overall goal of this study is to develop mesenchymal stem cell therapy for treatment of acute spontaneous hemorrhagic stroke.

A transient ischemic attack (TIA) is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. An ischemic stroke is a cerebral infarction. In POINT, eligibility is limited to brain TIAs and to minor ischemic strokes (with an NIH Stroke Scale [NIHSS] score less than or equal to 3).

TIAs are common, and are often harbingers of disabling strokes. Approximately 250,000-350,000 TIAs are diagnosed each year in the US. Given median survival of more than 8 years, there are approximately 2.4 million TIA survivors. In a national survey, one in fifteen of those ...

The purpose of this study is to engage Wisconsin's community hospitals statewide to identify the regional pre-hospital, hospital and community barriers to timely acute ischemic stroke therapy.

The purpose of this study is to assess the effectiveness of Clopidogrel for preventing the occurance of transient ischemic attacks (TIA) and minor strokes.

The purpose of this study is to provide clinical evidence of functional improvement, safety, and economic benefit when comparing intracerebral hemorrhage (ICH) evacuation surgery to medical treatment.

  • The primary purpose of this study is to assess the comparative effectiveness of the following 4 approaches to promote high-quality SDM for at-risk patients with AF:  a PDA alone, (2) an EDA alone, (3) a combination of a PDA and an EDA, and (4) control with neither a PDA nor an EDA .

The purpose of this trial is to identify cancer survivors who are at increased risk of developing late-occurring complications after undergoing treatment for childhood cancer. A patient's genes may affect the risk of developing complications, such as congestive heart failure, heart attack, stroke, and second cancer, years after undergoing cancer treatment. Genetic studies may help doctors identify survivors of childhood cancer who are more likely to develop late complications.

The purpose of this study is to assist patients and clinicians weigh the potential harms and benefits of different treatment options for atrial fibrillation.  The plan is to develop an evidence-based decision aid for use in clinical encounters. The goal is to promote evidence-based patient-centered care. Ideally, this care should reflect the research evidence about treatment options for atrial fibrillation. It should also reflect the values and preferences of the informed patient.

The primary objective of the study is to demonstrate that anticoagulation with bivalirudin results in fewer major bleeding complications compared with unfractionated heparin (UFH) in subjects undergoing peripheral endovascular interventions (PEI). The secondary objective is to identify potential benefits from bivalirudin therapy on other clinically important events such as death, myocardial infarction (MI), stroke and/or transient ischemic attack (TIA), amputation, unplanned repeat revascularization (URV), and minor bleeding, as well as potential economic benefits that may result from improved clinical outcomes.

The primary objective of the study is to compare the effect of 90-day treatment with ticagrelor (180 mg [two 90 mg tablets] loading dose on Day 1 followed by 90 mg twice daily maintenance dose for the remainder of the study) vs acetylsalicylic acid (ASA)-aspirin (300 mg [three 100 mg tablets] loading dose on Day 1 followed by 100 mg once daily maintenance dose for the remainder of the study) for the prevention of major vascular events (composite of stroke, myocardial infarction [MI], and death) in patients with acute ischaemic stroke or transient ischaemic attack (TIA).

The purpose of this study is to evaluate the use of a smartphone app for stroke patients with obstructive sleep apnea in order to better use their positive airway pressure (PAP) therapy.

The purpose of this study is to identify important physiologic trends in bedside ICU data such as cerebral perfusion pressure (CPP), intracranial pressure (ICP) using a bedside “Multimodal monitoring” (MMM) computer which utilizes ICM+ Cambridge software.

The purpose of this study is to test for the long-term outcomes in function for stroke patients who get an early tracheostomy, versus those who have prolonged orotracheal intubation. 

Patients with severe ischemic and hemorrhagic strokes, who require mechanical ventilation, have a particularly bad prognosis. If they require long-term ventilation, their orotracheal tube needs to be, like in any other intensive care patient, replaced by a shorter tracheal tube below the larynx. This so called tracheostomy might be associated with advantages such as less demand of narcotics and pain killers, less lesions in mouth and ...

We want to determine if treating acute ischemic stroke patients who have evidence of hypoxemia due to sleep apnea with low flow O2 during sleep might help improve clinical and functional outcomes.

The purpose of this study is to learn how uterine fibroids may be connected to heart disease and high blood pressure. It is not known what causes fibroids, but they frequently occur in women who also have high blood pressure, heart disease, and stroke. The investigators of this study want to learn if certain changes in the blood vessels or nerve activity can put women at risk for these diseases and for fibroids.

The purpose of this study is to compare the relatively new procedure of stent-assisted carotid angioplasty to the traditional and accepted surgical approach of carotid endarterectomy for the treatment of carotid artery stenosis to prevent recurrent strokes in those patients who have had a TIA (transient ischemic attack) or a mild stroke within the past 6 months (symptomatic) and in those patients who have not had any symptoms within the past 6 months (asymptomatic).

The purpose o fthis study

A total of 8,000 patients presenting to CPSs with acute-onset AIS, ICH or aSAH and no history of dementia will be enrolled within 6 weeks of stroke onset.

All participants will undergo baseline screening for evidence of pre-stroke dementia. Those who pass baseline screening will complete a blood draw and a series of cognitive and functional assessments at baseline.

Participants will undergo in-person (3-6 months, 18 months) and telephone (annual) follow-up visits for the duration of the study to assess for longitudinal cognitive and functional outcomes. In addition to Tier 1 procedures, at each in-person follow-up visit: Tier ...

Obstructive Sleep Apnea (OSA) is a condition in which a person stops breathing for several seconds at a time due to relaxation of the throat muscles. This can occur many times during sleep and is known to cause sleepiness and poor concentration during the day. Research indicates that OSA may be a modifiable risk factor for cardiovascular disease due to its association with hypertension, stroke, heart attack and sudden death. The standard therapy for symptomatic OSA is continuous positive airway pressure (CPAP). CPAP has been shown to effectively reduce snoring, obstructive episodes and daytime sleepiness and to modestly reduce blood pressure ...

This study is being done to collect skin samples from people with and without neurodegenerative and vascular disorders including Parkinson’s disease (PD), Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), stroke and many others. We will use these skin samples to make and bank (store) a group of cells (cell line) called inducible pluripotent stem (iPS) cells.

The overall objective of our network of investigators is to develop and conduct clinical trials and other large multi-centre studies in childhood stroke. Our specific aims are:

Objective 1: To ascertain in a prospective, consecutive cohort study the numbers of newborns and children with ischemic stroke, their stroke sub-types and risk factors, their current treatments and outcomes within our centers. These data will provide the rationale and feasibility data for our group to design and implement the initial randomized controlled trials (RCTs) in paediatric stroke as well as other fundable grant proposals.

Objective 2: To develop standardized data ...

Study summary:

The overall plan for this study is to conduct qualitative interviews among 40 family members of patients who have been hospitalized in a coma. Subjects for this study will be recruited by local site P.I.s from intensive care units at the following 18 U.S. centers:

All interviews will be conducted virtually via video conferencing by study staff at the Yale School of Medicine and Massachusetts General Hospital. All study activities following the interviews, including data analysis and manuscript writing, will take place at the Yale School of Medicine and Massachusetts General Hospital. We expect ...

The primary purpose of this study is to determine if apixaban is superior to aspirin for prevention of the composite outcome of any stroke (hemorrhagic or ischemic) or death from any cause in patients with recent ICH and atrial fibrillation (AF).

C3FIT’s overall goal is to assess if patient outcomes are improved when the Comprehensive and Primary Stroke Center (CSC/PSC) system is supplemented with an Integrated Stroke Practice Unit (ISPU) system of care, a patient-centric model of care involving the patient and caregiver/family that coordinates care from the acute management through the rehabilitation and recovery of the patient.

The purpose of this study is to determine whether treatment of obstructive sleep apnea (OSA) with positive airway pressure starting shortly after acute ischemic stroke or high risk TIA (1) reduces recurrent stroke, acute coronary syndrome, and all-cause mortality 6 months after the event, and (2) improves stroke outcomes at 3 months in patients who experienced an ischemic stroke.

The purpose of this study is to verify that high Premature Ventricular Complex (PVC) burden is associated with increased risk of stroke and/or Transient Ischemic Attack (TIA), to examine outcomes such as stroke/TIA, atrial fibrillation/flutter, and all-cause mortality associated with PVCs, and to evaluate whether PVCs are associated with development of appendage dysfunction.

The purpose of this study is to create and maintain a clinical database of patients with history of, or who are at high risk for thromboembolic diseases, along with a plasma/serum repository. We plan to evaluate novel biomarkers that might be associated with thromboembolic diseases and test whether these biomarkers will help predict the incident and recurrentrecurrences of thromboembolic episodes and other outcomes (e.g., mortality, post thrombotic syndrome).

The purpose of this study is to evaluate the effietiveness of remdesivir (RDV) in reducing the rate of of all-cause medically attended visits (MAVs; medical visits attended in person by the participant and a health care professional) or death in non-hospitalized participants with early stage coronavirus disease 2019 (COVID-19) and to evaluate the safety of RDV administered in an outpatient setting.

The aim of this study is to create a state-wide biorepository and resource center for cerebrovascular diseases in Florida. The Center will collect and store detailed phenotypic information, DNA, and other biofluids on affected subjects with diverse cerebrovascular conditions, including, but not limited to, ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage (ICH), aneurysmal subarachnoid hemorrhage (aSAH), vascular dementia (VAD), anoxic brain injury, unruptured intracranial aneurysm (UIA), cavernous malformation, arteriovenous malformations (AVM), carotid and vertebral arterial dissections, symptomatic and asymptomatic cervical carotid artery atherosclerotic stenosis, non-aneurysmal perimesencephalic subarachnoid hemorrhage (naSAH), cerebral venous thrombosis (CVT), moyamoya disease, fibrosmuscular dysplasia (FMD), non-traumatic, angiography-negative subarachnoid ...

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Stroke case study

  • Sanaya Batcho
  • Kara Kitzmiller
  • Emma Overman

Our reason for choosing this disorder

Stroke is the leading cause of disability in the United States. As advanced practice nurses, we anticipate caring for those impacted by strokes in many healthcare settings including emergency rooms, acute care, rehab settings, extended care facilities, and in primary care. Early diagnosis and treatment are imperative in the treatment of a stroke in order to minimize permanent deficits so it is important for advanced practice nurses to be proficient in recognizing clinical manifestations of a stroke. There are also many modifiable risk factors for strokes so advanced practice nurses need to be able to educate patients and families on potential lifestyle changes that can decrease stroke risk.

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Stroke case study

IMAGES

  1. Stroke Case Study

    sample case study stroke patient

  2. (PDF) For Better Evaluation and Treatment of Stroke Patients: A Case Study

    sample case study stroke patient

  3. case study of a stroke patient

    sample case study stroke patient

  4. Stroke

    sample case study stroke patient

  5. FDNS4500 Case Study: Stroke

    sample case study stroke patient

  6. (PDF) Ischemic Cerebral Stroke Case Report, Complications and

    sample case study stroke patient

VIDEO

  1. Case Discussion || Acute Stroke

  2. Stroke Patient treatment

  3. Stroke patient/ using classic iteracare

  4. Stroke Patient Very fast recovery in #sivasakthi #physioclinic #strokepatient #hospital #health

  5. Remarkable Brain Stroke patient's recovery/Dr. Amil Ali Shakur. 🧠🩺👨‍⚕️ @dr.amilshakur

  6. CBSE 10th Maths Polynomials Chapter Case Study Questions with Answers

COMMENTS

  1. PDF CASE STUDY 1 & 2

    CASE 1. A 20 year old man with no past medical history presented to a primary stroke center with sudden left sided weakness and imbalance followed by decreased level of consciousness. Head CT showed no hemorrhage, no acute ischemic changes, and a hyper-dense basilar artery. CT angiography showed a mid-basilar occlusion.

  2. Clinical course of a 66-year-old man with an acute ischaemic stroke in

    A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater ...

  3. Patient Case Presentation

    Patient Case Presentation. D.B. is a 72 year old African American female who presented to the ED with complaints of headache, altered mental status as evidenced by confusion and lethargy, slurred speech, right sided weakness, and a facial droop. Symptoms were first noted when patient woke up from a nap approximately one hour ago.

  4. Stroke:Case Study Section 2

    Los Angeles Prehospital Stroke Screen (LAPSS) & Los Angeles Motor Scale (LAMS) 1. Age greater than 45 years. 2. History of Seizures or Epilepsy. 3. Onset of Neurological Symptoms is less than 24 hours. 4. Patient was Ambulatory prior to onset of symptoms.

  5. The outpatient physical therapy experience of a 63 year ...

    This case presentation is of a 63 year old male who sustained an ischemic stroke of the right cerebellar hemisphere. It documents the main client characteristics and clinical examination findings identified on initial assessment, as well as the challenges currently facing the patient and the interventions identified to address the patient's goals with outpatient physiotherapy.

  6. 10 Real Cases on Transient Ischemic Attack and Stroke: Diagnosis

    Read chapter 7 of Patient Management in the Telemetry/Cardiac Step-Down Unit: A Case-Based Approach online now, exclusively on AccessMedicine. AccessMedicine is a subscription-based resource from McGraw Hill that features trusted medical content from the best minds in medicine.

  7. Case 13-2016

    Dr. Schwamm: The hospital-based response to acute stroke in this case began with the administration of intravenous t-PA, which according to established guidelines, 9 is a class 1, level of ...

  8. Case Report: The cause of the stroke: a diagnostic uncertainty

    A PFO has been demonstrated in 10%-26% of healthy adults. 14 In young patients who have had a cryptogenic stroke, however, the prevalence is thought to be much higher, for example, 40% in one study. 15 It is thought that a PFO allows microemboli to pass into the systemic circulation leading to a stroke.

  9. Understanding the Professional Care Experience of Patients with Stroke

    In the case of stroke patients, communication between trained professionals and patients promotes shared decision making and prevents ethical conflicts . ... In the current study, the sample size was determined following the proposal by Turner-Bowker et al . These authors reported that 99.3% of concepts, ...

  10. Stroke: Darrell Jackson

    Amani Baidwan, Kendyl Egizi and Alysha Payne. Darrell Jackson, 81 year old male, came to the Emergency Department at Los Robles Hospital by ambulance after he collapsed in a coffee shop. Upon arrival he presented with left sided weakness, facial drooping, and aphasia. He was diagnosed with an ischemic stroke, right humerus head fracture, and ...

  11. Ischemic stroke: A case study

    This presents an analysis of a case of Ischemic stroke in terms of possible etiology, pathophysiology, drug analysis and nursing care. Repository Posting Date. 2017-12-07T18:00:39Z. ... Stroke; Case Study: CINAHL Subject(s) Stroke; Cerebral Ischemia; Case Studies: Conference Information. Name: International Training Course in Stroke Nursing ...

  12. Stroke Case Study (45 min)

    View Answer. You call a Code Stroke and notify the charge nurse for help. You obtain suction to have at bedside just in case. The neurologist arrives at bedside within 7 minutes to assess Mrs. Blossom. He notes her NIH Stroke Scale score is 32. He orders a STAT CT scan, which shows there is no obvious bleed in the brain. Critical Thinking Check.

  13. Case report: Clinical course of a 66-year-old man with an acute

    Other hypothesised reasons for stroke development in COVID-19 patients are the development of hypercoagulability, as a result of critical illness or new onset of arrhythmias, caused by severe infection. Some case studies in Wuhan described immense inflammatory responses to COVID-19, including elevated acute phase reactants, such as CRP and D-dimer.

  14. PDF Case Study: Patient with TIA

    Clinical Scenarios: A patient was diagnosed to have an acute left cerebral stroke. As a health professional you are to present your result using SOAP method. Slide 2 is interactive and contains Quizzes and their Feedbacks by professions (major). A click on a Quiz takes you to the questions, which you are to answer using the SOAP method.

  15. (PDF) Ischemic Cerebral Stroke Case Report, Complications and

    In this retrospective study, the case records of 1,287 stroke patients admitted to Al-basher Hospital during a three-year period were reviewed. The stroke patient cohort included 60% men and 40% ...

  16. PDF Case Study Stroke Rehabilitation

    two handpicked specialist stroke recovery carers. Both have been trained by the Stroke Association and have experience of working with people who have survived strokes. Jennifer's care team liaised with the speech and language therapist in order to put together a menu plan which was delicious, nutritious and easy for Jennifer to swallow.

  17. A sample case study: Mrs Brown

    Social work report: Background. Mrs Beryl Brown (01/11/33) is an 85 year old woman who was admitted to the Hume Hospital by ambulance after being found by her youngest daughter lying in front of her toilet. Her daughter estimates that she may have been on the ground overnight. On admission, Mrs Brown was diagnosed with a right sided stroke ...

  18. The impact of education/training on nurses caring for patients with

    Stroke survivors have complex needs that necessitate the expertise and skill of well-trained healthcare professionals to provide effective rehabilitation and long-term support. Limited knowledge exists regarding the availability of specialized education and training programs specifically designed for nurses caring for stroke patients. This review aims to assess the content and methods of ...

  19. Stroke Clinical Trials

    The purpose of this study is to determine whether treatment of obstructive sleep apnea (OSA) with positive airway pressure starting shortly after acute ischemic stroke or high risk TIA (1) reduces recurrent stroke, acute coronary syndrome, and all-cause mortality 6 months after the event, and (2) improves stroke outcomes at 3 months in patients ...

  20. Stroke Case Study

    Our reason for choosing this disorder. Stroke is the leading cause of disability in the United States. As advanced practice nurses, we anticipate caring for those impacted by strokes in many healthcare settings including emergency rooms, acute care, rehab settings, extended care facilities, and in primary care. Early diagnosis and treatment are ...

  21. PBL

    View professional sample case studys here. View full disclaimer . Any opinions, findings, conclusions, or recommendations expressed in this case study are those of the author and do not necessarily reflect the views of NursingAnswers.net. ... This is the why the patient in this case did not present any sign of stroke at 7:05am on the head CT ...

  22. Stroke case study

    On examination I found : • The right arm was cold and blueish in color and hung limply with no feeling or movement from her elbow down. • There was oedema (swelling) of the whole arm. • The fingers of the right hand were curled and a splint was needed to keep them straight. • There was subluxation of the Glenohumeral joint, probably due ...

  23. Escape room challenge helps nurses master best practices in stroke care

    When nurses master the latest guidelines and can apply them to caring for stroke patients, there is a huge potential impact on patient care, Kramer said. "By adopting the most recent evidence into our nursing care and monitoring, we are able to improve outcomes for stroke patients receiving an ever-widening range of state-of-the-art treatments."