The Role of the Stroke Nurse - Essay Example

? Diagnosis and Assessment of Stroke ANNOTATED BIBLIOGRAPHY Diagnosis and Assessment of Stroke ANNOTATED BIBLIOGRAPHY Contents. Page Marking Grid Page 2………… Annotation Assessment criteria Page 3………… Title Page 4-8……… Annotations Page 9………… Critical Analysis Page 10…………Conclusion Page 11-20……..References Marking Grid: Overall Mark: 36Annotation assessment criteria Percentage of total marks for annotated bibliography Introduction (including background to the chosen topic and the why the literature chosen is relevant) and referencing Comments: The topic of your assignment is not as clearly identified in this section. This became apparent when I read the papers you included for your annotated bibliography. The identification and diagnosis of stroke and the role of nurse as the use of telemedicine are discussed. You could make it more specific and examine the assessment and diagnosis of stroke prior to thrombolysis and other factors that should be assessed. There are grammatical and referencing errors through out and the structure is not clear at all times. 3/10 Description & analysis of each individual annotation Explanation, analysis and understanding of the main points of each selected article, e.g. purpose or hypothesis for study, the point of view/perspective from which the work was written, type and appropriateness of study methodology, comments on usefulness of the work & consideration of authority of authors. Relevant links to related sources are briefly identified (this may appear in more detail in the next two sections). Comments: You have selected a number of papers to discuss you the purpose of your study. Some of the papers linked better and some others not as well. For example, the FAST tool could be a topic on its own. The final paper could be used to support some of the arguments made in the earlier papers. You have given a description and the purpose of the studies in some papers and some others this was not as clear (i.e. first two ones). You have used a great deal of evidence in some of the papers although at times not in a coherent manner. You have also made some good comments and pointed to a number of issues that are important and you could discuss/explore further). 13/30 Analysis (from your chosen literature as a whole) Key issues/important factors appropriate to the topic are critically analysed. Connections between the selected articles, coherence (or lack of) between studies, referenced linkage to other related sources. Analysis & comparison of argument/s & opposing views appropriate to the topic area. Comments: This section follows on some of my comments above about the coherence of the papers and topics that each of them negotiate. It was a challenging topic and a very interesting one. Your comments here are clearer and you also bring most of the papers together. I would also expect here to bring some of the ideas explored in the papers. Critical analysis and evaluation was also carried out in the previous section. 12/35 Overall conclusions and recommendations Your main conclusions. Make focused recommendations for practice which demonstrate an integration of previous and new learning (synthesis). Propose recommendations for further research that can address the gaps identified through this annotated bibliography. Comments: You have made some good suggestions although some of them are not as well related to the annotated bibliography. These suggestions are the reflection of your overall clinical role with some relevant aspects to this essay. It should be more focused and tailored to the topic of this essay. You tend to discuss a number of ideas and that does not allow to explore a specific topic in depth. You have not made any recommendations for further research. 8/25 Diagnosis and Assessment Annotated Bibliography C7059609 The role of the Stroke Nurse in Assessment of Stroke Survivor Stroke is used to refer to a clinical syndrome of presumed vascular origin, typified by rapidly developing signs of focal or global disturbances of cerebral functions lasting more than twenty four hours or leading to death (World Health Organisation, 1978). Stroke is the third largest cause of death in the United Kingdom (UK) according to the National audit office (2005). Ischemic stroke accounts for 70% of all strokes as researched by Wolfe (2004). Early diagnosis and treatment for stroke survivors can mean the difference between life and death or mild and severe disability for the rest of their lives (Baths and Lees, 2000). In this paper the Author will provide an annotated bibliography. This list of articles will provide the Stroke nurse with the methods and guidelines to accurately clinically assess for stroke (Long et al., 2003). These tools will lead to the correct diagnosis of stroke (NICE, 2008) through evidence based medicine (Sackett et al, 1996) and evidence based practice (Kania-Lachance et al., 2006). The Stroke nurse provides a 24 hour presence which enables continuous monitoring (RCP, 2002), high quality active care (RCP, 2000), and co-ordination of care within the Multidisciplinary Team (MDT). The author will demonstrate that with the continuous use of the FAST (Face-Arm-Speech-Time) test that the nurse will be able to observe for the signs and symptoms of stroke quickly with any deterioration detected immediately. The author will discuss the advantages of telemedicine in aiding the stroke nurse to correctly assess for stroke. Harbison J. Hossain O., Jenkinson D., Davis J., Louw S., Ford GA. (2003). Diagnostic accuracy of stroke referrals from primary care, emergency room physicians and ambulance staff using the Face-Arm-Speech test. Stroke 2003; 34:71-76. Clinical assessment is the main diagnostic method of stroke (Alder et al, 1999) and it can only be supplemented by CT or MRI (Allen., 1984). Urgent active care interventions after stroke can lead to faster access (Kwan et al, 2010) to the (ASU). Delivering high-quality acute stroke services is challenging even more so in a rural region (Derex et al 2002). The use of FAST developed in 1998 is used by front line staff including the ambulance to SPOT (2009) stroke. The study found that FAST is quick and a good assessment tool in an emergency as the person get an instant picture of the Peron and their symptoms and can get the stroke pathway commenced. The study did not include some stroke type’s e.g. haemorrhage strokes. Birns J. and Roots A. (2010). Innovations in the assessment and management of stroke: The use of Telemedicine. British Journal of Neuroscience nursing (2010). Vol 6. No 2. This paper provides an informative view of the beginning of Telemedicine (Telestroke). The authors, a stroke consultant and a nurse ,show their insight in to stroke medicine. A favourable outcome in its use is seen in the TRACTORS (Handschu et al, 2003) study. Telestroke (La Monte et al, 2003) gives the nurse remote access to a Stroke Specialist at any location and at any time. The author suggests that clinical skills cannot be replaced by Telemedicine as a natural disaster may occur at any time e.g. electrical failure or computer virus. Telemedicine as similar to stroke medicine provides a rub and spoke model of care (Demaerschalk, 2009). Telemedicine may provide education programmes (Schwann et al, 2009a; Schwann et al, 2009 b). A case study demonstrated Telemedicine to be effective and used timely. This Stroke nurse utilises telemedicine to facilitate an equitable service to all stroke patients (Kleindorfer, 2010) in her trust. Hsieh F., Lien L., Chen S., Bai C., Sun M., Tseng H., Chen Y., Chen C., Jeng J., Tsai S., Lin H., Liu C., Lo Y., Chen H., Chiu H., Lai M., Liu R., Sun M., Yip B., Chiou H., Chung Y. and the Taiwan Stroke Registry Investigators (2010). Get with the Guidelines-Stroke Performance Indicators: Surveillance of Stroke Care in the Taiwan Registry: Get With The Guidelines-Stroke in Taiwan. Journal of the American Heart Association. Circulation 122; 1116-1123. Published by American Heart Association http://circ.ahajournals.org/cgi/content/full/122/11/1116 This paper demonstrates that Quality of care (QoC) in stroke is a global priority (Schwann et al, 2010) despite economic barriers or ethnic barriers (Johnston et al, 2009). Get with the Guidelines-Stroke (GWTG-Stroke) is a tool to improve (QoC) and prevention of stroke complications administered by the American Heart and American Stroke Association. GWTG (Fonarow et al, 2010) has proven successful in the United States (U.S) in Academic hospital and community settings. GWTG-Stroke assessment of (QoC) of stroke care (Schwann et al, 2009) was based on pre-defined performance measures. This tool was compared to the Taiwan Stroke Registry (TSR). The study was carried out by 16 trained stroke neurologists, 2 epidemiologists and study nurses. These people received training in Data systems for the study. They had regular quality review meetings and this progressed to 4 steps of quality control to provide reliable and accurate data. The risk factors smoking (Shinton et al, 1989) and Deep venous thrombosis (Keenan et al, 2007) were excluded. A low dose tPA (Di Carlo, 2009) showed comparable and safety effect in Japan (Yamaguchi et al, 2006). The guidelines for thrombolysis (Taiwan Stroke Society, 2009) are associated with better outcomes for admission within two hours and receiving tPA. The country had a low uptake of tPA only 1.5 (Shultis et al, 2010,), the U.S (Reeves et al, 2005) was higher and Germany (Heuschmann et al, 2003) had the greatest uptake. The study demonstrated lower cardio-vascular events and mortality in patients receiving antithrombotics and especially favourable outcomes for the patient experiencing Atrial Fibrillation (AF). The research of the article was quite extensive, and the theme of the article was that rigorous compliance with guidelines promotes better outcomes. Moser D., Kimble L., Alberts M., Alonzo A., Croft J., Dracup K., Evenson K., Go A., Hand M., Kothari R., Mensah G., Morris D., Pancioli A., Riegel B. and Zerwic J. (2006). Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council. Circulation 114; 168-182. Published by the American Heart Association. http://circ.ahajournals.org/cgi/content/full/114/2/168. Stroke will be the number 1 cause of death by 2020 (WHO, 1996). The assessment similarities between stroke thrombolysis versus cardiac throbolysis are outlined in detail in this paper. Decision to treat myocardial infraction is based on clear electro-cardiograph (ECG); it is low risk treatment and mistakes have fewer consequences. Decision to treat for eligible stroke survivors is based on clinical assessment and radiological assessment. It is comparatively high risk and therefore mistakes can be fatal (Chao, 2010). This paper written by well known stroke specialists was based on scientific statements. It summarises evidence to show early treatments have better outcomes (AHA, 2006). (Table, 1) in their paper, identified sociodemographical, clinical social and cognitive and emotional factors that may delay access to care, like age, living condition and knowledge of symptoms. It suggested practice developments and further research (circulation, 2006) to aid the stroke survivor identify the longest phase of delay (Everson, 2001) and to try and correct this by research. All authors submitted Disclosure questionnaire. CRITICAL ANALYSIS The Stroke Nurse has an unjudgemental multi-faceted role on the clinical assessment of stroke (Fitzpatrick M et al, 2004). She provides the highest international recognised standards of quality of care (Marler J et al, 2000). She is one of the front line staff (Nedltchev et al, 2003) and continuously visually monitors the stroke survivor effectively by the aid of the internationally recognised FAST tool. The Rosier tool and the Glasgow coma scale are also good recording tools and these aid the stroke nurse to distinguish stroke mimics. Telemedicine provides 24 hour access to a stroke consultant and this aids the nurse (Birns et al, 2010) in providing fast access for the eligible stroke survivor for thrombolysis (Carty et al,2006) and it can bring every discipline into the MDT when required. She develops evidence based protocols for fast assessment (Kwan et al, 2010) and tries to access patient centred factors that may have contributed to this stroke (AHA, 2006) This will provide better outcomes for the stroke survivor. She is a constant point of contact as she assists her stroke survivors to the imaging suites to assist in the diagnosing and developing treatment plans for the full spectrum of strokes. Stroke is a disease specific (Schneider et al., 2003) which has a potential for delays. One has to rule out stroke mimics and this may cause delays in dialling 999. All the papers show the need to recognise stroke symptoms quickly (Kwan et al, 2010). The stroke nurse has a role to play as an educator in stroke and fibrinolytic therapy. The stroke nurse is also in a position to obtain information from consenting stroke survivors to be involved in further stroke trials. CONCLUSION. The author has discussed throughout the papers the importance of a structured organised direct “blue light” transfer by ambulance staff to the ASU. The stroke nurse tries to measures the stroke units outcome performance by comparing it to the best international standards and aims to continually improve its delivery of safe nursing care. The aid of clinical skills and the FAST (Harbison et al, 2003) test have facilitated the application of science in to practice. This tool is a constant observational tool for the stroke nurse (Whiteley, 2010). The advances in technology such as continuous cardiac monitors offer unbiased consistent assessment and interval reassessment as well as monitoring for potential unintended consequences. The stroke nurse can maintain up to date with new technologies by visiting the Stroke forums and seeing these devices working and can decide if they would aid the ASU in the assessment of stroke. The stroke nurse should have access to 24 stroke specialist by the consultant present on site or by the use of telemedicine to aid with the clinical diagnosis of stroke (DOH, 2006). The stroke unit should have access to 24 hour brain scanning and expertise in reading the scans (Liu and Wardlaw, 2004). The ASPECTS tool (Demchuk AM et al, 2010) is currently been reviewed by the stroke nurses in the acute stroke unit. The stroke nurse is continuously educating herself by pursuing specialised education courses in stroke like the masters course in Leeds Metropolitan University, UK which aids the stroke nurse to become a stroke practitioner. The experienced stroke nurse has to rule out stroke mimics at all times by using a rapid stroke screening tool, such as FAST, continuous observation of such observation indicators is part of a continuous learning package undertaken by all ASU staff. The nurse should automatically access the legs and observe eye movements. Since the introduction of the direct phone access for the Para medics to the stroke specialist the outcome of direct and faster treatment is offered to the stroke survivor. Hierarchy of empirical evidence need to be formulated by the MDT and the involvement of the ethics team and up-dated as new best practices emerge. The author suggests that Brain attack education standards should be brought in line with Heart attack (SIGN, 108) standards and should receive the financial support from the government for this to improve the holistic care for the potential stroke survivor and their families. The Elderly and the stroke survivor living alone need a system to establish the time of onset of symptoms and to direct fast access to hospital perhaps with an emergency push button system (Moser, 2006). Access to patients to the MDT has been enhanced. Ongoing stakeholder consultation and a unique rolling out audit ensure that efficiencies and deficiencies are monitored and that service evolves and adapts to ensure quality care in to the further (NHS, 2003). References: AHA (2006) Guideline for the primary prevention of ischemic stroke. Stroke. 37(6):1583-1634 American Heart Association. Heart Disease and Stroke Statistics-2005 Update. Dallas, Texas: American Heart Association;2005. 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