Stroke Unit Nursing Experience - Assignment Example

Introduction Cardiac health is one of the most urgent concerns in medicine. It has become such a concern that the United Nations (UN), through the World Health Organization (WHO) is now approaching the fifteenth year of its efforts to promote better cardiac health care and rehabilitation (1993). As one who is exposed to the field of health, this is not a new concept. However, working for intensively in the field makes one realizes not only the urgency of the issue as a medical concern but also its social and personal impacts. The United Kingdom (UK) is a country that is beginning to take more significant action in developing better cardiac care. According to Susan Mayor (2005), the success of cardiac care programs such as the establishment of stroke units have been very encouraging and. This, together with the rising demand of services is prompting the National Health Service (NHS) to study options for their deployment. Cathy Jackson (2005) however also points out that the process will be slow because of the financial and manpower costs of services. Thus, the focus of developing stroke units must not only be in developing the centers themselves but also in developing the skills of health care professional delivering care for patients. Description Strokes or cerebrovascular accident are arterial and venous acute neurological conditions that results to the reduction of blood supply to the brain which then leads to a loss of neuronal function because of cerebral perfusion (Thomson et al, 1997). However, the reality of the condition does not give a hint to its true impact and significance not only to those who suffer it but to families, friends and to the medical profession itself. Stoke units have significantly improved the treatment and prognosis of patients. Dennis and Langhorne (1994) believe that this success must extend itself in improving education regarding stroke and other cardiac conditions and in enhancing methods and approaches for patients. There has been a great deal of positive response in support of this view. One of the examples is in the greater availability of treatments and programs that have gained recognition through research (Kalra et al, 2000). Services The stroke unit is equipped with cardiopulmonary monitoring systems that are connected to a centralized monitoring console. Patients are in isolation in consideration of the vulnerability to immunological threats. Monitoring of vital statistics is automated though some units can also afford a degree of automation in medication. Whenever possible, defibrillation units are assigned individually and at the same time portable automated external defibrillators are maintained in the central station of hospital stroke units. Some can also utilize video monitoring systems: some are reserved for patients who are being needed to be isolated to a high degree and the rest are for general monitoring purposes. There are also consultation and lounges for patients' family and relatives. In summary the stroke units are designed to be an independent facility for stroke patients whose facilities target not only focused cardiac care but also consideration of so-existing conditions that challenge stroke patients. Admissions The numbers of patients accommodated are only those that need the highest level of cardiac care. The main constraint is the number of patients the stroke unit can accommodate. Prioritizations of patients depend on the severity of the case. Whenever possible, patients who can be transferred out to less intensive care programs promptly to ensure that at least a unit of accommodation is available in case of a patient suddenly being admitted for an extreme condition. Patient screening is also done to determine risk of exposure of the subject patient from and to other patients. Even if a patient has a stroke or a resultant condition that should afford him admittance to the stroke unit, if there is an indication of mental health problems or immunological considerations, admission to the stoke unit can be limited and channeled to other facilities of the hospital. Operations Aside from round the clock operations, central stations must be manned by a minimum of two personnel. Duties range from manning of central station, monitoring of machinery, rounds, medication and counseling or communication with patients' families. All primary care personnel have undergone training for the stroke unit facilities, extended courses regarding cardio pulmonary conditions and trauma nursing. The main personnel in the stroke unit are nurses and interring nurses. At least one cardiac doctor is on call at all times. The number of personnel at any given time ranges form five to ten depending on the number of patients being accommodated and the severity of cases. In other set ups of stroke units, the facility can be accessed via shortcut to the main hospital facilities to assist in the transfer of patients to emergency units or fir the support of personnel. Feelings The best way to describe working in the stroke unit is by describing as extremely ordered chaos. This is not to imply that the stroke unit is disorganized but rather to relate the constant activities and duties that need to be accomplished. When I first reported for work, I already expected that the work would be intense. Working in the stroke unit was like working a hive, everybody had their duties to do and the phrase busy as bee certainly applies in the situation. However, at the same time there is a certain stateliness of the activities going on. Everyone endeavors to maintain a hushed environment not only in deference to patients but I believe it is also an indication of the gravity of the conditions that is being dealt with. Nursing in such an environment is very challenging in several ways. First, the work is very technical and experiential skills that have to be mastered that can easily intimidate a person. Next, patients in the stroke unit depend much of the efficiency of the personnel nursing them in the unit. Lastly, the work will constantly challenge a person to learn and become more proficient and effective in their profession. There is also a lot of apprehension: the reality of death is real in the stroke unit. Talking with the nurses who have been with the unit the longest, they reflected that in the profession there is no difficulty in realizing that the possible of death is always there. An important perspective that I understood from them is that regardless of how advance stroke units get and the degree of care one receives, one must access that these only try to prolong peoples' lives. Many of the patients spend their last days in the stroke unit and more than anything else, the care and attention they receive from the personnel is great farewell gift. Evaluation Mayor (2005) points out that all stroke patients, even those suffering from mild ones can significantly benefit from the tools available in the programs so that the right care method is developed for that individual and also to prevent aggravation of conditions. The services, facilities, procedures and personnel in stroke units employ and comprehensive and constructivist approach in its operations. The objective is to be able to treat conditions and at the same time to improve patients' prognosis and survival. Care in the stroke units serve as the foundation for subsequent medical and nursing efforts for both acute and chronic conditions (Stone& Whincup, 1994). The stroke unit tries to consider all possible challenges and scenarios for stroke patients. These include not only the direct nursing care that they need but also the social and personal considerations for patients and family alike. However, recent shortages in personnel have concentrated most efforts in clinical services needed. In adapting a constructivist approach, stroke units are trying to emphasize the importance of self-actualization of the caring methods received. The idea is to be able to communicate the key competencies that will able future avoidance of strokes or conditions that makes individuals vulnerable to it. Though this is a laudable effort, there is grater need to be able to first accommodate the majority of stroke victims into stroke units. Also, hospitals need to think about developing programs for the nursing staff that comprise stroke units. The emotional and psychological pressure they experience can be significantly higher than their contemporaries. At the same time, there should be more supportive professional development programs made available so that nursing in the stroke units remain at forefront of c are practices. Analysis According to mayor (2005), only about a third of patients who have suffered strokes are actually accommodated. The main constraints are the capacity of facilities and the availability of appropriate manpower. Services are not being developed are not sufficient to support the demand and the ratio of patients not receiving care in stroke units is expected to rise (Sgarbossa, 2004). More than ten years ago, the challenge of being able to use stroke units as the platform of discussion and development of hospital was raised (Dennis & Langhorne, 1994). Considering this, succeeding features and methods of stroke unit include not only systems of care but also have included education as one of its main focus. Today, one of the major issues that are developing for stroke units is the incorporation of rehabilitative programs in them. As more literature support and advocate recovery and rehabilitation, stroke units have become more involved in the coordination and practice of rehabilitation. Thus, there is a growing complexity in the service that has to provide and wider range of expertise is needed as a nurse in stroke units. The other key issue that. Also, despite the universal view that stroke units play a key role in the prognosis and recovery of patients, many health institutions have reduced spending for the developing for them. Aside from express medical needs of patients, cost-effectiveness and access to other rehabilitation and support treatments or programs outside stroke units available to patients are also major factors to consider. Conclusion The experience in the stroke unit give the realization that despite advances in medical technology, medicine and health remains challenged to meet the growing demands for health care services. Though there has significantly greater hospitals commitment to remain updated with new technologies, the economic and structural requirements of doing so are constraints that challenge health institutions. In these scenarios, health professionals are pressured to support whatever is lacking in existing programs. The WHO has stated that as these issues continue, it become even more import more health professionals, particularly nursing professionals to gain the expertise and experience that can help alleviate these conditions. The nursing profession is being challenged not only to provide medical care but also to be as the driving force behind efforts to improve knowledge regarding stroke and its underlying conditions to the public. The ten weeks working in stroke unit did not only challenge one as a nursing professional, it also encouraged one to be proactive in kind of care one delivers. This means. Nurses should be able to participate more actively in the development of rehabilitation programs (Thomson et al, 1997). The insights of serving in actual stroke units can strengthen "patients' best possible physical, mental and social conditions so that they may, by their own efforts, preserve, or resume when lost, as normal a place as possible in the life of the community" (WHO, 1993). Action Plan Based on the experience of working in the stroke unit and because of the professional realization of the importance of nursing interventions in caring and rehabilitating patients, I believe that young health professionals should devise intervention programs that consider as closely as possible all possible scenarios for patients. Consider this intervention plan: Information/Orientation directly after stroke Problem/ Concern Disease/condition orientation Treatment and therapy requirements Post-MI care Expected Outcomes Identification and information regarding stroke, its impacts and implications to the person's lifestyle and health Detail therapy options an requirements based on the condition of the patient Establishment communication of issues and concerns of the patient and care givers Contract of therapy and rehabilitation objectives Nursing Instructions Interview of patient to asses comprehension of condition's implications and methods of prevention and treatment Processing and prescription of activities, diet, therapy needs and medical consultations with patient to determine if additional services are needed to be made available Discuss managed health care options Discuss cha Change in Lifestyle Problem/ Concern Concerns regarding changing habits Issues loss of mobility or change in capacity Expected Outcomes Enumeration of activities that he should avoid or engage in Discuss functional support that may be needed due to his changed functionality Nursing Instructions Identify with the patient if he needs orientation or help in the installation of functional aids like ramps or lifts Outline list of activities using a timeline that progresses degree of physical exertion Inclusion into physical therapy programs to regain physical or metal capacity (muscle conditioning and/or cognitive therapy) Leaving stroke unit facilities Problem/ Concern Post-operational care Assistance regarding care and needs Expected Outcomes Reduced physical strength, Development of stress due to rehabilitation requirements. Nursing Instructions Talk about the general 15-23% reduction in muscle strength (Kalra et al, 2000) and other expected physiological changes Orient the patient to stay positive to ensure mental and psychological health References Dennis, M. and Langhorne, P. (1994) Fortnightly Review: So Stroke Units Save Lives: Where Do We Go From Here Education and Debate BMJ 309:1273-1277 Jackson, Cathy (2005). Cardiac Rehabilitation. PatientPlus. Retrieved on March 1, 2007 from http://www.patient.co.uk/showdoc/40024523/ Kalra, L., Evans, A., Perez, I., Knapp, M., Donaldson, N. and Swift, C. G. (2000) Alternative Strategies for Stroke Care: A Prospective Randomized Controlled Trial of Stroke Unit, Stroke Team and Domiciliary Management of Stroke. Lancet 356: 894-899 Mayor, Susan 2005 Stroke patients prefer care in specialist units BMJ. July 16 331(7509): 130. Sgarbossa, Elena (2004). Progressive Build-Up of Plaque in Coronary Artery. ADAM Online Health Information and Services. Retrieved on September 22, 2006 from http://www.nlm.nih.gov/medlineplus/ency/imagepages/18031.htm. Stone, S. P. and Whincup, P. (1994) Standards for the Hospital Management of Stroke Patients. J R Coll Physicians 28: 52-58 Thomson, David R., Bowman, G., De Bono, D. et al. (1997). Cardiac Rehabilitation: Guidelines and Audit Standards. London: Royal College of Physicians. World Health Organization (1993). Needs and Action Priorities in Cardiac Rehabilitation and Secondary Prevention in Patients with Coronary Heart Disease. Copenhagen: World Health Organization. Read More