Stroke as Healthcare Issue Stroke is a significant public health issue globally, presenting numerous challenges for patients, families, and healthcare systems. Effective management of stroke encompasses understanding the disease, recognizing its warning signs, implementing medical and surgical interventions, addressing disabilities resulting from stroke, and providing comprehensive nursing and family care for stroke survivors. This article explores the multifaceted aspects of stroke management and highlights the critical role of healthcare professionals, particularly nurses, in ensuring optimal outcomes for stroke patients and their families.
What is Stroke
A stroke, also known as a cerebrovascular accident or apoplexy, is a sudden loss of brain function due to either an interruption of blood flow to the brain or a rupture of a blood vessel in or near the brain. There are two main types of strokes: ischemic and hemorrhagic.
An ischemic stroke is caused by a thrombus (a blood clot) due to narrowing of the arteries from arteriosclerosis, an embolus that has dislodged and traveled to the brain, or a lack of blood flow due to circulatory failure (American Heart Association, 2004). In contrast, a hemorrhagic stroke results from the rupture of a blood vessel either in the space between the brain and the skull (subarachnoid hemorrhage) or deep within the brain tissue (intracerebral hemorrhage) (American Heart Association). A transient ischemic attack (TIA), often called a mini-stroke, is a brief disruption of blood flow to the brain that causes warning signs to appear temporarily.
Stroke Warning Signs
Recognizing the warning signs of a stroke is critical for timely intervention and can significantly impact outcomes. The common warning signs include:
(a) Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
(b) Sudden confusion, trouble speaking, or difficulty understanding speech
(c) Sudden trouble seeing in one or both eyes
(d) Sudden difficulty walking, dizziness, loss of balance, or lack of coordination
(e) A sudden, severe headache with no known cause (American Heart Association).
These warning signs require immediate medical attention, as early intervention is crucial in minimizing brain damage and improving recovery chances.
Stroke as a Health Issue
Stroke is the third leading cause of death in the United States and a major cause of serious, long-term disability. About a quarter of first-time stroke survivors die within a year of having a stroke (American Heart Association, 2003). Each year, approximately 500,000 people experience a stroke for the first time, and another 200,000 suffer a recurrent stroke (American Heart Association). Stroke is also the number one cause of severe, long-term disability in the US, affecting approximately 4.8 million stroke survivors, with over 1.1 million reporting functional limitations or deficits in activities of daily living (American Heart Association).
The financial burden of stroke is substantial. In 2004, the cost of stroke in the United States was estimated at $53.6 billion, with a mean lifetime cost for an ischemic stroke estimated at $140,048 per person, including inpatient care, rehabilitation, and follow-up care (American Heart Association). These figures underscore the need for effective prevention, early intervention, and comprehensive management strategies to reduce the incidence and impact of stroke.
Medical and Surgical Procedures for Stroke
Carotid endarterectomy is the most common surgical procedure for stroke prevention, and anticoagulants and antiplatelet agents are the most commonly used medications (American Heart Association, 2003, 2004). In the past decade, an effective treatment for acute ischemic stroke, tissue-type plasminogen activator (tPA), has become available. This drug must be administered intravenously within three hours of the first warning sign to prevent disability. However, many stroke survivors cannot reach a physician within this critical three-hour window to receive tPA.
To address this challenge, primary stroke centers have been developed (Alberts et al., 2000). These centers have integrated emergency response systems, acute stroke teams, inpatient stroke units, and written care protocols. The acute stroke team must include a physician and a nurse available 24 hours a day for the rapid evaluation of patients experiencing stroke symptoms (Alberts et al.). After stabilization, stroke survivors enter the rehabilitation phase, where they learn to live with their disabilities. Multidisciplinary rehabilitation teams typically include physicians, physiatrists, nurses, psychologists or psychiatrists, counselors, and various therapists (American Heart Association, 2004).
Disabilities after Stroke as a Health Challenge
Living with disabilities following a stroke presents significant challenges for both survivors and their families. Common post-stroke disabilities include hemiparesis (weakness on one side of the body), inability to walk without assistance, dependence on activities of daily living, aphasia (difficulty speaking or understanding language), depressive symptoms, and, in many cases, the need for institutionalization in a nursing home (American Heart Association, 2003).
Post-stroke depression is a major complication and can significantly hinder recovery (American Heart Association, 2004). Other quality-of-life issues for stroke survivors include personality and mood disruptions, diminished self-care abilities, changes in social and family roles, and loss of work or productivity (Williams, LS, Weinberger, Harris, Clark, & Biller, 1999). Family caregivers also face challenges, including negative changes in social functioning, subjective well-being, and perceived health due to caregiving responsibilities (Bakas & Champion, 1999). Caregivers often find managing the behaviors and emotions of the stroke survivor, providing household tasks, and managing finances particularly difficult (Bakas, Austin, Jessup, Williams, & Oberst, 2004).
Nursing Care for Stroke Survivors
Nurses play a critical role in caring for stroke survivors throughout the continuum of care. They are involved from the acute phase, where they assist in the immediate management and stabilization of stroke patients, through the rehabilitation phase, where they help patients regain function and adapt to disabilities. Research by ET Miller and Spilker (2003) demonstrated that educational interventions could effectively reduce stroke risk factors and increase stroke knowledge in local family practice settings.
Judith Spilker and colleagues (1997) integrated the use of the National Institutes of Health Stroke Scale into current nursing practice as a clinical stroke assessment tool, which is now widely used in stroke centers across the nation. However, more nursing research is needed to identify and demonstrate best practices in the care of stroke survivors, especially as new protocols are developed and evaluated. There are few published nursing research articles on the quality of life of stroke survivors, but the development of outcome measures, such as the Stroke-Specific Quality of Life Scale (Williams, LS, et al., 1999), may stimulate further research in this area.
Recent searches of the Computer Retrieval of Information on Scientific Projects (CRISP) database, a resource for biomedical research funded by the National Institutes of Health, revealed two studies funded by the National Institute for Nursing Research (NINR). Pamela Mitchell is evaluating a nurse-delivered psychosocial/behavioral intervention for post-stroke depression, while Sharon Ostwald is evaluating an intervention for stroke survivors and spousal caregivers. These intervention programs hold promise for the future care of stroke survivors.
Family Care for Stroke Patients
Research focusing on family caregivers of stroke survivors is growing. Several brief research instruments show promise for clinical assessment in practice, including the Oberst Caregiving Burden Scale (Bakas et al., 2004) and the Bakas Caregiving Outcomes Scale (Bakas & Champion, 1999). JS Grant, Elliott, Weaver, Bartolucci, and Giger (2002) documented the effectiveness of a problem-solving intervention in reducing stroke caregiver depression and improving caregiver perceived health.
A search of the CRISP database (2004) revealed even more studies funded by NINR focused on family caregivers of stroke survivors. Patricia Clark has been funded to explore family function, stroke recovery, and caregiver outcomes, while Judith Matthews is investigating the use of technology with stroke caregivers. Rosemarie King recently received funding to evaluate the effectiveness of her problem-solving intervention for stroke caregivers, and Bakas has received funding to develop and pilot test the “Caregiver Telephone Assessment and Skill-Building Kit.” Linda Pierce has been funded to test her intervention, entitled “The Caring Web,” for stroke caregivers.
These studies show great potential for improving the care and well-being of stroke survivors and their families. Now is an opportune time for nurses to conduct research in the area of stroke and stroke caregivers. With stroke being the number one cause of serious, long-term disability in the US, nurses must take the lead in developing programs that enhance the care of stroke survivors and their family members.
Conclusion
In conclusion, stroke is a major healthcare issue with significant medical, social, and economic implications. Effective management requires prompt recognition of warning signs, timely medical and surgical interventions, comprehensive rehabilitation, and continuous nursing and family support. Nurses play a critical role in the continuum of stroke care, from acute management to rehabilitation and long-term support for survivors and their families. Future research should focus on developing evidence-based interventions, improving care protocols, and supporting family caregivers to enhance outcomes for stroke survivors and reduce the burden of this debilitating condition.