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Stroke Care at Hilo Medical Center the Care of a New Population of Patients

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Stroke Care at Hilo Medical Center
The Care of a New Population of Patients

Stroke Care at Hilo Medical Center
The incidence of strokes among our population is increasing. According to the American Heart Association “It's the third largest cause of death, ranking behind "diseases of the heart" and all forms of cancer. Stroke is a leading cause of serious, long-term disability in the United States” ("Stroke statistics," 2011). Approximately 15 million people worldwide survive stroke annually (Seneviratne, Mather, and Then, 2009). Hospitals need to be able to care for the increasing number of patients being admitted due to strokes, and Hilo Medical Center is no exception. Currently at Hilo Medical Center, the vast majority of patients that are inflicted by CVA’s, or cardiovascular accidents, are transferred off island to better equipped medical facilities, such as Queen’s Medical Center in Honolulu. In the near future, that some of those practices will change. According to the nurse manager at HMC’s cardiovascular unit, Lisa Marie Nance, 6 beds will be added to the current 11 bed unit to accommodate some these patients. The unit will be changed to accommodate patients that are stable and do not meet criteria to receive thrombolytic therapy. It did seem odd that the hospital would be expanding the unit to care for a limited portion of the stroke patient population. I wanted to know more information regarding HMC’s plans, as well as what steps is needed to care for this population of patients. Also upon speaking to the nursing staff on the cardiovascular unit, I noticed that they were not pleased with the changes being planned for their unit. They feel that they are strictly a cardiac unit and caring for stroke patients will change the way that they care for their patients. According to these nurses, stroke patients need more care, because of the paralysis that is caused; there will be more lifting and turning of patients. There will be an increase in the number of total care patients that they will have. Currently, they do not have regular staffed CNAs, and they usually do total care on their patients on the unit. So, a strategy should be implemented to increase employee satisfaction as well as training for this new undertaking. Also upon speaking to Ms. Nance, there will be changes to the unit which only now cares for cardiovascular patients. There will be new protocols implemented and training of the staff to properly care for these patients. At the present time, the nursing staff of the cardiovascular unit has all received online training on the NIH stroke scale from the American Heart Association website. This is a free training that anyone may enroll for, and at present time, is all the training that is required of the nurses.
Also, according to Ms. Nance, there will be a physician as well as a representative from the American Heart Association that will provide an in-service training for the staff. When the unit is able to admit patients, there will be a “stroke champion” on staff that will be able to field questions that the nursing staff may have while caring for patients.
Nursing Education Regarding Stroke Care
At present time, there are no national standards for nurses to learn how to care for stroke patients. There are continuing education modules, like the one offered through the NIH website to give nurses the knowledge on assessing patients’ statuses after a stroke. There is also are professional organizations, such as The American Association of Neuroscience Nurses. AANN states that they are “committed to working for the highest standard of care for neuroscience patients by advancing the science and practice of neuroscience nursing. AANN accomplishes this through continuing education, information dissemination, standard setting, and advocacy on behalf of neuroscience patients, families, and nurses.”(AANN) The AANN also offers continuing education for various neuroscience nursing, including national stroke association stroke modules, case studies, and Hemispheres stroke competency series training. Nurses may gain membership to AANN and have access to all training materials, publications and meetings to keep up to date with the latest evidenced based practice.
Authors Pound and Ebrahim concluded in a study of nurses in acute and rehabilitative setting that optimal stroke care requires engaging nurses in rehabilitation, increasing training in rehabilitation and compassionate care (Seneviratne, Mather, and Then, 2009). Nurses on medical and basic surgical units do not have the time to focus on rehabilitation during the course of their shift. There will be much more varied training needed for nurses to optimize the recovery of stroke patients.
Stroke Center Certifications
Although there are no standards for nurses, there have been protocols implemented to certify hospitals to become stroke centers. The Joint Commission on Accreditation of Healthcare Organizations (JACHO) has developed a certification based on the use of clinical guidelines from the American Stroke association and patient outcomes measurement (Kavanaugh, 2006).
On-site certification reviews are conducted by reviewers with expertise in stroke care. The certification decision is based on the evaluation of standards, clinical practice guidelines and performance measurement activities. Primary Stroke Centers that successfully demonstrate compliance in all three areas are awarded certification for a two-year period. There are currently eight measures that JACHO receives reports on: * Venous thromboembolism (VTE) prophylaxis * Discharged on antithrombotic therapy * Anticoagulation therapy for atrial fibrillation/flutter * Thrombolytic therapy * Antithrombotic therapy by end of hospital day two * Discharged on statin medication * Stroke education * Assessed for rehabilitation (Joint commission, 2011)
Currently in the state of Hawaii, we have only one certified Primary Stroke Center available. This is Queens’ Medical Center on Oahu. That is the reason why patients are transferred from all other hospitals within our state when requiring treatment with antithrombotic therapy.
There are two parts to an acute stroke team: (1) the code team members, who respond to a code pager and deliver urgent treatment, and (2) a task force that works daily to facilitate patient access to treatment. The code team consists of a neurologist, an ED physician and a nurse. The task force may include members from neurology, emergency medicine, neurosurgery, nursing, radiology, pharmacy, laboratory, and rehabilitation ("Stroke team creation," 2011).
Hilo Medical Center is not equipped at this time to become a certified stroke center. It does not have the facilities or equipment to support a neurosurgeon or have a neurology department. It is a rural hospital that will need much more funds to outfit the facility with what it would need to support a stroke team. For the present time, HMC will have to begin with the care of certain stroke patients that the facility could handle.

Increasing Nursing Approval The cardiovascular nurses will need a great deal of support to assist with the transition to also care for stroke population. There is already a shortage of nursing staff in many hospitals, including HMC and the nurse to patient ratio continues to increase. For nurses to be effective in their care, I feel that more support staff will be needed to assist the nurses to offer the most optimal care they are able to. Also, assisting the nurses with ongoing training and support with this new population of patients will allow them to feel confident in their skills. Nurses want to be able to give the best care possible, and having the proper resources will assist them to achieve their goals.
Conclusion
Although the change at Hilo Medical Center will not greatly change the procedure for the care of acute stroke patients, it will change the lives of those that will utilize the unit. Those that are able to stay to recover will have the support of their family as well as the nursing staff, which may aid in the recovery process. Hilo Medical Center will not become a certified stroke center anytime in the near future. Until there is increased funding and upgraded facilities, HMC will not have the means to reach that goal. Although that may not happen soon, the training of the nursing staff will allow them to increase their skills and care for their patients with the most up-to-date evidenced based care possible. I feel that if the nursing staff feels competent enough to care for this new population of patients, as well as the support that they need to succeed, morale will also improve.

Resources
AANN,(n.d.). American association of neuroscience nurses. Retrieved from http://www.aann.org/about/content/index.html

Full list: is there a primary stroke center near you. (2008, August 10). USA
Today, Retrieved from http://www.usatoday.com/news/health/2008-08-10- stroke-list_N.htm Joint commission, (2011). Facts about primary stroke center certification Retrieved from http://www.jointcommission.org/assets/1/18/Facts_about_Primary_Stroke_ Center_Certification.pdf

Kavanagh, D., Connolly, P., & Cohen, J. (2006). Promoting evidence-based practice: implementing the American Stroke Association's acute stroke program. Journal of
Nursing Care Quality, 21(2), 135-142. Retrieved from EBSCOhost.

Seneviratne, c., Mather, C., & Then, K. (2009). Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practice. Journal of advanced nursing, 65(9).

Stroke statistics. (2011). Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=4725 Stroke team creation and primary stroke center certification. (2011, March 29).
Retrieved from http://emedicine.medscape.com/article/1162677-
overview#aw2aab6b4.

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