Holistic Nursing Care for Ischemic Stroke Patients

Critical Evaluation of Nursing Care of a Patient who suffered Ischemic Stroke

The nurses caring for ischemic stroke patients are to focus on the psychosocial impact of the disease as ignoring the aspects leads to create gap in promoting multi-dimensional aspect of well-being of the patient along with compromising person-centred care (Love et al., 2019). Therefore, the biopsychosocial model is used in holistically evaluating the nursing care and determining nursing intervention for John who suffered stroke.

The Nursing and Midwifery Council (NMC) Code mention protecting the confidentiality and privacy of the patients under all condition to avoid abuse and promotion of good health in individuals (NMC, 2018). Thus, the pseudonym John is used to indicate the patient. John is a 76-year-old patient of British origin who is an ex-banker and diagnosed with coronary heart disease and hypertension 12 years back currently represented to the hospital to avail care for suffering stroke. John was prescribed Benazepril and Metoprolol which he took regularly along with retaining smoking and drinking which was asked to be stopped. John was referred to the emergency department following to the Stroke Care Unit for availing specialised care. The nursing care plan developed for John was based on meeting his key holistic needs which are cessation of smoking, promoting empowerment to take own care and reducing stress to avoid stroke reoccurrence.

The challenge faced with examining the psychosocial needs of John who suffered from stroke is that there is lack of adequate advanced tools to support the psychosocial assessments. This requires the nurses to use commonly available cognitive assessment tool in making the examination which may not provide effective identification of all the emotional and mental health needs created by stroke (Lim et al., 2018). It is evident as the Mini-Mental State Examination (MMSE) used for the psychosocial analysis of John is also used for patients with dementia and others. Therefore, the holistic psychosocial needs of John may not have been specifically identified which may have left gap in his care which remain unidentified.

Bai et al. (2018) assert that ischemic stroke and coronary heart disease management are interrelated as heart disease creates risk for deposition of plaque in the arteries that leads to blockage or reduced flow of blood leading to stroke. In John’s case, the nurse focussed on reviewing his previous health condition and analysed impact of the existing dose of medication to increase them as per discussion with the physician. Niriayo et al. (2020) inform that increasing dose of ACE inhibitors and beta-blockers assist in better control of hypertension and heart condition as they promoted avoiding stiffness of arteries and reduction of high blood pressure required to avoid stroke. Habibi-Koolaee et al. (2018) argue that avoiding improvement in care plan and pharmacological intervention based on previous prescriptions and health conditions leads the patients to suffer inconsistent care. Thus, the consideration of past history and medication to make current pharmacological interventions for John was effective approach in maintaining consistent care for him by the nurses. This is because it allowed the nurses caring for John to better understand his existing health condition and already provided care based on which further changes in interventions are made for his enhanced well-being and health without repetition of unsuccessful care (Okpara, 2018).

A major concern in stroke patient is the experience of stress and anxiety due to their deteriorated health condition which promote risk of reoccurrence of stroke (Almhdawi et al., 2021). In John’s case, the stroke specialist nurses according to their responsibility to delivery collaborative care involved clinical psychologists in the multi-disciplinary team to focus on improving mental health status of John. This is an effective approach for John as clinical psychologist by using their expertise works with the nurses to help them collaboratively resolve the impending stress and anxiety of the patient (Wilkins et al., 2018). Chen et al. (2019) mention that in persistent smokers, stroke recurrence ranges from 1.68 to 2.72 who smoke 1-20 cigarettes a day. Xia et al. (2019) argue that failure to cease smoking and drinking in patients makes them exposed to face reoccurrence of stroke that may be fatal. This is because the habits influence blood clotting or plaque formation that narrows to block normal blood flow to the brain or ruptured blood vessels. Therefore, the approach to smoking and drinking cessation for John by the nurses is a proactive initiative in improving his well-being and quality of health to avoid recurrent stroke and lower change of death. The approach of nurses to make John cease smoking is required to include use of nicotine replacement therapy (NRT) and social carers providing smoking deaddiction services (NHS, 2022). This is because NRT involve use of medication to resolve addiction towards nicotine due to which people smoke and deaddiction services helps to provide psychological support to smokers to intend to quit the habit (Kokane & Mitra, 2020).

The regular physical activity slower the clogging-up of arteries with plague to reduce or block normal blood flow (Gunnes et al., 2019). Kim et al. (2019) argue that extensive physical activity after stroke is risky as it creates exacerbation or regression of health conditions. In this condition, the use of physical trainer and occupational therapist for John was an effective approach by the nurses in care as they are professionals to mention the nature and extent of aerobic exercise to be executed by the individual to remain healthy and avoid regression of health. It also an act of autonomous nursing intervention where the nurses caring for John was able to use their expertise and decide effective care intervention for him. It is important as it provides freedom to nurse to care for the patients and manage effective care without extensive intervention from others (Both-Nwabuwe et al., 2020). Indrawati & Kimura (2021) argue that lack of patient empowerment to self-care leads individuals feel being the burden of care on others that lowers their self-esteem and makes them depressed. John has no immediate family member to support his care. Thus, the education and self-management strategy involved educating John reason and informing him way of changing his diet, smoking habit, need of executing physical exercise and changing everyday lifestyle to maintain good health and avoid recurrence of stroke.

In conclusion, the stroke specialist nurse caring for John performed effective assessment of his holistic health needs and symptoms which are managing good physical health, promoting enhanced social life, improving diet and others for his well-being. The collaboration with clinical psychologist, social carers , specialist nurses and physicians are made to holistically meet all the needs of John after experiencing stroke. This has helped the nurse to resolve psychosocial issues of John along with his physical needs while considering the key health factors leading to successful promotion of his quality of life after stroke.

References

Akkoç, Y., Yıldız, N., Bardak, A. N., Ersöz, M., Tunç, H., Köklü, K., ... & Koyuncu, E. (2019). The course of post-stroke bladder problems and their relation with functional and mental status and quality of life: A six-month, prospective, multicenter study. Turkish journal of physical medicine and rehabilitation, 65(4), 335. Retrieved on 7 July 2022 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935728/

Almhdawi, K. A., Alazrai, A., Kanaan, S., Shyyab, A. A., Oteir, A. O., Mansour, Z. M., & Jaber, H. (2021). Post-stroke depression, anxiety, and stress symptoms and their associated factors: a cross-sectional study. Neuropsychological Rehabilitation, 31(7), 1091-1104. Retrieved on 7 July 2022 from: https://www.tandfonline.com/doi/abs/10.1080/09602011.2020.1760893?journalCode=pnrh20

Ashcraft, S., Wilson, S. E., Nyström, K. V., Dusenbury, W., Wira, C. R., Burrus, T. M., & American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council. (2021). Care of the patient with acute ischemic stroke (prehospital and acute phase of care): update to the 2009 comprehensive nursing care scientific statement: a scientific statement from the American Heart Association. Stroke, 52(5), e164-e178. Retrieved on 7 July 2022 from: https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000356

Bai, L., Li, Q., Wang, J., Lavigne, E., Gasparrini, A., Copes, R., ... & Chen, H. (2018). Increased coronary heart disease and stroke hospitalisations from ambient temperatures in Ontario. Heart, 104(8), 673-679. Retrieved on 7 July 2022 from: https://heart.bmj.com/content/104/8/673.abstract

Both-Nwabuwe, J. M., Lips-Wiersma, M., Dijkstra, M. T., & Beersma, B. (2020). Understanding the autonomy–meaningful work relationship in nursing: A theoretical framework. Nursing outlook, 68(1), 104-113. Retrieved on 26 July 2022 from: https://research.vu.nl/ws/portalfiles/portal/118979833/Understanding_the_autonomymeaningful_work_relationship_in_nursing.pdf

Gunnes, M., Langhammer, B., Aamot, I. L., Lydersen, S., Ihle-Hansen, H., Indredavik, B., ... & LAST Collaboration group. (2019). Adherence to a long-term physical activity and exercise program after stroke applied in a randomized controlled trial. Physical therapy, 99(1), 74-85. Retrieved on 7 July 2022 from: https://academic.oup.com/ptj/article/99/1/74/5134178

Habibi-Koolaee, M., Shahmoradi, L., Niakan Kalhori, S. R., Ghannadan, H., & Younesi, E. (2018). Prevalence of stroke risk factors and their distribution based on stroke subtypes in Gorgan: a retrospective hospital-based study—2015-2016. Neurology research international, 2018. Retrieved on 7 July 2022 from: https://www.hindawi.com/journals/nri/2018/2709654/

Kim, Y., Lai, B., Mehta, T., Thirumalai, M., Padalabalanarayanan, S., Rimmer, J. H., & Motl, R. W. (2019). Exercise training guidelines for multiple sclerosis, stroke, and Parkinson’s disease: Rapid review and synthesis. American journal of physical medicine & rehabilitation, 98(7), 613. Retrieved on 7 July 2022 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586489/

Kimura, T. (2021). Interaction between Self-Care and Caregiving Ability on Home Discharged Stroke Patients Based on Motor Functional Independence Measure Score in Recovery Ward. Open Journal of Therapy and Rehabilitation, 9(2), 42-56. Retrieved on 7 July 2022 from: Retrieved on 7 July 2022 from: https://www.scirp.org/journal/paperinformation.aspx?paperid=108214

Kokane, A. M., & Mitra, A. (2020). Preparedness of primary health care providers for tobacco cessation—Experiences from a non-communicable disease training program. Indian Journal of Cancer, 57(4), 443. Retrieved on 26 July 2022 from: https://www.indianjcancer.com/article.asp?issn=0019-509X;year=2020;volume=57;issue=4;spage=443;epage=450;aulast=Kokane

Lim, K. B., Kim, J., Lee, H. J., Yoo, J., You, E. C., & Kang, J. (2018). Correlation between montreal cognitive assessment and functional outcome in subacute stroke patients with cognitive dysfunction. Annals of rehabilitation medicine, 42(1), 26-34. Retrieved on 7 July 2022 from: https://synapse.koreamed.org/articles/1150430

Love, M. F., Sharrief, A., Chaoul, A., Savitz, S., & Beauchamp, J. E. S. (2019). Mind-body interventions, psychological stressors, and quality of life in stroke survivors: A systematic review. Stroke, 50(2), 434-440. Retrieved on 7 July 2022 from: https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.021150

NHS 2022, Stop Smoking Services, Retrieved on 26 July 2022 from: https://www.nhs.uk/conditions/stop-smoking-treatments/

Niriayo, Y. L., Asgedom, S. W., Demoz, G. T., & Gidey, K. (2020). Treatment optimization of beta-blockers in chronic heart failure therapy. Scientific Reports, 10(1), 1-8. Retrieved on 7 July 2022 from: https://www.nature.com/articles/s41598-020-72836-4

NMC 2018, The Code, Retrieved on 7 July 2022 from: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Okpara, P. N. (2018). Challenges of nursing care of the paediatric surgical patient. African Journal of Paediatric Surgery: AJPS, 15(3-4), 154. Retrieved on 26 July 2022 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646682/

Rabinstein, A. A. (2020). Update on treatment of acute ischemic stroke. Continuum: Lifelong Learning in Neurology, 26(2), 268-286. Retrieved on 7 July 2022 from: https://cdn.mednet.co.il/2020/04/Acute-Stroke.pdf

Wilkins, S. S., Akhtar, N., Salam, A., Bourke, P., Joseph, S., Santos, M., & Shuaib, A. (2018). Acute post stroke depression at a Primary Stroke Center in the Middle East. PloS one, 13(12), e0208708. Retrieved on 26 July 2022 from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208708

Xia, X., Yue, W., Chao, B., Li, M., Cao, L., Wang, L., ... & Li, X. (2019). Prevalence and risk factors of stroke in the elderly in Northern China: data from the National Stroke Screening Survey. Journal of neurology, 266(6), 1449-1458. Retrieved on 7 July 2022 from: https://link.springer.com/article/10.1007/s00415-019-09281-5

Continue your journey with our comprehensive guide to Harnessing Big Data in Ophthalmology.