Elaine Tilka Miller

Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient: A Scientific Statement From the American Heart Association

Ischemic stroke represents 87% of all strokes.1 As worldwide initiatives move forward with stroke care, healthcare providers and institutions will be called on to deliver the most current evidence-based care. The American Heart Association/American Stroke Association (AHA/ASA) charged a panel of healthcare professionals from several disciplines with developing a practical, comprehensive overview of care for the patient with acute ischemic stroke (AIS). This article focuses on educating nursing and allied healthcare professionals about the roles and responsibilities of those who care for patients with AIS. Nurses play a pivotal role in all phases of care of the stroke patient. For the purposes of this article, the writing panel has defined 2 phases of stroke care: (1) The emergency or hyperacute care phase,2,3 which includes the prehospital setting and the emergency department (ED), and (2) the acute care phase, which includes critical care units, intermediate care units, stroke units, and general medical units. Stroke is a complex disease that requires the efforts and skills of all members of the multidisciplinary team. Nurses are often responsible for the coordination of care throughout the continuum.4–9 Coordinated care of the AIS patient results in improved outcomes, decreased lengths of stay, and decreased costs.10 In developing this comprehensive overview, the writing panel applied the rules of evidence and formulation of strength of evidence (recommendations) used by other AHA writing groups11 (Table 1). We also cross-reference other AHA guidelines as appropriate. Table 1. Applying Classification of Recommendations and Levels of Evidence *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. …

Readiness to change and brief educational interventions: successful strategies to reduce stroke risk.

&NA; Despite recent advances in stroke treatment and prevention, identifying effective educational interventions for “at‐risk” groups that will help reduce their stroke risk and improve the speed of seeking treatment remains of paramount importance. The purpose of this pilot study was to determine whether a brief educational intervention, tailored to the patients stage of readiness to change, could affect the initiation and achievement of stroke risk‐reducing behaviors for this at‐risk population. The study also explored potential demographic and medical confounders that could influence behavioral and knowledge goal achievement. Three groups of 20 participants, each with multiple risk factors for stroke, from a family practice clinic were randomly assigned to a control, simple‐advice, or brief intervention group. The majority of the participants were African American with a mean age of 68 years. Selected findings showed (a) significant differences in the number of newly initiated stroke‐risk‐reduction behaviors and stroke knowledge among the three groups and (b) significant positive correlations between the action stage of readiness to change and the initiation and achievement of the new stroke‐risk‐reduction behaviors. Although results supported the usefulness of the brief intervention model to reduce modifiable stroke‐risk factors and increase stroke knowledge, the necessity of additional longitudinal research that refines the targeting of interventions for diverse racial, cultural, and age groups was acknowledged.

Improved training for disasters using 3-D virtual reality simulation

The purpose of this study was to examine the effects of virtual reality simulation (VRS) on learning outcomes and retention of disaster training. The study used a longitudinal experimental design using two groups and repeated measures. A convenience sample of associate degree nursing students enrolled in a disaster course was randomized into two groups; both groups completed web-based modules; the treatment group also completed a virtually simulated disaster experience. Learning was measured using a 20-question multiple-choice knowledge assessment pre/post and at 2 months following training. Results were analyzed using the generalized linear model. Independent and paired t tests were used to examine the between- and within-participant differences. The main effect of the virtual simulation was strongly significant (p < .0001). The VRS effect demonstrated stability over time. In this preliminary examination, VRS is an instructional method that reinforces learning and improves learning retention.

FAST stroke prevention educational program for middle school students : Pilot study results

&NA; This pilot study evaluated the effects of FAST Stroke Prevention Educational Program for Middle School Students, a 2‐month stroke prevention educational program targeted to middle school students. The FAST program focused on improving knowledge of stroke signs and symptoms; risk factors; treatment‐seeking behaviors (call 911); overall attitude toward stroke, including perceived self‐efficacy in identifying stroke warning signs and dealing with a stroke victim; stroke risk‐reduction behaviors; and other risk factors for stroke, such as hypertension and diabetes. The FAST program evaluation consisted of a pretest, an educational intervention, immediate posttest, and a long‐term posttest at 2 months. A convenience sample of 72 students with a mean age of 13.25 years was used. After obtaining school, parental, and student consent, the FAST program was implemented by the school nurse, health teachers, and research nurses. Results indicated significant increases in knowledge of stroke risk factors and warning signs and in attitudes of self‐efficacy among middle school students that were sustained from pretest to long‐term posttest; data supported the effectiveness of this novel intervention. Additional research using a variety of educational strategies and a longer time frame of intervention is recommended to further expand use of this program.

Nurse call systems: impact on nursing performance.

Outcries for health care reform and more cost-effective patient care have motivated many organizations to examine routine unit activities. The article reports a study that used a descriptive design to examine nursing utilization of and satisfaction with nurse call systems in two large metropolitan hospitals. Findings revealed that nurse call system features such as the ability of unit secretaries to receive and screen patient calls reduced unnecessary nurse interruptions, saved actual nursing time, and enabled some nurses to begin preparing to meet patients, needs before entering their rooms. Problems with the nurse call system identified from the data were the sound quality of the transmission, inability to locate the nurse, inability to prioritize and confirm calls, and inability to speak directly to patients and staff.

Virtual reality disaster training: Translation to practice

Disaster training is crucial to the mitigation of both mortality and morbidity associated with disasters. Just as clinical practice needs to be grounded in evidence, effective disaster education is dependent upon the development and use of andragogic and pedagogic evidence. Educational research findings must be transformed into useable education strategies. Virtual reality simulation is a teaching methodology that has the potential to be a powerful educational tool. The purpose of this article is to translate research findings related to the use of virtual reality simulation in disaster training into education practice. The Ace Star Model serves as a valuable framework to translate the VRS teaching methodology and improve disaster training of healthcare professionals. Using the Ace Star Model as a framework to put evidence into practice, strategies for implementing a virtual reality simulation are addressed. Practice guidelines, implementation recommendations, integration to practice and evaluation are discussed. It is imperative that health educators provide more exemplars of how research evidence can be moved through the various stages of the model to advance practice and sustain learning outcomes.

Nurse Call and the Work Environment: Lessons Learned

Because of the complexity and dynamic nature of the health care system, effective communication remains pivotal to the health care process. This article compares nursing time and user friendliness of two nurse call systems in a large metropolitan hospital. Results identify ways to save RN time and acknowledge the importance of unit secretaries in the daily operation of a nurse call system operation on an adult medical-surgical unit.

Multidimensional Team-Based Intervention Using Musical Cues to Reduce Odds of Facility-Acquired Pressure Ulcers in Long-Term Care: A Paired Randomized Intervention Study

To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long‐term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours.

Update on the State of the Evidence for Stroke Family Caregiver and Dyad Interventions

Stroke remains a leading cause of serious long-term disability,1 with most stroke survivors returning home under the care of family members who are often unprepared for the caregiving role and lack training from healthcare providers.2,3 As a result, many stroke family caregivers experience burden, depressive symptoms, and reduced health-related quality of life.2,3 Aside from these individual issues, caregivers commonly experience interpersonal and organizational issues.2,3 Interpersonal issues reflect changes in relationships with the survivor and others, impacting roles and social activities.2 Organizational issues involve difficulty in finding resources and services.2 The American Heart Association/American Stroke Association published a scientific statement with evidence-based recommendations for stroke family caregiver and dyad interventions that are summarized in 5 main areas (Table I in the online-only Data Supplement).4 Dyad interventions were defined as those that targeted both the stroke survivor and the family caregiver, with both being active participants in the intervention.4 Intervention studies that involved family caregivers in the intervention, but did not target the health or well-being of the caregiver, were not considered to be dyad interventions.4 The recommendations were based on a critical analysis of 17 caregiver and 15 dyad intervention studies found in the literature between January 1990 and October 2012.4 Because of the rapidly growing literature in this area, the purpose of this article is to provide an update on the state of the evidence for stroke family caregiver and dyad interventions published between November 2012 and December 2016. A critical analysis of published stroke family caregiver and dyad intervention studies was conducted using the following inclusion criteria: (1) written in the English language; (2) published from November 2012 through December 2016; (3) used a quasi-experimental or experimental research design; (4) involved a …

Attribution for successful relationships between severely disabled adults and personal care attendants.

&NA; This study explored the mutual perceptions of a convenience sample of 22 pairs of severely disabled adults and their personal care attendants regarding their definitions of the relationship and causal explanations for the relationship outcome (either success or failure). A semi‐structured interview and Delphi instrument were used to collect data. Attribution theory was used to shape the study design. The most frequently cited causal explanations for a successful outcome were mutual effort, skill, and commitment of the personal care attendant and disabled employer. The majority of subjects defined their relationship as productive and friendly. The data support previous findings and provide direction for programs to prepare disabled people and personal care attendants for their respective roles.