Acute Stroke: An Evidence-Based Practice

Table of Contents

Summary

The study uses a pretest/post-test research design, with the aim to improve the quality of care provided by nurses to patients presenting in emergency department (ED) settings with acute stroke, particularly by facilitating the utilization of evidence-based practices on prevention of early complications. Using a total of 104 patient participants with an ED discharge diagnoses of stroke (ICD-10 code 164), the researchers come up with three important evidence-based practices, as follows: (1) changing the triage decision making for acute stroke under the Australian Triage Scale Category (ATSC) from Category 3 to Category 2, not only to increase the perception of urgency of stroke care by emergency nursing professionals, but also reinforce the belief that stroke is a medical emergency, (2) increasing the frequency of repeated physiological assessments to control potentially fatal abnormal physiological parameters, and (3) enhancing risk managements strategies for stroke patients, including constantly assessing their swallowing capability and speech functionality, and also undertaking and documenting pressure ulcer risk assessments and prophylaxis (Considine & McGillivray, 2010).

Critique

The article, in my view, is well written and utilizes primary sources to compose informative and up-to-date background information to the study, hence not only bringing out the dynamics of acute stroke but also explaining the population most at risk. However, in my view, the study is biased because it relies on nursing documentation as an alternative for care delivery while extant literature demonstrates that documentation alone is inadequate in developing and presenting evidence-based practices (Scott & McSherry, 2008). So, the bias here is slanted towards the excessive use of hospital documentation to develop evidence-based practices. The evidence of this bias is grounded on the fact that the researchers used documented cases of patients with an ED discharge diagnosis of stroke at the Northern Hospital (Considine & McGillivray, 2010). By virtue of the fact that such documentation may not be representative of all people with this condition, especially after the consideration that this was a relatively small study, it may be possible that the findings of this study could have failed to reflect the core tenet of evidence based practice, which is to save time and money and enhance patient outcomes by decreasing costs through standardizing and streamlining care (Scott & McSherry, 2008).

Opinion

The quality of the article is relatively good, but results have been affected substantially by the excessive use of documented data rather than interacting with participants at a personal level. However, the authors cite authoritative sources in their introduction and discussion sections, and it can be argued that they have made a noble attempt in trying to link their findings to available literature. Additionally, it can be argued that the article is technically correct to the extent that its major findings are in sync with current literature regarding acute stroke as demonstrated by the articles used to support critical arguments. However, in my view, the authors could have taken time to explain the three evidence-based practices so that they are easily understood by the nurse care givers. For instance, the authors mention physiological assessments but fail to expound on what these assessments entail, as well as their importance in managing the medical condition. Extant literature demonstrates that there are numerous physiological assessments that should be considered in managing acute stroke and nurses may have limited time to undertake all the tests due to the severity of the condition (Jones et al., 2007). Hence, a follow up article would attempt to expound on the critically important physiological assessments so as to save time. Overall, I agree with the article and it has changed my opinion regarding the need to provide immediate interventions to patients with acute stroke.

References

Considine, J., & McGillivray, B. (2010). An evidence-based practice approach to improving nursing care of acute stroke in an Australian emergency department. Journal of Clinical Nursing, 19(1/2), 138-144.

Jones, S.P., Leathley, M.J., McAdam, J.J., & Watkins, C.L. (2007). Physiological monitoring in acute stroke: A literature review. Journal of Advanced Nursing, 60(6), 577-594.

Scott, K., & McSherry, R. (2008). Evidence-based nursing: Clarifying the concepts for nurses in practice. Journal of Clinical Nursing, 18(8), 1085-1095.

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