Die Rolle der Pflegenden im therapeutischen Team der Stroke Unit

Pflege ◽  
2009 ◽  
Vol 22 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Sascha Köpke ◽  
Kathrin Dehning ◽  
Nadine Molsen ◽  
Ralph Möhler ◽  
Jürgen Kasper ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Units ◽  
Rolle Der Pflegenden

Stroke Units haben sich in der Versorgung von Schlaganfallpatienten deutschlandweit etabliert. Zum spezifischen Beitrag Pflegender am Erfolg des Konzepts der Stroke Units liegen international bisher wenige Daten vor. Die vorliegenden Studien beschreiben u.a. eine Schnittstellenfunktion der Pflegenden im multiprofessionellen Team der Stroke Units. Für Deutschland fehlen solche Daten. In einer Fragebogenstudie mit 55 Mitarbeitern der Teams dreier überregionaler Stroke Units wurden die am Versorgungsprozess einer Stroke Unit beteiligten Berufsgruppen zu verschiedenen Aspekten der Zusammenarbeit (u.a. Kommunikationsverhalten, Anerkennung im Team) befragt und um Einschätzung des spezifischen Anteils der Pflegenden an der Organisation der Stroke Unit und der Genesung der Patienten gebeten. Die Vertreter der verschiedenen Berufsgruppen kommen zu ähnlichen Einschätzungen bezüglich der interdisziplinären Zusammenarbeit. Pflegende und therapeutische Mitarbeitende schätzen den Anteil der Pflegenden an der Organisation der Stroke Unit vergleichbar hoch ein, Ärzte schätzen ihn niedriger ein. Die Einschätzung des Anteils der Pflegenden an der Genesung der Patienten unterscheidet sich zwischen den Berufsgruppen. Die Ergebnisse der Befragung legen nahe, dass auch in Deutschland Pflegende auf Stroke Units eine Schnittstellenfunktion innerhalb des multiprofessionellen Teams wahrnehmen. Diese ist besonders auf Koordinations- und Organisationsfunktionen und weniger auf therapeutische Funktionen ausgerichtet.

Abstract 5: Management Of Intravenous tPA In Non-ICU Environments: Safety, Clinical Outcome, And Cost Savings

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kisha C Coleman ◽  
Paola Palazzo ◽  
Reza B Shahripour ◽  
Amy L Brooks ◽  
Mary A Cronin ◽  
...  
Keyword(s):  
Critical Care ◽  
Stroke Unit ◽  
Cost Savings ◽  
Pressure Control ◽  
Cardiac Monitoring ◽  
Arterial Line ◽  
Systemic Hemodynamic ◽  
Stroke Units ◽  
Critical Care Admission ◽  
Iv Tpa

Background: Administration of IV tPA has traditionally necessitated admission to an ICU solely for monitoring, with relatively no need for extensive critical care services. Stroke Units that are capable of monitoring IV tPA patients have been proposed to reduce ICU use, but limited data exist that demonstrate safety. We report the largest series of non-ICU managed tPA cases in relation to safety and discharge outcomes. Methods: Consecutive cases admitted to our intermediate-level Stroke Unit spanning 2009-2011 were assembled. Unit capabilities include IV tPA management with nicardipine infusion for blood pressure control as needed, non-invasive or direct central/arterial line and cardiac monitoring, and BiPAP ventilation. Stroke Unit nurses underwent extensive orientation and participate in NET SMART Junior for continuing education. Overall sICH, and drip/ship sICH (parenchymal hemorrhage in combination with > 4 point increase on the NIHSS), systemic hemorrhage, and tPA related death rates were calculated, along with discharge mRS and total ICU cost savings per day. Results: A total of 302 Stroke Unit admissions for intravenous tPA occurred over the 3 year period, while another 31 (10%) were excluded due to critical care admission for systemic hemodynamic or pulmonary instability. Nicardipine infusions were used in 9 (10.5%) Stroke Unit tPA cases in 2009, 10 (9%) in 2010, and 14 (13%) in 2011. Overall sICH rate was 3.3% (n=10) and systemic hemorrhage rate was 2.9% (n=9) with 5 of these (56%) requiring transfusion. Estimated cost savings in total for this 3 year period was $362,400 for “avoided” ICU days. Conclusions: Intravenous tPA patients may be safely managed on non-ICU Stroke Units when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for management of tPA monitoring needs may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

Stroke Rehabilitation 2007: What Should it Be?

2007 ◽  
Vol 2 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Helen M. Dewey ◽  
Lisa J. Sherry ◽  
Janice M. Collier
Keyword(s):  
Stroke Unit ◽  
Stroke Rehabilitation ◽  
Number Needed To Treat ◽  
Stroke Patients ◽  
High Quality ◽  
High Quality Research ◽  
Stroke Units ◽  
Proven Efficacy ◽  
Stroke Unit Care ◽  
Medical Wards

Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include ( 1 ) a functional approach targeted at specific activities e.g. walking, activities of daily living, ( 2 ) frequent and intense practice, and ( 3 ) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.

scholarly journals European Stroke Organisation certification of stroke units and stroke centres

2018 ◽  
Vol 3 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Ulrike Waje-Andreassen ◽  
Darius G Nabavi ◽  
Stefan T Engelter ◽  
Diederik WJ Dippel ◽  
Damian Jenkinson ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Care ◽  
Evidence Base ◽  
Final Decision ◽  
Major Step ◽  
High Quality ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Research Activities ◽  
Stroke Centre

To improve quality and to overcome the wide discrepancies in stroke care both within- and between European countries, the European Stroke Organisation Executive Committee initiated in 2007 activities to establish certification processes for stroke units and stroke centres. The rapidly expanding evidence base in stroke care provided the mandate for the European Stroke Organisation Stroke Unit-Committee to develop certification procedures for stroke units and stroke centres with the goals of setting standards for stroke treatment in Europe, improving quality and minimising variation. The purpose of this article is to present the certification criteria and the auditing process for stroke units and stroke centres that aim to standardise and harmonise care for stroke patients, and hence become members of the European Stroke Organisation Stroke Unit and Stroke Centre network. Standardised application forms and guidelines for national and international auditors have been developed and updated by members of the European Stroke Organisation Stroke Unit-Committee. Key features are availability of trained personnel, diagnostic equipment, acute treatment and collaboration with other stroke-caregivers. After submission, the application is reviewed by one national and two international auditors. Based on their reports, the Stroke Unit-Committee will make a final decision. Validating on-site visits for a subset of stroke units and stroke centres are planned. We herein describe a novel, European Stroke Organisation-based online certification process of stroke units and stroke centres. This is a major step forward towards high-quality stroke care across Europe. The additional value by connecting high-quality European Stroke Organisation Stroke Unit and Stroke Centre is facilitation of future collaboration and research activities, enabling building and maintenance of a high-quality stroke care network in Europe.

scholarly journals A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Malin C. Nylén ◽  
Hanna C. Persson ◽  
Tamar Abzhandadze ◽  
Katharina S. Sunnerhagen
Keyword(s):  
Stroke Unit ◽  
Community Hospital ◽  
Binary Logistic Regression ◽  
University Hospital ◽  
Impaired Consciousness ◽  
University Hospitals ◽  
Cross Sectional ◽  
Severe Stroke ◽  
Stroke Units ◽  
Explanatory Variables

AbstractThis cross-sectional, register-based study aimed to explore patterns of planned rehabilitation at discharge from stroke units in Sweden in 2011 and 2017 and identify explanatory variables for planned rehabilitation. Multivariable binary logistic regression was used to identify variables that could explain planned rehabilitation. There were 19,158 patients in 2011 and 16,508 patients in 2017 with stroke, included in the study. In 2011, 57% of patients were planned for some form of rehabilitation at discharge from stroke unit, which increased to 72% in 2017 (p < 0.001). Patients with impaired consciousness at admission had increased odds for planned rehabilitation (hemorrhage 2011 OR 1.43, 95% CI 1.13–1.81, 2017 OR 1.66, 95% CI 1.20–2.32), (IS 2011 OR 1.21, 95% CI 1.08–1.34, 2017 OR 1.49, 95% CI 1.28–1.75). Admission to a community hospital (hemorrhage 2011 OR 0.56, 95% CI 0.43–0.74, 2017 OR 0.39, 95% CI 0.27–0.56) (IS 2011 OR 0.63, 95% CI 0.58–0.69, 2017 OR 0.54, 95% CI 0.49–0.61) or to a specialized non-university hospital (hemorrhage 2017 OR 0.66, 95% CI 0.46–0.94), (IS 2011 OR 0.90, 95% CI 0.82–0.98, 2017 OR 0.76, 95% CI 0.68–0.84) was associated with decreased odds of receiving planned rehabilitation compared to admission to a university hospital. As a conclusion severe stroke was associated with increased odds for planned rehabilitation and patients discharged from non-university hospitals had consistently decreased odds for planned rehabilitation.

scholarly journals The Stroke Unit Story: Where Have We Been and Where Are We Going?

2021 ◽  
pp. 1-8
Author(s):  
Peter Langhorne
Keyword(s):  
Collaborative Research ◽  
Stroke Unit ◽  
Final Section ◽  
Evidence Base ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Units ◽  
History Of ◽  
Stroke Unit Care ◽  
Stroke Type

<b><i>Background:</i></b> The concept of stroke unit care has been discussed for over 50 years, but it is only in the last 25 years that clear evidence of its effectiveness has emerged to inform these discussions. <b><i>Summary:</i></b> This review outlines the history of the concept of stroke units to improve recovery after stroke and their evaluation in clinical trials. It describes the first systematic review of stroke unit trials published in 1993, the establishment of a collaborative research group (the Stroke Unit Trialists’ Collaboration), the subsequent analyses and updates of the evidence base, and the efforts to implement stroke unit care in routine settings. The final section considers some of the remaining challenges in this area of research and clinical practice. <b><i>Key Messages:</i></b> Good quality evidence confirms that stroke patients who are looked after in a stroke unit are more likely to survive and be independent and living at home 1 year after their stroke. The apparent benefits are independent of patient age, sex, stroke type, or initial stroke severity. The benefits are most obvious in units based in a discrete ward (stroke ward). The current challenges include integrating effective stroke units with more recent systems to deliver hyper-acute stroke interventions and implementing stroke units in lower resource regions.

Organisierte Behandlung in einer Stroke Unit -Voraussetzung zur optimierten Behandlungdes akuten Hirnschlages

2012 ◽  
Vol 69 (9) ◽  
pp. 549-553
Author(s):  
A. Lyrer ◽  
Bonati ◽  
Michel
Keyword(s):  
Stroke Unit ◽  
Stroke Units

Eine Stroke Unit (SU) ist eine Behandlungseinheit eines Spitals, die für Hirnschlagpatienten konzipiert ist. Die Behandlung in einer SU ist für alle Schweregrade und alle Altersgruppen von Patienten mit Hirnschlag wirksam. Sie verfügt über monitorisierte und nicht-monitorisierte Behandlungsplätze. Patienten, die in Stroke Units behandelt werden, haben - im Vergleich zur herkömmlichen, weniger strukturierten Behandlung - eine signifikant höhere Wahrscheinlichkeit zu überleben, ihre Selbständigkeit wieder zu erlangen und nach Hause zurückzukehren. Eine Behandlung in einer organisierten Einheit gewährleistet aber auch die die Applikation von Einzelmaßnahmen, wie z. B. die Thrombolyse, die nachweislich eine Wirksamkeit mit günstigem Einfluss auf den Verlauf haben.

Stroke Units from Scientific Evidence to Practice: The Experience of the Lille Stroke Unit

2000 ◽  
Vol 10 (4) ◽  
pp. 17-20 ◽  
Author(s):  
C. Cordonnier ◽  
M. Girot ◽  
E. Dorp ◽  
P. Rimetz ◽  
S. Bouillaguet ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Scientific Evidence ◽  
Stroke Units

scholarly journals “It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit

2018 ◽  
Vol 12 (3) ◽  
pp. 141-152 ◽  
Author(s):  
Anna Anåker ◽  
Lena von Koch ◽  
Ann Heylighen ◽  
Marie Elf
Keyword(s):  
Physical Environment ◽  
Stroke Unit ◽  
Well Being ◽  
Stroke Care ◽  
Stroke Units ◽  
Healthcare Facilities ◽  
Room Design ◽  
Single Room ◽  
Starting Point ◽  
Communal Areas

Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

scholarly journals Qualitätsmanagement in der Stroke Unit

2018 ◽  
Vol 45 (09) ◽  
pp. 655-664 ◽  
Author(s):  
Darius Nabavi ◽  
Martin Ossenbrink ◽  
Otto Busse
Keyword(s):  
Stroke Unit ◽  
Stroke Units

ZusammenfassungQualitätsmanagement (QM) ist ein gesetzlich vorgeschriebenes strukturelles Element für Krankenhäuser in Deutschland. Zwar ist das Bestreben nach Qualitätsverbesserungen fester Bestandteil der Medizin, der formale QM-Ansatz wird in der Ärzteschaft dennoch bis heute kontrovers betrachtet. Aufgrund zeitkritischer Aspekte, risikobehafteter Therapiemaßnahmen und der interdisziplinären Herangehensweise besteht zweifelsfrei eine QM-Rationale für die Schlaganfallmedizin. Durch das in Deutschland bereits seit Mitte der 90er Jahre etablierte Zertifizierungsverfahren von Stroke Units (SU) werden qualitative Mindeststandards regelmäßig überprüft und QM-Maßnahmen verbindlich eingefordert. Dies umfasst die gesamte Versorgungskette vom prähospitalen Initialmanagement bis hin zum poststationären Konzept. Allerdings darf die Erlangung eines Zertifikates allein nicht als Endpunkt eines erfolgreichen QM betrachtet werden. Das fortlaufende Bemühen um Qualitätsverbesserungen setzt eine Haltung voraus, die von der Führungsebene glaubhaft vermittelt und in der gesamten Abteilung fest verankert sein muss. Insgesamt stellt die Entwicklung der Schlaganfallmedizin in Deutschland ein überzeugendes Beispiel für gelungenes QM dar.

scholarly journals Stroke in neurological services in Italy

2009 ◽  
Vol 1 (1) ◽  
pp. 8 ◽  
Author(s):  
Fabrizio Antonio De Falco ◽  
Maurizio A. Leone ◽  
Ettore Beghi
Keyword(s):  
Multivariate Analysis ◽  
Ct Scan ◽  
Stroke Unit ◽  
Emergency Setting ◽  
Discharge Diagnosis ◽  
Stroke Patients ◽  
Stroke Units ◽  
Very High ◽  
Italian Neurological ◽  
Structured Questionnaire

o assess the stroke workload of Italian neurological services and to correlate it with indicators of each hospital’s emergency setting. A semi-structured questionnaire was sent to the 220 neurology units (NU) located in hospitals with an emergency room (ER) (155 responders, 71%). Stroke was the most common discharge diagnosis (29%) (273 patients/year/NU on average) and condition requiring consultation in ER (28%). A stroke unit was available in 28% of NU, bedside monitors in 45%, a 24 hour/day and 7 day/week (24/7) CT scan in 90%, a 24/7-MRI in 32%, a 24/7 on-duty neurologist in 36%. The stroke workload was correlated only with the number of ER consultations per year, and marginally to the presence of stroke units and the number of monitored beds in the univariate, but not in the multivariate analysis. The stroke workload in Italian NU is very high, but is largely unrelated to their structural and functional characteristics, in contrast with the international indications requiring several essential criteria for the best hospital management of all stroke patients.

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