Exploring advanced nursing practice in stroke services: a scoping review

Background: Stroke care is becoming increasingly reliant on advanced nursing practice (ANP); however, little is known about these roles within the stroke specialty. Aims: To explore the current knowledge of advanced nursing practice in stroke services internationally, specifically, the conceptualisation of ANP and the rationale for its implementation. Methods: Arskey and O'Malley's scoping review methodology was employed, and six academic databases were used. Findings: Two key themes were identified; ‘role development’ and ‘four pillars of advanced practice’. The review identifies that ANP is implemented primarily to provide acute stroke care. Conclusions: Current research does not clarify the rationale for implementing these posts or how ANP is conceptualised. This review does identify that stroke ANP incorporates the four pillars of advanced practice (clinical, research, leadership and education) and was implemented to improve the quality of stroke care. Barriers and facilitators to implementation were also identified.

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Effects of centralizing acute stroke services

Neurology ◽

10.1212/wnl.0000000000005822 ◽

2018 ◽

Vol 91 (3) ◽

pp. e236-e248 ◽

Cited By ~ 6

Author(s):

Sidsel Hastrup ◽

Soren P. Johnsen ◽

Thorkild Terkelsen ◽

Heidi H. Hundborg ◽

Paul von Weitzel-Mudersbach ◽

...

Keyword(s):

Hospital Stay ◽

Acute Stroke ◽

Stroke Care ◽

Acute Hospital ◽

Acute Stroke Care ◽

Difference In Differences ◽

Stroke Units ◽

Before And After ◽

Stroke Services

ObjectiveTo investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).MethodsThe CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective “before-and-after” cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.ResultsCentralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38–0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.ConclusionsCentralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

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Ein Jahr Advanced Nursing Practice in der Kinderkardiologie – ein erster Rückblick

Pflege ◽

10.1024/1012-5302/a000080 ◽

2010 ◽

Vol 23 (6) ◽

pp. 411-416 ◽

Cited By ~ 1

Author(s):

Christine Spitz-Köberich ◽

Bettina Steinle-Feser

Keyword(s):

Nursing Practice ◽

Practice Nurse ◽

Advanced Practice ◽

Advanced Practice Nurse ◽

Advanced Nursing Practice

Im Jahr 2008 wurde in der kinderkardiologischen Abteilung des Universitätsklinikums Freiburg i. Br. das patientenorientierte Konzept Advanced Nursing Practice (ANP) eingeführt, um den Bedürfnissen der dort behandelten, meist chronisch kranken Patienten zu begegnen. Ziel von ANP in diesem Bereich ist es, den Patienten und deren Eltern bzw. Familien eine erweiterte und vertiefte Betreuung und Pflege zu bieten. Die Advanced Practice Nurse (APN), eine Pflegende mit einem Masterabschluss in Pflegewissenschaft, arbeitete dabei in der direkten Betreuung von Patienten und Eltern. Im Rahmen von leitfadengestützten Fokusgesprächen sammelte die APN Themen für mögliche unterstützende Interventionen. Aus dieser Sammlung heraus erstellte sie Schulungs- und Beratungsprogramme wie die Medikamentenberatung vor der Entlassung und die Schulung der Eltern zum Erkennen von Herzinsuffizienzzeichen bei ihrem Kind. Die Beratungsprogramme sollen den Patienten und Eltern mehr Sicherheit geben und die Eltern in ihrer Dependenzpflegekompetenz unterstützen. Die bisherige Rückmeldung von Seiten der Patienten, Eltern und Mitarbeiter zur Umsetzung des ANP-Konzepts ist positiv, eine Evaluation steht noch aus. Es zeigte sich, dass die Implementierung und Umsetzung eines solchen Konzepts Zeit braucht und dass Rahmenbedingungen wie beispielsweise ein fachlich versiertes Pflegeteam vorhanden sein müssen. Um diese Rahmenbedingungen zu schaffen, musste die APN vor allem in den ersten Monaten, aber auch jetzt noch die fachliche Entwicklung der Pflegenden in ihren Fokus mit aufnehmen.

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Advanced Nursing Practice (ANP) im direkten Pflegealltag: Die pflegerische Praxisentwicklung eines akutgeriatrischen ANP-Teams

Pflege ◽

10.1024/1012-5302/a000079 ◽

2010 ◽

Vol 23 (6) ◽

pp. 403-410 ◽

Cited By ~ 4

Author(s):

Anja Ulrich ◽

Peter Hellstern ◽

Reto W. Kressig ◽

Germaine Eze ◽

Rebecca Spirig

Keyword(s):

Nursing Practice ◽

Advanced Practice Nurses ◽

Geriatrische Patienten ◽

Advanced Practice ◽

Advanced Nursing Practice ◽

Practice Nurses ◽

Know How ◽

Chronisch Kranke

Im Jahr 2000 startete das Institut für Pflegewissenschaft in Basel mit einem klinisch ausgerichteten Masterprogramm in Advanced Nursing Practice (ANP). Die mit einem Masterabschluss erlangte Pflegeexpertise beinhaltet vertieftes Wissen und Know-how in einem Spezialgebiet. Zusammen mit anderen Pflegefachpersonen entwickeln diese klinisch tätigen, wissenschaftlich- und praxisorientierten Advanced Practice Nurses (APNs) die Pflegepraxis in der Schweiz weiter, insbesondere für chronisch kranke oder geriatrische Patienten. Bis zu 25 % der über 80-jährigen Menschen erfahren jährlich mindestens einen Spitalaufenthalt. Neben dem akuten Einlieferungsgrund leiden sie oft an zusätzlichen chronischen Erkrankungen, welche gleichzeitig exazerbieren. Diese fragilen Patienten benötigen Unterstützung durch Pflegende, welche erweiterte gerontologische Pflege anbieten können. In der akutgeriatrischen Universitätsklinik Basel findet unter der Leitung einer APN eine systematische, kontinuierliche und effektive Praxisentwicklung statt, welche eine personenorientierte und geriatrisch-spezialisierte Pflege fördert. Die Prinzipien der Aktionsforschung leiten das Praxisentwicklungsprojekt. Der zyklische Prozess «Look-Think-Act» fördert die kritische Auseinandersetzung mit der Praxis. Erste Resultate zeigen eine kürzere Aufenthaltsdauer und verbesserte Betreuungsresultate bei den Patienten sowie eine erhöhte Arbeitszufriedenheit und Selbstwirksamkeit aus Sicht der Pflegenden. Mit dem vorliegenden Artikel wird die Geschichte von ANP kurz eingeführt und anschließend werden die Entwicklung und Einführung des Projekts sowie erste Resultate der Evaluation dargestellt.

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Quality of life of patients with lung cancer: A scoping review

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1981-22562019022.180162 ◽

2019 ◽

Vol 22 (2) ◽

Author(s):

Rafael Turano Mota ◽

Helder Márcio Ferreira Júnior ◽

Fabiane Silva Pereira ◽

Maria Aparecida Vieira ◽

Simone de Melo Costa

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Scoping Review ◽

Prospective Studies ◽

Current Knowledge ◽

Care Quality ◽

Life Questionnaire ◽

Cross Sectional ◽

European Organization

Abstract Objective: To characterize scientific publications on the quality of life of people with lung cancer in order to explore current knowledge of the subject, with emphasis on assessment instruments and methodological aspects. Method: A scoping type literature review was performed. Articles were sought in the databases of the Virtual Health Library, in an integrative manner, with the descriptors: Quality of life and Lung Neoplasms, with no date of publication or language restrictions (n=138). The selection of articles was based on inclusion and exclusion criteria defined in the study proposal. Results: We included 18 publications published between 2006 and 2017, the majority (n = 10) of which had a cross-sectional design. Eight different instruments were used to evaluate the quality of life of patients with lung cancer, four of which were specific for people with cancer. There was a prevalence of the use of the European Organization for Research and Treatment of Cancer Care Quality of Life Questionnaire - EORTC QLQ-C30 (n=8). Prospective studies (n=8) assessed quality of life before and after chemotherapy, physical therapy or pulmonary resection. The studies adopted different methodologies and provided conflicting results of quality of life. Cross-sectional studies with comparatively healthy subjects found an inferior quality of life for people with lung cancer. Conclusion: The scoping review contributed to the identification of the multiple evaluated instruments, both generic and specific. It found a lack of homogeneity in the methodological approaches of the studies. Further prospective studies with a specific instrument and methodological standardization to evaluate the quality of life of people with lung cancer are recommended.

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FP22-TU-01 Quality of acute stroke care in Thailand, a prospective multicenter countrywide study

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(09)70380-6 ◽

2009 ◽

Vol 285 ◽

pp. S91

Author(s):

Y. Nilanont ◽

S. Nidhinandana ◽

N. Suwanwela ◽

N. Poungvarin

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care

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Abstract W MP104: Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Stroke ◽

10.1161/str.45.suppl_1.wmp104 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Nerses Sanossian ◽

May A Kim-Tenser ◽

David S Liebeskind ◽

Justina Breen ◽

Scott Hamilton ◽

...

Keyword(s):

Los Angeles ◽

Acute Stroke ◽

Stroke Care ◽

Care Quality ◽

Acute Stroke Care ◽

Phase 3 ◽

Before And After ◽

Beneficial Impact ◽

Mean Time

Background: Primary Stroke Centers (PSC) provide better acute stroke care than non-PSC hospitals, including faster times to imaging and lytic treatment, and higher rates of lytic delivery. Nationwide less than 1 in 3 hospital has achieved this designation. We aimed to determine the extent to which the better performance at PSC is driven by improvements within hospitals after PSC designation versus better baseline hospital care among facilities seeking PSC certification. Methods: From 2005 to 2012, the NIH Field Administration of Stroke Therapy -Magnesium (FAST-MAG) Phase 3 clinical trial enrolled subjects with likely stroke within 2 hours of onset in a study of prehospital start of a neuroprotective agent. Subjects were routed to 59 community and academic centers in Los Angeles and Orange Counties. Of the original 59 centers, 39 eventually achieved PSC status during the study period. Each subject was classified as enrolled at a PSC before certification (pre-PSC), at a PSC post certification (post-PSC), or at a hospital that never achieved PSC (non-PSC). Results: Of 1700 cases, 529 (31%) were enrolled at pre-PSC, 856 (50%) at post-PSC, and 315 (19%) at non-PSC hospitals. Mean time in minutes from ED arrival to first scan was 33 minutes at post-PSC, 47 minutes at pre-PSC and 49 at non-PSCs [p<0.001 by Mann-Whitney]. Among cases of cerebral ischemia (CI) [N=1223], rates of TPA utilization were 43% at post-PSC, 27% at pre-PSC and 28% at non-PSC hospitals [p<0.001 by X2]. Time in minutes from ED arrival to thrombolysis in treated cases was 71 at post-PSC, 98 at pre-PSC, and 95 at non-PSC hospitals [p<0.001 by Mann-Whitney]. Hospitals that achieved PSC showed improvements in pre-PSC and post-PSC performance on door to imaging time, from 47 to 33 minutes [p=0.014]; percent TPA use in CI, from 27% to 43% [p<0.001], and reduced door-to-needle times, from 98 to 71 minutes [p=0.003]. There was no difference in time to imaging [47 vs. 49 minutes], time to thrombolysis [98 vs. 95 minutes] and percent TPA use [27% vs. 28%] between pre-PSC hospitals and non-PSC hospitals. Conclusions: Better performance of Primary Stroke Centers on acute care quality metrics is primarily driven by a beneficial impact of the PSC-certification process, and not better performance prior to seeking PSC status.

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Deutsches Netzwerk Advanced Practice Nursing & Advanced Nursing Practice g. e. V.

PPH ◽

10.1055/s-0042-104677 ◽

2016 ◽

Vol 22 (03) ◽

pp. 132-132

Author(s):

Peter Ullmann ◽

Günter Gantschnig ◽

Heike Müller

Keyword(s):

Nursing Practice ◽

Advanced Practice Nursing ◽

Advanced Practice ◽

Advanced Nursing Practice

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Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Frontiers in Neurology ◽

10.3389/fneur.2019.01396 ◽

2020 ◽

Vol 10 ◽

Author(s):

Kristina Shkirkova ◽

Theodore T. Wang ◽

Lily Vartanyan ◽

David S. Liebeskind ◽

Marc Eckstein ◽

...

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care ◽

Before And After

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Scoping review of acute stroke care management and rehabilitation in low and middle-income countries

BMC Health Services Research ◽

10.1186/s12913-019-4654-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

George Lameck Chimatiro ◽

Anthea J. Rhoda

Keyword(s):

Developing Countries ◽

Scoping Review ◽

Stroke Care ◽

Middle Income ◽

Middle Income Countries ◽

Care Processes ◽

Care Structure ◽

Care Outcomes ◽

Low And Middle Income

Abstract Background Stroke is a major public health concern, affecting millions of people worldwide. Care of the condition however, remain inconsistent in developing countries. The purpose of this scoping review was to document evidence of stroke care and service delivery in low and middle-income countries to better inform development of a context-fit stroke model of care. Methods An interpretative scoping literature review based on Arksey and O’Malley’s five-stage-process was executed. The following databases searched for literature published between 2010 and 2017; Cochrane Library, Credo Reference, Health Source: Nursing/Academic Edition, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature (CINNAHL), Academic Search Complete, and Google Scholar. Single combined search terms included acute stroke, stroke care, stroke rehabilitation, developing countries, low and middle-income countries. Results A total of 177 references were identified. Twenty of them, published between 2010 and 2017, were included in the review. Applying the Donebedian Model of quality of care, seven dimensions of stroke-care structure, six dimensions of stroke care processes, and six dimensions of stroke care outcomes were identified. Structure of stroke care included availability of a stroke unit, an accident and emergency department, a multidisciplinary team, stroke specialists, neuroimaging, medication, and health care policies. Stroke care processes that emerged were assessment and diagnosis, referrals, intravenous thrombolysis, rehabilitation, and primary and secondary prevention strategies. Stroke-care outcomes included quality of stroke-care practice, functional independence level, length of stay, mortality, living at home, and institutionalization. Conclusions There is lack of uniformity in the way stroke care is advanced in low and middle-income countries. This is reflected in the unsatisfactory stroke care structure, processes, and outcomes. There is a need for stroke care settings to adopt quality improvement strategies. Health ministry and governments need to decisively face stroke burden by setting policies that advance improved care of patients with stroke. Stroke Units and Recombinant Tissue Plasminogen Activator (rtPA) administration could be considered as both a structural and process necessity towards improvement of outcomes of patients with stroke in the LMICs.

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The Dutch Acute Stroke Audit: Benchmarking acute stroke care in the Netherlands

European Stroke Journal ◽

10.1177/2396987318787695 ◽

2018 ◽

Vol 3 (4) ◽

pp. 361-368 ◽

Cited By ~ 8

Author(s):

Laurien S Kuhrij ◽

Michel WJM Wouters ◽

Renske M van den Berg-Vos ◽

Frank-Erik de Leeuw ◽

Paul J Nederkoorn

Keyword(s):

Acute Stroke ◽

Best Practice ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Favourable Outcome ◽

Hospital Level ◽

Acute Stroke Care ◽

Related Factors ◽

Variation In Care

Introduction In the nationwide Dutch Acute Stroke Audit (DASA), consecutive patients with acute ischaemic stroke (AIS) and intracranial haemorrhage (ICH) are prospectively registered. Acute stroke care is a rapidly evolving field in which intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT) play a crucial role in increasing odds of favourable outcome. The DASA can be used to assess the variation in care between hospitals and develop ‘best practice’ in acute stroke care. Patients and methods: We describe the initiation and design of the DASA as well as the results from 2015 and 2016. Results In 2015 and 2016, 55,854 patients with AIS and 7727 patients with ICH were registered in the DASA. Treatment with IVT was administered to 10,637 patients (with an increase of 1.3% in 2016) and 1740 patients underwent IAT (with an increase of 1% in 2016). Median door-to-needle time for IVT and median door-to-groin time for IAT have decreased from 27 to 25 min and 66 to 64 min, respectively. Mortality during admission was 4.9% in patients with AIS, whereas 26% of patients with ICH died. Modified Rankin Scale score at three months was registered in 49% of AIS patients and 45% of ICH patients. Discussion During the nationwide DASA, time to treatment is reduced for IVT as well as IAT. With the rapidly evolving treatment of acute stroke care, the DASA can be used to monitor the quality provided on patient- and hospital level. Conclusion Increasing completeness of registration of the outcome, in combination with adjustment for patient-related factors, is necessary to define and further improve the quality of the acute stroke care.

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