Strokes are a concern to nursing as they are a relatively common precursor for those that require nursing. This is primarily due to the diverse nature of the after effects of strokes, in which language loss, frustration, afflictions to cognitive function alongside a general need for medical expertise and assistance occurs (Kutner et al, 2010). Furthermore, the extent of nursing has been found to be successful to stroke victims as they generally require assistance in acclimatising to their new condition, if not overcoming the disabilities that the condition has brought about.
This makes the nursing of stroke victims a relatively positive and rewarding one as positive results can be achieved. Due also to the commonality and diversity of the subsequent affliction, the study of strokes is an appropriate subject for the topic of nursing. Another aspect of nursing in relation to strokes and stroke victims is the way in which the multi-disciplinary aspects of the health service come into place. This is relative owing to its contemporary nature, as many health service institutions have turned to interdepartmental and multi-disciplinary techniques to assist in health care practice.
Unlike some other subjects involved in nursing, the nursing of stroke victims brings about a large proportion of such inter-disciplinary measures, relating to many of the academic schools. For example, psychological, functional, biological, sociological, familial and medical issues are all associated with strokes and the rehabilitation of stroke victims. The practices that have to be put into place range from counselling through to the distribution of medicine. This is another emphasis that makes undergoing an essay on strokes and stroke based interventions alluring.
In recent years, the understanding of how motor learning, neuro-plasticity and functional recovery adapt and respond after the occurrence of stroke induced brain lesions has grown to a significant degree. Although a considerable number of physic-therapeutic schools of thought and interventional programmes have been established stemming from this time, conclusive proof of the benefit has not yet been completely verified in any definitive way. Furthermore, a physiological model of their impact upon neuronal structures and processes is still missing in relation to outcomes (Teasdale et al, 1993).
Nevertheless, there seems to be a great deal of success attributed to the development of multi-disciplinary intervention techniques owing to the favourable outcomes in terms of cognitive functioning and physical-motor neuronal outcomes. Due to the gaps in much of the contemporary literature concerning stroke interventions and the seemingly positive leaps in rehabilitation techniques, a review of the evidence in light of a multidisciplinary approach was chosen to be assessed for the purposes of this nursing assignment.
Due to all of these reasons it was decided that an analysis of the study and contemporary understanding of stress in relation to nursing interventions would be undergone for the purposes of this assignment. The Underlying Patho-physiology of Strokes The patho-physiological aspects of a stroke are crucial to nursing and health care interventions. The knowledge derived from the patho-physiological aspects is primary to the nursing setting because it relates to the immediate effects of the condition that informs us of the subsequent effects of a stroke associated with problems that may occur in stroke victims.
Although there are a number of different ways in which the stroke may manifest in the cognitive and functional aspects of the person after they have recovered from the initial attack, there are nevertheless a number of established factors associated with the onset of the stroke from a biological perspective. This in turn has generated a number of different approaches to the treatment of the stroke in relation to identifying certain needs. These factors constitute the prevalence in contributing towards the condition of a stroke in any individual.
One of the foundational aspects to a stroke from a patho-physiological aspect is that the brain or spinal neurons become severely ischemic following a haemorrhage or trauma (Villacara et al, 1989). This has been found to lead to the leaking of various intracellular constituents that are normally stored in high concentrations (Wertman & Zervas, 1974). In more recent times, the major bio-psychological aspects of a stroke have been defined in relation to stroke pathology (Woldag & Hummelsheim, 2002).
In this sense, the stroke is attributed to rises in glutamate, which make up the extra cellular activity essential to the condition. This has been evidenced in a number of studies that have backed up the Wertman & Zervas findings. For example, a study conducted by Davalos found that; ‘There is convincing evidence from animal models of stroke that ischemia leads to an increase in the extra cellular concentrations of excitatory amino acids (EAAs), especially glutamate.
This accumulation of glutamate, which can reach up to 80 times normal at the centre of an ischemic lesion, is believed to be an important factor for the premature death of neurons that would otherwise survive the ischemic conditions and recover when flow is restored. ’ (Davalos, 2000) However, the patho-physiological effects do not only consist of medical and purely biological effects. Rather, they lead to a number of psychological and cognitive effects, which are indicative of the post stroke condition and manifest in language, cognitive function, perception, communication and mobility (Huijben-Schoenmakers et al, 2009).
For instance, depression has been found to be an extremely common occurrence after a stroke and is associated with excess disability, cognitive impairment, and also mortality (Woldag & Hummelsheim, 2002). In a study conducted by Whyteab and Mulsantab it was concluded that the available evidence supported the notion that ‘post stroke depression is multi-factorial in origin and consistent with the bio-psychosocial model of mental illness’ (Whyteab & Mulsantab, 2002). This revealed the ultimately very complex and multi-orientation based nature of the post stress condition.
Other factors pertaining to both the likelihood and nature of a stroke and the subsequent post stroke condition have included genetic oriented conditional factors, culminating in a genetic approach to the diagnosis as well as psychological and physiological pathologies (Humphries & Morgan, 2004). Main Body – Evidence Based Analysis of the Nursing Interventions for Stroke Sufferers There are a number of factors relating to the needs of stroke sufferers that indicate that any approach to intervention must take into account a number of inter-disciplinary approaches and measures.
For example, the physiological aspect of the sufferer reveals that psychological and cognitive factors are indicative of the condition in that utilising other aspects of the brain through regular bio-cognitive treatment can generate physiological functioning from other aspects of the brain (Plow et al, 2009). Furthermore, aspects such as dietary requirements due to changes in the functional capacity to eat have provided the nurse with more areas of concern.
This means that dieticians, alongside doctors and psychologists, are of significance in relation to nursing those who have suffered a stroke as this phenomena has to be recognised before interventions can be utilised. Evidence based implementations have provided the approach to nursing stroke patients with a number of multi-disciplinary needs due to the varied and complex nature in which recovery can be undergone depending upon the diverse nature of those afflicted (NICE, 2010).
For example, strong evidence has been found in favour of ‘task-oriented exercise training’ in relation to restoring both balance and gait in those suffering from motor neural afflictions associated with perception, as well as for ‘strengthening the lower paretic limb‘ in stroke sufferers (Peppen et al, 2004). This indicates that the physiological aspects are deeply intertwined with various elements relating to the cognitive and psychological domains.
Outside of the functional aspects of the purely patho-physiological domain, intervention programmes have also been found to fail across a number of institutional variables. That is to say that the counselling approaches adopted by various nursing programmes have revealed side effects that have led to poor therapeutic measures (Peppen et al, 2004). This seems to be primarily associated with a need for emotional and familial support, including the need for knowledge and motivation (Peppen et al, 2004).
For example, in one study conducted by Huijben-Schoenmakers et al the use of patient time in intervention programmes was analysed and addressed in terms of emotional well being and inclination to adopt patterns of adaptive behaviours, rather than in terms of patient outcomes. The use of therapeutic techniques in the trial undergone by stroke patients on rehabilitation units of a nursing home were found to show that the time spent on therapeutic activities was minor when compared to time spent on non-therapeutic activities, interactions and the location where the counselling interventions took place (Huijben-Schoenmakers et al, 2009).
In summary, the authors concluded that; ‘Stroke patients spend only short periods of time during the day on therapeutic activities. For the largest part of the day, the patient is alone and passive. A challenge for nurses is how to activate patients and engage them in purposeful task-oriented training in daily activities. ’ (Huijben-Schoenmakers et al, 2009) These findings highlight the challenges to the nurse in relation to the psychological and cognitive needs of the individual sufferer in terms of their own needs.
However, other aspects also include the familial environment and the motivation that may be ascertained from the family having the required knowledge of the therapeutic goals. Indeed, current NICE policy specifically states this requirement, when it says that; ‘Good communication between healthcare professionals and people with acute stroke or TIA, as well as their families and carers, is essential. It should be supported by evidence-based written information tailored to the person’s needs. (NICE, 2010)
It is clear from the policy and the evidence here that there is a clear need for a multi-disciplinary form of nursing intervention and identification in accordance with the stroke sufferer’s own environmental and functional needs. As the study by Hankey and Warlow implies, this is indicative of a number of interventions that transcend only the purely physical aspects and must incorporate the needs of the individual sufferer in relation to their own evaluation (Hankey & Wardow, ).
This is further accentuated when the potential impacts concerning communication and language are considered as well as potentially sensitive dietary requirements (NICE, 2010). For example, the occupational therapist is required to negotiate the individual needs of the patient and refer them to a dietician if there is a significant danger (NICE, 2010). This can be assisted by the doctor or physician involved as they are best placed to be able to diagnose the physical problem.
However, this need has to be coordinated through the family as well as the nursing domain as the individual patient may not comprehend the severity of the problem, though they are autonomous in any decision. This lies heavy on the nurse as they must formulate and maintain an individual relationship with the patient as it is the patient who is best equipped to asses the benefit and harm of any particular intervention (Glasziou & Irwing, 1995). Alongside the physical and psycho-social aspects of stroke rehabilitation, implementing successful programmes based upon cognition is also of significant importance.
For example, supporting evidence exists for the effectiveness of a number of forms of cognitive rehabilitation programmes for persons who have suffered from strokes. This evidence also verifies the individualisation of implementation settings. This can be seen in the findings of the Cicerone et al study that revealed that; ‘Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning. (Cicerone et al, 2000)
These findings show that the emphasis placed upon an intervention concerning the many cognitive functions of the stroke sufferer is of significant importance. Essentially, if the individual is to be able to adapt to the condition of a stroke they require a range of assistance, meaning an emphasis upon a multi-disciplinary system based upon individual needs, patient autonomy and wealth of readily available knowledge.