Medicine and Health Sciences Commons^™

Brain Matters: Cognitive-Behavioral Therapy And Antidepressants For Post-Stroke Depression, Lindsey Anne Smith

MSN Capstone Projects

Stroke is the leading cause of death and disability in the United States, and approximately one-third of these patients will develop post-stroke depression, which is associated with higher rates of morbidity and mortality (American Stroke Association, 2022). Even though post-stroke depression is prevalent, it often goes undertreated. The combination of antidepressants and cognitive-behavioral therapy has shown to be an effective method of treating post-stroke depression. There are cognitive-behavioral exercises that nurses can implement, such as group therapy, acceptance therapy, and cognitive retraining, a method of coaching the patient to replace negative thoughts with positive ones (Byun et al., 2021). With …

Impact Of Strokes: The Burden Of Care, Post-Cva Fatigue & Caregiver Role Strain, Tanya G. Schlemmer

Nursing Faculty Publications and Presentations

Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke …

Improving Post-Stroke Dysphagia Screening In The Intensive Care Unit., Chelsea Bills

Doctor of Nursing Practice Papers

Background: Dysphagia screening is a critical aspect in the care of patients experiencing acute stroke and dysphagia may often determine life or death following a stroke event. Inconsistent nurse dysphagia assessment and documentation were identified in the Medical/Surgical Intensive Care Unit project organization.

Purpose: The purpose of this project was to explore the impact of an educational program on stroke nurse dysphagia screening and nursing self-efficacy in the ICU.

Methods: Fifteen nurses completed a modified General Self-Efficacy Scale survey which measured nurse perceptions of change in their own self-efficacy to perform dysphagia screenings; dysphagia screening rates and rates of dysphagia …

Nurse-Led Post Stroke Depression Screening (Psd) For Patients With Acute Stroke Using Patient Health Questionnaire-9 (Phq9), Stefan Panov

Doctor of Nursing Practice Final Manuscripts

Introduction: This Evidence-Based Practice Doctor of Nursing Practice project aimed to implement a nurse-led post-stroke depression (PSD) screening using Patient Health Queastionnaire-9 (PHQ-9) in a 12-bed progressive care neuro-stroke unit at a tertiary care hospital. The first goal of this project was to detect stroke patients at risk for depression who met specific inclusion criteria. The second goal was to provide depression education, initiate social work and medical referrals, and start pharmacological treatment to reduce the medical and socioeconomic burden associated with untreated PSD before discharge from the hospital.

Background: Globally, stroke is a prominent cause of death and disability. …

Fall Prevention On The In-Patient Neurological Stroke Unit, Syvol Letwan Middleton

Walden Dissertations and Doctoral Studies

AbstractThe purpose of this quality improvement (QI) evaluation project was to decrease patient falls on a neurological stroke unit. This unit had the most falls throughout the hospital system. The unit averaged 50-60 falls per year with an average of 4.75 falls per month. Guided by Neumann’s system model, the project targeted those patients at the highest risk for falling related to deficits post-stroke and post-neurological disease process. Staff were informed about Last fall, Express needs, Awareness of safety, and Frequency of bowel and bladder (LEAF) to determine if this tool could decrease falls in the neurological stroke population patients. …

Fall Prevention On The In-Patient Neurological Stroke Unit, Syvol Letwan Middleton

Walden Dissertations and Doctoral Studies

AbstractThe purpose of this quality improvement (QI) evaluation project was to decrease patient falls on a neurological stroke unit. This unit had the most falls throughout the hospital system. The unit averaged 50-60 falls per year with an average of 4.75 falls per month. Guided by Neumann’s system model, the project targeted those patients at the highest risk for falling related to deficits post-stroke and post-neurological disease process. Staff were informed about Last fall, Express needs, Awareness of safety, and Frequency of bowel and bladder (LEAF) to determine if this tool could decrease falls in the neurological stroke population patients. …

Improving Outreach With Stroke Patients After Discharge, Marsha Belen

Master's Projects and Capstones

Problem: The 90-day mRS post discharge call project aimed to improve the outreach in stroke patients treated with thrombolytics alone or in combination with mechanical endovascular reperfusion (MER) therapy. An audit of calls was completed and revealed a gap that a number of patients were not reached or did not receive a call attempt. Having a higher outreach provides useful feedback on the patient’s progress within 90-days of being discharged in relation to the effectiveness of the stroke treatment received according to the mRS.

Context: The Neuro Coordinator was responsible for making the 90-day post discharge call and worked in …

Stroke Care: Achieving Recommended Door To Computed Tomography Times In Ambulatory Patients Presenting To The Emergency Department Of A Rural Hospital Through The Application Of American Stroke Association Guidelines, Ricardo Paitz

Doctor of Nursing Practice Projects

Background: Time matters in stroke care, and every second counts because the extent of irreversible neuronal damage increases over time (Saver, 2006). Therefore, the American Stroke Association (ASA) recommends a door to computed tomography time of 20 minutes or less for patients presenting with signs of acute ischemic stroke. This time metric in stroke care is often not met, resulting in the delay of care of patients which translates to poorer outcomes, including death and a decreased quality of life in patients who have suffered an acute ischemic stroke (Kamal, Sheng, et al., 2017).

Purpose: The purpose of this DNP …

Effective Therapies And Nursing Approaches: Improving Cognition In Older Adult Stroke Patients, Selyna Baltazar

Nursing | Senior Theses

Background

Ischemic stroke occurs in thousands of older adults throughout the year. Due to the lack of oxygen entering the brain, many patients experience a decline in cognitive function due to ischemic stroke. Cognition is the ability to understand, learn, and remember information which is needed for completing daily tasks. Modern technology has allowed for patients to survive ischemic strokes but has yet to provide proper screening tools and methods for stroke-related cognitive impairment.

Objective

To investigate the best practices for identifying, treating, and caring for patients with a cognitive injury related to a stroke. A review of the research …

To Use Or Not To Use Oxygen For Mi Benchmark Study, Alexia Celaya

MSN Capstone Projects

It is a common practice for emergency personnel to administer oxygen for a patient diagnosed with a myocardial infarction. It is a well-known practice to place the patient on supplemental oxygen even if they are not hypoxic. The use of supplemental oxygen has been a cornerstone in the treatment of myocardial infarction. The rationale behind the administration of oxygen therapy is to increase oxygen delivery to the myocardium, therefore limiting the infarct size and future complications (Hofmann et al., 2017). The use of supplemental oxygen on normoxic patients has been challenged due to the possibility of causing further injury to …

The Correlation Of D-Dimer To Stroke Diagnosis Within 24 Hours: A Meta-Analysis, Adeel Ahmad, Zara Islam, Saad Manzoor Ahmad, Zouina Sarfraz, Azza Sarfraz, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Diagnosing D-Dimer early is essential to optimize clinical treatment and quality of life and reduce mortality. This study aims to identify the difference of D-Dimer levels (ng/ml) in patients with stroke within the 6- and 24-h period compared to patients that mimic stroke.
Methods: An electronic database search across PubMed/MEDLINE, Cochrane, Web of Science, CINAHL, EMBASE, and Scopus was conducted until December 10, 2021. Studies were eligible if they included adult patients with stroke compared to stroke mimics or controls reporting D-Dimer values. Quality assessment was conducted using GRADE. The standardized mean difference and 95% confidence intervals were calculated …

Core Measures Improve Health Outcomes In Stroke Patients, Katelyn Ponce

Student Research Poster Presentations 2022

No abstract provided.

Neurointerventional Post-Procedure Assessment And Documentation Compliance, Chandra Brower

Nursing Posters

Per stroke best practice guidelines, pulse and groin checks need to be completed post-neurointerventional procedure per orders. Our plan is to improve assessment and documentation of post-procedure pulse and groin checks by improving the flow of the Electronic Medical Record (EMR). By enhancing clinical documentation and improving the documentation process, nursing practice can be supported, and best patient care delivered.

Stroke Patient Outcomes When Fever Is Present, Anthony Grant

Nursing Masters Papers

Introduction to the Problem: Prescribers in the acute care setting differ in opinions with the role fever plays with stroke patient outcomes. This is evident by contrasting guideline recommendations and differing plan of care development amongst prescribers. This lack of clarity has led to the question; does fever affect stroke patient outcomes in that acute care setting.

Supporting Literature: The research utilized for this inquiry was specific to both ischemic and hemorrhagic stroke patient outcomes when fever is present.

Methods Used for Inquiry: An integrative literature review was conducted for this inquiry. A total of ninety articles were …

Enhancing The Accuracy And Effectiveness Of The National Institute Of Health Stroke Scale In A Rural Emergency Departmennt, Emily Nicole Addington

Doctor of Nursing Practice Projects

A rural facility in the foothills of North Carolina found a need for process improvement regarding the emergency department and completion of the NIHSS. The DNP student and the Stroke Coordinator along with the Quality Improvement Coordinator agreed with the need for education of staff concerning accurate assessment and documentation of the NIHSS. The DNP project implemented additional training for the emergency department nurses and paramedics in the form of face-to-face classes with a PowerPoint. A pre-and post-survey was conducted to gauge the comfort level of staff with the NIHSS and stroke processes of the rural emergency department. The Stroke …

A Pilot Mixed Methods Study Examining Factors Affecting Return To Work Among African American Stroke Survivors, Kristin D. Ashley

All ETDs from UAB

BACKGROUND: Stroke is a highly prevalent and disabling condition among African Americans. Although there is limited research regarding barriers and facilitators to return to work among stroke survivors, evidence suggests that African American stroke survivors return to work (RTW) less frequently than Caucasians. Most of the research on this topic has been conducted in European countries, leaving significant knowledge gaps on RTW among African Americans in the United States. The purpose of this study was to identify factors that affect RTW for African American stroke survivors and then build upon those results to better understand facilitators and barriers to RTW. …

Reflecting On Experiences Of Care: An Exploratory Qualitative Descriptive Study Of The Perspectives Of Stroke Survivors, Families And Staff, Caroline Bulsara, Rosemary Saunders, Laura Emery, Christopher Etherton-Beer

Research outputs 2014 to 2021

Objective:

The aim of this study was to identify barriers and enablers from the perspectives of stroke survivors, carers and staff to understand the experiences of care.

Design:

The study used a qualitative descriptive methodology and employed semistructured interview technique.

Setting:

A metropolitan stroke rehabilitation unit in Western Australia providing rehabilitation services for inpatients and outpatients.

Participants:

Overall, 10 participants (four staff, four stroke survivors and two primary carers) were interviewed. Transcripts were analysed using thematic analysis.

Results:

Experiences of care focused on lack of time, urgency to regain mobility, postshock recovery, uncertainty about the future and the importance of …

Stroke Depression And Rehabilitation Willingness: Benchmark Study, India J. Lewis

MSN Capstone Projects

The purpose of this paper is to examine, identify, and treat patients with post-stroke depression. Post-stroke depression can affect a patient's willingness to perform activities of daily living, this may result in poor functional outcomes on discharge. Depression is not regularly screened during the acute stroke phase, therefore not regularly treated with the intent to improve functional outcomes. The Patient Health screening questionnaire (PHQ-9) is an available tool that can assist in recognizing and treating depression. This project will determine that the current literature supports implementation of a protocol needed to improve rehabilitation participation.

Stroke Education Program To Reduce Readmission, Karnesha Dominguez

MSN Capstone Projects

Stroke is a major cause of long-term disability and mortality in the United States, exemplifying a complex chronic disease with high co-morbidity, associated healthcare costs, and readmission rates. Unfortunately, patients diagnosed with strokes often present to acute care settings with stroke events after they have had been previously diagnosed. Readmission rates among stroke patients are as high as 13% with most readmissions being unplanned and many avoidable (Brom et al., 2021). An estimated 6.6 million Americans aged 20 years and older have had a stroke, and each year approximately 795,000 people experience a new or recurrent stroke (Duncan et al., …

Health Providers Perspectives On The Access And Use Of Formal Health And Social Services By Stroke Caregivers, Hannah Pollock

Electronic Thesis and Dissertation Repository

Informal stroke caregivers, comprised of family and friends, can experience prolonged stress that places them at risk of poor health and social outcomes. These caregivers may benefit from formal health and social services, but they are often underused and challenging to access. This qualitative interpretive description study sought to explore health providers’ perspectives on the factors that impact stroke caregivers' access and use of formal health and social services. In addition, it sought to explore health providers' experiences and how they perceive their role in supporting stroke caregivers'. In-depth, semi-structured interviews were conducted with 18 health providers. Through inductive thematic …

Ischemic Stroke, Brett Winner

Nursing Student Class Projects (Formerly MSN)

Cerebrovascular accident, or stroke, as it is referred to is a serious neurological event that affects almost 800,000 people in the United States annually, of which approximately 87% is ischemic in nature. Ischemic stroke is mostly caused by atherosclerotic plaques that develop due to endothelial injury in vessels that supply blood flow to the brain. An ischemic stroke can be the result of thrombi breaking off from vessels in the brain, emboli from outside the brain, or small vessel stenosis, all of which occlude a vessel within brain and cause tissue ischemia. When perfusion to portions of the brain is …

Improving Handover Process For Stroke Patients Transferring From Emergency Department To Interventional Radiology: A Quality Improvement Project, Megan Buchman

Doctoral Projects

Background: A standardized handover process is needed for stroke patients transferring from the Emergency Department to Interventional Radiology.

Local Problem: Emergency Department and Interventional Radiology had different handover processes.

Methods: A quality improvement project was conducted in a large Magnet® designated midwestern health system. Participants included emergency department and interventional radiology nurses and stroke patients. Pre/post-quality and post implementation measures were obtained.

Interventions: The interventions included utilizing a standardized handover tool between departments, calling report prior to patient transfer, and turning in handover tool following stroke case to ensure compliance. Two cycles of the Plan-Do-Study-Act Cycle were completed.

Results: No …

A Pilot One Group Feasibility, Acceptability, And Initial Efficacy Trial Of Listen For Loneliness In Lonely Stroke Survivors., Laurie A. Theeke, Jennifer A Mallow, Elliott Theeke

Nursing Faculty Publications

Loneliness is a prevalent problem for adult stroke survivors, and a known contributor to hypertension, secondary stroke, functional decline, poorer quality of life, and mortality in older adults. LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a theoretically based behavioral health intervention designed to target loneliness, in a sample of lonely survivors of ischemic stroke.

Atrial Fibrillation, Nicholas Anderson

Nursing Student Class Projects (Formerly MSN)

Atrial fibrillation (AF) is the most diagnosed cardiac arrhythmia that clinicians and patients should be educated on. Due to the increased morbidity, mortality, and healthcare costs associated with AF, it is important to have a solid understanding of the signs, symptoms, diagnosis, underlying pathophysiology, significance of the pathophysiology, treatments, and nursing implications that are involved with this cardiac arrhythmia. One of the most significant complications due to AF is stroke, thus stroke prevention measures such as oral anticoagulation should be considered.

Nursing And Allied Health Staff Perceptions And Experiences Of A Volunteer Stroke Peer Support Program: A Qualitative Study, Rosemary Saunders, Kien Chan, Renée M. Graham, Elena Adams, Caroline E. Bulsara, Karla Seaman, Marcella Cranny-Connolly

Research outputs 2014 to 2021

Purpose: Stroke brings about physical, cognitive, and psychosocial changes and, conse-quently, many stroke survivors feel underprepared for the transition from hospital to home. Nursing and allied health staff have a key role in stroke rehabilitation. Peer support programs have been found effective in supporting stroke survivors, alongside hospital staff caring for stroke patients, by providing experiential knowledge that staff are not able to provide. Aim: This study explored the perceptions and experiences of nursing and allied health staff of a volunteer peer support program for stroke inpatients. Methods: This study utilised a qualitative, evaluative case study design. This study was …

The Relationship Between Anosgnosia For Hemiplegia After Stroke And Fall Events In The Acute Inpatient Stroke Rehabilitation Population, Elizabeth Mosley Byrd

All ETDs from UAB

Background/Significance: Inpatient falls on acute stroke rehabilitation units remains a significant issue that negatively affects healthcare costs and causes physical and psychological injury. Prevelance of falls in the stroke rehabilitation population may be due to the presence of anosognosia for hemiplegia (AHP), which is as an unawareness of physical disability. Though the link between AHP and falls has been suggested in the literature, a formal investigation has not been conducted to address the relationship between the variables. Purpose: To explore the association between the presence of anosognosia for hemiplegia after stroke and patient fall events while admitted to an acute …

Poststroke Depression And The Lived Experiences Of The Family Caregiver And Care Recipient Dyad, Tiffany Chere' Gurley-Nettles

Walden Dissertations and Doctoral Studies

AbstractPoststroke depression in stroke survivors is a more common occurrence than once believed as the survivor of stroke must contend with the loss of their former self and with residual physical, communicative, cognitive, and/or psychological changes. Family members who become informal caregivers, with minimal to no training in some cases, may experience stress from having to adjust to new family roles and responsibilities. Limited information is available on the lived experiences of the family caregiver and the survivor of stroke. The objective of this study was to explore the lived experiences of the survivor or stroke with poststroke depression and …

Stroke Preventive In African American Women Ages 20-40 That Are Using Or Have Used Oral Contraceptives, Ashanti L. N. Coleman

Electronic Theses and Dissertations

This Doctor of Nursing Practice project will inform the audience of stroke awareness as it pertains to oral contraceptives. The study’s focus was to enhance the knowledge of African American women ages 20–40 that have used or are currently using an oral contraceptive. It has been identified that this patient population lacked the knowledge regarding stroke and oral contraceptives, and African American women continue to have the highest incidence of stroke. African American women also make up more than half of the consumers utilizing oral contraceptives. An oral contraceptive knowledge questionnaire was utilized from previous research to determine if any …

A Narrative Analysis Of Psychological Adjustments Of Professionals Transitioning To Work Following Cerebral Vascular Accident (Cva), Mabel Munachiso Korie

Theses & Dissertations

This research study was a narrative analysis of the psychological adjustment of professionals transitioning to work after a cerebral vascular accident, commonly known as a stroke. The purpose of this research was to explore the psychological adjustment of professionals who returned to work after a stroke following their subsequent rehabilitation. This has been an important subject because stroke research predominantly addresses older adults, which means that there has not been enough information on the experience of affected working-age professionals. The Roy Adaptation Model and Social Cognitive Theory were the frameworks for the study. The data collected were from audio-recorded and …

Atrial Fibrillation, Ayushma Neupane

Nursing Student Class Projects (Formerly MSN)

Atrial fibrillation is one of the most common cardiac arrhythmias. Patient can be either symptomatic or asymptomatic. Atrial fibrillation poses a high risk for the development of thromboembolitic stroke and heart failure along with other complications. Nursing provider must take a responsibility to educate the patient regarding the knowledge of disease and importance of adherence to medication and anticoagulants to ensure the quality of life. Understanding the pathophysiology of atrial fibrillation is essential to treat a patient and also to estimate the lifetime risk of atrial fibrillation in various subgroups with one or multiple elevated or borderline-elevated risk factors might …