Chasing stroke knowledge.
Subject: Nursing education (Personal narratives)
Stroke (Disease) (Care and treatment)
Stroke (Disease) (Diagnosis)
Stroke patients (Care and treatment)
Author: Owens, Pauline
Pub Date: 08/01/2011
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2011 Source Volume: 17 Source Issue: 7
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 266344855
Full Text: [ILLUSTRATION OMITTED]

I recently travelled to Birmingham, Alabama, the United States, to complete the practical component of the online neurovascular education and training in stroke management and acute reperfusion therapy (NET SMART) course. My travel was made possible by a $7000 British Commonwealth Nurses' War Memorial Fund scholarship.

The course is run by the Arizona State University of Alabama and is the only postgraduate neurovascular fellowship programme in the world for nurses working in expanded practice roles. Participants complete a total of 14 internet-based modules, complemented by clinical learning activities and post-tests. Being able to fulfil my passion for advanced education in this speciality has been incredibly fulfilling.

I am an acute stroke unit charge nurse manager ar Counties Manukau District Health Board. My aim in completing this course is to share my new knowledge with stroke nurse leaders in New Zealand and to develop the specialty. For me, stroke nursing is the most complex and exciting field nurses can enter. Stroke is the second largest killer in New Zealand, with Pacific and Maori communities grossly over-represented. We are also under-performing in this area, compared to other Organisation for Economic Co-operation and Development nations.

The primary aim of the NET SMART course is to improve acute stroke treatment outcomes by increasing the number of specialist nurses working in expanded roles; and to support improved medical response and treatment of acute stroke patients. Depending on their scope of practice, NET SMART nurse fellows are prepared for roles that could include: diagnosing a variety of acute stroke presentations through interpretation of neuro-imaging and identifying the likely area in the brain affected by the clot; establishing causes of stroke; acute intravenous thrombolysis (dissolving of clots) and intra-arterial treatment decision making; stroke risk factor analysis and treatment decision making for secondary stroke prevention; treatment decision making for complication prevention; and clinical and administrative stroke centre leadership.

Visit to Canadian rapid assessment unit

On my way to Alabama, I visited the stroke rapid assessment unit at Vancouver General Hospital on Vancouver Island, Canada. The unit caters for minor stroke and transient ischaemic attack (TIA) patients. The unit's clinical nurse specialist (CNS) spends a lot of time in the emergency department (ED), assessing and referring patients as they come in. Stroke thrombolysis for ischaemic stroke was first used in New Zealand in 2004. However, the latest audit in 2009 by the Stroke Foundation New Zealand suggests only three percent of stroke victims are receiving this therapy

The CNS requests the imaging method(s) she feels will best assist with diagnosis of stroke and/or pathogenic mechanism, and therefore guide secondary prevention treatments. The nurse is highly skilled and trained to read the results of these images. She can either call the neurologist for major conditions discovered and/ or begin education. Their statistics showed a marked decrease in stroke admissions as people began attended the TIA clinic, but admissions began to rise again when their resources became too stretched to cope with the rise in numbers.

Working at Birmingham Hospital

The 12 days I spent at Birmingham Hospital were challenging and exhausting, involving on-the-spot assessments of patients we--the three "fellows" on the course--had never met before. I was very impressed by the calibre of my fellows. Both Susie Kons and Todd Ramer are advanced practice nurses, with a wide scope of practice and varied expectations of the role, far surpassing New Zealand nurses' expectations. We were assessed on our theory and practised on each other, and then were expected to be able to read the findings. One evening we had three intravenous (IV) thrombolysis patients--all done in under two hours and all had an excellent recovery! The next day was spent with stroke expert James Grotta. His current project is on the use of hypothermia in conjunction with the clot busting drug alteplase for ischaemic stroke. The results so far look promising.

The next day we went to the neurological intensive care where ali thrombolysed ischaemic stroke patients are cared for during the next 24 hours. The stroke unit has 20 beds with one nurse assigned to three patients. I discovered that in ischaemic stroke patients who also suffer from obstructive sleep apnoea, the flow to the injured part of the brain is diverted to the healthy brain, thus worsening the ischaemic problem.

The followings days are, in hindsight, a blur. We admitted about six patients each day, with at least one thrombolysis each day. One night we had six patients with thrombolysis. I found the system in the ED stunningly slick. The patient was scanned within ten minutes, their medical history acquired as we went. One surprising thing was that relatives do not always--in fact rarely--accompany the patient. Often the patient's history is taken by a paramedic at a fire station!

Another study day I attended was on Botox for spasticity following stroke. I had at least seen this procedure in New Zealand but found the training fascinating.

Apparently I have passed the NET SMART course and will get my diploma in the post. My conclusion, after much reflection, is that I am proud to be a part of the nursing workforce in New Zealand, as I feel our profession allows and encourages us to demonstrate the true meaning of nursing, which is caring. We work as an interdisciplinary team and, much as we may complain, our system gives us the opportunity to individualise and tailor the care we deliver to our patients. We have much to do and a long way to go, but we have a direction and we know our weaponry of choice--knowledge, education and a united goal of reducing inequalities in the delivery of stroke care for ali New Zealanders. We also have the chance to learn from others and not make the same mistakes, yet improve our services to the same levels of excellence. We will succeed, for we have no choice.

Report by Counties Manukau District Health Board acute stroke unit charge nurse manager Pauline Owens
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