Welcome to the WSC 2022 Interactive Program

Background and Aims

Acute ischemic stroke is a serious disease, but it can have a good prognosis with early therapeutic intervention. However, this depends not only on therapy in the acute phase, but also on care in the first days of hospitalization, when the patient is at risk of secondary complications. One of the most serious is aspiration pneumonia with unrecognized dysphagia. Patients also have a higher risk of recurrence of a stroke in the first days, even if the secondary prevention is set correctly. Nursing monitoring during this period can be crucial.The aim of the presentation is to present a comprehensive monitoring program for acute stroke at the standard neurology department in our center and as a source of inspiration for similar projects in stroke centers.

Methods

Transfer of experience with the implementation of clearly defined procedures for monitoring body temperature, glycemia, dysphagia screening and unique nursing monitoring of the patient's neurological condition in the standard ward.

Results

The result of setting up comprehensive nursing patient monitoring is the capture of virtually all recurrences of stroke in the therapeutic window and a significant reduction in aspiration pneumonias in patients with stroke.

Conclusions

Comprehensive nursing monitoring of a patient after a stroke can have a major impact on the patient's prognosis and in our center is an effective mandatory part of care for all these patients.

Background and Aims

Stroke-related disability burden is on the rise with a 12% increase worldwide since the late 20^th century. Especially in China, stroke is the leading cause of death and disability-adjusted life-years(DALYs) at the national level. Meanwhile, care services could play an importment role in the rehabilitation of post stroke survivors. The aim of our study was to synthesise qualitative evidences on Chinese post stroke survivors' experiences of care sevices in order to explain where these experiences stem from and how they could be addressed by care services.

Methods

We conducted a systematic literature search in several databases such as Pubmed, Web of Science,CNKI. All Published qualitative studies focusing on Chinese post stroke survivors' experiences of care sevices were identified. We synthesized the findings after assessing the quality of included studies.

Results

10 studies were sythesised. All included studies were sequently integrated into eight categories and finally three integrative results were summarized, including: (1) post stroke survivors were constantly adjusting themselves, (2) post stroke survivors expected holistic and multiple care services, (3) limitations of care services and inadequate information provision made post stroke survivors marginalized and passive.

Conclusions

Stroke survivors in China sometimes feel abandoned . Meanwhile, they do not have enough knowledge or skills to solve the problem. This could be addressed by: (1) improving continuity of both generalist and specialist care services, and (2) consolidating stroke specific health system by timely and targeted provision of care services information.

Background and Aims

The aim of this study was to identify risk factors for 30-day readmission in ischemic stroke survivors, with an attempt to improve post-discharge care and lower the 30-day readmission rate.

Methods

Seven databases were searched from inception to April 30, 2021. Retrospective studies focusing on 30-day readmission risk factors in patients with ischemic stroke were included. Two authors independently screened the literature and evaluated the quality of the studies using the Newcastle-Ottawa scale. The pooled effect size was estimated using the odds ratio (OR). The Cochrane Q (χ²) and I² tests were used to assess heterogeneity among studies, and each risk factor was tested for its robustness using fixed- or random-effects models.

Results

A total of 17 retrospective observational studies were included. The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64%, with a mean value of 10.66%±6.87%. We finally identified 6 risk factors: history of stroke (OR, 1.33; 95% CI: 1.08–1.64; P=0.007), diabetes mellitus (OR, 1.15; 95% CI: 1.13–1.17; P<0.001), hypertension (OR, 1.10; 95% CI:1.07–1.13; P<0.001), atrial fibrillation (OR, 1.26; 95% CI: 1.23–1.29; P<0.001), heart failure (OR, 1.59; 95%CI: 1.56–1.63; P<0.001). Four risk factors were ruled out: hyperlipidemia (OR, 1.01; 95% CI: 0.87–1.17; P=0.91), coronary artery disease (OR, 0.83;95% CI: 0.73–0.96; P=0.009), smoking (OR, 0.97; 95% CI: 0.83–1.14; P=0.71), and gender (female, OR, 0.97;95% CI: 0.96–0.98; P<0.001).

Conclusions

We found that stroke history, diabetes mellitus, hypertension, atrial fibrillation, heart failure, and advanced age were risk factors for 30-day readmission, whereas hyperlipidemia, coronary artery disease, smoking, and gender were not.

Background and Aims

The presence of a code stroke nurse has been demonstrated to reduce door-to-treatment time. Unprecedented COVID-19 pandemic have halted face-to-face training program, resulting in a hybrid training program development. The aim of this project was to explore the users’ experience and effectiveness of a new hybrid program for hyperacute stroke nursing training.

Methods

This hybrid workshop was incorporated virtual learning platforms and traditional in-person learning. Pre-post self-assessment knowledge was evaluated using a 20 multiple choice questions (MCQs) and a 5-point Likert scale. A virtual Objective Structured Clinical Examination (OSCE) was conducted as summative assessment. All faculty and participants completed the course evaluation.

Results

Six neuroscience Advanced Practice Nurses with no prior experience in stroke activation participated in the training program. There was only a 10% increase in MCQ mean score. Feedback received for MCQs include having plausible distractors and difficult vocabulary. Five participants completed the virtual OSCE with mean score of 80%. Majority would prefer to have more clinical exposure. Overall, there was 39.4% increase of self-assessment on knowledge post workshop. Being able to conduct proper assessment and debrief in safe environment were key positive feedbacks.

Conclusions

This hybrid workshop enhances nurses’ knowledge in code stroke nursing training. Faculty will need to review and improve the MCQ construct. Clinical attachment extension would have created more opportunity to gain clinical knowledge and insight on the stroke activation processes. Overall, hybrid session on hyperacute stroke nursing training is feasible especially in this COVID-19 pandemic.

Background and Aims

Urinary tract infection (UTI) is common in post Stroke patients. Patients who have impaired mobility, immunosuppressed, bladder dysfunction and use of indwelling urinary catheter are at risk of developing UTI.

This results in longer hospital stays, increased healthcare cost and mortality rates.

UTI in stroke patients is highly preventable and strategies were develop to curb it.

Methods

Post removal of Indwelling Catheter (IDC), patients were assessed at the 4th hour if they were able to void successfully. A bedside bladder scan was also performed to check post void residual urine (PVRU) to determine the success of IDC removal.

In the new workflow, instead, patients were encouraged and checked HOURLY for the next 4hours for their voiding ability.

Patients who have high volume of PVRU were provided with necessary interventions.

Results

Results showed that by monitoring patient’s ability to void on hourly basis, it will reduce incidence of acute retention of urine and allow nurses to provide early intervention.

This result in a decrease from 8.1% to 4.5% in UTI rate.

Conclusions

Patients with UTI have higher risk developing recurrent UTI episodes. By reducing the incidence, patients are less likely to experience another event and prevent mortality.

With diligent nursing care of patients with IDC, and by encouraging patients to “letting it go”, not holding on to the urine, we are able to reduce our UTI rate significantly in our Stroke patients.

Background and Aims

Background: Stroke patients require a comprehensive treatment at the hospital. At the other hand, length of hospitalization is related to the cost of health care and risk of complication. By understanding more about the contributing factors of length of hospitalization, stroke units can develop better interventions to reduce prolonged hospitalization and to prevent complications during hospital stay.

Aims: This study aims to determine the association between demographic characteristics, comorbidities, complications, type of stroke, severity of stroke, and level of consciousness with length of hospitalization among stroke patients in Atma Jaya Hospital.

Methods

Method: This cross-sectional study was performed on 254 eligible stroke patients in Atma Jaya Hospital during 2014-2019. Assessment of variables based on secondary data from stroke registry. Prolonged hospitalization was defined as >7 days. Data analysis was performed using Fisher-exact test, Breslow-Day test, Mantel-Haenzel test, and logistic regression test.

Results

Result: From a total of 254 respondents, 65 (25.6%) have a prolonged length of hospitalization. Analysis showed that complications, type of stroke, severity of stroke and level consciousness had a significant association with length of hospitalization. The most influential risk factor on prolonged hospitalization was type of stroke, complication and severity of stroke.

Conclusions

Conclusion: There is a significant relationship between complications, type of stroke, severity of stroke, and level of consciousness with length of hospitalization. Hemorrhagic stroke, patient with severe stroke and complication are the dominant factors for prolonged length of hospitalization in stroke patient.

Background and Aims

This study explored the influencing factors of chronic psychological stress in patients with stroke, analyzed the risk index of patients, and developed a nomogram model to predict these risks. This will contribute to the prevention of post-stroke depression.

Methods

Methods: In this cross-sectional study, a total of 354 patients with stroke from the neurological diseases department of a tertiary hospital in China were selected as the research subjects from December 2020 to July 2021, and the independent risk factors of chronic psychological stress through univariate analysis and Logistic regression analysis were explored. According to these selected independent risk factors, a risk prediction model was established and incorporated into the nomogram, and the model power and its accuracy were evaluated by receiver operating characteristics.Demographic characteristics included age, gender, education level, marital status, working status, type of medical insurance reimbursement, family per capita monthly income, main caregivers, brain injury site, BMI value, whether exercise ≥30 min/d, treatment methods, duration of illness, combined chronic diseases, number of lesions, etc.

Results

This study found that nutritional status, primary caregiver, site of stroke, coping style, economic problems, Karnofsky score, PSQI score, Numerical Rating Scale score, and exercise status were the influencing factors of chronic psychological stress in patients with stroke.

Conclusions

The model constructed in this study has a good prediction effect, which can provide reference for medical staff to quickly identify the risk of chronic psychological stress in strokr patients and take preventive management measures in time.