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Introduction
Stroke is one of the leading causes of mortality and disability among people globally. Those who survive the disease oftentimes suffer from many functional impairments and depend on individualized treatments for years (Deutschbein et al., 2020). Therefore ultimate care requires a combination of approaches, including physiotherapy, occupational therapy, speech therapy, and nursing care. However, healthcare coordination for patients after stroke is insufficient even in developed counties like the United States and Europe and does not meet the patient’s needs (Deutschbein et al., 2020). After discharge from hospitals, stroke patients and their caregivers are oftentimes left alone to manage their conditions without proper coordination from health experts. To change this, various strategies like early supported discharge, patient education programs, behavioral interventions, and the coordination of care through case management for stroke survivors should be adopted (Deutschbein et al., 2020). Nurses should also support patients individually and coordinate their access to treatment and other services.
Priorities When Discussing Stroke Care Plan with the Patient and Their Family Members
Nurses in charge of stroke care coordination should be able to understand and teach patients and families the warning signs of stroke. The coordination must incorporate giving clues to the patient about danger signs and getting rapid treatment to save brain cells from being damaged (Moore, 2016). Care coordinators must also discuss risk factors like high blood pressure and smoking with stroke patients, which can be reduced through behavioral change. The coordinator should make the patients understand that when receiving tPA, they must undergo neurologic assessment after every 15 minutes during infusion and the first hour after infusion ends. The neurologic checks should be repeated every 30 minutes for the next 6 hours and then hourly for the next 24 hours after infusion. The blood pressure must be monitored every 15 minutes during the first hour after infusion, every 30 minutes for around 6 hours, and hourly for the next 24 hours.
Communication and Teaching Needed for a Hypothetical Patient with Stroke
In some cases of stroke, survivors do have communication problems, so it is important that care coordinators be calm or tolerant with the patient. The questions asked to the patient must also be simple, which just require a yes or a no response. Care coordinators should eliminate distractions and noise (Cleveland, 2019). The survivors need time to respond to the questions and do not rush them to respond. Some stroke survivors may develop garbled speech due to muscle weakness or difficulty with coordination of speech (Cleveland, 2019). In such a case, it is necessary that a speech-language pathologist should be involved to assess the patient’s communication skills and discuss with the family how to improve the survivors’ communication. Train the survivors to recognize the affected part as very much part of their bodies.
Stroke Patient-centered Health Interventions
Patient-centered care is the provision of healthcare that is respectful of and responsive to patient’s preferences, needs, and values which guide the decision-making. This approach requires a high level of partnership between the patient and medics (Health Leads, 2018). The collaboration must be guided by the aspirations of the patient when making decisions. This model of intervention allows stroke care providers to treat the patient while equally paying attention to their mental health and social needs. The model brings attention to active partnerships and shared decision–making with patients and their families.
The care must focus on the physical comfort and emotional well-being of the patient. The stroke patient and family must be part of the care team and actively participate in decision-making (Health Leads, 2018). The coordination should ensure that the patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected, and it should first establish a foundation for post-stroke management that incorporates caregivers and family members. There should be a screening of complications such as depression both in the short term and long term (Kernan et al., 2021). The care should involve managing risk factors like blood pressure, diabetes, carotid, and the effort to reduce recurrent stroke by managing the patient lifestyle like diet regulations and exercise.
Three Health Care Issues Common in Stroke Patients and Intervention for Them
In most cases, stroke patients have a wide range of health issues after they survive the incident. Three of these issues are physical disability, depression, and anxiety, and they can be mitigated by medication therapy, physical exercise, psychological intervention, assistive devices, and surgical procedures (Hailu et al., 2020). Physical disability is common in almost all stroke survivors – who normally experience shoulder pain, leg pain, and ulceration; these problems can be mitigated through physical exercises. The exercises are necessary because they help individuals regain their walking ability post-stroke (Hailu et al., 2020). It is also necessary to administer drugs to reduce the pain or effects of depression. Psychological interventions like cognitive should be administered to reduce depression, fear, and anxiety and help improve stroke patients’ mental health (Hailu et al., 2020). Additionally, knowledge interventions using videos and lectures are important in helping patients adhere to other interventions.
Community Resources for Stroke Intervention
There are stroke support groups that offer social interaction and connection for patients to ease depression and isolation. Further, treatment of a patient after a stroke is multidisciplinary, involving the support of several medical professionals. These include rehabilitation specialists, rehabilitation nurses, physical, occupational, recreation, speech and language therapists, and mental health professionals (Adeoye et al., 2019). Community-based rehabilitation centers have therapists to help the patient with full recovery.
Ethical Decisions in Designing Patient-centered Health Interventions
Ethical concerns in the care of patients with stroke include the evaluation of the decision-making capacity of the sufferer when their communication is impaired. It also entails evaluating the patients’ quality of life, withdrawal of life-sustaining treatment, and optimizing surrogate decision-making (Mahanes, 2019). The healthcare coordination plan must ensure communication between providers and patients or their families promotes shared decision-making to eliminate ethical conflict (Mahanes, 2019). However, the coordinator must address ethical questions like a breakdown in communication, patient autonomy, how to share decision-making, and non-beneficial care. The coordination should follow the stroke system of care policy which recommends that patients get optimal stroke care like prevention, EMS, acute hospital care, rehabilitation, and cooperation at all levels of care.
Health Policy Provisions for Stroke
The American Stroke Association policy of 2005, which was expanded in 2013, is a comprehensive review of evidence about stroke systems care. This policy, over the years, has assisted in the realization of endovascular therapy, neurocritical care, telestroke, and mobile stroke units (Adeoye et al., 2019). It provides updates to publications that assist policymakers in continuous modifications of stroke care systems in areas like primary prevention and rehabilitation.
Priorities for the Coordinator during the Discussion with the Patient and Their Family
The coordinator should establish the patients’ and their families’ preferences in advance before the discussion. This information is used as the foundation for providing safe, appropriate, and effective care to stroke patients (AHRQ, 2018). The care coordinator must establish the care plan immediately in consultation with the patient’s family, but the plan should be changed from time to time depending on the progress made by the patient. The coordinator may use broad approaches like teamwork, care management, health information technology, and a patient-centered medical home. This approach has specific activities, including sharing knowledge, assessing patient needs and goals, agreeing on responsibilities, linking to community resources, supporting patient’s self–management goals, and monitoring changes in the victim’s needs. This is in line with the Healthy people 2030 framework which envisions a society in which all people can meet their full potential for health and well-being. The goals of this framework guide the actions of individuals, communities, and stakeholders to improve health (“Healthy People,” 2020). Through this, communities are mandated to adopt and change Healthy People goals to meet their own needs, and they may also set priorities for their regions or groups.
Conclusion
Nurses charged with coordinating stroke care plans should always sensitize the patients and their families to warning signs and risk factors of the disease. Their communication with patients must be gentle, calm, and tolerant because, in most cases, stroke patients have language impairment. Further, coordination of care must be patient-centered, involving collaboration between the providers, patients, and their families when making decisions to eliminate ethical issues which may impede planned activities.
References
Deutschbein, J., Grittner, U., Schneider, A., & Schenk, L. (2020). Community care coordination for stroke survivors: Results of a complex intervention study. BMC Health Services Research. Web.
Moore, D. (2016). Urgent care for stroke patients: Timing is everything. American Nurse.
Cleveland Clinic. (2019). How to best communicate with stroke patients. Web.
Health Leads. (2018). Patient-centered care: Elements, benefits and examples. Web.
Kernan, et al. (2021). Primary Care of Adult Patients after Stroke: A Scientific Statement from the American Heart Association/American Stroke Association. AHA Journals. Web.
Hailu, D. A., Mohamed, S. A., & Yimer, Y. S. (2020). Health-related quality of life of stroke patients before and after intervention: Systematic review. Journal of Biology and Medicine. Web.
Healthy people 2030 framework. (2020). Healthy People.gov. Web.
Mahanes, D. (2019). Ethical concerns are caring for the stroke patient. National Library of Medicine. Web.
Adeoye, O., Nyström, K. V., Yavagal, D. R., Luciano, J., Nogueira, R. G., Zorowitz, R. D., & Jauch, E. C. (2019). Recommendations for the establishment of stroke systems of care: A 2019 update: A policy statement from the American stroke association. AHA Journals, 50(7), 187-210. Web.
AHRQ. (2018). Care coordination. Agency for Health Research and Quality. Web.
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