Commentary: Acute Nursing Management of Ischemic Stroke: Content for Nurses, by Nurses and Highlighting the Role of Nurses in Acute Stroke Management

Disclosure: Lombardi-Hill/Stroke Challenges, Consultant/owner
Pub Date: Thursday, Mar 11, 2021
Author: Sarah L. Livesay, DNP, APRN, FNCS, FAAN
Affiliation: Rush University College of Nursing

Few in healthcare would deny that nurses are integral to the management of acute ischemic stroke. Nursing leadership in stroke takes many forms, including providing care to individual patients in all healthcare settings, educating patients, families and the general public, leading stroke programs across the nation and leading research to improve care for patients with stroke. Yet, national guidelines and other key documents written about stroke management are often silent regarding the role of the nurse.¹ With the publication of American Heart Association Scientific Statement Care of the Acute Ischemic Stroke Patient by Ashcraft et al², The American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council provide an update for nurses on the prehospital and hospital management of patients with ischemic stroke. This publication provides an update to the 2009 document by the same title and is one of three documents that provide key information for nurses and highlight the role of the nurse in stroke care across the healthcare continuum.

The authors provide a comprehensive review of the evidence to guide nurses to prioritize their interventions as patients who suffer from stroke present in the prehospital setting, through the emergency department, concluding with admission to the hospital. One important function of this document is to name stroke and neuroscience nursing as a distinct specialty, highlighting the contributions of nurses from multiple backgrounds to stroke care. The publication touches on important developments in stroke care, including the expanded availability of care via Mobile Stroke Units (MSU), successful community outreach efforts to facilitate detection of new stroke symptoms and address social determinants of health, and the nurse’s role in appropriate routing of patients to stroke centers. The authors also highlight several aspects of care that ensure organized and timely care including stroke protocols and pathways, quality improvement, changes in neuroimaging approaches and other aspects of the acute stroke evaluation in the emergency department. Nurses are fundamental to the functioning of these systems. The role of nurses in these systems may not lend itself easily to scientific study, but are critical, nonetheless. Timely reperfusion through either IV thrombolysis, mechanical thrombectomy, or both are also discussed, including aspects of nursing care that are essential to safe care and often omitted from published literature. This includes key documentation elements, safe drug administration and strategies to reduce complications and harm. Finally, the authors tackle several aspects of stroke care that continue to rapidly evolve and impact stroke care including the global COVID-19 pandemic and the role of telemedicine in the delivery of stroke.

The American Heart Association Scientific Statement Care of the Acute Ischemic Stroke Patient² eloquently provides nurses updated information to improve their knowledge of stroke and better understand the key role they play in stroke care. This is fundamental to ensure that the care provided by nurses is visible and respected by the interdisciplinary team of healthcare providers and by the patients we serve.