Nursing interventions in stroke care delivery: An evidence-based clinical review

Introduction: Generally, nursing interventions during the acute stages following a stroke aim at preventing secondary brain injury (intracranial hypertension), maintaining the airways (due to paralysis of the pharynx muscles), providing general body support (vital signs, fluid and electrolyte balance), and anticipating the occurrence of complications (atelectasis and pneumonia). Aim: This literature review is to prioritize nursing interventions for acute stroke and to update nursing roles and input considering recommended levels of evidence of care to date. Method and materials: A systematic review was undertaken, and databases searched were Electronic Library Information Navigator (ELIN), Medline and the Cumulative Index to Nursing and Allied Health Literature from 1990 to 2015, using the OVID interface. Results: The search originally yielded 400 articles of which 65 were selected for analysis and 12 of these included evidence synthesis (class I-IV, level A-Good Clinical Practice [GCP]). To facilitate early patient recovery, advanced nursing care should include the routine practice of a wide range of specific nursing interventions such as continence management, pressure area care, swallowing management, and early mobilization. Other important nursing interventions include the prevention of pulmonary thromboembolism and early antiplatelet therapy. Conclusions: For over 20 years, it has been established that specialized stroke care save lives, reduce disability, shorten length of stay, and generally have been associated with improved patient outcomes. Highly specialized nursing input is of paramount importance in achieving optimum patient outcomes and high quality of interdisciplinary care, providing a comprehensive, interactive, and holistic approach for both acute stroke and rehabilitation.