The need for knowledge and skills in the care of post-stroke patients

Stroke is the second leading cause of death worldwide, and a major cause of disability. The incidence of stroke is increasing because the population is aging. ¹ Effective post-stroke care is essential to improve outcomes for both patients and families; however, limited skills and competence, as well as low levels of awareness and knowledge, represent barriers to optimal evidence-based practice in stroke care. ² The aim of this editorial is to highlight the importance of stroke-related knowledge and skills among nurses and allied professionals.

As an example of difficulties, nurses cited limited expertise in oral care and stroke-specific skills as barriers for implementing water protocols in acute stroke care. ³ Previous studies demonstrated that nurses did not have the adequate knowledge and skills to allow them to screen for and treat dysphagia in post-stroke patients, and that they required additional training.^4–6 In addition, a survey of cardiovascular nurses reported poor knowledge and training in the area of atrial fibrillation and oral anticoagulant therapy, which is vital to prevent stroke. ⁷ Clinical protocols to manage fever, high sugar, and dysphagia, made digitally available by the Quality in Acute Stroke Care Trial, were downloaded by less than half of the 159 healthcare professionals from 21 countries participating in the study, and the instructions for protocol implementation were not always followed successfully. ⁸ The findings of these studies represent a sample of the evidence that healthcare providers may have insufficient knowledge and skills to allow them to provide efficient treatment for the post-stroke patient. Such suboptimal care might have serious implications for patient and care outcomes. The current issue of the European Journal of Cardiovascular Nursing includes three papers that not only outline the deficiencies of knowledge and skills in the treatment of post-stroke patients, but also note the potential benefits that might be derived from acquiring stroke-related knowledge and skills.

The first article, “Cardiac disease and stroke: practical implications for personalised care in cardiac-stroke patients. A state of the art review supported by the Association of Cardiovascular Nursing and Allied Profession,” outlines the significance of primary stroke prevention in cardiac patients. ⁹ The authors emphasize that global healthcare systems are not sufficiently integrated to allow them to provide individualized care for cardiac-stroke patients. Moreover, the authors highlight the necessity of healthcare providers having significant knowledge about stroke and being aware of challenges faced by patients suffering from both cardiac disease and stroke.

In the second article, “Exploring nursing and allied health perspectives of quality oral care after stroke: a qualitative study,” the authors examine the perceptions of stroke nurses and allied healthcare professionals regarding the quality of oral care among patients post stroke. ¹⁰ The main findings of this paper highlighted inadequate knowledge, resources, training, and practice related to oral healthcare for patients post stroke in both acute and rehabilitation settings.

The third article, “Risk stratification model for post-stroke pneumonia in patients with acute ischemic stroke,” deals with the development of a prediction model for post-stroke pneumonia (PSP) in patients with acute ischemic stroke. ¹¹ Here, the authors identified factors such as the National Institute of Health Stroke Scale score at admission, pulse rate at admission, and percentage of lymphocytes, as important for stratifying the risk of PSP. Applying the risk stratification model will allow healthcare providers to recognize high-risk patients early and undertake interventions to reduce PSP.

Given the shortcomings in knowledge and skills, it could be useful to consider the introduction of a broad stroke-training program for nurses and allied professionals. This could improve the quality of post-stroke patient care, promote interactive education and training, and encourage the correct use of protocols or guidelines. This type of approach is associated with a positive impact on patient and quality-of-care outcomes among nurses and healthcare staff involved in post-stroke patient care. ¹² A novel mHealth, smartphone-based, spaced-learning intervention has been shown to improve nurses’ knowledge of atrial fibrillation and anticoagulation, and to influence their use of stroke and bleeding risk assessment tools in clinical practice. ¹³ In addition, both stroke nurse managers, who are senior nurses with specialized stroke knowledge, and stroke nursing practitioners, who undergo an advanced practice training, might usefully educate nurses on neurology units about different aspects of recommended treatment for post-stroke patients. ¹⁴ Nurses might also benefit from practical workshops and modules providing tips from senior personnel with experience in establishing training programs and/or assessments.