Nursing Research and Evidence Based Practice

Questions: 1. Summarizes the literature support for the project? 2. Discusses the findings trustworthiness and validity? 3. Identifies any conflicts, gaps, and over conclusions from the findings? 4. Discusses legal and ethical issues relevant to the articles or research topic? 5. Identifies the findings applicability to the clinical issue or topic with regard to policy, procedure, guideline, or protocol procedure that promotes an evidence-based practice change? Answers: Introduction This projects aims to develop a content outline of the provided clinical issue that is stroke. It will shed light on the importance of early recognization and treatment of the stroke. It will focus on a interview conducted for the carer in which it will discuss about the changing life of carer when their family members were affected by stroke. Lastly it discuss about the issues and the new technology that helps in assessing stroke. 1. Summary of the Literature Support In clinical article issue Clements, Hamilton, Johnson and Mujhtaba, in 2015 said stroke is a 2nd leading reason of death for industrial nations and a leading cause of disability in adult. According to this study, the major cause of stroke is lack of recognization of the symptoms and lack of proper assessment of the patients. Ischemic strokes are caused due to the blockage or in arteries that connect the brain. Patients with stroke were administered with t-PA within 60 minutes of their admission. Patients with symptoms like weakness, dizziness, sensory loss etc were diagnosed with acute posterior stroke( National Stroke Association, 2015). The most useful tools for assessing the stroke are NIHSS and FAST (Gulli Markus, 2012). Cecil, R., Thompson, K., Parahoo, K., McCaughan, E in 2013 in a journal of Advanced nursing states that there is a change in life of carer after their families are affected by stroke. Based on three broad categories the interview was conducted for the carers. First was about the impact of the stroke event on carer, the extrinsic factors that support the scenario of caring, and the factors, which help in coping the new role. These were further divided into 9 thematic areas changes to lifestyle such as worries and concerns, family support etc. Haley, W., Roth, D., Kissela, B., Perkins, M., Howard, G., in 2011, in a research article quality of life researches states that the point of the study is to evaluate the life after a stroke Harrison, J. K., McArthur, K. S., Quinn, T. J, in 2013 in article of Clinical Interventions in Aging states that utilization of an assessment tools and knowing the assessment scale can recognize strokes, which is useful for early treatment. Rubin, M. N., Fugate, J. E., Rabinstein, A., Flemming, K, 2015 in a journal, An acute stroke evaluation app: a practice improvement project states that adaptation and application of new technology like few apps in phones and computers for improvement of the treatment 2. Findings Trustworthyness and Validity From the above literature reviews, it was found that most of the patients identified with stroke on their admission were misdiagnosed. FAST assessment fails to diagnose the patients who are suffering from posterior fossa strokes. NIHSS and FAST that assesses motor function but may not detect the main signs of posterior stroke and often leads to misdiagnosis. Early recognization of symptoms, treatment reduces stroke, and it is an important way to reduce long-term effects on family and patients. Using effective assessment tools for detecting strokes help the caregivers (Clements,S et al). The main concern for caregiver was reoccurrence of the stroke or illness or further injury of their loved ones. The study emphasis that the stroke victims caregivers have negative impact by the experience and it is important for the nurse to cope with both the caregivers and stroke victims (Cecil,R et al,2013).. Results showed that the persons who are staying alone, Americans-Africans have a have a higher risk of low quality life, and depression (Harley,W et al., 2013) Application of new technologies results in fast detection and the treatment can be faster (Rubin, M. N,2015) . 3. Gaps and Conflicts In the above study, it was observed that most of the patients admitted with stroke diagnosis were diagnosed wrongly. This leads to failing of treatment of patients under the CMS and TJC guidelines and have a poor outcome ( Merwick, Werring, 2014). FAST assessment for the stroke patients fails to assess posterior fossa strokes, especially those who are suffering from visual disturbance and ataxia (Huwez Casswell, 2013). Wrong diagnosis leads to wrong treatment. NIHSS sometimes cannot detect all the symptoms of strokes and score 0, despite of having stroke. This leads to misleading of diagnosis and treatment (Kwah Diong, 2014) In the study of exploring carer for stroke patients data collection, it failed to include both the genders in equal amount. New technologies were used to assess the stroke but it needs more research for more improvement of detection of stroke. 4. Ethical And Legal Issues As in the above research studies many ethical and legal issues arises such as after the admission of the patient in the hospitals and misdiagnosis is leading to wrong treatment for strokes even many nontraditional strokes are misdiagnosed as strokes which all raises ethical issues. 5. Policy, guideline, procedure, protocol Qualitative descriptive METHOD Collection of data from the carers who participated 27 women and 7 men were done. Consent of carer was taken. Procedure- An interview was conducted based on three broad categories, Impact of stroke Extrinsic factors which support the carer Intrinsic factors which helps in coping the new role These categories were further divided into 9 thematic areas It was observed that major concern of the carer was reoccurrence of stroke or any other injury among the family members of the carer. This study gave an view of how the carer of stroke patients were impacted negatively by the experience (Cecil,R et al,2013). And it also concluded that the nurses shouLd be well versed with the methologies of coping both the patient as weel as the carer Conclusion From the above review literature study, we can conclude that proper assessment tool usage reduces the time as well as helps in early treatment of the stroke patient. The nurses must have a proper training for learning the assessment techniques as well as they must be well versed with the newer application of computer and mobile phone, for fast detection of the stroke. We must not forget that prevention is better than cure and early detection of the stroke may give life to many people if properly diagnosed and treated. Reference Kwah, L., Diong, J. (2014). National Institutes of Health Stroke Scale (NIHSS).Journal Of Physiotherapy,60(1), 61. doi:10.1016/j.jphys.2013.12.012 Cecil, R., Thompson, K., Parahoo, K., McCaughan, E. (2013). Towards an understanding Of the lives of families affected by stroke: a qualitative study of home careers. Journal ofAdvanced Nursing, 69(8), 1761-1770. doi:10.1111/jan.1203 Haley, W., Roth, D., Kissela, B., Perkins, M., Howard, G. (2011, August). Quality of life after stroke: a prospective longitudinal study. Quality of Life Research, 20(6), 799-806. Harrison, J. K., McArthur, K. S., Quinn, T. J. (2013, February). Assessment scales in stroke: clinimetric and clinical considerations. Clinical Interventions in Aging, 8, 201-211. doi:10.2174/CIA.S32405 Rubin, M. N., Fugate, J. E., Rabinstein, A., Flemming, K. (2015). An acute stroke evaluation app: a practice improvement project. The Neurohospitalist, 5(2), 63-69. doi:10.1177/1941874414564982 Gulli, G., Markus, H. (2012, February). The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischemic attack. Journal of Neurology, Neurosurgery and Psychiatry, 83(2), 228-229. Merwick, A., Werring, D. (2014, May). Posterior circulation ischemic stroke. British Medical Journal, 348(7959), 28-34. National Stroke Association (2015). Stroke facts. Retrieved from: https://www.stroke.org/understand-stroke/what-stroke/stroke-facts