Vascular diseases of the brain continue to be the most critical medical and social problem of modern society due to their high percentage in the structure of morbidity and mortality, significant indicators of temporary labor losses, and primary disability. The main types of stroke include ischemic stroke (cerebral infarction) and hemorrhagic stroke. Primary prevention of cerebrovascular diseases, including the impact on regulated social, household, and medical risk factors, is of primary importance in reducing morbidity and disability due to stroke (Kuriakose & Xiao, 2020). Many patients have comorbidities that increase the risk of recurrence of acute cerebrovascular accidents and reduce the patient’s ability to participate in active rehabilitation (Boehme et al., 2017). Among concomitant diseases in stroke patients, arterial hypertension, coronary pathology, obesity, diabetes mellitus, arthritis, left ventricular hypertrophy and heart failure are much more common. For stroke patients, an interdisciplinary approach and continuous care are essential for the fastest recovery. This final outline is designed to discuss the best methods and resources for effective patient-centered and attentive treatment.
Patient-Centered Health Interventions and Timeline for Care
The patient, at all stages of his recovery, should be provided with complete and high-quality care. At the same time, any difficulties associated with ensuring this process should be resolved within a year. For example, it should be noted that the three critical problems in the treatment and recovery from stroke are the following:
- High mortality;
- Insufficient length of the recovery period;
- Inadequate involvement of several specialists in the recovery.
To prevent the problems indicated, it is recommended to inform the population about the benefits of following a healthy lifestyle. It is essential to train nurses in the necessary skills to treat and assist in stroke recovery (Clare, 2018). It is also recommended not to reduce the time patients spend within the hospital walls and to monitor the participation of the necessary specialists in treatment.
Ethical Decisions in Designing Patient-Centered Health Intervention
If one suspects a stroke, the ambulance service team must be called, and the patient should be hospitalized immediately. The urgency of hospitalization and initiation of therapy is due to the existence of a so-called therapeutic window for stroke (Inoue & Toyoda, 2021). The beginning of treatment within this period can minimize or eliminate the severe consequences of this disease (Yan et al., 2016). Not all people will agree to follow the principles of a healthy lifestyle, but the idea of spreading knowledge about the importance of non-smoking and a balanced diet should not be left aside. Although controversial from an ethical point of view, this initiative, as it is to some extent based on coercion, in practical terms, contributes to the population’s overall well-being.
The primary role in rehabilitation is assigned to the nurse since it is she who provides round-the-clock supervision. She fulfills the doctor’s prescriptions; that is, she is maximally involved in the process of regular contact with patients, and the success of rehabilitation largely depends on the quality of her work. The nurse’s tasks include control over vital functions, the satisfaction of physiological needs, the demand for safety, the prevention of complications, and the fulfillment of social requirements (Clare, 2018). Nurses of the neurological department for the treatment of patients with an acute cerebrovascular accident must have all the knowledge and skills of a complex rehabilitation system. The growth of the professional skills of a nurse does not cause any ethical controversy. From the point of view of practice, it will only lead to a positive result – a safer quality assurance for patients.
It should be noted here that not only the nurses themselves but also other employees are involved in restoring the patient’s health. The overall success of the work done by medical specialists, namely, the patient’s recovery, depends on their well-coordinated interaction (World Health Organization, 2018). Ethical uncertainty is, of course, caused by questions of the forced necessity of cooperation between doctors, but this is compensated by the restoration of the patient’s health from a practical point of view. Moreover, reducing the recovery period can only negatively affect the quality of medical services and does not contribute to the strengthening of the policy of continued patient care.
The importance of nursing care for acute disorders of cerebral circulation is because, at each stage of therapy, many unforeseen problems can arise. The general condition of patients and the speed of their recovery depend on the nurse’s observation and her reaction (Clare, 2018). During treatment and rehabilitation, the stroke victim must receive drug treatment in the form of injections and pills. The nurse must deliver medications to the wards and ensure that the patient gets the required dosage of the drug and the required one. Patient-centered care design involves avoiding procedures that could harm patients. However, it should be remembered how important it will be from an ethical point of view to respect their values and preferences.
Health Policy Implications for the Coordination and Continuum of Care
Heart attacks and strokes, along with cancer, are the cause of many deaths around the world. Therefore, a stroke requires the close attention of doctors and the people themselves. Achieving the fastest patient recovery is a key mission for healthcare organizations (U.S. Department of Health and Human Services, 2021). Thus, changes or reforms aimed exclusively at improving the quality of services should be provided. Timeliness of treatment is what significantly affects the likelihood of a patient’s recovery (CDC, 2021). At the same time, systems have been developed to provide care to patients who have survived a stroke, both at the state and regional levels (CDC, 2021). Since stroke remains a major cause of death and severe disability, therefore, it is required that policies and regulations that guide stroke care will be developed and adopted at the state level.
Priorities to Establish When Discussing a Care Plan
The care coordinator needs to explain that the introduced initiatives are part of an overall plan to achieve the fastest possible rehabilitation for the patient. Treatment will depend on the underlying factor – this will affect what kind of primary therapy will be selected. In general, drug therapy may include the following drugs: sedatives, neuroprotectors, multivitamins, vasodilators, and antioxidants. All drug therapy, regardless of etiology, is aimed at protecting the brain’s neurons from damage. The patient should be constantly monitored for blood pressure during drug therapy, as there is a high risk of stroke and heart attack. In addition to drug treatment, a course of physical activity can be prescribed.
The care coordinator should consider the patient’s views on treatment, discussion, and other essential circumstances. It also needs to be constantly monitored to ensure that the care coordinator’s therapy is appropriate and helpful to the individual patient. In any case, treatment should only be based on evidence-based and accurate therapies; other options are not acceptable. A stroke often leaves behind severe consequences in the form of motor, speech, and other disorders, significantly disabling patients and reducing the quality of life of the patients themselves and their relatives. Restoration of impaired functions can be a supplement and accelerated with rehabilitation measures (Lieber et al., 2018). Rationality and correct conduct of measures for patients with a stroke by a care coordinator help reduce lethality and ensure independence in daily life.
Learning Session Content
Evidence-based medicine requires integrating the best scientific evidence with healthcare organizations’ clinical experience and the unique characteristics of a patient. It implies the conscientious and transparent use of the best evidence available at any given time when making treatment decisions for a concrete person. A perfect evidence-based clinical information system will integrate and summarize all relevant scientific data about a clinical problem and automatically link the patient’s circumstances with the appropriate information through the electronic health record. The nurse should then consult the system whenever a patient’s medical history is reviewed. The information contained in the system will need to be constantly updated as new evidence is published. Thus, the care coordinator and patient can always take advantage of the best evidence available at the time.
The goals of the Healthy People 2030 program can only be achieved if the population is guaranteed adequate and effective health services. Performance-based financing is the provision of cash or goods based on measurable action or performance. With this principle in mind, Healthy People 2030 can make a significant difference over ten years to better utilize health services, improve the quality and efficiency of services, and promote equity.
CDC. (2021). Stroke systems of care: Policy resources. Centers for Disease Control and Prevention. Web.
Clare C. S. (2018). Role of the nurse in stroke rehabilitation. Nursing Standard. 33(7), 59–66. Web.
Boehme, A. K., Esenwa, C., & Elkind, M. S. (2017). Stroke risk factors, genetics, and prevention. Circulation research, 120(3), 472–495. Web.
Inoue, M., & Toyoda, K. (2021). Expanding the therapeutic window in acute ischemic stroke by advanced imaging. Vessel Plus, 5(11), 1-10. Web.
Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. International Journal of Molecular Sciences, 21(20), 1-24. Web.
Lieber, A. C., Hong, E., Putrino, D., Nistal, D. A., Pan, J. S., & Kellner, C. P. (2018). Nutrition, energy expenditure, dysphagia, and self-efficacy in stroke rehabilitation: A review of the literature. Brain Sciences 8(12), 1-12. Web.
U.S. Department of Health and Human Services. Healthy People 2030. (2021). Web.
World Health Organization. (2018). Delivering quality health services: A global imperative for universal health coverage. Web.
Yan, L. L., Li, C., Chen, J., Miranda, J. J., Luo, R., Bettger, J., Zhu, Y., Feigin, V., O’Donnell, M., Zhao, D., & Wu, Y. (2016). Prevention, management, and rehabilitation of stroke in low- and middle-income countries. eNeurologicalSci, 2, 21–30. Web.