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Research Article | Volume 5 Issue 1 (Jan-June, 2024) | Pages 1 - 9
Quality of the Nursing Care Provided to Patients Diagnosed with Cerebrovascular Accident (CVA)
 ,
1
Lecturer, Community Health Department, AL-Kut technical institute /Middle Technical University, Baghdad 10001, Iraq
2
Lecturer, Adult nursing department, College of nursing/University of Thi-Qar, Thi-Qar 64001, Iraq
Under a Creative Commons license
Open Access
Received
Jan. 1, 2024
Revised
Jan. 10, 2024
Accepted
Feb. 17, 2024
Published
March 30, 2024
Abstract
Quality, nursing care, patients, Cerebrovascular accidents (CVA
Keywords
Introduction

Cerebrovascular accidents (C.V.A) are the most common disorder for brain blood vessels damage which in return causes decreased blood supply to brain cells leading to ischemic and necrosis of tissue [1]. The causes of C.V.A may be a thrombotic or hemorrhagic accident. The C.V.A are neurological disabilities resulting from occlusion of cerebral vessels, Cerebrovascular accidents are among the most important health problems to which an individual is exposed. They are classified among the most dangerous global problems and diseases, as they affect both parts of the brain, which supervises all organic and cognitive functions [2]. Cerebrovascular accident, which has another name is cerebral stroke or brain stroke, is considered one of the pathological physiological damages that causes a lack of blood flow, as the cell enters a stage of hypoxia, which leads to infarction of the affected brain tissue and other tissues surrounding it [3]. When the right side of the cerebral hemisphere is injured, it results in paralysis of the left hemisphere, accompanied by neuropsychiatric and cognitive disorders, while injury to the left side of the left cerebral hemisphere results in right hemisphere paralysis, also accompanied by neuropsychiatric and cognitive disorders that differ from the first injury, which hinders the process of his daily life and makes it difficult to integrate into society [4]. In this regard, this study came to show the specificity of injury to each part of the brain and the resulting physical and cognitive symptoms that affect daily life. This leads to an exacerbation of the medical condition, and that cell may die, causing functional and mental disability [5].the person turns from independent to dependent, C.V. A may cause permanent or temporary disability such as paraplegia or quadriplegia [6]. The wearing signs from very important identification by physician as FAST and medical; history for patient e.g. Diabetes mellitus, one of the main causes, Should be focused on high cartier pressure as. chronic condition (hypertension) which is a main cause of stroke, especially bleeding stroke, which is caused by bursting of blood vessels in the cerebral capillaries, which is called cerebrovascular accident [7]. Atrial fibrillation is one of the most common heart disorders. Throughout an episode of arrhythmia, indirect contractions of the atria are replaced by ineffective contractions via their communication network [8]. As a result, the blood can restrict and form clots and these masses can then help cause an ischemic stroke. Strokes that result from clots, including arrhythmia, also transmit a greater risk of damage and often demise than other ischemic blows [9].

Methods

Research Design:

This study worked on a descriptive, quantitative, cross-sectional design to collect data for measuring the Quality of the nursing care that was provided to patients diagnosed with Cerebrovascular accidents (C.V.A).

 

Siting and samples:

The sample was taken from Al-Zahraa Teaching Hospital affiliated with the Iraq Ministry of Health in AL-Kute city. The study period was from 6/29/2023 to 1/31/2024, where the number of nurses working in the medicine and surgical wards reached (25) Nurses, which include patients with cerebrovascular accidents. It is necessary to measure the quality of nursing care they provide towards C.V.A patients. The appropriate sample of (25) nurses was chosen from this hospital; It included the head nurses, the responsible nurses, the guard nurses, and the morning nurses who are concerned with providing nursing care to patients with cerebrovascular accidents lying on those wards.

 

Staffing and Data Gathering

Members were employed after the researcher got ethical consent to conduct the study through coordination with the hospital administration, as well as conducting interviews with nurses and obtaining written approval with a signature. This data was collected by using a questionnaire as a study instrument, which consists of two parts: a demo-graphic information questionnaire, which includes age of sample, the degree of education, years of work as the nurse in this wards, and years of experience in the field of nursing. While the second questionnaire, the researcher focused on (18) items, The members’ responses were slow through a five-point Likert- scale, composed as follows: (1) Strongly disagree, (2) Disagree, (3) Neutral, (4) Agree, (5) Strongly agree. The researcher relied on several steps to develop a questionnaire as the research instrument for measuring quality of the nursing care for cerebrovascular accident patients. This is done by reviewing the literature and following the guidelines used in commerce with patients with cerebrovascular accidents, according to the rules published by the AHA/ASA. First, the goal of the study was a focal point for the researcher through the design of the questionnaire. Second, the researcher chose a 5-point (Likert- scale) to ascertain participants' levels of agreement regarding the nursing care. Third, the questionnaire focused on nursing care based on the guidelines that are available for patients with cerebrovascular accidents. Finally, all items of nursing upkeep were based on a work review of previous articles and research for multiple studies [10-11]. The questionnaire was reviewed (5) times and arranged according to the opinions of experts, so that the questionnaire became composed of main items for measuring quality of nursing care. They have several years of experience in this field. According to internal consistency, the questionnaire was found to have a high reliability (α= 0.82).

 

Ethical Considerations

Each participant has been provided with an informed consent along with the questionnaire whether they would agree to participate in the study or not. Also, formal approval has been gained from AL-Kut health directorate board of ethics (No. 311 in 28/6/2023).

 

Data analysis

Through SPSS version 26, the data for this study were analyzed through descriptive analysis of means, frequencies, percentages, and means of score. In addition, ANOVA-Test was used to conduct the test individually to determine the difference between the quality of nursing care and socio-demographic data.

Results

 

Table 1. Characteristics of sample (individual data)

Items

F

%

Age group

20-29

12

48

30-39

6

24

40-49

4

16

50 and more

3

12

Total

25

100%

Educational degree

Diploma

17

68

Baccalaureate

5

20

Master’s and more

3

12

Total

25

100%

Years of experience as the nurse

1-10 years

19

76

11-20 years

4

16

More than 20 years

2

8

Total

25

100%

Period of work with C.V.A Patients’

1-5 years

21

84

6-10 years

2

8

More than 11 years

2

8

Total

25

100%

Fr.: frequency, %: percentage

 

Measuring quality of nursing care for patients diagnosed with Cerebrovascular accidents (CVA).

Items

Mean

Ass.

FeSS protocols which used to measure quality nursing care for C.V.A patients

Measuring body temperature 4-6 hrs during 72 of admitted

1.08

Poor

Measuring blood sugar during 4−6 hrs within 72 hrs from admission ( at 48 hr for non-diabetic patients )

1.36

Poor

Measuring the Dysphagia during 24 hrs from admitted, before oral diet/treatment

1.40

Good

Measuring Nursing Care for C.V.A patients as Generally

Raise the patient's head to 30 degrees to fully increase brain tissue perfusion and reduce the possibility of gastrointestinal injuries.

1.08     poor

Perform an electrocardiogram less than 24 hours after the patient's admission

1.07     poor

Pulse oximetry is measured every 3 hours from the patient’s admission to determine the oxygen saturation in the blood, and treatment with oxygen when necessary.

1.07     poor

Measure the amount of urine continuously every 4 hours to determine the state of urinary retention, and a urinary catheter may be required

1.04     poor

Provide a safe environment using handrails to prevent injuries or falls while providing safe support measures

1.04     poor

Periodic evaluation to determine that the patient needs early rehabilitation within 48 days from the date of the patient’s charge to the hospital

1.04     poor

Periodic evaluation of peripheral nerves to determine the patient’s need for rehabilitation. Applications of the NIHSS scale

1.31     Good

Prophylactic treatment such as heparin should be started within 24-48 hours of noticing symptoms

1.03     Poor

Periodically measuring depression with several cerebrovascular accidents through the use of the depression scale should be screened for depression

1.08     poor

Reducing skin friction through the use of mattresses and light pillows with pressure, along with the use of movable seats to facilitate patient movement and prevent skin friction.

1.08     poor

The skin must be cleaned regularly, the skin must be kept sufficiently hydrated, and excessive moisture must be prevented

1.23     Good

Designing a nutritional plan to meet the patient’s needs to manage indigestion and achieve nutritional balance for the patient’s body

1.03     Poor

Organizing a schedule for giving nutritional supplements, especially to patients with stroke, as they have malnutrition, to prevent the risk of imbalance

1.00     poor

Monitoring fluid balance and comparing fluids entering and leaving the body within 24 hours, especially patients suffering from kidney disease and heart disease.

1.06     poor

Level of assessment: poor level ≤ 1.3 good level ≥ 1.3

 

Table 3. Statistical significance between socio-demographic data and quality of current practice of nursing care for patients recently diagnosed with C.V.A.

ANOVA test: The mean change is significant at the 0.05 level, (Least Significant Difference – LSD)

 

Discussion

This study examined the quality of current nursing care provided to patients with cerebrovascular accidents in Iraq at Al-Zahra Teaching Hospital in Wasit Governorate. The results showed that the quality of care provided by nurses is at a very low level, as most of them did not recognize the clinical signs related to the medical history of the disease due to the lack of use of standards. Reliable and coordinated within patient lobbies as a use FeSS protocol , which facilitates the identification of clinical signs indicating the possibility of C.V.A. Regarding the quality of nursing care that provided by nurses for diagnosed patients with cerebrovascular accidents according to (NIHSS) scale ,the data revealed 70%  to 69% of the nurses disagree in the quality of nursing care (table 2). In line with other findings, a study led by Dancer et al. originates that nursing care provided to patients with cerebrovascular accidents depends on nurses' knowledge of the common factors and warning signs of C.V.A [12]. In Table 1. The number of participants in the study was (25) nurses who completely answered the questions. The social and demographic characteristics of the sample. The most shared age collection was 20 to 29 years old (48%) 12. The majority of the sample obtained a diploma degree (68%) 17 while 19 nurses had 1-10 years of service in the field of nursing. While the service period of the majority of the sample was about 1-5 years, at a rate of 84%, with a frequency of 21.The finding agreement with results by Rangaraj, It was found that most of the sample had 1-10 years of service in the field of nursing, and most of them were less than 30 years old. [13]. in table (3) shows that there are statistically important changes between the quality of current practice of nursing care for patients Recently diagnosed with C.V.A  and Years of experience as a nurse, as the probability value = 0.003, less than 0.05. When using LSD, it was found that nurses with years of experience as the nurses more than 16 years are statistically more significant compared to the rest of the years. This resulted in agreement with another study in Saudi Arabia, King Fahad Medical City. It was found to be highly significant between age groups with years of experience as the nurse and Nursing Care for Patients with C.V.A [14].

 

Summary:

Through this study was to know the quality of current nursing care practices provided to patients newly diagnosed with cerebrovascular accidents in order to identify future needs and focus on developing the levels of that care in Iraq, especially Wasit Governorate. By activating a special sheet for stroke patients by identifying the warning signs and risk factors associated with medical history, using of (NIHSS) scale.

 

Author Contribution: Nil

References
  1. Al-Senani, Fahmi, et al. "An epidemiological model for first stroke in Saudi Arabia." Journal of Stroke and Cerebrovascular Diseases 29.1 (2020): 104465. https://www.sciencedirect.com/science/article/pii/S1052305719305488  

  2. Jaromin, Joanna, et al. "Nurses’ Opinion on Nursing Problems in the Care of Patients after Stroke." Pielęgniarstwo Neurologiczne i Neurochirurgiczne 6.2 (2017): 73-80. https://apcz.umk.pl/PNIN/article/view/38389.

  3. Loft, Mia I., et al. "Nurses’ and nurse assistants’ beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit—A qualitative study." Journal of clinical nursing 26.23-24 (2017): 4905-4914. https://doi.org/10.1111/jocn.13972.

  4. Dancer, Sandy, Allen J. Brown, and Lisa Rietz Yanase. "National Institutes of Health Stroke Scale in plain English is reliable for novice nurse users with minimal training." Journal of Emergency Nursing 43.3 (2017): 221-227. https://doi.org/10.1016/j.jen.2016.09.002 

  5. Meng, Xianmei, et al. "Nursing practice in stroke rehabilitation: Perspectives from multi‐disciplinary healthcare professionals." Nursing & health sciences 22.1 (2020): 28-37.https://doi.org/10.1111/nhs.12641

  6. Nor, Azlisham Mohd, et al. "The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument." The Lancet Neurology 4.11 (2005): 727-734.https://www.thelancet.com/article/S1474-4422(05)70201-5/abstract.

  7. O’Sullivan, S. B. "Stroke In: O’Sullivan SB and Schmitz TJ." Physical Rehabilitation. FA Davis, Philadelphia, PA (2007): 706-776.. https://fadavispt.mhmedical.com/content.aspx?bookid=2603&sectionid=214788026 

  8. "The Internet Stroke Center. "MedlinePlus Encyclopedia: Thrombus Circle of Willis." Archived from the original on 5 Feb. 2016. https://medlineplus.gov/ency/article/000726.htm 

  9. Correia, Pamela N., et al. "Beauty parlor stroke revisited: An 11-year single-center consecutive series." International Journal of Stroke 11.3 (2016): 356-360. https://doi.org/10.1177/1747493015620809 .

  10. "NHS Choices. "Brain Aneurysm – Introduction." 19 Oct. (2017). Archived from the original on 8 Feb. 2016. https://www.nhs.uk/conditions/brain-aneurysm/#:~:text=Contents&text=An%20aneurysm%20is%20a%20bulge,bulge%20outwards%20like%20a%20balloon

  11. Fisher, C. M. "The arterial lesions underlying lacunes." Acta neuropathologica 12 (1969): 1-15. doi:10.1007/BF00685305. PMID 5708546. S2CID 6942826

  12. Bjartmarz, Ingibjörg, Helga Jónsdóttir, and Thóra B. Hafsteinsdóttir. "Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study." BMC nursing 16.1 (2017): 1-17.https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0262-y.

  13. Winstein, Carolee J., et al. "Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association." Stroke 47.6 (2016): e98-e169. https://doi.org/10.1161/STR.0000000000000098 

  14. Powers, William J., et al. "Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association." Stroke 50.12 (2019): e344-e418. https://doi.org/10.1161/STR.0000000000000211
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