According to the National Institute of Neurological Disorders and Stroke (NINDS), more than 700,000 people suffer from stroke each year in the United States, and approximately two-thirds of those individuals survive and require rehabilitation. Although rehabilitation does not entirely cure the effects of stroke in patients with brain damage, it can substantially help stroke survivors relearn necessary skills and achieve the best possible long-term outcome.
“The primary goal of rehabilitation is to help patients become as independent as possible to promote recovery and prevent secondary complications,” said Michelle Camicia, MSN, RN, CRRN, president of the Association of Rehabilitation Nurses (ARN). “Rehabilitation nurses can help patients achieve that independence by educating them and their caregivers about life after stroke, as well as ways to reduce risk factors that may lead to further complications, including another stroke.”
According to Camicia, as the length of stay in acute care hospitals has shortened in the past few decades, the demand for post-acute care for stroke patients has increased. Yet, studies have shown that sometimes there is a delay between stroke onset and transfer to an inpatient rehabilitation hospital (IRH), which has often been associated with poorer outcomes after stroke rehabilitation.
To further investigate the correlation of IRH admission timing and functional outcomes for patients, Camicia and her colleagues conducted a study, published in the Journal of Physical Medicine and Rehabilitation in 2011, that measured the change in total, motor and cognitive Functional Independence Measure (FIM) scores of stroke patients between IRH admission and discharge. The study found that patients – even those with very severe impairments – experienced better functional outcomes after early admission to IRHs.
“These findings point to the importance of early admission to a rehabilitation facility after stroke,” said Camicia. “However, it’s equally as important for nurses to act quickly as soon as a stroke patient is admitted to the hospital setting. Prompt and comprehensive evaluation of presenting signs and symptoms once a patient is admitted to a hospital can make a significant difference in a patient’s recovery.”
According to the NINDS, a neurological exam to evaluate vision, movement, sensation and language is vital to preserving function and minimizing devastating side effects of stroke. One such tool that nurses can use to measure brain function in a post-stroke patient is the National Institutes of Health Stroke Scale (NIHSS), a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit.
“The NIHSS scale is designed to be a simple tool that can be administered at the bedside by nurses and other rehabilitation and medical staff. It provides valuable information that can help the treatment team predict long-term patient outcomes,” said Camicia. “It also serves as a data collection tool for planning patient care and provides a common language for information exchange among healthcare providers.”
Rehabilitation nurses play several roles in the post-stroke rehabilitation process. They can serve as teachers, educating patients not only how to prevent secondary complications, but also how to live with a new disability or injury; they act as facilitators of personal recovery and multidisciplinary care; they advocate for survivors’ return to independent living; and they can provide support for patients and their families.
For more information about the role of rehabilitation nurses in post-stroke rehabilitation, visit the ARN website at www.rehabnurse.org. And be sure to register for the ARN’s 39th Annual Education Conference – “The Continuum of Care: Navigating the Road to Recovery” – being held in Charlotte, N.C. from October 2-5. The conference will provide discussions on basic rehabilitation nursing knowledge and skills, recent developments in research and science, best practices and evidence-based recommendations.