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Home > RNJ > 2010 > May/June > Editorial: Act Now to Stop Strokes

Editorial: Act Now to Stop Strokes
Elaine Tilka Miller,PhD RN CRRN FAHA FAAN

Strokes remain the third leading cause of death and a major cause of disability worldwide (American Heart Association [AHA], 2010a). Every 40 seconds someone in the United States has a stroke; 60% of stroke-related deaths occur in women (Kurth & Boausser, 2009). Traditionally, stroke has been considered a disease of older adults, but this picture appears to be changing. At the February 2010 International Stroke Conference, it was reported that the incidence of stroke in 20–45 year olds has increased since the 1990s, causing speculation that the greater prevalence of obesity, hypertension, and diabetes may be key contributing factors (AHA, 2010b). Although we recognize that stroke can be a life-changing and devastating disease, these new data serve as a wake-up call to the public and all healthcare professionals that immediate, tailored actions must be taken.

It is important to recognize that 80% of strokes are preventable (National Stroke Association [NSA], 2010). Given that nursing is primarily a female profession and women have a higher likelihood of death and disability resulting from stroke, nurses are the most likely professional group to take a prominent leadership role in the primary and secondary prevention of strokes and transient ischemic attacks (TIA), a frequent precursor to stroke. What follows are several suggested actions to reduce the occurrence of strokes and TIAs.

  • Educate all nurses, other professional colleagues, patients, their families, and others in the community about the signs and symptoms of stroke and the importance of immediately calling 911 when a stroke is suspected. The AHA (www.heart.org), American Stroke Association (ASA; www.asa.org), NSA (www.stroke.org), and the National Institute of Neurological Disorders and Stroke (www.ninds.nih.gov) all have excellent and readily available public and professional stroke educational materials such as “Give me 5,” the “FAST” message (Face, Arm, Speech, and Time), and others tailored according to gender, age, and race/ethnicity.
  • If you haven’t already, learn more about “Get with the Guidelines,” available from the AHA and ASA.
  • Recognize the evidence beginning to emerge that women may not always present with the traditional stroke symptoms. In particular, Lisabeth, Brown, Hughes, Majersik, and Morgenstern (2009) found that almost half of the women in their study had nontraditional stroke signs and symptoms involving mental status change (e.g., disorientation, confusion, loss of consciousness). This new information suggests, when these signs and symptoms occur in females, it should trigger nurses to always consider stroke or TIA as a possibility. In addition, we should consider modifying our educational information to include these nontraditional signs and symptoms.
  • Take advantage of “teachable moments” when interacting with patients, families, colleagues, and others to educate them regarding stroke signs and symptoms, risk factors, and treatment-seeking behaviors (e.g., call 911).
  • Establish a specific facility-based protocol when a stroke or TIA is suspected in your workplace environment.
  • Require yearly continuing education requirements for nurses and other healthcare professionals to receive the latest evidence and best practice updates pertaining to stroke and TIA with particular emphasis on gender, age, and race/ethnicity differences in the signs and symptoms, risk factors, and efficacy of tailored educational efforts for professionals and the public.
  • Prominently hang posters in patient and family waiting rooms, nursing stations, and conference rooms listing the signs and symptoms of stroke and modifiable stroke risk factors (e.g., smoking, exercise, hypertension, diabetes, atrial fibrillation) as well as nonmodifiable stroke risk factors (e.g., age, race, family history, prior TIA).
  • Have readily available age-, gender-, and race/ethnicity-appropriate stroke and TIA prevention and follow-up information when a stroke or TIA has occurred, always emphasizing the importance of prevention on all inpatient and outpatient units.
  • Establish workplace staff health promotion programs (if not already in place) to reduce modifiable stroke risk factors and consider extending this benefit to family members of employees.

Given the increasing incidence of stroke in younger adults, now is the time to reexamine the actions of rehabilitation nurses pertaining to strokes and TIAs.

References

American Heart Association. (2010a). Get with the guidelines: Stroke fact sheet. Retrieved March 5, 2010, from www.americanheart.org/downloadable/heart/1264178600027StrokeFactsheet.pdf.

American Heart Association. (2010b). Stroke incidence rising among younger adults, decreasing among elderly. Retrieved March 3, 2010, from http://americanheart.mediaroom.com/index.php?s=43&item=953.

Kurth, T., & Bousser, M. G. (2009). Stroke in women: An evolving topic. Stroke, 40, 1027–1028.

Lisabeth, L. D., Brown, D. L., Hughes, R., Majersik, J. J., & Morgenstern, L. B. (2009). Acute stroke symptoms: Comparing women and men. Stroke, 40, 2011–2036.

National Stroke Association. (2010). Public stroke prevention guidelines. Retrieved March 5, 2010, from www.stroke.org/site/PageServer?pagename=PREVENT.