Importance of Evidence-Based Practice on Stroke Patients

Nurses work in a dynamic environment of care

Nurses work in a dynamic environment of care. For student nurses, it is crucial that they make sense of what they learn in classrooms and how it relates to the realities of the workplace. Nurses have to choose interventions that are most likely to meet patients' expectations as well as provide the best care using nursing expertise. Nurses have to include the best obtainable evidence, their theoretical knowledge, available resources, and patients' inclinations to achieve the best practice (Hopp and Rittenmeyer, 2012). The above elements are components of evidence-based practice. Nursing interventions are important for patients during the acute stage after a stroke to prevent further complications such as secondary brain injuries. The use of evidence-based practice to cater for stroke victims is vital to facilitate a patient's early recovery. The following paper discusses the importance of evidence-based practice on stroke patients.

Evidence-Based Practice

Porter-O'Grady (2010, p.1) defines evidence-based practice (EBP) as the integration of the best possible research evidence with clinical expertise and with patient needs. EBP takes into consideration the expectations, fears, and needs of the patients. Evaluation of evidence should always be patient-centred because every patient is unique. Meeting a patient's expectations require that nurses and health practitioners integrate clinical applications with the best available clinical evidence. Data utilised in EBP is collected from the examination of relevant information dependent on its applicability on different patient situations (Porter-O'Grady, 2010). A personal clinical knowledge needs a certain degree of proficiency in the judgement of every situation and the data collected. The expertise in EBP experts is majorly gained from formal education as well as life experiences (Hopp and Rittenmeyer, 2012; Porter-O'Grady, 2010). According to Porter-O'Grady (2010), EBP combines academic research and practical applications of care, which provides a strong foundation for clinical outcomes. EBP experiences continuous changes to replicate the most current and applicable practice (Hopp and Rittenmeyer, 2012).

The current era appreciates the importance of evidence in affirming of actions of different health practitioners. Incorporation of evidence into practice is essential because it improves the quality of life for patients as well as reduces their length of the hospital, which proves to be cost-effective. Evidence-based practice can help nurses come up with appropriate and realistic methods of intervention that can be applied and duplicated in various clinical situations. EBP is vital in realising effectiveness and cost-efficiency of care delivery. EBP further reduces undesirable disparities in clinical outcomes. EBP in nursing helps in improving patient outcomes and quality of care. According to Porter-O'Grady (2010), EBP involves the practice of operative problem-solving. Nurses should have the capability of identifying issues, understand its components, and find the best direction to solve it. The only possible way of effectively identifying such matters is to have enough information and evidence on a particular clinical issue. A nurse should have the right skills to utilize the evidence collected to make sound decisions. As mentioned above, these skills can be acquired through formal education or everyday experiences as a nurse.

Case Study Evaluation

Stroke is an unexpected condition with long-term consequences. Stroke is a personal experience; therefore, any support services provided to the patient should consider the patient's perspective and preferences (Jenkins, Brigden, and King, 2013). A patient's diet will affect their clinical outcome, which makes it essential to understand the nutritional needs of acute care, rehabilitation, and community-living. Food and eating are a vital part of a stroke patient's quality of life. However, most of the patients cannot take solid food or liquids. Some of the patients lose the capacity to use their dominant limbs, which prevents self-feeding. For these patients, health practitioners prefer the use of enteral tube feeding to ensure that the patient's quality of life is not majorly affected. If a stroke patient does not feed as they should, it might lead to malnutrition, dehydration, pneumonia, and death. Mr. Omar Banerjee is not allowed to take food or water.

At the start of enteral tube feeding (ETF), it is essential to consider the side effects of the intervention. Arevalo-Manso et al. note that diarrhoea is a common issue in patients who undergo the above intervention (2014). Cases of diarrhoea may negatively affect the individual's quality of life by increasing the risk of new complications as well as extending the length of hospital stay for the patient. For this reason, it is essential that the nurses and health practitioners ensure that they prevent the occurrence of diarrhoea among stroke patients who use enteral tube feeding. Mr. Omar has not eaten or taken any beverage for two days, which means that it is important to start feeding him using tubes to avoid the occurrence of pneumonia and malnutrition. According to Arevalo-Manso et al., for patients using enteral tube feeding, a temporal cut-off point should be seven days (2014). After the first seven days, the patient will have an increased risk of diarrhoea (Arevalo-Manso et al., 2014).

However, before deciding to stop ETF, it is crucial to understand the implications it will have on the patient's health. Further, it is essential to consider the other factors that may cause diarrhoea such as illness seriousness, antibiotic administration, clinical information of a patient, and age (Arevalo-Manso et al., 2014). Not every antibiotic will cause diarrhoea, which makes it essential to take note of every individual's case. It is not explicitly stated if Mr. Omar takes any antibiotics. However, before the use of ETF should consider every factor that may lead to an increased risk of diarrhoea for the patient. Arevalo-Manso et al. suggest the use of fibre-enriched enteral formulas to avoid high risks of diarrhoea for patients (2014). Mr. Omar should not use tubes to feed to more than seven days to avoid high chances of diarrhoea occurrence. Omar's family should be given the right evidence to ensure that they make informed choices on the use of ETF. Apart from nutrition, Omar and his family need education and information on different ways to deal with his condition during the transition from hospital to community living.

Evidence-based practice should include the patient preference for their treatment. Mavaddat et al. note that self-rated health helps health practitioners forecast future health outcomes for populations under study (2018). For stroke patients, self-rated health predicts the probability of stroke occurrence, rates of mortality, and any functional outcome that will enable the patient to recover quickly. It is vital to understand the severity and type of stroke for a patient that will help in post-stroke recovery. A patient who experiences physical disability after their stroke might find difficulties in carrying out their daily activities (Mavaddat et al., 2018).

Mr. Omar experienced physical disability after his stroke. He could not speak or move his hands. According to Mavaddat et al., individuals who suffer physical disabilities after a stroke should have alternative ways to perform their daily tasks (2018). Apart from daily tasks, the nurses should provide guidance to the survivors on the change of lifestyle after release from the hospital. As Mavaddat et al. note, many stroke survivors have to change their lifestyle, including their diet and exercise routine to feel healthier and reduce the chances of another stroke episode (2018).

Mavaddat et al. state that stroke survivors experience anxiety or depression (2018). There are noticeable changes in an individual's mood with some individuals reporting impatience, worry, and fear. Omar's wife stated that his husband was frightened and could not talk. Even though this was pre-diagnosis, it is imperative to note that the stroke probably affected Omar's mental capability. However, the patient may experience these signs post-discharge because of a low mood. The depressed mood is majorly connected to a loss of independence, changes in status, loss of confidence, and poor advancement in rehabilitation. These are some of the issues that Mr. Omar could face post-discharge. It is paramount that the nurse and caregivers ensure that they tackle his low moods in the best way possible to avoid poor progress in his recovery.

Numerous ways can be utilized to ensure that Mr. Omar does not experience psychological trauma, which might affect his recovery. Mavaddat et al. note that survivors of stroke should be encouraged to have life goals and motivations to continue with their recovery (2018). Omar should be encouraged to take personal responsibility, have some sense of control, and strive for independence to help him deal with his new condition. The feeling of having control over his health will positively impact his recovery process. Further, Mavaddat et al. note that it is essential to have quality social relationships with close family members including children and grandchildren (2018). Family members are significant sources of social support and encouragement especially during daily activities and rehabilitation processes. Omar's family has to be educated on the importance of being around him during his recovery process. His children and grandchildren should also be encouraged to visit him during rehabilitation to ensure psychological and mental health. However, it is vital that the patient is consulted on issues that he can handle and those he cannot. Mavaddat et al. noted that overprotective family members led to a negative impact on the mental health of the patients (2018).

The transition from acute care to rehabilitation centres and community living is vital for stroke patients and their family members (Jenkins, Brigden, and King, 2013). Continuity of care for stroke patients requires a combination of services by the hospital and rehabilitation centres or caregivers. Mavaddat et al. concluded that positive relationships with healthcare practitioners and community staff led to better outcomes among the patients (2018). Jenkins, Brigden, and King note that stroke patients require information and support after their discharge from acute hospital care (2013). For a first-time stroke patient, Omar and his family should be provided with accurate and reliable information on how to survive during rehabilitation within the community. A majority of stroke survivors want long-term support in many aspects of their lives including returning to work, stroke prevention, and communication. Omar could not speak after the occurrence of stroke, which means that he will need help with contact as well as going back eventually because he is his family's sole breadwinner.

Life after stroke support workers play a vital role in helping survivors with issues such as speech and psychological difficulties. As discussed above, stroke patients deal with a plethora of mental problems after the occurrence. Therefore, they need psychological help to aid them in dealing with their current situation. However, this would be more appropriate if a patient does not have psychological help from different family members. A stroke patient's needs and preference must be considered immediately they arrive at the hospital. Healthcare officials should work towards ensuring that any intervention at the hospital does not end up in a prolonged stay.

Further, the post-discharge period is vital because a majority of the patients go through rehabilitation to regain their quality of life. After his discharge from the hospital, it is critical that Omar is connected to a local community support system that has the proper resources to deal with minority groups. According to Jenkins, Brigden, and King, a majority of support systems are not well-equipped in dealing with individuals from minority groups (2013). Stroke victims cannot experience the proper transition from the hospital to community rehabilitation centres if their needs are not fully supported. Moreover, it is imperative that the family supports Omar to make a complete recovery through constant encouragement and motivation.

Conclusion

Evidence-based practice requires that health practitioners incorporate the latest evidence into their practice to ensure that the patient gets the best care to improve their quality of life. For stroke patients, many factors affect their quality of life during their stay in hospital and rehabilitation in the community. Nutrition is an integral part of the recovery process of stroke patients. However, for patients who cannot feed, enteral tube feeding is utilised. The use of ETF ensures that a patient does not suffer from aspiration pneumonia or malnutrition. However, it is vital to consider the long-term effects of ETF such as diarrhoea to avoid more extended hospital stay for the patient and higher costs. A transition from acute hospital care to community living further requires more considerations and integration of care from different caregivers and health practitioners.

References

Arevalo-Manso, J., Martinez-Sanchez, P., Juarez-Martin, B., Fuentes, B., Ruiz-Ares, G., Sanz-Cuesta, B., Parrilla-Novo, P. and Diez-Tejedor, E., 2014. Enteral tube feeding of patients with acute stroke: when does the risk of diarrhoea increase?. Internal Medicine Journal, 44(12a), pp.1199-1204.

Hopp, L. and Rittenmeyer, L., 2012. Introduction to evidence-based practice: a practical guide for nursing. Philadelphia, F.A. Davis Company.

Jenkins, L., Brigden, C. and King, A., 2013. Evaluating a third sector community service following stroke. Journal of Integrated Care, 21(5), pp.248-262.

Mavaddat, N., Sadler, E., Lim, L., Williams, K., Warburton, E., Kinmonth, A., Mant, J., Burt, J. and McKevitt, C., 2018. Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom. BMC Geriatrics, 18(81), pp.1-12.

Porter-O'Grady, T., 2010. A new age for practice: creating a framework for evidence. In: K. Malloch and T. Porter-O'Grady, ed., Introduction to Evidence-Based Practice in Nursing and Health Care, 2nd ed. Massachusetts: Jones and Bartlett Publishers, pp.1-29.