Kitko Lisa, Hupcey Judith E
School of Nursing at The Pennsylvania State University, University Park, PA, USA.
J Neurosci Nurs. 2008 Dec;40(6):333-40. doi: 10.1097/01376517-200812000-00004.
Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Patients who sustain a sudden ischemic stroke can benefit from the administration of intravenous recombinant tissue plasminogen activator (rt-PA). rt-PA may reduce disability, yet few patients arrive in emergency departments in time to be eligible for rt-PA administration. The purpose of this study was to discover factors that influence patients' decision-making process when seeking treatment for acute-stroke symptoms. Qualitative inquiry using grounded-theory methods was used to elicit descriptions of the decision-making process. The primary purpose of grounded theory is to generate explanatory models of human behavior that are grounded in the data. A purposive sample of 10 clinically stable patients or their caregivers were interviewed after acute ischemic stroke. Data were analyzed and broken down into descriptive themes following the grounded-theory approach. Distinct themes emerged for patients who presented for treatment early and late. Five themes emerged for patients who presented late for treatment: lack of knowledge, fear of hospitals, denial, living alone, and preexisting health concerns. The theme that emerged from the group that presented early for treatment was previous history or knowledge of stroke. The most significant implication for practice identified in this study is that nurses must take a leading role in educating the public regarding symptoms, risk factors, and available treatments for stroke.
中风是美国第三大死因，也是严重长期残疾的主要原因。突发缺血性中风患者可通过静脉注射重组组织型纤溶酶原激活剂（rt-PA）获益。rt-PA可能会减少残疾，但很少有患者能及时抵达急诊科以符合接受rt-PA治疗的条件。本研究的目的是发现影响患者在出现急性中风症状时寻求治疗的决策过程的因素。采用扎根理论方法进行定性探究，以引出对决策过程的描述。扎根理论的主要目的是生成基于数据的人类行为解释模型。在急性缺血性中风后，对10名临床状况稳定的患者或其护理人员进行了有目的抽样访谈。按照扎根理论方法对数据进行分析并分解为描述性主题。早就诊和晚就诊的患者出现了不同的主题。晚就诊的患者出现了五个主题：知识缺乏、对医院的恐惧、否认、独居和既往健康问题。早就诊的患者出现的主题是中风病史或相关知识。本研究确定的对实践最重要的影响是，护士必须发挥主导作用，向公众宣传中风的症状、风险因素和可用治疗方法。
