Ireland Sandra, MacKenzie Gail, Gould Linda, Dassinger Diane, Koper Alicja, LeBlanc Kathryn
McMaster University, Hamilton General Site, Hamilton Health Sciences, ON.
Can J Neurosci Nurs. 2010;32(4):7-13.
Stroke prevention clinic health care professionals are mandated to provide early access to neurological consultation and treatment, diagnostic testing, and behavioural risk factor management for clients with transient ischemic attack or mild non-disabling stroke. Clinic nurses collaborate with clients and interprofessional teams to support risk factor reduction to prevent recurrent stroke events. Although hypertension is the most important modifiable risk factor for stroke, broader evidence indicates that adherence to prescribed medications may be less than 50%. One clinic identified a need to improve risk factor outcomes through identifying clients with uncontrolled hypertension, cognitive, self-eficacy and/or adherence characteristics predictive of non-achievement of blood pressure targets. To address this need, an expanded nurse case management care delivery model was pilot tested for feasibility in a participant sample of 20 clients. Motivational interviewing and self-management approaches were combined with interventions designed to improve adherence:facilitation of the simplification of medication routines, providing memory cues and home self-monitoring equipment, counselling, and six-month nursing follow-up. Results demonstrated that an expanded nurse case management model of care delivery is feasible with only a modest impact on clinic resources. At six months, there were significant reductions in blood pressure and increases in medication self-efficacy and adherence for selected clients identified with high risk for stroke and non-achievement of treatment outcomes.
中风预防诊所的医护人员必须为短暂性脑缺血发作或轻度非致残性中风患者提供早期神经科会诊与治疗、诊断测试以及行为风险因素管理。诊所护士与患者及跨专业团队合作，以支持降低风险因素，预防中风复发事件。尽管高血压是中风最重要的可改变风险因素，但更广泛的证据表明，遵医嘱服药的比例可能低于50%。一家诊所发现有必要通过识别高血压未得到控制、具有认知、自我效能和/或依从性特征且预示无法实现血压目标的患者，来改善风险因素控制效果。为满足这一需求，在20名患者的样本中对一种扩展的护士病例管理护理模式进行了可行性试点测试。动机性访谈和自我管理方法与旨在提高依从性的干预措施相结合：简化用药流程、提供记忆提示和家庭自我监测设备、咨询以及为期六个月的护士随访。结果表明，扩展的护士病例管理护理模式是可行的，对诊所资源的影响较小。六个月时，对于选定的有中风高风险且未实现治疗效果的患者，血压显著降低，用药自我效能和依从性提高。
