Hamilton Helen, Dale Simeon, McElduff Benjamin, Craig Louise E, Fasugba Oyebola, McInnes Elizabeth, Alexandrov Anne W, Cadilhac Dominique A, Lightbody Elizabeth, Watkins Dame Caroline, Middleton Sandy
Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, North Sydney, NSW, Australia.
College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA.
J Clin Nurs. 2022 Jan;31(1-2):158-166. doi: 10.1111/jocn.15892. Epub 2021 Jun 1.
The role of stroke nurses in patient selection and administration of recombinant tissue plasminogen activator (rt-PA) for acute ischaemic stroke is evolving.
To compare differences in stroke nurses' practices related to rt-PA administration in Australia and the United Kingdom (UK) and to examine whether these differences influence rt-PA treatment rates.
A cross-sectional, self-administered questionnaire administered to a lead stroke clinician from hospitals known to provide rt-PA for acute ischaemic stroke. Chi-square tests were used to analyse between-country differences in ten pre-specified rt-PA practices. Non-parametric equality of medians test was used to assess within-country differences for likelihood of undertaking practices and association with rt-PA treatment rates. Reporting followed STROBE checklist.
Response rate 68%; (Australia: 74% [n = 63/85]; UK: 65% [n = 93/144]). There were significant differences between countries for 7/10 practices. UK nurses were more likely to: request CT scan; screen patient for rt-PA suitability; gain informed consent; use telemedicine to assess, diagnose or treat; assist in the decision for rt-PA with Emergency Department physician or neurologist; and undergo training in rt-PA administration. Reported median hospital rt-PA treatment rates were 12% in the UK and 7.8% in Australia: (7.8%). In Australia, there was an association between higher treatment rates and nurses involvement in 5/10 practices; read and interpret CT scans; screen patient for rt-PA suitability; gain informed consent; assess suitability for rt-PA with neurologist/stroke physician; undergo training in rt-PA administration. There was no relationship between UK treatment rates and likelihood of a stroke nurse to undertake any of the ten rt-PA practices.
Stroke nurses' active role in rt-PA administration can improve rt-PA treatment rates. Models of care that broaden stroke nurses' scope of practice to maximise rt-PA treatment rates for ischaemic stroke patients are needed.
This study demonstrates that UK and Australian nurses play an important role in thrombolysis practices; however, they are underused. Formalising and extending the role of stroke nurses in rt-PA administration could potentially increase thrombolysis rates with clinical benefits for patients.
中风护士在急性缺血性中风患者选择和重组组织型纤溶酶原激活剂（rt-PA）给药方面的作用正在不断演变。
比较澳大利亚和英国中风护士在rt-PA给药方面的实践差异，并研究这些差异是否会影响rt-PA治疗率。
对已知为急性缺血性中风提供rt-PA的医院的一名中风首席临床医生进行一项横断面自填式问卷调查。卡方检验用于分析十个预先指定的rt-PA实践中的国家间差异。非参数中位数相等性检验用于评估国内在进行实践的可能性以及与rt-PA治疗率的关联方面的差异。报告遵循STROBE清单。
回复率为68%；（澳大利亚：74%[n = 63/85]；英国：65%[n = 93/144]）。在10项实践中的7项上，两国之间存在显著差异。英国护士更有可能：要求进行CT扫描；筛查患者是否适合使用rt-PA；获得知情同意；使用远程医疗进行评估、诊断或治疗；与急诊科医生或神经科医生协助做出rt-PA治疗决策；以及接受rt-PA给药培训。报告的医院rt-PA中位数治疗率在英国为12%，在澳大利亚为7.8%。在澳大利亚，较高的治疗率与护士参与10项实践中的5项有关；阅读和解读CT扫描；筛查患者是否适合使用rt-PA；获得知情同意；与神经科医生/中风医生评估rt-PA适用性；接受rt-PA给药培训。英国的治疗率与中风护士进行10项rt-PA实践中任何一项的可能性之间没有关系。
中风护士在rt-PA给药中的积极作用可以提高rt-PA治疗率。需要扩大中风护士实践范围以最大限度提高缺血性中风患者rt-PA治疗率的护理模式。
本研究表明，英国和澳大利亚护士在溶栓实践中发挥着重要作用；然而，他们的作用未得到充分利用。规范并扩大中风护士在rt-PA给药中的作用可能会提高溶栓率，给患者带来临床益处。
