paving the way for future stroke care!

EDITORIAL

Paving the Way for FutureStroke Care!

Elaine Tilka Miller, DNS RN CGuest Editor

In spite of the recent advances in stroketreatment (e.g., thrombolytic agents),each year more than 750,000 Americansexperience a stroke. Of those, approxi­mately 160,000 die at the time of theirstroke or during hospitalization, makingstroke the leading cause of death behindheart disease and cancer, and a majorcause of disability worldwide (NationalStroke Association, 200 I). For survivors,a stroke can have a catastrophic impactupon their personal, emotional, and eco­nomic situations and on their families asthey learn to live and cope with varyingdegrees of disability.

Granted, the continued focus on costcontainment and payment issues is dra­matically affecting the ability of rehabil­itation nurses to provide the coordinated,comprehensive, and safe care that permitsstroke survivors and their families toachieve the highest level of wellness andquality of life. However, tremendous op­portunities exist for rehabilitation nursesto take a leadership role in developing theknowledge that underpins our practice, to

expand the use of evidence-based prac­tice, and to play a more active role inshaping healthcare policy related to strokecare and quality-of-life issues.

Currently, within the 107th U.S. Con­gress there has been a movement to ex­plore the development of legislation toimprove stroke care and prevention mea­sures. Multidisciplinary teams are alsoworking to develop more stroke treat­ment options and disseminate this infor­mation beyond our large medical centersso that more Americans can reap the ben­efit of these successful new treatments.Within our profession, more rehabilita­tion nurses are trying to expand their un­derstanding of the stroke survivor andfamily members' experiences; developmodels to help guide our practice; in­crease our knowledge related to how gen­der, culture, and race can affect respons­es to stroke care long-term; and perhaps,most importantly, test the quality of ouroutcome measures. These are just someof the challenges addressed by authorsDonna Brauer, Betty Schmidt, ValindaPearson, Mary Burman, Linda Pierce,Jan Gross, Elizabeth Faulkner, StacyGoodrich, and Mary Kain in this issue ofRehabilitation Nursing.

Great advances have taken place, butmany challenges still remain for rehabil­itation nurses, including (a) examining theramifications of shorter acute hospitallengths of stay upon outcome achievementin rehabilitation and home care settings aswell as the role of the rehabilitation nursein this process; (b) developing moreeffective and efficient interventions to

reduce modifiable stroke risk factors (e.g.,smoking, sedentary lifestyle, excessivedrinking, high-fat diet) and decrease thelikelihood of another stroke; and (c) be­coming more active in professional orga­nizations outside of nursing such as theNationalStrokeAssociation,the AmericanStroke Association (a division of theAmerican Heart Association), and othergroups that address issues of importanceto rehabilitation nurses in the broaderhealthcare arena.

In many respects, the dynamic natureof the healthcare system and treatmentadvances-especially regarding ischemicstroke, which comprises 80% ofstroke events-gives rehabilitation nurs­es tremendous opportunities. It is time toreexamine what we value, what works,and what to change or explore in the fu­ture. Priorities should be to build allianceswith other disciplines and healthcare pol­icy decision makers, focus on quality-of­life issues, and refine our stroke care out­come measures and the cost-effectivenessof our interventions. By assuming astronger role in the development and re­finement of the information needed to de­velop healthcare policy, rehabilitationnurses can take a more proactive positionin shaping the care of stroke survivors andtheir families now and in the future.

ReferenceNational Stroke Association. (2001). Brain

attack statistics. Retrieved February 22,2001, from the World Wide Web: http://209.107.43.85/brain_stat.cfm

82 Rehabilitation Nursing> Volume 26, Number 3' May/Juri 2001