Emergency Staff Knowledge, Attitude and Behaviors in Emergency Treatment of Stroke
Emergency Stroke Treatment
Keywords:
Acute ischemic stroke, emergency physicians and nurses, barrier, emergency department, thrombolytic therapy
Abstract
Background: The main purpose of our study was to evaluate the awareness level of emergency physicians and nurses in our city of stroke treatment and their knowledge of its use, and to identify obstacles in the way of utilization of emergency stroke treatment from the perspective of emergency department staff.
Material and Method: The study was designed as a survey study with physicians and nurses working in the emergency departments of hospitals in our city.
Results: When compared to other healthcare personnel, healthcare professionals who received stroke training and accepted a greater number of stroke cases monthly were found to support thrombolytic application to eligible patients, and these individuals also had greater belief that thrombolytic therapy was effective in acute stroke. In our study, the most important barrier to emergency stroke treatment was reported as the lack of information from patients and patient relatives from the perspective of emergency practitioner physicians and nurses; whereas, according to emergency physicians, there were problems in the referral chain.
Conclusion: Barriers to acute stroke treatment can be reduced by eliminating the lack of knowledge among healthcare professionals and the public on acute stroke treatment and awareness of early symptoms of stroke, in addition to solving problems in the referral chain.
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References
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25. Al Khathaami AM, Aloraini H, Almudlej S, Al Issa H, Elshammaa N, Alsolamy S. Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke. Neurol Res Int. 2018;2018:3050278. doi: 10.1155/2018/3050278.
26. Scott PA, Xu Z, Meurer WJ, et al. Attitudes and beliefs of Michigan emergency physicians toward tissue plasminogen activator use in stroke: baseline survey results from the INcreasing Stroke Treatment through INteractive behavioral Change Tactic (INSTINCT) trial hospitals. Stroke. 2010;41(9):2026-2032. doi: 10.1161/strokeaha.110.581942.
27. Paul C, D'este C, Ryan A, et al. Staff perspectives from Australian hospitals seeking to improve implementation of thrombolysis care for acute stroke. SAGE Open Med. 2019;7:2050312119865656. doi: 10.1177/2050312119865656.
28. Sulena S, Kumawat BL, Sharma AK. Awareness of stroke among stroke patients in a tertiary-care level hospital in northwest India. Int J Med Sci Public Health. 2016;5:1-5. doi: 10.5455/ijmsph.2016.281020141
29. Haki C, Ali A. Comparative Evaluation of Stroke Awareness of Individuals Whose First-Degree Relatives had a Stroke and that of Individuals Whose First-Degree Relatives Did Not. Neurologist. 2020;26(1):10-14. doi: 10.1097/nrl.0000000000000306.
30. Baby P, Srijithesh P, Ashraf J, Kannan D. Emergency nurses' knowledge about tissue plasminogen activator therapy and their perception about barriers for thrombolysis in acute stroke care. International Journal of Noncommunicable Diseases. 2019;4(4):121. doi: 10.4103/jncd.jncd_16_19
31. Heikkilä I, Kuusisto H, Holmberg M, Palomäki A. Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians. Ann Emerg Med. 2019;73(2):105-112. doi: 10.1016/j.annemergmed.2018.07.019.
2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223. doi: 10.1016/s0140-6736(12)61689-4.
3. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317-1329. doi: 10.1056/NEJMoa0804656.
4. Group NIONDaSR-PSS. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-1587. doi: 10.1056/nejm199512143332401.
5. Kutluk K, Kaya D, Afsar N, et al. Analyses of the Turkish National Intravenous Thrombolysis Registry. J Stroke Cerebrovasc Dis. 2016;25(5):1041-1047. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.015.
6. Berkowitz AL, Mittal MK, Mclane HC, et al. Worldwide reported use of IV tissue plasminogen activator for acute ischemic stroke. Int J Stroke. 2014;9(3):349-355. doi: 10.1111/ijs.12205.
7. Khatib R, Arevalo YA, Berendsen MA, Prabhakaran S, Huffman MD. Presentation, Evaluation, Management, and Outcomes of Acute Stroke in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Neuroepidemiology. 2018;51(1-2):104-112. doi: 10.1159/000491442.
8. Ghandehari K. Barriers of thrombolysis therapy in developing countries. Stroke Res Treat. 2011;2011:686797. doi: 10.4061/2011/686797.
9. Durai Pandian J, Padma V, Vijaya P, Sylaja PN, Murthy JM. Stroke and thrombolysis in developing countries. Int J Stroke. 2007;2(1):17-26. doi: 10.1111/j.1747-4949.2007.00089.x.
10. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020-3035. doi: 10.1161/str.0000000000000074.
11. Meurer WJ, Majersik JJ, Frederiksen SM, Kade AM, Sandretto AM, Scott PA. Provider perceptions of barriers to the emergency use of tPA for acute ischemic stroke: a qualitative study. BMC Emerg Med. 2011;11:5. doi: 10.1186/1471-227x-11-5.
12. Eissa A, Krass I, Bajorek BV. Barriers to the utilization of thrombolysis for acute ischaemic stroke. J Clin Pharm Ther. 2012;37(4):399-409. doi: 10.1111/j.1365-2710.2011.01329.x.
13. Ehlers L, Jensen LG, Bech MA, Andersen G, Kjølby M. Organisational barriers to thrombolysis treatment of acute ischaemic stroke. Curr Med Res Opin. 2007;23(11):2833-2839. doi: 10.1185/030079907x242557.
14. Baatiema L, Otim ME, Mnatzaganian G, De-Graft Aikins A, Coombes J, Somerset S. Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implement Sci. 2017;12(1):74. doi: 10.1186/s13012-017-0599-3.
15. Craig LE, Mcinnes E, Taylor N, et al. Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF). Implement Sci. 2016;11(1):157. doi: 10.1186/s13012-016-0524-1.
16. Johnson M, Bakas T. A review of barriers to thrombolytic therapy: implications for nursing care in the emergency department. J Neurosci Nurs. 2010;42(2):88-94. doi: 10.1097/JNN.0b013e3181ce5a48
17. Kwan J, Hand P, Sandercock P. A systematic review of barriers to delivery of thrombolysis for acute stroke. Age Ageing. 2004;33(2):116-121. doi: 10.1093/ageing/afh064.
18. Lachkhem Y, Rican S, Minvielle É. Understanding delays in acute stroke care: a systematic review of reviews. Eur J Public Health. 2018;28(3):426-433. doi: 10.1093/eurpub/cky066.
19. Ferrari J, Knoflach M, Kiechl S, et al. Stroke thrombolysis: having more time translates into delayed therapy: data from the Austrian Stroke Unit Registry. Stroke. 2010;41(9):2001-2004. doi: 10.1161/strokeaha.110.590372.
20. Meretoja A, Keshtkaran M, Saver JL, et al. Stroke thrombolysis: save a minute, save a day. Stroke. 2014;45(4):1053-1058. doi: 10.1161/strokeaha.113.002910.
21. Meretoja A, Keshtkaran M, Tatlisumak T, Donnan GA, Churilov L. Endovascular therapy for ischemic stroke: Save a minute-save a week. Neurology. 2017;88(22):2123-2127. doi: 10.1212/wnl.0000000000003981.
22. Behrens S, Daffertshofer M, Interthal C, Ellinger K, Van Ackern K, Hennerici M. Improvement in stroke quality management by an educational programme. Cerebrovasc Dis. 2002;13(4):262-266. doi: 10.1159/000057853.
23. Puri I, Bhatia R, Vibha D, et al. Stroke-related education to emergency department staff: An acute stroke care quality improvement initiative. Neurol India. 2019;67(1):129-133. doi: 10.4103/0028-3886.253636.
24. Bobrow BJ, Demaerschalk BM, Wood JP, Villarin A, Clark L, Jennings A. Views of emergency physicians on thrombolysis for acute ischemic stroke. J Brain Dis. 2009;1:29-37. doi: 10.4137/jcnsd.s2231.
25. Al Khathaami AM, Aloraini H, Almudlej S, Al Issa H, Elshammaa N, Alsolamy S. Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke. Neurol Res Int. 2018;2018:3050278. doi: 10.1155/2018/3050278.
26. Scott PA, Xu Z, Meurer WJ, et al. Attitudes and beliefs of Michigan emergency physicians toward tissue plasminogen activator use in stroke: baseline survey results from the INcreasing Stroke Treatment through INteractive behavioral Change Tactic (INSTINCT) trial hospitals. Stroke. 2010;41(9):2026-2032. doi: 10.1161/strokeaha.110.581942.
27. Paul C, D'este C, Ryan A, et al. Staff perspectives from Australian hospitals seeking to improve implementation of thrombolysis care for acute stroke. SAGE Open Med. 2019;7:2050312119865656. doi: 10.1177/2050312119865656.
28. Sulena S, Kumawat BL, Sharma AK. Awareness of stroke among stroke patients in a tertiary-care level hospital in northwest India. Int J Med Sci Public Health. 2016;5:1-5. doi: 10.5455/ijmsph.2016.281020141
29. Haki C, Ali A. Comparative Evaluation of Stroke Awareness of Individuals Whose First-Degree Relatives had a Stroke and that of Individuals Whose First-Degree Relatives Did Not. Neurologist. 2020;26(1):10-14. doi: 10.1097/nrl.0000000000000306.
30. Baby P, Srijithesh P, Ashraf J, Kannan D. Emergency nurses' knowledge about tissue plasminogen activator therapy and their perception about barriers for thrombolysis in acute stroke care. International Journal of Noncommunicable Diseases. 2019;4(4):121. doi: 10.4103/jncd.jncd_16_19
31. Heikkilä I, Kuusisto H, Holmberg M, Palomäki A. Fast Protocol for Treating Acute Ischemic Stroke by Emergency Physicians. Ann Emerg Med. 2019;73(2):105-112. doi: 10.1016/j.annemergmed.2018.07.019.
Published
2022-01-21
How to Cite
1.
Haki C, Demirci H. Emergency Staff Knowledge, Attitude and Behaviors in Emergency Treatment of Stroke. jms [Internet]. 2022Jan.21 [cited 2026Oct.3];25(1):17-4. Available from: https://old.jmsskims.org/index.php/jms/article/view/1155
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Original Articles
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