Thursday, April 3, 2014

Stroke Survivors Need Team Approach to Palliative Care

A new scientific statement from the American Heart Association (AHA) recommends that people recovering from a stroke should have a well-coordinated medical team, working in collaboration with the patients and their families, to personalize care, optimize quality of life, and minimize suffering.

The statement provides guidance on how patients and families should work with the stroke team and providers, including nurses, neurologists, neurosurgeons, primary care providers, and therapists, reports.

“The stroke team and its members can manage many of the palliative care problems themselves. It encourages patient independence and informed choices,” Robert Holloway, lead author of the statement, said in a news release

AHA states that stroke survivors and family members should expect health care providers to:

  • Discuss preferences, needs, and values as a guide to medical decisions;
  • Discuss which aspects of recovery are most important to them;
  • Have effective, sensitive discussions about the prognosis, how to deal with physical or mental losses from a stroke and, if necessary, about dying, among other serious topics;
  • Provide guidance regarding life-sustaining treatment options. Providers should address pros and cons of CPR, ventilators, feeding tubes, surgery, do-not-resuscitate orders, do-not-intubate orders, and natural feeding;
  • Know the best treatment options for common post-stroke symptoms, including pain, other physical symptoms and psychological problems such as depression and anxiety;
  • Engage a palliative care specialist if complex issues arise; and
  • Help preserve dignity and maximize comfort throughout the course of a stroke, including during the dying process and when nearing death.
Nearly 800,000 stroke and 130,000 stroke-related deaths occur in the U.S. each year, according to the AHA and up to 30 percent of all survivors are permanently disabled. The AHA’s scientific statement is available here.

The INQRI-funded “Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice” explores the relationships between quality palliative nursing care delivered in intensive care units (ICUs) and patient and family outcomes and on how to measure and to improve these outcomes. The purpose of this investigator-initiated study was to examine nursing's specific contributions to quality palliative care provided to patients and their families in the ICU. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

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