22. European Stroke Conference 2009 Acute stroke: clinical patterns and practise including nursing Identifying family caregivers at risk during the acute stroke phase J.I. Cameron1, A. Czerwonka2, G. Naglie3, M.A.M. Gignac4, T. Green5, G. Warner6, M. Bayley7, A. Cheung8, S. Phillips9, F. Silver10, M. Huijbregts11 University of Toronto, Toronto, CANADA1, University of Toronto, Toronto, CANADA2, Baycrest Centre for Geriatric Care, Toronto, CANADA3, University Health Network, Toronto, CANADA4, University of Calgary, Calgary, CANADA5, Dalhousie University, Halifax, CANADA6, Toronto Re-habilitation Institute - UHN, Toronto, CANADA7, University Health Network, Toronto, CANADA8, Dalhousie University, Halifax, CANADA9, University Health Network, Toronto, CANADA10 Background: Family caregivers play a central role in stroke survivors’ recovery, rehabilitation, and return to community living. Best practice guidelines recognize caregivers’ important role and rec-ommend the provision of timely education and support. The aim of this paper is to identify care-givers at risk for poor mental health outcomes during the acute stroke phase and, therefore, in need of support from the health care system. The primary hypothesis is that caregivers will report more depression symptoms if they are caring for stroke survivors with more severe stroke and more stroke related disability and the caregiver has less knowledge about stroke, less mastery, less social sup-port, more fatigue, and providing care impacts their everyday life. Methods: Participants included caregivers who consented to participate in an ongoing trial. They are caring for survivors of their first stroke and had to be able to speak and read English. The baseline assessment, completed during the first month post-stroke, included: 1) indicators of stroke severity (e.g., Canadian Neurological Scale, Barthel Index); 2) demographic characteristics; and 3) standard-ized measurement instruments (e.g., Mastery Scale, Stroke Knowledge Test, Caregiving Impact and Assistance Scales, and the CESD). Linear regression was used to test the study hypothesis. Results: Caregivers (n=299) were 74% female and 58 years of age. They reported more depressive symptoms when they had less mastery, experienced more fatigue and the care-giving role affected their ability to participate in valued activities (F (8,291) = 32.6, p<.001; adjusted R2=.46). Caregiver knowledge, assistance provided, patient illness severity and disability were not significantly related to caregiver depression. Conclusions: Our results suggest caregivers may be in need of support from the health care system during the acute stroke phase if they have less mastery, are fatigued, and are not able to participate in valued activities. 200 © 2013 S. Karger AG, Basel 7. Nurses & AHP‘s Meeting 2010 Acute stroke: clinical patterns and practise including nursing The development and evaluation of percutaneuous gastrostomy tube (PEG) nursing care plan in one acute stroke unit. E.J. Catangui1, C. Mejia2, S. Banerjee3 Imperial College Healthcare NHS Trust, London, UNITED KINGDOM1, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM2, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM3 Background:Stroke is a clinical syndrome which can affect swallowing. Swallowing difficulty can be a major concern which may affect a patient’s nutrition and hydration status. With the clinical de-cision of the multidisciplinary team, placement of a PEG may be carried out to facilitate the nutri-tion and hydration support of patients in whom oral intake is either insufficient to meet their needs or in whom anatomical or neurological abnormalities preclude safe swallowing, whereby long term artificial feeding is required. Complications after PEG tube insertion (infection, swelling, bleeding, leakage, peritonitis, hypergranulation, blockage) can be prevented, managed and treated. Metic-ulous care is vital.Method: A PEG nursing care plan ( PEG-NCP) has been devised to help nurses look after stroke patients with PEG. Its aim is to monitor and evaluate early algorithm of PEG in-fection on a daily basis and to ensure that the tube is rotated in a way that is based on recommended guidelines. The nursing team developed a training pack and a competency checklist to ensure that all nurses are equipped with the necessary skills on how to use the PEG-NCP and to manage stroke pa-tients with PEG. An audit was carried out in order to identify actual and potential infections arising after its implementation.Result: An audit was done prior to the implementation of the PEG –NCP from June 2012 to September 2012. 8 of the stroke patients had PEG related infections as manifested through raised CRP, leuko-cytosis and presence of exudates in the site. Another audit was carried out during the implementa-tion of the initiative from September 2012 to October 2012. Out of 6 patients with PEG there was no incidence of PEG related infections or complications. Conclusion: Appropriate training, competen-cies and the provision of a nursing care plan help nurses to monitor and prevent PEG infection and other related complications. The monitoring and evaluation of this care plan on a daily basis is an important role for a nurse to ensure patient care and safety. Nurses have been empowered to make clinical decisions in managing patients with PEG.
Karger_ESC London_2013
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