Nursing Management of Acute Stroke Patients in Emergency Department of the First level referral Hospitals

Abstract

Stroke is a critical medical emergency requiring timely and accurate assessment to ensure effective treatment. Emergency nurses at first-level referral hospitals play a vital role in the early identification and management of life-threatening conditions, despite limitations in resources and equipment. This study aimed to develop a nursing management guideline for patients with acute stroke and to evaluate its outcomes based on Soukup’s evidence-based nursing practice framework. The process involved identifying clinical problems, conducting an evidence search using the PICO-T framework, appraising evidence quality using the Joanna Briggs Institute criteria, and developing a nursing guideline from 17 selected studies. The developed nursing management guideline comprised 4 core components 1. patient screening, 2. assessment of clinical manifestations and stroke mimics, 3. nursing management in the emergency department, and 4. referral coordination. The guideline was piloted with 5 suspected stroke patients in a first-level referral hospital. Results indicated improvements in the accuracy of nurse-led screening, reduced time to physician notification, prevention of patient deterioration during referral waiting, and decreased time from admission to referral compared to previous practices. The findings demonstrated that the developed guideline enhanced the timeliness of patient care and was feasible for implementation in first-level referral hospitals. Nevertheless, individualized nursing care tailored to patients’ specific conditions remains essential to reduce mortality and long-term disability.