Stroke Nursing Second Edition Stroke Nursing Second Edition Edited by JANE WILLIAMS Southern Health Foundation Trust Southampton, UK LIN PERRY University of Technology Sydney Northern Hospitals Network South Eastern Sydney Local Health District Sydney, NSW, Australia CAROLINE WATKINS University of Central Lancashire Preston, UK This edition first published 2020 © 2020 by John Wiley & Sons Ltd Edition History [1e, 2010] All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or other- wise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Jane Williams, Lin Perry, and Caroline Watkins to be identified as the author of editorial in this work has been asserted in accordance with law. 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Library of Congress Cataloging‐in‐Publication Data Names: Williams, Jane (Jane E.), editor. | Perry, Lin, editor. | Watkins, Caroline, editor. Title: Stroke nursing / edited by Jane Williams, Lin Perry, Caroline Watkins. Other titles: Acute stroke nursing Description: Second edition. | Hoboken, NJ : Wiley-Blackwell, 2019. | Preceded by: Acute stroke nursing / edited by Jane Williams, Lin Perry, Caroline Watkins. 2010. | Includes bibliographical references and index. | Identifiers: LCCN 2018054706 (print) | LCCN 2018057605 (ebook) | ISBN 9781119111467 (AdobePDF) | ISBN 9781119111474 (ePub) | ISBN 9781119111450 (pbk.) Subjects: | MESH: Stroke–nursing | Evidence-Based Nursing Classification: LCC RC388.5 (ebook) | LCC RC388.5 (print) | NLM WY 152.5 | DDC 616.8/10231–dc23 LC record available at https://lccn.loc.gov/2018054706 Cover Design: Wiley Cover Image: © KTSDESIGN/SCIENCE PHOTO LIBRARY/Getty Images Set in 10/12pt Stix by SPi Global, Pondicherry, India 10 9 8 7 6 5 4 3 2 1 Contents EDITORS AND CONTRIBUTORS ix FOREWORD: STROKE NURSING xiii FOREWORD: STROKE SERVICES IN AUSTRALIA xv FOREWORD: STROKE CARE IN HONG KONG xix ACKNOWLEDGEMENTS xxiii 1 Setting the Scene 1 Caroline Watkins and Dominique Cadilhac 1.1 Introduction 1 1.2 Stroke Epidemiology 2 1.3 Cost Burden 3 1.4 Stroke Policy 4 1.5 Stroke Management Strategies 8 1.6 Research and Education 11 1.7 Conclusion 13 References 13 2 What Is a Stroke? 19 Anne W. Alexandrov 2.1 Introduction 19 2.2 Stroke Classification 20 2.3 Risk Factors for Stroke 22 2.4 Anatomy, Physiology, and Related Stroke Clinical Findings 23 2.5 Standardised Instruments for Acute Neurological Assessment 41 2.6 Conclusion 44 References 50 3 Reducing the Risk of Stroke 53 Josephine Gibson and Stephanie Jones 3.1 Introduction 54 3.2 Primary Prevention 55 3.3 Primary Prevention – Medical Considerations 56 3.4 Secondary Medical Prevention After TIA or Stroke 59 3.5 Interventions for Secondary Prevention After TIA or Recovered Stroke 63 3.6 Conclusion 68 References 68 v vi Contents 4 Acute Stroke Nursing Management 75 Anne W. Alexandrov 4.1 Introduction 76 4.2 Priorities in Acute Stroke Management 76 4.3 Hyper-acute Stroke Management 77 4.4 Hyper-acute Treatment of Haemorrhagic Stroke 90 4.5 Acute Stroke Management 93 4.6 Conclusion 96 References 96 5 Nutritional Aspects of Stroke Care 103 Lin Perry and Elizabeth Boaden 5.1 Introduction 104 5.2 Do Stroke Patients Experience Nutritional Problems Pre-Stroke? 106 5.3 How Does Stroke Affect Dietary Intake? 107 5.4 How Can Stroke Patients Be Helped to Maintain Adequate Dietary Intake? 119 5.5 Conclusion 132 References 133 6 Oral Care After Stroke 143 Mary Lyons 6.1 Introduction 144 6.2 Oral Assessment 145 6.3 Management and Care 146 6.4 Patient and Carer Perspective 147 6.5 Conclusion 148 References 148 7 Communication 153 Jane Marshall, Katerina Hilari, Madeline Cruice, and Kirsty Harrison 7.1 Introduction 154 7.2 Aphasia 155 7.3 Dysarthria and Apraxia of Speech 160 7.4 Right-Hemisphere Damage (RHD) Communication Deficit 163 7.5 Language Minorities 165 7.6 What Can SLTs Contribute in Acute Stroke Care? 166 7.7 Psychological Issues and Quality of Life 169 7.8 Conclusion 171 References 171 8 Management of Physical Impairments Post-Stroke 177 Cherry Kilbride, Rosie Kneafsey, and Vicky Kean 8.1 Introduction 178 8.2 Movement 179 8.3 Promoting Physical Activity and Movement After Stroke 180 Contents vii 8.4 Promoting Early Rehabilitation 184 8.5 Re-education of Movement 188 8.6 Management of the Upper Limb 192 8.7 Patients’ Perspectives on Early Physical Rehabilitation 195 8.8 Conclusion 195 References 196 9 Rehabilitation and Recovery Processes 203 Jane Williams and Julie Pryor 9.1 Introduction 204 9.2 Understanding Rehabilitation 204 9.3 Initiation of Rehabilitation 207 9.4 Nursing’s Rehabilitation Role 208 9.5 Outcomes of Rehabilitation 210 9.6 Goal–Directed Rehabilitation 210 9.7 Recovery Processes 212 9.8 Transfer to Rehabilitation 214 9.9 Rehabilitation Provision 216 9.10 Length of Rehabilitation 219 9.11 Adjustment to Life After Stroke 220 9.12 Conclusion 221 References 222 10 Promoting Continence 229 Kathryn Getliffe and Lois Thomas 10.1 Introduction 230 10.2 Prevalence and Causes of Continence Problems Post-Stroke 230 10.3 Importance of Continence Care 231 10.4 Bladder Function and Dysfunction 233 10.5 Main Types of UI 234 10.6 Transient Causes of UI 236 10.7 Assessment of UI and Bladder Dysfunction 236 10.8 Treatment Strategies and Care Planning for UI 242 10.9 Management and Containment of Incontinence 247 10.10 Bowel Problems and Care 249 10.11 Conclusion 254 References 255 11 Emotional and Cognitive Changes Following a Stroke 259 Peter Knapp and Elizabeth Lightbody 11.1 Introduction 260 11.2 Psychological Reactions to the Onset of Stroke 260 11.3 Coping with Stroke 261 11.4 Depression 261 11.5 Conclusion 274 References 274 viii Contents 12 Stroke and Palliative Care 281 Clare Thetford, Munirah Bangee, Elizabeth Lightbody, and Caroline Watkins 12.1 Introduction 282 12.2 Specific Challenges in Stroke 283 12.3 Tools to Support Palliative Care 286 12.4 Case Studies 291 12.5 Discussion 294 12.6 Conclusion 296 References 296 13 Minimally Responsive Stroke Patients 301 Elaine Pierce 13.1 Introduction 302 13.2 Definitions 302 13.3 Assessment and Diagnosis 303 13.4 Management and Care 308 13.5 Locked-In Syndrome 314 13.6 Conclusion 318 References 319 14 Longer-Term Support for Survivors of Stroke and Their Carers 323 Judith Redfern, Clare Gordon, and Dominique Cadilhac 14.1 Introduction 324 14.2 Longer-Term Consequences of Stroke, Informal Care and Costs 325 14.3 The Need for Support 325 14.4 Responsibilities of Health and Social Care Professionals 330 14.5 Identifying Those at Risk 331 14.6 Interventions to Support Stroke Survivors and Carers 334 14.7 Supporting Working-Age Survivors of Stroke 338 14.8 Conclusion 339 References 340 APPENDIX A: THE STROKE-SPECIFIC EDUCATION FRAMEWORK (SSEF) 347 INDEX 349 Editors and Contributors Editors Dr. Jane Williams Jane Williams is Director for Transformation, Director of Transformation for physical health services based in Southern Health NHS Foundation Trust, South- ampton, UK. She spent 20 years, until 2014, developing the stroke service in Ports- mouth. During this time, Jane was involved in many national working parties, including the National Stroke Strategy, UK Forum for Stroke Training, and UK Stroke Forum. Jane has been a member of The Stroke Association research awards committee. A founder member of the National Stroke Nursing Forum, Jane under- took a term of office as chair. Jane’s current role is based in a large community health organisation which provides services across physical, mental health, and learning disabilities both in people’s own homes and in bed‐based services. The current foci of her work include development of new models for community health services, integration of intermediate care services, and how clinicians can use activation to support their own practice whilst supporting patients with health behaviour change techniques. Professor Lin Perry Lin Perry is Professor of Nursing Research and Practice Development, University of Technology Sydney and the Northern Hospitals Network, South Eastern Sydney Local Health District, Sydney, NSW, Australia. She has a specialist interest in chronic conditions, practice, and service development, particularly in relation to knowledge translation and change management for frontline staff. A past mem- ber of the Intercollegiate Stroke Working Party in the UK and current member of the Stroke Foundation Guidelines Working Party and Stroke Network, New South Wales Agency for Clinical Innovation in Australia, she has extensive expe- rience with national guideline development, benchmarking, service review, and evaluation. Professor Dame Caroline Watkins Dame Caroline Watkins is Professor of Stroke and Older People’s Care, Director of Research and Innovation, Faculty of Health & Wellbeing, University of Central Lancashire, Director of Lancashire Clinical Trials Unit, and Director of Lancashire research Institute For global health and wellbeing (LIFE), Preston, UK. She is Chair of the UK Stroke Forum. Her multidisciplinary team of researchers have a large portfolio of clinically relevant stroke research and contribute to stroke service development locally, nationally and internationally. Caroline’s Services to Nursing and Older People’s Care were recognised with the award of the DBE in the New Year Honours 2017. ix x Editors and Contributors Contributors Professor Anne W. Alexandrov, Professor and Program Director for NET SMART at the Health Outcomes Institute, Fountain Hills, AZ, USA; a Professor of Nursing and a Professor of Neurology at the University of Tennessee Health Science Center at Memphis, Memphis, TN, USA; and the Chief Nurse Practitioner of the University of Tennessee – Memphis Mobile Stroke Unit, Memphis, TN, USA Dr. Munirah Bangee, Research Associate, Faculty of Health & Wellbeing, University of Central Lancashire, Preston, UK Dr. Elizabeth Boaden, Senior Research Fellow, School of Nursing, University of Central Lancashire, Preston, UK Professor Dominique Cadilhac, Head of Translational Public Health and Evalu- ation Division in Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, VIC, Australia and Head of Public Health, Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia Dr. Madeline Cruice, Reader/Associate Professor, School of Health Sciences, City, University of London, London, UK Professor Kathryn Getliffe, Previously Professor of Nursing, School of Nursing and Midwifery, University of Southampton, Southampton, UK (now retired) Dr. Josephine Gibson, Reader in Health Services Research, School of Nursing, University of Central Lancashire, Preston, UK Clare Gordon, Consultant Nurse, Stroke Services, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK Kirsty Harrison, Senior Lecturer, School of Health Sciences, City, University of London, London, UK Professor Katerina Hilari, Professor of Acquired Communication Disorders, School of Health Sciences, City, University of London, London, UK Dr. Stephanie Jones, Senior Research Fellow, School of Nursing, University of Central Lancashire, Preston, UK Vicky Kean, Advanced Nurse Practitioner, George Eliot Hospital NHS Trust, Nuneaton, UK Dr. Cherry Kilbride, Senior Lecturer in Physiotherapy, Brunel University London, London, UK and Lead Therapist, Research and Practice Development, Royal Free London NHS Foundation Trust, London, UK Dr. Peter Knapp, Senior Lecturer in Evidence-based Decision Making, Department of Health Sciences & the Hull York Medical School, University of York, York, UK Editors and Contributors xi Dr. Rosie Kneafsey, Head of School for Nursing, Midwifery and Health, Coven- try University, Coventry, UK Professor Diana Lee, Professor of Nursing, The Nethersole School of Nursing; Director of the Y.K. Pao Foundation Centre for Nursing Excellence in Chronic Illness Care; and Deputy Director of the CUHK Jockey Club Institute of Ageing at the The Chinese University of Hong Kong Dr. Elizabeth Lightbody, Reader in Health Services Research, Faculty of Health & Wellbeing, University of Central Lancashire, Preston, UK Mary Lyons, Senior Lecturer in Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; and Senior Research Fellow, University of Central Lancashire, Preston, UK Professor Jane Marshall, Professor, Division of Language and Communication Science, School of Health Sciences, City, University of London, London, UK Professor Sandy Middleton, Professor of Nursing and Director of the Nursing Research Institute, a joint collaboration between St Vincent’s Health Australia (Sydney) and Australian Catholic University, Syndey, NSW, Australia Dr. Elaine Pierce, Independent Lecturer and Researcher Associate Professor Julie Pryor, Nursing Research & Development Leader, Royal Rehab, Sydney, NSW, Australia and Clinical Associate Professor, University of Sydney, Sydney, NSW, Australia Dr. Judith Redfern†, Senior Research Fellow, School of Nursing, University of Central Lancashire, Preston, UK Dr. Clare Thetford, Senior Research Fellow, Faculty of Health & Wellbeing, University of Central Lancashire, Preston, UK Dr. Lois Thomas, Reader in Health Services Research, School of Health Sciences, University of Central Lancashire, Preston, UK †Judith Redfern sadly lost her battle with cancer in February 2018, prior to the publication of this book. Judith started her research career in 1993 as a student working at the Home Office on the British Crime Survey. After graduating in Mathematics and Psychology, she moved into health services research. Her first research post was at University College London, working with Ann Bowling on a study into the appropriateness of outpatient care in the North Thames region. Judith has made an important contribution to the field of stroke since 1999, including a national study into the longer‐ term needs of stroke survivors. Jude joined the University of Central Lancashire in 2013 and was a Senior Research Fellow until her death in February 2018. During this time, she contributed to various research outputs, including the development of the Stroke Patient Concerns Inventory.