A Pocket-sized Tool for Stroke Rehabilitation

An NP-designed care guide proves simpler is often better.

Official guidelines for adult stroke rehabilitation cover in granular detail everything from preventing life-threatening deep vein thromboses to post-stroke osteoporosis and depression.

Meanwhile, at point-of-care, practical concerns prevail. Nurses and techs must have immediate knowledge to manage tasks such as vitals and toileting with hemiparetic patients who may not have full use of their bodies.

Because simpler is often better in the field, Sean Anderson, M.S.N., a nurse practitioner at Vanderbilt University Medical Center, created a printed, pocket-sized reference tool that summarizes care guidelines for cerebrovascular accident (CVA) and stroke rehabilitation patients from a nursing care perspective.

“I designed the reference tool as an educational resource for nurses taking care of stroke patients, and nurses can use it to teach the patient’s family about safe ways to care for their loved one,” Anderson said.

Practical Needs

Anderson designed the tool around a simple “CVAs” acronym to highlight key care considerations:

  • C: Check the patient (including how often and ways to consolidate care)
  • V: Vitals (cutoffs and when to notify an attending)
  • A: Alarms (bed and chair alarms, call button placement)
  • S: Safety (checking siderails, diet, liquid consistency, etc.)

The backside of the tool holds more detail, including brief, practical rationales, such as “do not put an IV in a patient’s hemiparetic arm/hand. Therapy will need that hand/arm for things like e-stim and PT/OT activity.” All of the information fits on a 4×5 inch sheet of paper that Anderson hands out at Vanderbilt Stallworth Rehabilitation Hospital.

Focus on Patient Safety

“I was spurred to do this for patient safety and to avoid injuries,” Anderson said. “Many hemiparetic patients have decreased sensation in their affected arm and can be injured without even knowing it, if we’re not careful.”

More overtly, stroke patients are at high fall risk. One study found 73 percent of patients hospitalized for rehabilitation following acute stroke fell at least once during their hospital stay. Other studies find similar fall rates when extending the timeframe to six months after discharge. The new tool incorporates several fall risk management strategies.

Anderson has received positive feedback on the tool from physical medicine and rehabilitation care teams.

“Stroke population has unique needs such as sensory deficit, comprehension and cognition and ability to communicate their needs. This tool has reduced ambiguity about clinical care protocol and increased support staff confidence in their ability to care for stroke population,” said Vartgez Mansourian, M.D., medical director of Vanderbilt’s Stroke Rehabilitation Program.

Educational Benefit

The new reference tool has also started a conversation, Anderson says. “The tool has encouraged more communication between the floor staff – RNs and techs – and attendings. It is an opportunity to explain the ‘why’ behind some treatment modalities. I’ve seen nurses and techs want to understand more about the patients they care for after using it.”

Anderson has begun collecting data to quantify the tool’s benefit, and plans to contribute his findings and as educational tool to a peer-reviewed journal that focuses on nursing education.

Said Anderson, “This work is focused on education. It’s all about incorporating strategies and activities that connect care to the bigger picture.”