From Symptoms to Medication, Research Paper Example

The specific learning objectives for the course can be broadly be categorized under three general concerns: first, to be able to integrate academic in addition to field the experience gained in the work to progress understanding, values, along with skills in their context of development of advanced as well as generalist practice capability.; second, to have the potential of using structured reflection along with self-evaluation in an attempt of gaining an insight to the practice considering policies, values, ethics, theoretical representations, along with agency expectations, in addition to third, to have potential for reflecting upon personal values along with beliefs as well as explore solutions to the real issues.

1. To make use of research-based knowledge, appraise research studies along with make use of research findings in the context of practice, including evaluating agency’s own practice involvements furthermore other applicable systems;
2. To demonstrate aptitude for decisive self-reflection along with assessment of presentation;
3. To express potential to function effectively within the structure of organizations and service delivery systems, utilize information technology and, with appropriate supervision and consultation, be able to advocate for organizational change.
4. To express potential to describe the range of techniques for developing evidence-based practice including decisive evaluation of literature, expansion of research questions, in addition to approaches in addition to techniques of conducting practice pertinent research.

Background Research

Stroke is caused by a decreased perfusion to the human brain. Most often, stroke is differentiated by commencement of a neurologic shortfall. There are also various types of stroke, namely: (1) ischemic and (2) hemorrhagic (Hickey, 2009). Certain risk factors, just like any disease is present in stroke. Some of the non-modifiable risk factors include heredity, race, history of previous stroke or heart attack, and age (World Health Organization, 2002). Between the sexes, males have a higher incidence rate for stroke while women have a higher mortality rate due to the fact that women lead longer lives. Blacks, meanwhile, are fifty percent more likely to suffer from Stroke compared to whites, due to their predisposition to systemic hypertension.

Stroke may have different presentations, depending on the area of the brain involved. Strokes occurring in the left hemisphere can cause left sided deficits and neglect while strokes in the cerebellar area can cause uncoordination, dizziness and nausea. Timing is of the essence when dealing with Stroke so it is important therefore, to treat every slight neurologic deficit as a possible stroke. Today, it is widely propagated to treat Stroke as an emergency, similar to that of Heart Attack, as outlined by the Advanced Cardiac Life Support (Adams et al., 2007).

Strokes can be determined through Magnetic Resonance Imaging, also called MRI. It is a test that fabricates very precise brain pictures along with its arteries devoid of the need for x-rays otherwise dyes. This type of test is helpful in order to detect a broad multiplicity of brain along with blood vessel abnormalities along with it can usually decide the damaged area of the brain brought about by an ischemic stroke. During this painless test, an individual is asked to lie on a table that moves into the opening of the MRI machine. The machine creates a magnetic field which briefly alters the water molecules in the brain cells of the individual being examined. An image of the brain is re-created through the response gained from the magnetic field. MRI scans can be used on any part of the body although the following description applies only to MRI of the head.

MRI shows the soft tissues in the brain in great detail, thus becoming a useful tool to detect discrepancies. It has the ability to detect even the smallest of details in areas that are similar, a characteristic that the CAT scan lacks since it is only useful in bone in addition to soft tissue imaging with fewer detail. MRI can also be performed without the use of any x-rays or dyes although gadolinium, an intravenous dye, may be used as contrast material for the brain and other blood vessels. Brain MRI is also usually used to diagnose lots of kinds of abnormalities of the skull, brain, along with spinal cord as well as abnormal growths including tumors, blood vessel abnormalities, infections, or disorders such as multiple sclerosis. MRI also provides direct views of the body from approximately any direction, while CAT scans only provide images in an axial orientation. Images of the human body are displayed in a variety of orientations to give a clear view of the structure. These are: (1) Coronal orientation: divides the head into two halves: the front and back, (2) Sagittal orientation: divides the head into the left and right, and (3) Axial orientation: divides the head into the upper part and lower part.

MRI as a diagnostic tool is very important, particularly in differentiating the different types of stroke. In ischemic stroke, determining the time of onset is important to assess eligibility for IV rtPA. The standard time frame to administer this medication is 3 hours from the time of onset. However, the American Heart Association Stroke Council recently published some guidelines to manage ischemic stroke, particularly in the administration Intravenous rtPA (Recombinant bandanna plasminogen activator). rtPA has been widely known for its effectiveness in improving patient outcomes, however most patients who present with ischemic stroke are never treated with rtPA. This is due to the fact that these patients arrive well after the recommended 3 hour window for the administration of rtPA. As a result, experts in the field are looking into increasing a longer time frame to administer the said medication and increase the opportunities to treat ischemic stroke.

Ischemic Stroke and the administration of rtPA

The European Cooperative Acute Stroke Study has recently conducted a prospective study wherein rtPA was administered within a 3 to 4.5 hours time frame (Hacke et al., 2008). By 2009, the American Stroke Association published an advisory that expanded the time frame for the administration of rtPA from 3 hours to 4.5 hours with the following excluding criteria that would apply on last 1.5 hours (Del Zoppo et al., 2009):

1. 80 years and above
2. International Normalized Ratio (INR) result is 1.7 and less
3. The baseline NIHSS score is more than 25
4. History of stroke and diabetes

These excluding criteria are placed as rtPA provides unclear positive outcomes on these patients. It is acknowledged by the American Stroke Association and Stroke Council that the time of administration of rtPA would affect the patient’s outcome, with an earlier administration time providing better outcomes.

An experimental type of research would be beneficial in this area, as it is one of the longest ever-used research methodologies. This is the application of the scientific method as a means of gaining insight into the causal relationships of situations. Two situations (cause and consequence) are analyzed and evaluated in order to make a comparison. Attempts are then made to treat the one situation from the outside by an external variable to affect change. The two situations are then re-assessed and the observable changes which are presumed to have been caused by the external variables are recorded. External variables are broken down into independent (circumstances or characteristics which can be manipulated) and dependent variables (circumstances or characteristics that change, disappear or appear when independent variable is implemented). Experimental research is fundamentally based on control; hence, selection of control groups is prerequisite to this type of research. Control groups are representative samples of a population which bear similar characteristics or experiences with that of the experimental group although treated differently. Another pre-requisite is validity, which indicates the extent to which an experiment complies with the purpose it was designed for. By validity is meant that a conclusion can possibly be drawn from the results obtained and can be confirmed in similar situations

Some have preconceived notions that experimental research having been obtained through scientific method is free of human error. This is relatively far from the truth because experimental research may be influenced by the researcher’s personal or preconceived biases. However, while the researcher may bring bias to experimentation, this does not necessarily mean that it limits his or her ability to be reflective. Despite these limitations, the advantage of experimental research is that it allows the researcher to control the situation, to identify the cause and effect and to distinguish placebo from treatment effects. It is also necessary to evaluate the research outcome. The process of evaluation serves to identify and distinguish programs that may have a significant impact or outcome in the said field. Evaluation also serves to help plan effective strategies for health as well as improve current programs (Schorr 1997).

Process evaluation serves to identify the relationships between theory and practice. Due to the increasing utilization of theory-based interventions, it is now necessary to determine which theories really do make a difference (Glanz, Lewis and Rimer 1997). Process evaluation also provides insight on which interventions work thus equating to positive implications both in the field of research and in practice as well. In addition, process evaluation also makes use of both qualitative and quantitative methods (National Institutes of Health, 2001), thus accounting for its rise in usage.

Formative evaluation serves to improve the program design and implementation as well as its foundation and progress. Formative evaluation ensures that the interventions developed within the study are in accordance with the needs of the general public or the community. It also serves to identify the reason for the decisions made or any actions that were taken (Earle, Lloyd, Sidell, and Spurr 2007). In outcome evaluation, the general impact and result of the program is assessed. As the name implies, outcome evaluation attempts to review and analyze whether the objectives or outcome of the program has been attained. This type of evaluation is particularly useful to the stakeholders as its effectiveness may be taken in comparison with another program which has the same objective.

Although increasing the window time for rtPA administration is associated with increased positive outcomes, the implementation of these recommendations are still besieged with controversy, thus, a specific protocol is clearly needed that should be strongly supported by research and facts. Bringing about this change in the healthcare setting may provide some challenges but it should be considered that change requires a commitment of time, resources and perseverance. Without these ingredients, almost all change will be doomed to fail. Within the organization, there should be a strong social structure including a strong support system within the organization, good working climate and solid systems for distributing information about the upcoming change in order for it to be effective.

In addition, the organization must have some degree of risk management in place, as it is essential to achieving success in business. It is an integral component of any good business practice which must be made part of any organization’s culture to be embedded deep into its philosophy, practices, goals and plans. In the field of health care, we constantly deal with the lives of individuals. As such, we have far greater responsibilities than any other business organization and concomitantly, our operation entail more risks. In addition, the health care facility is mandated by laws and industry practice to live up to certain core standards or level of efficiency in the delivery of services. Among these standards pertain to matters of safety, clinical and cost effectiveness, governance, patient focus, accessible and responsive care, care environment and amenities and public health (Department of Health, U.K).

Risk assessment helps management to focus on the risks that really matter in the workplace, especially the ones with the potential to cause real harm. Health and Safety Executive of London provide us with five basic steps in assessing risks in the workplace: (1) identify the hazards; (2) decide who might be harmed and how; (3) evaluate the risks and decide on precaution; (4) record findings and implement them; and, (5) review assessment and update, if necessary. This is where the staff inputs are significant and most valuable because being at the forefront of this facility’s operations, most useful information about how the work is done that will make for a thorough and effective risk assessment is at their disposal.

References

Adams HP Jr, del Zoppo G, Alberts MJ, et al. (2007). Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 38(5), pp. 1655-1711.

Lloyd-Jones D, Adams RJ, Brown TM, et al. (2010) Heart disease and stroke statistics-2010 update: a report from the American Heart Association. Circulation. 121(7), e46-e215.

Hacke W. et al. (2008). ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 359, pp. 1317–1329.

Hickey JV (2009) The Clinical Practice of Neurological and Neurosurgical Nursing. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins

World Health Organization (2002). Cardiovascular diseases. 3. Risk factors. Accessed April 13, 2012, from http://www.who.int/cardiovascular_diseases/en/cvd_atlas_03_risk_factors.pdf