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Stroke patients' behavior and caregivers coping mechanisms.

Author

Karina L. Cubillo,
Lourdes P. Aparicio

Related Institution

College of Health Sciences - Holy Name University

Publication Information

Publication Type
Thesis/Dissertations
Thesis Degree
MA
Specialization
Nursing
Publication Date
March 2015

Abstract

INTRODUCTION:


Whenever a sudden attack of disease may happen, a person who gets affected by the disease is vigilant enough on factors that may contribute for another disease incidence. A stroke may seem like something that only happens to other people typically older individuals that are poor in health and also have heart disease. But in reality, a stroke can happen to many different kinds of people and have a range of effects on their health, life, and physical and mental abilities. A stroke or CVA may happen when blood cannot reach the brain. It may be caused by two main reasons such as blood clot in an artery that may block vessels causing stroke and blood vessels bursts causing hemorrhagic stroke. Brain cells quickly die and leave permanent damage when blood, nutrients and oxygen it carries cannot reach the brain (Bass, 2014).


Stroke is the primary cerebrovascular disorder in the United States and it is the third leading cause of death after heart disease and cancer. Approximately 780,000 people experience a stroke each year in the United States, 600,000 of these are new strokes, and 180,000 are recurrent strokes (Rosamond, 2010). About 5.6 million non-institutionalized stroke survivors are alive today; stroke is the leading cause of serious and long term disability in the United States. The financial impact of stroke is profound, with estimated direct and indirect costs of 65.5 billion dollars in 2008 (Smeltzer et al., 2004).


Improved short-term survival after a stroke has resulted in a population of an estimated 4,700,000 stroke survivors in the United States. The majority of recurrent events in stroke survivors are recurrent strokes, at least for the first time in several years. Moreover, individuals presenting with stroke frequently have significant atherosclerotic lesions throughout their vascular system at are heightened risk for or have associated comorbid cardiovascular disease. Both coronary artery disease and ischemic stroke share links to many predisposing, potentially modifiable risk factors (hypertension, abnormal blood lipids, cigarette smoking, physical inactivity, obesity) which highlights the prominent role lifestyle phases in the origin of stroke. Modification of multiple risk factors through a combination of comprehensive lifestyle interventions and appropriate pharmacological therapy is now recognized as the cornerstone of initiatives aimed at the prevention of recurrent stroke and acute cardiac events in stroke survivors (National Stroke Statistics, 2003).


In the Philippines, based on Philippine Health Statistics by DOH (2009), the registered number of death caused by cerebrovascular rate of 61.4 per 100,000 population.


Cerebrovascular disease ranks second as the leading cause of mortality in Philippines with 13.6 percent in both sexes (Sinson, Rebanal, and Timbang, 2009). It follows the diseases of the heart as the top causes of death. These high numbers of death causes alarmed to the community and health workers particularly in our province. Hence, cerebrovascular disease affects a long range of aged from adolescent to late adulthood.


It is believed that nurses play a pivotal role in all phases of care of the stroke patient. The phases include emergency or hyperacute care phase which includes the prehospital setting and the emergency department and acute care phase, which includes critical care units, intermediate care units, stroke units, and general medical units. Stroke is a complex disease that requires the efforts and skills of all members of the multidisciplinary team. Nurses are often responsible for the coordination of care throughout the continuum. Coordinated care of stroke patients results in improved outcomes, decreased lengths of stay, member is the emergency medical technician(EMT) or paramedic. Nurses may work as EMTs and paramedics, radio providers of online medical control to EMT personnel from base stations, and educators who teach EMT personnel about stroke and the care of stroke patients (Summers et al., 2003)


The emotional, psychological, and behavioral changes that take place following a stroke are, in part, caused by physical damage to the brain. Each stroke is different, and to a large extent, the psychological problems that someone may experience will vary depending on the part of the brain affected and the extent of the damage. For example, impulsive behavior is associated with damage to the right half of the brain, while tearfulness and outbursts of anger are more common in those with damage to the left half of the brain. Apart from the psychological effects caused by the damage to the brain, having a serious illness such as stroke, being in the hospital, or facing up to reality of having to live with any lasting disabilities can affect emotional health. Someone may feel anxious or depressed, be frustrated, angry or bewildered. All these feelings are common and although they usually fade with time, they may persist in some people (Intersource Group, Ireland, 2015).


It is normal for a stroke survivor to feel sad over the problems caused by stroke. Some people experience a major depressive disorder, which should be treated as soon as possible. A person with a major depressive disorder has a number of symptoms nearly every day, all day, for at least 2 weeks. If a stroke survivor has symptoms of depression, especially thoughts of death or suicide, profesional help is needed right away. Once the depression is properly treated, these thoughts will go away. Depression can be treated with medication, psychotherapy, or both. If it is not treated, it can cause needless suffering and also makes it harder to recover from the stroke (US Agency for Healthcare Research and Quality 1995).


Most stroke patients have families that are providing some level of care and support. In the case of older adults and people with chronic disabilities of all ages, this "informal care" can be substantial in scope, intensity, and duration. Family caregiving raises safety issues in two ways that should concern nurses in all settings. First, caregivers are sometimes referred to as "secondary patients," who need and deserve protection and guidance. Research supporting this caregiver-as-client perspective focuses on ways to protect family caregivers' health and safety, because their caregiving demands place them at high risk for injury and adverse events. Second, family caregivers are unpaid providers who often need help to learn how to become competent, safe volunteer workers who can better protect their family members (Reinhard et al., 2004).


On one hand, stroke patients as well have bigger part in the rehabilitation process. Patients have the right to make decisions about their health care, including refusing a particular treatment or a life-sustaining activity such as eating. However, patients must be able to understand and appreciate their particular medical condition or its consequences. It is therefore a must that nurses, family or significant others work in progress as a team in providing accurate information on health recovery benifits to patients suffering from stroke. This would be to avoid noncompliance of stroke patients to their immediate care (Finestone and Blackmer, 2007).


As a medical surgical nurse in the ward, the researcher has observed many stroke patients with first history of stroke came in at a hospital for admission, recurrent sudden attack of stroke the second time and even many times. It is for this reason that the researcher wanted to make a study about patient himself and significant others in the overall care. This would greatly help the quality of life for stroke patients. The findings of the study would serve as the basis of implementing an appropriate health program for a stroke patient to understand the significance of coping effects of stroke and eventually live a normal balance life.


 

References

1. Arellano Law Foundation(). Philippine Laws and Jurisprudence. . Retrieved from: http://www.lawphil.net/statutes/repacts/ra2002/ra_9173_2002.html
2. Aveyard, H.. Oxford Brooks University(). The patient who refuses nursing care. . Retrieved from: http://jme.bmj.com
3. Bass, P.. (). What is stroke?. . Retrieved from: http://www.everydayhealth.com/senior-health/stroke/index
4. Chapman, L.. Using supported learning to ensure nurse recruits are skilled to care for acutely ill patients.. The Deteriorating Patient Nursing Times 2010. 3-4.
5. Finestone, H.M. . Refusal to eat, capacity and ethics in stroke patients: A Report of 3 cases. Canadian Association of Physical Medicine & Rehabilitation Canada: 2007. 1474-1477. (Vol.88,Iss)
6. Ross, May H.L.. Supporting family caregivers in stroke care: A review of the evidence for problem solving 2005.
7. National Stroke StatisticsHeart disease and stroke statistics U.S.A.: 2003.
8. Sinson, Rebanal L.. The 2009 Philippine health statistics department of health national epidemiology center Manila: 2009.
9. Smeltzer, Bare S.C.. Brunner and Suddarths textbook of medical-surgical nursing 12th edition Philadelphia: Lippincott Williams and Wilkins A Wolters Kluwer Company, 2004.
10. US Agency for HealthCare Research and QualityRecovering after a stroke: A Patient and family guide U.S.A.: 1995. 4-6, 10-13.
11. Summers, Leonard D.. American Heart AssociationComprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient. U.S.A.: 2003.

Physical Location

LocationLocation CodeAvailable FormatAvailability
Holy Name University Grad/T C89 c2015 Fulltext Print Format

 
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