Effects of nurse-led hierarchical management care on acute stroke patients: A pilot study to promote stroke-associated pneumonia management

Dongxiang Zheng; Shengjuan Li; Yan Ding; Huaihua Chen; Dong Wang; Huan Wang; Yuyao Xie; Chen Li; Jinglan Luo

doi:10.3389/fneur.2023.1121836

Effects of nurse-led hierarchical management care on acute stroke patients: A pilot study to promote stroke-associated pneumonia management

Front Neurol. 2023 Apr 12:14:1121836. doi: 10.3389/fneur.2023.1121836. eCollection 2023.

Authors

Dongxiang Zheng^#¹, Shengjuan Li^#², Yan Ding³, Huaihua Chen³, Dong Wang⁴, Huan Wang², Yuyao Xie², Chen Li¹, Jinglan Luo⁵

Affiliations

¹ Department of Neurology and Stroke Center, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
² School of Nursing, Jinan University, Guangzhou, Guangdong, China.
³ Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China.
⁴ Dapeng New District Nan'ao People's Hospital, Shenzhen, China.
⁵ Department of Internal Medicine, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.

^# Contributed equally.

Abstract

Background: Stroke-related pneumonia (SAP) is a common complication in acute ischemic stroke (AIS) patients, and it has adverse effects on the clinical outcomes and increases the burden on patients' families and society. Early identification and individualized care are necessary to reduce the incidence of SAP.

Objective: The present study aimed to explore the effect of nurse-led hierarchical management care based on the acute ischemic stroke-associated pneumonia score (AIS-APS) scale in AIS patients.

Methods: A quasi-intervention pilot study design was adopted for the present study. A total of 120 AIS patients were enrolled and assigned to the intervention group and the control group, with 60 subjects in each group in a tertiary hospital in Guangzhou, China. The control group received routine care, whereas the intervention group was given nurse-led hierarchical management care based on the AIS-APS scale. The intervention duration was more than 7 days, and the incidence of SAP, neurological function, swallowing function, and activities of daily living (ADLs) at discharge were observed. The outcomes were assessed at baseline and at outpatient time.

Results: A total of 120 participants were enrolled in our study. A significant decrease was found in the incidence of SAP in the intervention group (18.3%) compared with that in the control group (41.7%). Positive outcomes were shown in neurology function, swallowing function, and ADL in the intervention group.

Conclusion: Nurse-led hierarchical management care based on AIS-APS can reduce the incidence of SAP, promote AIS patients' neurological function, and maintain patients' ADL. The results of our study indicated that nurse-led hierarchical management care is feasible for AIS patients and provides individualized interventions for patients with different levels of SAP risk. Nurse-led hierarchical management care could be incorporated into routine nursing practice. Further study is needed and expected to solve more clinical problems.

Keywords: hierarchical management care; ischemic stroke; nursing care; pilot study; stroke-associated pneumonia.