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Nursing practices improve outcomes for stroke patients

05 Oct 2017

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Professor Sandy Middleton’s landmark study, “Improving management of fever, hyperglycaemia and swallowing dysfunction in patients with acute stroke at St Vincent’s Hospital” has had a large impact in changing nursing practice in stroke care around Australia and the world.

Co-funded by the National Health and Medical Research Council and a St Vincent’s Clinic Foundation Multidisciplinary Patient Focused Grant, the project investigated the impact of nurse-initiated acute stroke care. Nurses were required to monitor patients’ temperature and treat fever quickly, test their blood glucose levels and treat with insulin where appropriate, and make sure patients were safe to swallow before they were given food and drink. Patients who were cared for in this way whilst in a stroke unit were 16% more likely to survive and remain independent, an effect that further research showed to be sustained over four years.

Professor Middleton explains: “We had outstanding results that showed that nursing care can really impact on the hard endpoints of death and dependency, outcomes not often measured in nursing research…we more frequently measure, reduced complications or adherence to evidence based care practices or patient satisfaction…so to actually have an impact on death and dependency arising from good nursing care was amazing and led to the study being fast tracked for publication in The Lancet.”

The funding from the St Vincent’s Clinic Foundation grant was crucial for the study to be completed. “I don’t know if I could have finished the trial without it.” Professor Middleton said.

The recommendations of the project have since been rolled out in hospitals across NSW and will soon be implemented in up to 300 hospitals in Europe. Additionally, fever, sugar, swallow management recommendations have been included in the 2017 national acute stroke guidelines, something Professor Middleton refers to as “the gold standard” for demonstrating policy and practice change arising from research.

Thanks to the grant, Professor Middleton was also able to employ a research assistant to look at processes of stroke care at St Vincent’s Hospital. The researcher has since gone on to build a career as an epidemiologist. “These grants have been amazing for identifying people who are interested in going on to do more formal study” Professor Middleton said “having the funding to foster that culture of research makes all the difference.”