Nurse staffing levels: Adjusted Hazard Ratio of 30day Mortality of Patients Admitted on Weekends, by Ratio of Registered Nurses Per Ten Beds on the Weekend. (Figure 1).Using data from the same source, the association between different processes of care and mortality highlights the importance of some of the basic aspects of stroke nursing care in determining a good outcome [3]. Impact of care processes on odds of death at 30 days after stroke (Figure 2). Stroke Nurse Competency FrameworkAs part of the process of improving stroke care in London, a group of senior stroke nurses developed a document outlining the key competencies that all nurses should achieve [4]. Some are core nursing skills that all nurses should have, others are specific to stroke. In this chapter we will cover some of the main stroke specific issues. Although developed for nurses in London it has relevance for all stroke services internationally. It will not attempt to comprehensively cover all aspects of care. Ultimately working in a good stroke service that is providing high quality specialist care from admission through to the longer term in the community, is the best way to understand the huge potential for specialist stroke nursing. Domains for stroke nursing skills included in the London Stroke Nurse Competency Framework (Table 1). Neurological assessment and careA core role for stroke nurses is the monitoring and management of neurological status. This is often very frequent in hyper-acute stroke care where observations may be needed every 15 minutes. The aim of neurological observations is to identify any early deterioration and institute management to prevent long term consequences. Causes of deteriorationo New neurological damage e.g. recurrent stroke, hemorrhagic transformation Competency 1: Acute neurological care Competency 2: Thrombolysis and thrombectomy care Competency 3: Respiratory care Competency 4: Cardiovascular care Competency 5: Management of sepsis and infection control Competency 6: Diabetes care Competency 7: Nutrition and hydration Competency 8: Bladder and bowel continence Competency 9: Rehabilitation after stroke Competency 10: Fatigue after stroke Competency 11: Positioning and pressure area care Competency 12: Pain control
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