Nursing's Role in Addressing Palliative Care Needs of Stroke Patients.

Although patient survival after stroke has improved, stroke remains a leading cause of death and severe disability. It is the second leading cause of death globally and fifth in the United States. The risk of death in the first 5 years after stroke is ≈50%, with the greatest risk in the first year. With advances in acute stroke treatment, stroke survivors and their family members are faced with making potentially life-altering decisions in both acute and chronic phases of stroke. Patient and family engagement in decision-making is critical, especially when faced with treatment decisions that may include transitioning from active treatment to a palliative approach to care. Palliative care is an emerging focal area and an important part of stroke care, but healthcare professionals are still uncertain about the intersection of palliative care with acute stroke care and the timing of initiating transitions to palliative care. Given these uncertainties, the palliative care needs of patients and families may go unrecognized. The purpose of this article is to provide an overview of stroke palliative care and recommendations for nurses caring for stroke patients and their families. Palliative care is defined by the World Health Organization as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems” (WHO Definition of Palliative Care, paragraph 1). Palliative care throughout the illness continuum involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice. Table 1 includes key elements of palliative care. Palliative care may be appropriate at any stage of serious or life-limiting illness, regardless of current goals of care. According to an American Heart Association scientific statement, palliative care should be considered for all patients who have suffered a stroke that interferes with daily functioning or will predictably reduce life expectancy or quality of life (Holloway et al, p 1890). Quality of life preferences may be predicated on multiple factors, including prognosis, comorbidities, age, culture, social support, and resources. Essential Aspects of Stroke Palliative Nursing Care When interacting with patients and families living with stroke, providing a family-centered approach that optimizes quality of life by anticipating, preventing, and treating distressing symptoms and emotional distress becomes the goal of nursing care. Family-centered care begins with understanding what matters most to patients and their loved ones and, with the palliative care team, building a care plan to achieve the goals they articulate. At the heart of the palliative care team are the patient and family; the team should also include physicians, nurses, and other clinicians with expertise in palliative care and stroke, as well as social workers, chaplains, massage therapists, pharmacists, nutritionists, and others as needed for each patient. Patient and family-centered communication across care settings requires active engagement among patients, families, and the healthcare team and is imperative in the palliative care process. Nurses have a pivotal role in integrating a palliative approach to care for people with advancing chronic, life-limiting conditions, such as stroke, through interpersonal relationships and therapeutic communication with patients and families. Understanding what matters most to patients and their loved ones requires engaging in sensitive conversations. Because they are providing care at the bedside, nurses have opportunities for initiating these focused discussions in the moment that may not be available to other healthcare providers. Within the growing body of nursing research focused on palliative care and stroke, there are consistent key messages about palliative care needs of stroke patients. This research provides suggestions aimed at enhancing quality of life, including relieving pain and other distressing symptoms, integrating psychological and spiritual aspects of patient care, and providing a support system to help patients and carers. For example, researchers assessing the palliative care needs of 191 primarily white, acute stroke patients reported moderate to major fatigue and symptom-related problems (eg, pain and headache) or psychological distress (eg, anxiety, low mood, confusion, and loneliness) in over 50% of study participants. Higher levels of dependence, being female, and more comorbidities were predictors of increased palliative care needs. Approximately 25% worried about death and dying, while over 50% were concerned with dependence and disability and expressed significant concern over the burden their stroke Nursing’s Role in Addressing Palliative Care Needs of Stroke Patients