Discuss the nurses role within the multidisciplinary team when caring for a patient diagnosed with a Cerebral

Vascular Accident

This essay will discuss the nurses role alongside other members of the multidisciplinary team (MDT). This essay will be referring specifically to the nurses role within the MDT when caring for a patient diagnosed with a Cerebral Vascular Accident, more commonly referred to as Stroke. This essay will define what is meant by stroke, including what causes a Stroke, risk factors and high risk groups of Stroke. This essay will discuss the care that a patient diagnosed with Stroke will receive from the different members of the MDT and how different health professionals expertise is overlapping in ensuring the continuity of care. It will specifically focus on the care delivered by the Physiotherapist and Occupational Therapist as members of the MDT and also the dieticians input. It will include the different interventions implemented by the different disciplines and how these coincide with nursing care. This essay will explore the government guidelines and strategies which have been developed to mandate the provision of quality stroke care.

In the UK each year and estimated 150,000 people will suffer a stroke. The Stroke Association (2010 pp 2 -3.) defines a stroke as A stroke is an attack of the brain. It happens when the blood supply to part of your brain is cut off. There are two types of stroke, Ischaemic and Haemorrhagic. Ischaemic is the most common form of stroke accounting for almost 80% of diagnoses. An Ischaemic stroke is the result of a blood clot or narrowing of the blood vessels which feed the brain vital oxygen and nutrients, which leads to the

damage or death of the brain cells. Blood clots in the brain which cause stroke are known as a cerebral thrombosis. A cerebral thrombosis is caused when blood clots form in the main artery to the brain, the carotid arteries. Ischaemic strokes can also be caused by a cerebral embolism. When a blockage forms in a blood vessel away from the brain such as an air bubble or globule of fat and is carried to the brain in the blood stream. A blockage within the brain itself will also a cause of stroke, this is referred to as a lacunar stoke.(Pocock, 2006.) A Haemorrhagic stroke is the result of a bleed within the brain accounting for 20% of all cases. A haemorrhagic stroke can be caused by an intracerebral haemorrhage, when a blood vessel bursts and bleeds within the brain. A subarachnoid haemorrhage is when a blood vessel on the surface of the brain burst and bleeds in the subarachnoid space, the space between the brain and the skull also resulting in stroke. (Always, 2009.) A stroke will present in symptoms such as weakness, numbness or paralysis on one side of the body such as a drooping arm or leg. Slurred speech or difficulty finding words or understanding words is also a common symptom of stroke, this is known as aphasia. (Royal College of Physicians, 2004.) A stroke is medical emergency and can cause permanent neurological damage, or even death in many cases. Strokes can have a devastating lasting impact on the lives of people and their family and friends. Approximately a third of all stroke sufferers are rendered with a lifelong disability. Common problems following stroke include weakness or paralysis, loss of communication skills, depression and other mental health problems. (National Audit Office, 2005.)

The determining factors of stroke are age, sex, family history and ethnic background. Certain clinical conditions are known to increase the risk of stroke. High blood pressure, high cholesterol, atrial fibrillation and also diabetes are all identified as risk factors. (DoH, 2005.) Lifestyle choices such as smoking, increase alcohol consumption and recreational drug use and lack of exercise are all known to increase the risk of stroke. (DoH, 2005.) The priorities of stroke treatment are centred on identifying if a diagnosis of stroke can be made, the cause of stroke, acute treatment to salvage brain tissue, prevent clinical deterioration and to implement secondary prevention of stroke. As stroke is the leading cause of severe disability in the UK, the care of stroke patients is centred on getting patients back to normal life and how to live with the lasting effects of stroke, this achieved in the form of stroke rehabilitation. (National Institute of Neurological Disorders and Stroke, 2009.) Rehabilitation following stroke is proven to reduce mortality and long term disability. Rehabilitation is defined as a process aiming to restore personal autonomy in those aspects of daily living considered most relevant by patients or service users, and their family carers.(Kauffman, 2007.) Rehabilitation is a process which requires multiple inputs. Due to this, rehabilitation will usually require a range of skills and expertise which is not usually available from one discipline of healthcare. This often means that many members of the MDT will deliver rehabilitation centred on a goal orientated approach. (Kauffman, 2007.) The role of the nurse as a member of the MDT within stroke rehabilitation is often viewed as co-coordinator. This is due to nurses are the sole provider of 24 hours care and responsibility of the stroke patient (RCN, 2007.) Nursing care delivered during stroke rehabilitation being underpinned by the care plans which have been developed by the different members of the MDT. When delivering care, which is multi disciplinary, the nurse

will need to use skills such as interviewing patients in order to establish consent. Observation of a patient to establish as to whether the care delivered is working and also interpretation of the information given by the patient to establish the need for input from the different disciplines. (Johnson, 1997.) The way in which nursing care is delivered during stroke rehabilitation will greatly be based around the Roper, Logan & Tierney model of nursing. The model, activities of daily living defines aspects of daily living which patients should aim to complete in order to maximize independence. Therefore the main components of stroke rehabilitation will focus on, amongst others, mobility and movement, communication, swallowing and everyday care activities, which are defined as activities of daily living within the model. (Roper et al, 2000.)

Members of the MDT which are greatly involved in stroke rehabilitation are that of the physiotherapist and occupations therapist. Both will work in collaboration with the nurse to implement and execute the delivery of the specific aspects of stroke rehabilitation which the different disciplines provide. This is achieved by the nurse ensuring strong communication amongst the various health professionals across the different disciplines, using methods such as multidisciplinary patient handovers. (NICE, 2008.) Physiotherapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention and rehabilitation. (Smith, 2004.) The input from a physiotherapist will be strongly geared towards mobility and movement. A common effect of stroke is weakness and paralysis in one side of the body which can cause problems with balance and co-ordination. This in turn can cause the affected side of

the body to become heavy and weak, resulting in difficulty moving. This will result in the stronger side of the body to overcompensate for the weaker side. (Uchino, 2011.) A physiotherapist will assess the alignment of the body, and will aim treatment towards the affected side moving more effectively with the rest of the body. A physiotherapist will achieve this in various ways such as, specific exercises techniques and massage. (Lennon, 2009.) The physiotherapist will do the initial assessment of a patients level of mobility to gain baseline information which will be used in creating a tailor made care plan. This is why the input from a physiotherapist is implemented straight away following a diagnosis. (Langhorne, 2005.) When developing care plans within stroke rehabilitation, all members of the MDT will work towards the National Stroke Strategys framework of quality markers. In 2007 the Department of Health (DoH) working alongside the National Institute for Health and Clinical Excellence developed the national stroke strategy. The national stroke strategy is seen as the gold standard when developing care plans and multidisciplinary input. The strategy presents healthcare professionals with a framework of 20 quality markers outlining the features of good stroke care, such as awareness, preventing stroke and stroke unit quality. Collectively the quality markers provide health professionals with an ambitious agenda in how to deliver world class stroke services. (DoH, 2007.) The daily nursing care to be delivered is greatly dictated on the assessments made by the other members of the MDT. The physiotherapist will communicate with the nurse as to the patients current level of mobility and as to how they are to be manually handled. Once the physiotherapist has established how a patient is to be mobilised it is then the job of the nurse to implement this within their day to day care of the patient as per Roper, Logan &

Tierney model. The physiotherapist will also advise the nurse on the level of self care a patient is capable of. Such as, whether a patient is able to wash and dress themselves independently or whether they will need input from the nursing staff. Where input from the nurse is required this must be done in a dignified manner and following consent as per the Nursing and Midwifery Code (NMC). Make the care of people your first concern, treating them as individuals and respecting their dignity. (NMC, 2010. 2) The occupational Therapist is another member of the MDT who is involved within stroke rehabilitation. The occupational therapist is concerned with helping to find practical solutions to let a person live as full of a life as possible. (Burton, 2000.) The referral for occupational therapy input is usually made via the nurse, to prepare for the patients discharge. The aim of the occupational therapist in stroke rehabilitation is to help a patient learn to live with the various disabilities following a stroke, in order return to their normal life as much as possible. The occupational therapist will aim to achieve this by using certain techniques tailored for common problems following stroke. Such as, many people who suffer left sided weakness following stroke. The occupational therapist will establish certain skills with the patient to minimize this to allow them to return to normal life. (Kristensen, 2011.) The occupational therapist will work closely with the nurse and physiotherapist when developing a care plan for the patient. As how much input a patient will require from occupational therapy is greatly determined on the assessments made by the nurse and physiotherapist on such things as moving and handling. It is vital that the occupational therapist communicates with the nurse to establish whether a patient would benefit from any adaptations to their home. The occupational therapist will assess the patients home

environment to establish its safety and if there are any adaptations such which could be used to allow the patient more independence. (Burton, 2000.) The dietician is a vital member of the MDT when caring for stroke patients. The dietician is concerned with educating the patient on healthy eating and drinking awareness, as high cholesterol and high blood pressure are identified as stroke risk factors. A dietician will work alongside the nurse within a hospital setting to advise the patient on healthy food and drink choices. The dietician can also have community input in following up with a patient and to advise of practical tips and advice such as recipes. This is deemed as secondary stroke prevention. (Kauffman, 2007.) In conclusion nurses bring a special quality to rehabilitation. That is the ability to blend the knowledge, experience and skill of the various members of the MDT to ensure the seamless transfer of care. Many members of the MDT contribute to the rehabilitation of the stroke patient. Many strokes are preventable and treatable and the damage caused by strokes may be greatly reduced following appropriate care. Nursing care delivered to coincide with the national stroke strategy will ensure that stroke patients can benefit from expert multidisciplinary care.

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