Attitudes of Nurses Toward Disability and Treatment in Space-Occupying Middle Cerebral Artery Stroke
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Attitudes toward the degree of acceptable disability and the importance of aphasia are critical in deciding on decompressive hemicraniectomy (DHC) in space-occupying middle cerebral artery stroke (SOS). The attitudes of nurses deserve strong attention, because of their close interaction with patients during acute stroke treatment.
This is a multicenter survey among 627 nurses from 132 hospitals in Germany. Questions address the acceptance of disability, importance of aphasia, and the preferred treatment in the hypothetical case of SOS.
Modified Rankin Scale (mRS) scores of 1 and 2 were considered acceptable by the majority of all respondents (89.7%). A mRS of 3, 4, and 5 was considered acceptable by 60.0, 15.5, and 1.6%, respectively. DHC was indicated as the treatment of choice in 31.4%. Every third participant considered the presence of aphasia important for treatment decision (33.3%). Older respondents more often refrained from DHC, irrespective of the presence of aphasia (dominant hemisphere p = 0.001, non-dominant hemisphere p = 0.004). Differences regarding acceptable disability and treatment decision were dependent on age, sex, and having relatives with stroke.
Most German nurses indicate moderately severe disability after SOS not to be acceptable, without emphasizing the presence of aphasia. The results call for greater scientific efforts in order to find reliable predictors for outcome after SOS.
KeywordsDecompressive hemicraniectomy Malignant middle cerebral artery infarction Outcome Disability Survey
H.N. was involved in study design, analysis and interpretation of data, and drafting the manuscript. F.M. was involved in clinical data collection and critical revision of the manuscript for important intellectual content. I.U. was involved in interpretation of data and critical revision of the manuscript for important intellectual content. M.K. was involved in analysis and interpretation of data and critical revision of the manuscript for important intellectual content. E.J. was involved in study concept, design, supervision, and critical revision of the manuscript for important intellectual content.
Source of Support
Compliance with Ethical Standards
Conflict of interest
Hermann Neugebauer received travel grants and speaker’s honoraria from Boehringer Ingelheim, Bayer, and Daiichi Sankyo. Eric Jüttler received research grants from the German Research Foundation (DFG) and from the Federal Ministry of Education and Research (BMBF), and speaker’s honoraria and travel grants from Daiichi Sankyo, Bristol Myers Squibb, Pfizer, Bayer, and Boehringer Ingelheim. Flora Malakou, Melitta Köpke, and Ingo Uttner do not report any disclosures. The study was investigator driven and not industry sponsored.
The Ethics Committee of the Charite - University Hospital Berlin, Germany (EA4/127/10), approved the survey.
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