Journal List > Korean J Adult Nurs > v.30(3) > 1099909

Lee and Lee: Nursing Algorithm for Stroke Patients with Sensory Disorder

Abstract

Purpose

Although post-stroke sensory disorder is different from post-stroke pain, it is often considered as central pain or overlooked in the clinical field. The purposes of this study were to develop the nursing algorithm for stroke patients with sensory disorder and examine its effect.

Methods

The study used a methodological design to develop the nursing algorithm and a pretest-posttest design to examine its effect in stroke patients. The algorithm was developed through the ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) using systematic review, expert panel interview, and patient interview. The algorithm was applied to 51 ischemic stroke patients experi-encing sensory disorder at subacute stage by 10 nurses in a university hospital in Seoul city, Korea.

Results

The contents of the algorithm included inclusion and exclusion criteria for relevant patients, assessment tool developed in this study, and the intervention (non-pharmacological and pharmacological) process based on the assessment results. The assessment tool and the intervention process had acceptable inter-rater reliability with Cohen's Kappa .82 and .94, respectively. The scores of sensory disorder decreased from 2.71 to 0.51 with the algorithm application in 51 patients.

Conclusion

The nursing algorithm for sensory disorder in stroke patients improved the symptoms and can be used conveniently by clinical nurses. Using this algorithm, nurses can provide relevant care for stroke patients with stiff, cool, obtuse, or vibrating sensors that cause insomnia, anorexia, and physical functional decline.

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Figure 1.
The development process of nursing algorithm.
kjan-30-301f1.tif
Figure 2.
Nursing algorithm for stroke patients with sensory disorder.
kjan-30-301f2.tif
Table 1.
General Characteristics of Participants (N=61)
Participants Variables Categories n (%) M± SD
Patients (n=51) Gender Men 34 (66.7)
Women 17 (33.3)
Age (year) 63.76±11.81
Religion Christian 11 (21.6)
Roman catholic 9 (17.6)
Buddhism 8 (15.7)
No religion 21 (41.2)
Shamanism 2 (3.9)
Marital status Single 5 (9.8)
Married 29 (56.9)
Bereaved 17 (33.3)
Location of stroke Medulla infarction 1 (1.9)
Corona radiata infarction 2 (3.9)
Basal ganglion infarction 17 (33.3)
Internal capsule infarction 6 (11.8)
Thalamus infarction 6 (11.8)
Pons infarction 13 (25.5)
Cerebella infarction 6 (11.8)
Length of hospital stay (days) 33.53±12.53
Location of sensory symptom Hand 18 (32.3)
Foot 9 (17.6)
Upper extremity 11 (21.6)
Lower extremity 6 (11.8)
Face 7 (13.7)
Type of symptom Stiffness 16 (31.4)
Coolness 10 (19.6)
Obtuseness 15 (29.4)
Vibration 10 (19.6)
Severity of sensory symptom ≤1 2 (3.9)
2~3 47 (92.2)
≥4 2 (3.9)
Type of intervention Hot pack & aroma massage 22 (43.2)
Paraffin therapy 25 (49.0)
Pharmacological therapy 2 (3.9)
Observation 2 (3.9)
Nurses (n=10) Gender Women 10 (100.0)
Age (year) 36.40±8.37
Religion Christian 3 (30.0)
Buddhism 1 (10.0)
No religion 6 (60.0)
Marital status Single 2 (20.0)
Married 7 (70.0)
Bereaved 1 (10.0)
Education Bachelor degree 8 (80.0)
Master degree 2 (20.0)
Position Staff nurse 9 (90.0)
Charge nurse 1 (10.0)
Clinical experience (year) 13.24±9.02
Present ward experience (year) 4.86±2.90
Table 2.
Differences of Means between Importance and Performance (N=10)
Domains Items Importance Performance t p
M± SD M± SD
Selection Select the client by the inclusion criteria 4.70±0.48 4.40±0.52 1.96 .081
Select the client by the exclusion criteria 4.80±0.42 4.40±0.52 2.45 .037
Assessment Assess the sensory disorder whenever checking vital sign or if a patient complains 4.40±0.70 4.00±0.82 2.45 .037
Apply the body diagram 4.90±0.32 4.40±0.70 2.24 .052
Classify the symptoms into the types of sensory disorder 4.80±0.42 4.40±0.70 1.50 .168
Check the severity of the symptoms using the NRS 4.90±0.32 4.80±0.42 1.00 .343
Reassess the client at 60 minutes after the intervention 4.80±0.32 4.50±0.53 1.96 .081
Reassess if the pattern changes or the sensory disorder newly occurs 4.90±0.32 4.40±0.52 3.00 .015
Nursing intervention Preparation Notify to the physicians if the NRS score is 4 or over 5.00±0.00 4.90±0.32 1.00 .343
Decide the type of intervention by the NRS score 5.00±0.00 4.90±0.32 1.00 .343
Explain the intervention, purpose, side-effect and running time, and get permission 4.80±0.42 4.40±0.52 2.45 .037
Keep the privacy and calm environment 4.90±0.32 4.20±0.42 4.58 .001
Non-pharmacological therapy Hot pack Position the client to get the intervention comfortably 4.90±0.32 4.60±0.52 1.96 .081
Heat hot pack and check the temperature (46~52℃) 4.90±0.32 4.50±0.71 2.45 .037
Apply hot pack for 20~30 minutes and check the skin 5.00±0.00 4.70±0.48 1.96 .081
Aroma Position the client for aroma massage 4.90±0.32 4.60±0.70 1.41 .193
Apply the hot pack before massage 5.00±0.00 4.50±0.53 3.00 .015
Perform the aroma massage after selecting the oil 4.90±0.32 4.30±0.48 3.67 .005
Clean the oil by wet towel 4.80±0.63 4.40±0.70 2.45 .037
Paraffin Cleanse the hand or foot by warm and wet towel 4.80±0.42 4.40±0.70 2.45 .037
Check the temperature of paraffin wax (50~60℃) 4.90±0.32 4.80±0.63 1.00 .343
Apply vinyl and towel for 20 minutes, and remove them 4.70±0.48 4.60±0.52 0.56 .591
Check the skin for burn 5.00±0.00 4.60±0.52 2.45 .037
Pharmacological therapy Get the prescription for medicine from physicians if the NRS is 4 points or over 5.00±0.00 5.00±0.00 - >.999
Explain to the client about the medicine and administer it 5.00±0.00 5.00±0.00 - >.999

NRS=numeric rating scale.

Table 3.
Effects of the Nursing Algorithm for Sensory Disorder (N=51)
Variable Pretest Posttest t p
M± SD M± SD
Severity of sensory disorder 2.71±0.67 0.51±0.54 19.59 .001
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