Effectiveness of the “Elevated Position” Nursing Care Program in promoting the reconditioning of patients with acute cerebrovascular disease

Abstract

Aim: Over 34,000 Japanese patients suffer from a persistent disturbance of consciousness. The purpose of this study was to investigate the effectiveness of the "Elevated Position" Nursing Care Program (EPNCP) in promoting the reconditioning of patients with acute cerebrovascular disease (ACD). The primary assumption of this study was that they could experience the reconditioning process and would reach a reconditioned state through their involvement in the EPNCP, thus improving their level of consciousness and quality of life. Method: A historical controlled trial study, based on an intention-to-treat analysis of hospitalized patients with ACD who became participants the day after starting medical or surgical treatment, was used. Trained nurses implemented the EPNCP from May to September 2005 for an experimental group of 45 participants. The data on two independent control groups of 92 and 40 patients with ACD were gathered from historical medical records. The six measures were: Japan Coma Scale; Level of Cognitive Functioning Assessment Scale; number of days from the intervention to sitting in a wheelchair; number of participants who left the intensive care unit (ICU) by wheelchair; Barthel Index; and modified Rankin Scale. Results: Significant differences were found regarding the number of participants who left the ICU by wheelchair, length of time from the EPNCP's commencement to the wheelchair-sitting position, and the Barthel Index 1 week after leaving the ICU. Conclusion: The EPNCP was safe for the reconditioning of patients with ACD and somewhat effective in improving their physical function. A comprehensive nursing care program now exists for elevating patients with cerebrovascular disease during the early phase following the onset of symptoms or immediately after surgery. Further research should be conducted, extending the duration of the intervention program and the length of the measurement period, followed by a careful analysis of the results.

The effect of discharge training and telephone counseling service on patients’ functional status and caregiver burden after stroke: A randomized controlled trial

“…24 The mRS evaluating the functional limitation and degree of addiction occurring in the patient after stroke was evaluated in seven categories (0: No symptoms, 1: No obvious deficits, 2: Mild deficits, 3: Moderate deficits, 4: Severe deficits, 5: Very severe deficit and 6: Death). 25 According to this scale, those who scored 1-2 points continue to live independently, and those who score 3 or more depended on. This scale is also used clinically to distinguish post-stroke disability and recovery levels.…”

Effectiveness of the Sitting Position Without Back Support

“…Even in previous research on the implemen- tation of SB on post-surgery patients with cerebrovascular disorder in the ICU, and the adoption of an SB care program that included an assessment guide for nurses there was no worsening of the APACHE II score, and the acquisition rate for daily activities rose (Okubo, 2012). From this research as well, there is a strong possibility that the administration of SB for acutely ill patients, along with a nurse's assessment, is safe.…”

“…Later, systematic studies utilizing physiological indexes were carried out to verify results presented in the case studies (Okubo & Hishinuma, 1998;Okubo et al, 2012;Okubo, Eguchi, Shinaji & Hishinuma, 2005;Okubo, Kohgo, Mizusawa & Hishinuma , 2002). Currently, there is research reported on SB for example with acutely ill patients (Tamura, Sugano, Watanabe & Okawa), patients with acute cerebrovascular disease (Okubo, 2012) and head trauma patients (Kishibe et al, 2011;Okubo & Hishinuma, 2005). Patients on ventilators, and patients that have undergone a thoracotomy procedure (Abe, Okubo & Ueno, 2014) represent a newer group of patients that may benefit from SB related to their prolonged recovery time.…”