Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l'identificazione (Il parte)

Introduction: the aim of this study was fo highlighf the advanced nursing competences in the stroke clinical pathway in order to define effectivestrategies for patients treatment, useful in ensuring greater chances of functional recovery. Three major objectives were identified: to stress thepresence and the application of advanced clinical practice tools; to look info the basic knowledge specific for stroke care; to explore postgraduateeducation programs and the actual attendance at professional continuing education courses.Materials and Methods: a cross-sectional observational study design was used to study a convenìence sample of 109 nurses working in the various unitsinvolved in the stroke clinical pathway of three Roman hospitals. The variables were measured by an investigator-developed questionnaire, from September20 ì 2 lo January 2013.Results: nurses working in the emergency area use the Cincinnati Prehospital Scale and the Glascow Coma Scale with a rate of9l% in the Terrìtorial EmergencyService and 81% in the Casualty and Emergency Department; the Ifalian National Institute of Health Stroke Scale (NIHSS) is used by 98% of nursesworking in Ihe Stroke Units. A low percentage of professionals uses clinical governance tools such as clinical audit (37%) and Evidence Based Nursing(33%>). 70% of nurses recognize the importance of brain tomography for stroke diagnosis and 80%, of them know the time limit for the administration oftreatment of thromboembolism rtPA (Recombinant Tissue Plasminogen Activator); 33% of nurses aftended a master, mainly in criticai care; 46% attendedrefresh courses, 8%> chose courses on stroke.Discussion: nurses with advanced competencies are called to improve their expertise and to extend their role through specific training sessions. Nursesshould also expand their knowledge on how to acquire an advanced clinical practise.Conclusions: advanced clinical knowledge and skills are currently used by nurses involved in the management of stroke. Both knowledge and skills are keyto manage such complex and instable patients, though these nursing advanced competences usually don't receive any formai recognition.Key words: stroke care, stroke nursing management, advanced nursing practice, clinical nurse specialist, stroke clinical pathwa