Management of elderly people with Stroke: strategies based on action research

To elaborate and implement, through an educational intervention with the nursing team of the Emergency Unit, strategies that contribute to the management of elderly people suspected/affected by Stroke.

Method:

Action research with eighteen nursing professionals working in the Emergency Unit of a reference hospital. The data were collected through five pedagogical workshops and systematized through the thematic analysis.

Results:

After a situational analysis and identification of the difficulties in the management of these elderly, a synthesis chart was prepared with strategic actions, responsible professionals and perspectives for implementation in the short, medium and long term. Short-term strategies had, for the most part, immediate implementation; the others were agreed on the need for further implementation.

Final considerations:

The educational intervention allowed the construction of strategies that were implemented or agreed with the management for later applicability, sensitizing the group regarding the importance of the qualification and prompt care in the management of the elderly suspected/affected by Stroke.

Descriptors:
Aged; Nursing, Team; Stroke; Emergency Service, Hospital; Education, Continuing

Intervening Factors	Formulated actions	Responsibles	Opinion of the Nursing Coordination
Insufficient multi-parameter monitoring equipment.	To notify the termination/breakdown of the equipment to the maintenance sector. To acquire new materials. To create daily checklist of materials for checking vital signs.		The checklist for checking the materials at the end of each shift was developed and implemented. To clarify to the nursing team the flow to be followed in case of break/lack of material. To request hospital acquisition of multiparametric monitors.
Difficulty in identifying people affected by Stroke due to the diseases that mimic this disease.		Nursing Coordination of the EU Research Support Team	Educational material already prepared and printed, awaiting the availability of this in the units.
Poor accommodation in the beds.	To install Pyramidal Foam Mattress in the bed when the elderly person is admitted. To inspect the skin daily, intervening as needed. To guide the family to assist in the daily inspection of the skin, communicating some abnormality.		To discuss with the care team the availability of the Pyramidal Foam Mattress, and how to proceed with the request.
Precarious periodic evaluation in the waiting room, elderly people outside therapeutic window.	To scale nursing technician in the waiting room. To check vital signs at least 6/6 h.	Nursing Technicians Nursing Coordination of the EU	Not feasible action in short term, due to the large number of patients in the EU, and the limitation of professionals.
Absence of food for the elderly in the EU waiting room.	To discuss with the nutrition team about the feasibility of feeding the elderly patients in the waiting room.	Nursing Coordination of the EU	The nutrition service indicated that this action is feasible only in the long term.
Unknowing the elderly and their relatives about the signs and symptoms of Stroke.	To perform Health Education activities in the waiting room. To deploy TV in the waiting room, with health information and hospital service profile.	Permanent Education Sector Hospital managers and nursing director	It will be discussed with the Permanent Education team, the creation of posters with educational material, for presentation in the waiting room. The TV was bought and installed in the waiting room. The personnel of the hospital’s communication department will make available exhibition material on TV, on topics related to Stroke, among other things.

Interveining factors	Formulated actions	Responsibles	Opinion of the Nursing Coordination
Unpreparedness of bioimaging and EU professionals in patient management and prioritization.	To conduct Stroke training for bioimaging and EU professionals.	The Stroke U and Permanent Education Sector of the Hospital	The Permanent Education sector of the hospital was informed about the need for training of EU professionals and bioimaging.
Insufficient sizing of professionals.	To daily size technical professionals according to clinical criteria and level of care complexity.	Nurses of the EU	The nurses were advised on the need to enable the sizing according to demand.
Elderly users with high dependence for care.	To carry out Health Education activities for patients and caregivers, emphasizing the importance of stimulating self-care and support in the process of hospitalization and discharge.	Nurses and nursing technicians of the EU	Long-term activity.

Problems identified	Formulated actions	Responsibles	Opinion of the Nursing Coordination of the EU
Overcrowding of the EU with low complexity patients.	Regulation of patients for support units- Medical reassessment in a timely manner	Public managers- Medical Board	Agree with the need, but it goes beyond the sphere of the hospital.
Insufficient human resource.	Hiring new professionals	Hospital Board, Nursing Board	Agree with need, however it goes beyond the sphere of the hospital.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Alyne Henri Motta Coifman. E-mail: alymotta@yahoo.com.br