Palliative treatment for stroke

Randomized comparison between objective-based lectures and outcome-based concept mapping for teaching neurological care to nursing students

BACKGROUND

Pre-registration programs have been found to insufficiently prepare nurses for working in the neurosciences specialism. Effective approaches to neurology education are important, not only to enhance motivation to learn, but also for learners to develop basic competence in handling patients with neurological problems.

OBJECTIVES

To demonstrate that outcome-based course design using concept mapping would bring about significant differences in the nursing students' competency, cognitive load, and learning satisfaction with the neurological care course.

METHODS

A two-group pretest and post-test experimental study was administered. Two of the four clusters of participants were randomly assigned to the experimental group for experiencing an outcome-based course design using concept mapping, and the rest were designated the control group to be given objective-based lectures only. The Competency Inventory of Nursing Students, Cognitive Load Scale of Neurological Nursing, and Learning Satisfaction Scale of Neurological Nursing were used in this study for the students to rate their own performance. In addition, The Concept Map Scoring Scale was used in the experimental group for examining students' concept mapping ability.

RESULTS

Significant increases of mean nursing competency scores in both groups from pre-test to post-test were found. There was no statistically significant difference in mean nursing competency score between the experimental group and the control groups at post-test. The mean cognitive load score of the experimental group was lower than the control group at post-test. The mean learning satisfaction scores of the experimental group were higher than the control group.

CONCLUSIONS

This article provides that outcome-based concept mapping as educational method could encourage a group of nursing students to take a bio-psycho-social approach to medicine, which might ultimately result in better nursing care quality.

A Palliative Approach to Neurological Care: A Literature Review

This review assesses the current opinion towards early palliative care in neurology and discusses the existing evidence base. A comprehensive literature search resulted in 714 publications with 53 being directly relevant to the scope of this review. The current literature reflects primarily expert opinion and describes a growing interest in the early introduction of palliative principles into neurological care. Early initiation of palliative interventions has the potential to improve quality of life, enhance symptom management and assist in advance care planning. Further data is required to determine whether this shift in philosophy has a positive impact on patient care.

[Changes in therapy aims and palliative treatment for severe stroke]

Recent years have seen considerable advances in acute stroke treatment. Patients who survive the acute phase following major stroke often retain severe limitations of motor, cognitive, and communicative functions. In such patients whose death is imminent, curative therapies should be avoided. Instead, the goal of any therapy should shift to palliative treatment and concentrate on reducing causes of suffering. Palliative methodologies and concepts are already well established in neurology, e.g. for amytrophic lateral sclerosis. Particularly those stroke patients who remain stable for a long period with massive neurological deficits require interdisciplinary palliative care that goes beyond mere reduction of symptoms and seeks a response to possible complications and the question of maintaining life-preserving measures. Not only medical indications but also the expressed or presumed will of the patient must be included in such considerations. This article describes and elucidates basic questions of palliative medicine and symptomatic palliative treatment concepts for stroke patients.