Abstract WP465: Roles of Nurses in Providing Intravenous rt-PA Therapy for Patients With Acute Cerebral Infarction

Abstract

Purpose: Intravenous rt-PA therapy is effective, however the frequency of this therapy for cerebral infarctions in Japan is only 6 to 7 percent, and the roles of nurses after patients are admitted to hospitals vary depending on the institutions. This study aimed to identify the roles of nurses conducting this treatment. Methods: We conducted a questionnaire survey with 67 participating hospitals. Questions for supervisors were about institutional arrangements, and those for the nurse were about the role of nurses. The research was conducted with the approval of the Ethics Committee of Nakamura Memorial Hospital. Results: The facility size of 18 facilities was with less than 300 beds, 24 with 300 - 500 beds, and 26 with 500 beds or more. The facilities reported that they have ‘nursing service regulations’ (n = 55), ‘roles are clearly defined’ (n = 55), ‘arrangements for routine examinations’ (n = 65), ‘target time frames for each task’ (n = 53), and ‘meetings with other staff members involved’ (n = 35). In more than 80% of the facilities, nurses conduct ‘procedures for accepting patients’, ‘vital sign measurements’, and ‘‘physical preparation of the patient’. Few conducted the ‘NIHSS evaluation’, ‘information collection’, ‘ordering of pre-examinations’, and ‘confirmation of the results of blood samples’. About half of the facilities reported that the ‘NIHSS evaluation’ and ‘information collection’ are the roles of physicians and nurses in cooperation. Further, ‘blood sample collection and insertion of intravenous catheters,’ ( p =.004), ‘observing patients during pre-examination and transfer’, ( p =.008), and ‘insertion of urethral indwelling catheters’ ( p =.004) were significantly correlated with the number of beds, the roles of nurses in facilities with < 300 beds. Items in ‘patient’s observations during pre-examination and transfer,’ ( p =.006) were significantly different from the use of role allocation rules, and this role was conducted by nurses in facilities with clear role allocations. Conclusions: In this treatment, preparations for treatment and observing patients are commonly considered the roles of nurses, but nurses in smaller hospitals were assigned more roles, suggesting that the main factor behind this is the number of physicians available.