Evidence-Based Initial Nursing Care for Acute Stroke in Emergency Settings: a Scoping Review
Main Article Content
Abstract
Objective: To identify and map evidence-based practices and international guidelines related to initial nursing interventions in the emergency management of acute stroke.
Method: This scoping review followed the Joanna Briggs Institute (JBI) framework and the PRISMA-ScR checklist. A comprehensive literature search was conducted in PubMed, CINAHL, Scopus, the WHO guideline repository, and Google Scholar. Studies and guidelines published between 2015 and 2024 were included. Data extraction focused on study characteristics, nursing roles, and intervention components. Results were analyzed descriptively and thematically.
Results: Fourteen studies and guidelines met the inclusion criteria. Most originated from high-income countries, with the USA and China being the most represented. The included documents comprised experimental studies, guidelines, reviews, and implementation evaluations. Key nursing roles included stroke triage, NIHSS assessment, vital sign monitoring, dysphagia screening, thrombolysis preparation, and coordination with stroke teams. Structured protocols, such as FeSS bundles, and simulation-based training were reported to enhance care delivery and patient outcomes. However, gaps remain in the explicit articulation of nursing responsibilities in many guidelines.
Conclusion: Nurses play a critical role in the early management of acute stroke in emergency settings. Standardized, context-adapted nursing protocols and targeted training are needed to optimize stroke outcomes and ensure effective integration of nursing practices into emergency stroke pathways.
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References
I. Pu L, Wang L, Zhang R, Zhao T, Jiang Y, Han L. Projected Global Trends in Ischemic Stroke Incidence, Deaths and Disability-Adjusted Life Years From 2020 to 2030. Stroke. 2023 May;54(5):1330–9.
II. Singh RJ, Chen S, Ganesh A, Hill MD. Long-term neurological, vascular, and mortality outcomes after stroke. International Journal of Stroke. 2018 Oct 1;13(8):787–96.
III. Coleman ER, Moudgal R, Lang K, Hyacinth HI, Awosika OO, Kissela BM, et al. Early Rehabilitation After Stroke: a Narrative Review. Curr Atheroscler Rep. 2017 Nov 7;19(12):59.
IV. Whitehead S, Baalbergen E. Post-stroke rehabilitation. South African Medical Journal. 2019 Mar 7;109(2):81–3.
V. Bernhardt J, Godecke E, Johnson L, Langhorne P. Early rehabilitation after stroke. Current Opinion in Neurology. 2017 Feb;30(1):48.
VI. Waqas M, Vakharia K, Munich SA, Morrison JF, Mokin M, Levy EI, et al. Initial Emergency Room Triage of Acute Ischemic Stroke. Neurosurgery. 2019 July;85(suppl_1):S38.
VII. Cereda CW, Olivot JM. Emergency Department (ED) Triage for Transient Ischemic Attack (TIA). Curr Atheroscler Rep. 2018 Sept 25;20(11):56.
VIII. Middleton S, Dale S, Cheung NW, Cadilhac DA, Grimshaw JM, Levi C, et al. Nurse-Initiated Acute Stroke Care in Emergency Departments. Stroke. 2019 June;50(6):1346–55.
IX. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation. 2018 July 1;128:191–7.
X. Ebker-White A, Dinh M, Paver I, Bein K, Tastula K, Gattellari M, et al. Evaluating Stroke Code Activation Pathway in Emergency Departments study. Emergency Medicine Australasia. 2022;34(6):976–83.
XI. Ma SY. Evaluating the impact of evidence-based nursing in combination with clinical nursing pathway for nursing care of patients with stroke: A protocol for systematic review and meta-analysis. Medicine. 2022 Jan 14;101(2):e28278.
XII. Theofanidis D, Gibbon B. Nursing interventions in stroke care delivery: An evidence-based clinical review. Journal of Vascular Nursing. 2016 Dec 1;34(4):144–51.
XIII. Green TL, McNair ND, Hinkle JL, Middleton S, Miller ET, Perrin S, et al. Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association. Stroke. 2021 May;52(5):e179–97.
XIV. Kumar A, Kumar M, Verma P, Pal R, Nagi M, Mahesh KV, et al. Effects of stroke nurse-led acute stroke management on treatment time benchmarks, intravenous thrombolysis rates, and patient outcomes: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108216.
XV. Middleton S, Dale S, Cheung NW, Cadilhac DA, Grimshaw JM, Levi C, et al. Nurse-Initiated Acute Stroke Care in Emergency Departments: The Triage, Treatment, and Transfer Implementation Cluster Randomized Controlled Trial. Stroke. 2019 June;50(6):1346–55.
XVI. Wang S, Xin HN, Chung Lim Vico C, Liao JH, Li SL, Xie NM, et al. Effect of an ICU diary on psychiatric disorders, quality of life, and sleep quality among adult cardiac surgical ICU survivors: a randomized controlled trial. Crit Care. 2020 Mar 6;24(1):81.
XVII. Ashcraft S, Wilson SE, Nyström KV, Dusenbury W, Wira CR, Burrus TM, et al. Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association. Stroke. 2021 May;52(5):e164–78.
XVIII. Camicia M, Lutz B, Summers D, Klassman L, Vaughn S. Nursing’s Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community. Stroke. 2021 Dec;52(12):e794–805.
XIX. Boulanger JM, Lindsay MP, Gubitz G, Smith EE, Stotts G, Foley N, et al. Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. Int J Stroke. 2018 Dec;13(9):949–84.
XX. Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013 June;12(6):585–96.
XXI. Lee SH, Ryoo HW, Jin SC, Ahn JY, Sohn SI, Hwang YH, et al. Prehospital Notification Using a Mobile Application Can Improve Regional Stroke Care System in a Metropolitan Area. Journal of Korean Medical Science [Internet]. 2021 Nov 10 [cited 2025 July 24];36(48). Available from:
https://doi.org/10.3346/jkms.2021.36.e327
XXII. Zhang T, Li X, Sun G, Wang J, Chen H. Establishment of emergency-nursing pathway of interventional thrombectomy in acute ischemic stroke. Am J Transl Res. 2021 Oct 15;13(10):11966–73.
XXIII. Considine J, McGillivray B. An evidence-based practice approach to improving nursing care of acute stroke in an Australian Emergency Department. J Clin Nurs. 2010 Jan;19(1–2):138–44.
XXIV. Zhang T, Li X, Sun G, Wang J, Chen H. Establishment of emergency-nursing pathway of interventional thrombectomy in acute ischemic stroke. Am J Transl Res. 2021;13(10):11966–73.
Muniyandi AD, Raju N, Vibha D. The Efficacy of Nurse-Led Bundle Care in Preventing Post-Acute Complications and Enhancing Quality of Life in Stroke Patients: A Systematic Review and Meta-analysis. J Pharm Bioallied Sci. 2024 Dec;16(Suppl 5):S4310–3.
XXV. Sun Z, Jiang H, Chen C, Fan Y. Effect of Comprehensive Nursing Intervention on the Effect of CT-Guided Intravenous Thrombolysis in Acute Cerebral Infarction. J Healthc Eng. 2022 Jan 17;2022:6959416.
XXVI. Quinn C. Stroke care in the emergency department: The nurse’s role. Journal of Intensive and Critical Care Nursing [Internet]. 2023 [cited 2025 July 24];6(5). Available from:
https://www.alliedacademies.org/abstract/
XXVII. Sanjuan E, Pancorbo O, Santana K, Miñarro O, Sala V, Muchada M, et al. Management of acute stroke. Specific nursing care and treatments in the stroke unit. Neurologia (Engl Ed). 2020 Nov 2;S0213-4853(20)30291-7.
XXVIII. Theofanidis D, Gibbon B. Nursing interventions in stroke care delivery: An evidence-based clinical review. J Vasc Nurs. 2016 Dec;34(4):144–51.
XXIX. Sun Z, Jiang H, Chen C, Fan Y. Effect of Comprehensive Nursing Intervention on the Effect of CT-Guided Intravenous Thrombolysis in Acute Cerebral Infarction. J Healthc Eng. 2022 Jan 17;2022:6959416.
XXX. Liu Z, Zhao Y, Liu D, Guo ZN, Jin H, Sun X, et al. Effects of Nursing Quality Improvement on Thrombolytic Therapy for Acute Ischemic Stroke. Front Neurol. 2018;9:1025.
XXXI. Kotalux C, Kensakoo T, Srithumsuk W. Nursing outcome quality indicators for patients with ischemic stroke receiving thrombectomy treatment: A Delphi study. Belitung Nurs J. 2022 Dec 27;8(6):491–6.
XXXII. Zhao Y, Xu Y, Ma D, Fang S, Zhi S, He M, et al. The impact of education/training on nurses caring for patients with stroke: a scoping review. BMC Nursing. 2024 Feb 2;23(1):90.
XXXIII. Bohmann FO, Guenther J, Gruber K, Manser T, Steinmetz H, Pfeilschifter W, et al. Simulation-based training improves patient safety climate in acute stroke care (STREAM). Neurol Res Pract. 2021 July 12;3(1):37.
XXXIV. Tahtali D, Bohmann F, Kurka N, Rostek P, Todorova-Rudolph A, Buchkremer M, et al. Implementation of stroke teams and simulation training shortened process times in a regional stroke network—A network-wide prospective trial. PLoS One. 2017 Dec 5;12(12):e0188231.
XXXV. Aljuwaiser S, Abdel-Fattah AR, Brown C, Kane L, Cooper J, Mostafa A. Evaluating the effects of simulation training on stroke thrombolysis: a systematic review and meta-analysis. Advances in Simulation. 2024 Feb 29;9(1):11.
XXXVI. Harring AKV, Røislien J, Larsen K, Guterud M, Bugge HF, Sandset EC, et al. Gamification of the National Institutes of Health Stroke Scale (NIHSS) for simulation training—a feasibility study. Advances in Simulation. 2023 Feb 22;8(1):4.
XXXVII. Sezgin MG, Bektas H. Effectiveness of interprofessional simulation-based education programs to improve teamwork and communication for students in the healthcare profession: A systematic review and meta-analysis of randomized controlled trials. Nurse Education Today. 2023 Jan 1;120:105619.
XXXVIII. Chu CH, Sorin-Peters R, Sidani S, De La Huerta B, McGilton KS. An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders. Rehabil Nurs. 2018;43(6):E25–34.
XXXIX. Dees ML, Carpenter JS, Longtin K. Communication Between Registered Nurses and Family Members of Intensive Care Unit Patients. Crit Care Nurse. 2022 Dec 1;42(6):25–34.
XL. Blaquera AP, Soriano GP, Ito H, Yasuhara Y, Tanioka T. Elements of a nurse-coordinated post-stroke home care rehabilitation in the Philippines: A cross-sectional study. Belitung Nurs J. 2024 Nov 24;10(6):624–34.
XLI. Gausvik C, Lautar A, Miller L, Pallerla H, Schlaudecker J. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. J Multidiscip Healthc. 2015;8:33–7.