الفهرس 
Anatomy of the brainOnly 14 pages are availabe for public view
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Abstract
S
troke remains a major cause of death and disability. Globally, it affects 13.7 million people per year and is the second leading cause of death, with 5.5 million deaths per year also, results in up to 50% of survivors being chronically disabled (Davis & Lockhart, 2016). (Eric, 2018), (Swan & Jay, 2019) & (Bruce et al., 2019).
Abd-Allah, (2014), Shehata et al., (2016) & Araf, (2017) mentioned that, the overall prevalence of stroke rate in Egypt is high with crude prevalence rate of 963/100.000 inhabitants and the annual incidence of stroke has been roughly estimated to be 150.000-210.000 or 270.000 patient with stroke annually in Egypt.
Stroke is an emergency that requires effective triage, diagnosis and critical management. Hypertension, coagulation disorders, and cardiac diseases are common causes of both ischemic and hemorrhagic stroke. A detailed evaluation of the focal neurological deficits may provide a clue as to the affected cerebral vessel or region. (AMBOSS, 2019)
Care of patient with stroke provided in the first hours is critical in shaping patient’s long term recovery and prognosis as it is directed toward minimizing damage resulting from CVS, maintaining cerebral perfusion and decreasing risk of farther damage. As members of the healthcare team strive to meet treatment goals for stroke, nurses serve as timekeepers and provide constant updates throughout the process (English & Victoria, 2019).
Nurses play a pivotal role in rapid identification and triage of patients with acute stroke, initial assessment and coordinating the timely flow of patients with acute stroke through the health system. Nurses enable delivery of relevant time treatments and rapid transfer to acute stroke units for ongoing assessment and provision of further treatment (Middleton et al, 2015).
Aim of the study: -
The aim of this study was to assess the health team performance in the first 24hrs regarding patients with stroke through the following:-
• Assessing the health team level of knowledge regarding patient with stroke.
• Assessing the health team level of practice regarding patient with stroke.
• Assessing the health team attitude regarding patient with stroke.
Research questions:
• What is the health team level of knowledge regarding patient with stroke in the first 24hrs?
• What is the level of health team practice regarding patients with stroke in the first24hrs?
• What is the health team attitude regarding patients with stroke in the first 24hrs?
The present study was carried out through:
-Technical design
- Operational design
- Statistical design
- Administrative design.
Study tools: Three tools were used to collect data of the study as following:-
I. Tool І: Health team self-administered questionnaire (Appendix І): it was developed by the researcher based on the related literatures(Sullivan & Dunton, 2006), (Ibrahim, 2012), (Ibrahim, 2016) (Carter & Farhaan, 2017)& (Turco, 2017) modified by the researcher and was consisted of two parts:
A. 1st part concerned with assessment of demographic characteristic data that included (age, gender, level of education, experience years and pervious training courses).
B. 2nd part concerned with assessment health team knowledge test about stroke that consists of questions including different areas for nurses, neurologists and ICU physicians.
II. Tool ІІ: Observational checklist (Appendix ІІ) that was developed by the researcher based on the related literatures (Wellwood et al., 2011), (Ibrahim, 2012), (Ibrahim, 2016) & (Fathy, 2017). It used to assess practice of health team in the first 24hrs regarding patients with stroke.
A- For nurses’ performance observational checklist. It included 2 parts as following:
• 1stpart:- Immediately patient’s assessment.
• 2nd Part: Nurses’ interventions during first 24 hours
B- For neurologists and ICU physicians’ performance observational checklist. It included 5 parts.
III. Tool Ш: Health team self-administered form (attitude scale) (Appendix Ш): It was developed by the researcher after reviewing the relevant literature (Lillis & et al., (2011), (Ibrahim, 2012), (J Neurosci Rural Pract. 2016) and (Egyptian Journal of Neurology, psychiatry and Neurosurgery, 2016), (Ibrahim, 2016) & (Fathy, 2017). It used to assess health team attitude in the first 24 hours regarding patients with stroke.
Pilot study: - was conducted on 10 % of health team (6nurses and 4 neurologists & ICU physicians) under study in order to test the applicability of the developed tools, the clarity of included questions as well as the average time needed to complete all questions. Results obtained were studied and analyzed accordingly, modifications were made for the final development of the tools, and the study’s health team who shared in pilot study was excluded from the study sample.
Field work: Was included two phases as following:-
1- Preparatory phase: it included reviewing of the current and more recent national & international literature reviews concerning health team performance regarding patients with stroke in first 24hours of various aspects of this issue in order to develop data collection tools.
2- Implementation phase: including first: field work
Interviewing with (60) nurses and (40) neurologists and ICU physicians caring for patient with stroke in the first 24 hours at the previously mentioned setting to explain the aim of the study, the effect of this study on their performance as well as impact of this study on patient quality of care, patients’ safety and take their approval to participate in the study prior to any data collection. Second: assessing health team performance (knowledge and practice & attitude) regarding care of patients with stroke in first 24hours. By using self-administered questionnaire tool, observational checklist & attitude likert scale.
Results of this study showed that:
In summary, the results of the study revealed that for nurses, (60%, 51.7%, and 55.0%) respectively of them had an unsatisfactory level of knowledge, practice and had a negative attitude in the first 24 hours regarding patients with stroke. Also, there was a highly statistically significant relation between nurses’ knowledge, practice, attitude and their demographic data (age, level of education, years of experience and training courses). And, for neurologists’ and ICU physicians’ results, (65%, 60% and 55%) respectively of them had satisfactory level of knowledge, practice and had a positive attitude. Furthermore, there was a highly statistically significant relation between nurses’ knowledge, practice, attitude and their demographic data (age, level of education, years of experience and training courses). Also, there was a highly statistically significant relation between neurologists and ICU physicians’ knowledge, practice, attitude and their demographic data (age, level of education, years of experience and training courses).
It was concluded from this study that:
• About two thirds of nurses had an unsatisfactory level of knowledge, about more than half of them had unsatisfactory level of practice and more than half of them had a negative attitude.
• More than two thirds of neurologists and ICU physicians had a satisfactory level of knowledge, about two thirds of them had a satisfactory level of practice and more than half of them had a positive attitude.
The study recommended that:
• Establish in- service educational and training programs for continuous updating health team knowledge and practice especially nurses about stroke management.
• Hospitals should establish policies for stroke management especially in the first 24 hours and should be available.
• Develop a protocol for stroke management especially in the first 24 hours written in Arabic and English which contain interventions for stroke in the first 24hours.