Researching stroke incidence: working as a research nurse can be challenging, leading to new ways of working in a variety of hospital and community settings.

WHEN MIDDLEMORE Hospital staff nurse Helen Walters began nursing six years ago, she assumed she would always be working rostered and rotating shifts in the acute hospital setting. These days, however, she's working four days a week as a research nurse, and has been surprised to discover how many other nurses are involved in this work.

Her move away from the ward began last year when she was invited to apply for a position as a research nurse on the Auckland Regional Community Stroke Study (ARCOS), working under the auspices of the University of Auckland's Faculty of Medicine and Health Sciences' clinical trials research unit. She completes her last interviews with patients next month, with principal investigator Craig Anderson expected to release results mid-next year.

ARCOS studies were conducted in 1981 and 1991 into the incidences of coronary heart disease and stroke. ARCOS 111 focuses on stroke alone. A team of eight nurses has interviewed more than 2000 people who suffered a stroke between March 2002 and February 2003. Each interviewee was interviewed three times over a six-month period. The study aims to measure the frequency, causes and effects of stroke, which is the third leading cause of death in New Zealand and a major cause of disability. About 18,000 New Zealanders are living with the effects of stroke and this number is predicted to double by 2020, as the population ages. (1) It is hoped the information gained, particularly about the factors that influence recovery, will allow better targeting of services and improvements for patients and families affected by this illness.

As a community research nurse working in the South Auckland region, Walters' initial task was to approach people to participate in the study if their stroke occurred during the study period. She visited private hospitals, rest-homes and people in their own homes to interview them or their families/caregivers or representatives. Information gathered included socio-demographic data, medications, treatment and any possible risk factors, including depression and suicidal ideation.

"The change from working in the acute hospital setting to focusing on people in the community and being self-managing has been dramatic," said Waiters. "The autonomy and initiative needed in this new role has challenged and changed my approach and style of nursing. My role has been a bit like that of a detective, analysing and critiquing the information to distill it to its essence. I have had to develop very good listening skills as well as a super capacity bladder to hold all the tea I have been given.

"I have never felt unsafe working in the community. People have always been welcoming and very grateful when I have been able to help them in return, for example providing further education and support, and referring them to other providers where needed. It has been encouraging to see people so willing to take part in this study for the benefit of others."

Like the other research nurses, Waiters has encountered a wide range of nationalities among her interviewees, and was grateful for the assistance of interpreters. "Unlike the Stroke Foundation, we had funding for this resource. It was clear to me that a number of new immigrant people, including refugees, are falling through the gaps and missing out on the health services they need. The key to stroke prevention is education--there is still a lot of ignorance in the community about the risk factors for having a stroke."

Being an ARCOS research nurse, says Waiters, has developed her skills in communication and interpersonal interaction with both patients and health professionals. Her admiration and appreciation for the profession of nursing has also deepened, as she has explored new ways of using her nursing skills. Auckland University has recently employed Waiters three days a week as a stroke research nurse at Middlemore Hospital. She hopes to begin work soon on two further stroke studies (one on acute thrombolisis; the other on fish oil treatment efficacy), once ethical approval has been gained.

Facts about stroke and rehabilitation 

ON AVERAGE, New Zealanders have a one-in-eight chance of having a stroke (ischaemic or haemorrhagic). Of every 20 cases, about five will die within the first month. By six months, eight will be living at home, another two or three will have died and the remainder will be in a hospital or rest-home. (1)

A national survey into stroke rehabilitation services last year (2) found most New Zealanders do not have access to stroke specific, in-patient stroke rehabilitation, despite evidence this reduces the risk of death or instititionalised care. In 36 hospitals out of 48, stroke rehabilitation was performed in assessment, treatment and rehabilitation units or general medical wards. Only 37 percent of the population had access to hospitals with a nominated lead clinician for stroke rehabilitiation services, and 30 percent were served by hospitals without a multi-disciplinary therapy team expert in stroke care. New Zealand and international guidelines recommend that co-ordinated, specialist, multi-disciplinary teams, including a lead stroke physician, should provide rehabilitation.

REFERENCES

(1) Stroke Background Information. (2003) Stroke Foundation of New Zealand. Wellington.

(2) Gommans, J. et al (2003) Stroke rehabilitation services in New Zealand. The New Zealand Medical Journal; 116: 1174.