A review of barriers to thrombolytic therapy: Implications for nursing care in the emergency department

Melissa Johnson, Tamilyn Bakas

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Despite stroke being the third leading cause of death and a leading cause of disability in the United States, less than 7% of stroke survivors receive tissue plasminogen activator (tPA) in the treatment of acute stroke. The purpose of this review was to determine what research is available on barriers to tPA use and to determine gaps in the literature. A search of the literature was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed. Keywords were stroke, emergency, nursing, thrombolytics, cerebrovascular accident, ischemia, intervention, tPA, and barriers. Pertinent references from articles obtained were searched as well. The search yielded 45 articles for review. Barriers to tPA use were found in both prehospital and in-hospital settings. Prehospital delays were related to contacting primary care physicians, mode of arrival to the hospital, and survivors' lack of knowledge regarding stroke. Sources of in-hospital delays included non-stroke center status, lack of training of emergency department staff, delays in computed tomography scans, and poor understanding regarding priority stroke treatment (e.g., mild or improving symptoms and disparities related to age, gender, and race). Future research to evaluate the impact of nursing care and attitudes toward stroke patients on the administration of tPA is recommended.

Original languageEnglish
Pages (from-to)88-94
Number of pages7
JournalThe Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
Volume42
Issue number2
DOIs
StatePublished - Apr 2010

Fingerprint

Thrombolytic Therapy
Nursing Care
Hospital Emergency Service
Stroke
Tissue Plasminogen Activator
Survivors
Emergency Nursing
Primary Care Physicians
PubMed
Cause of Death
Nursing
Ischemia
Tomography
Health
Therapeutics
Research

ASJC Scopus subject areas

  • Clinical Neurology
  • Endocrine and Autonomic Systems
  • Medical–Surgical
  • Surgery

Cite this

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