Good nursing practice guide results aimed at the care of patients with ischemic stroke or transit ischemic attack. A cohort study.

Background Stroke is one of the leading causes of morbidity and mortality worldwide, classified as ischemic (85%) or haemorrhagic (15%), with transient ischemic attack (TIA) as an additional clinical entity. Advances in therapeutic strategies, including intravenous thrombolysis and mechanical thrombectomy, have significantly improved patient outcomes. However, specialized critical care, particularly nursing interventions, plays a pivotal role in addressing complications such as pressure ulcers, aspiration pneumonia, and falls, which can adversely affect functional recovery. Objective To evaluate adherence to the recommendations of a good nursing practice guide in the care of patients with ischemic stroke or transient ischemic attack (TIA) admitted to the Neurology Unit of the Lucus Augusti Hospital between 2020 and 2022. Method This cohort study included a sample of 745 patients diagnosed with ischemic stroke or transient ischemic attack (TIA) who met the inclusion criteria. Patients received recombinant tissue plasminogen activator (rt-PA) treatment within 4.5 hours of symptom onset and hospital arrival. Baseline computed tomography (CT) scans were evaluated using the Alberta Stroke Program Early CT Score (ASPECTS). Functional outcomes were assessed using the Barthel Index. Descriptive analyses were performed using measures of central tendency, dispersion, and percentages. Differences between groups were analysed using the Chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. Pairwise comparisons were conducted with the Mann-Whitney U test. Results The implementation of a good practice guide facilitated the systematic recording of quality indicators and potentially improved the overall quality of care. Among the patients included, 81.3% experienced an ischemic stroke between 2020 and 2022, with a mean age of 73.3 (± 11.98) years and a Barthel Index score of 78.84 (± 29.42) points at admission. An inverse correlation was observed between functional outcomes and adverse events, including falls (p = 0.001), pain (p = 0.001), and aspiration pneumonia (p = 0.001). Poorer functional outcomes were associated with a higher frequency of these complications and greater pain intensity. Conclusion The implementation of a good nursing practice guide improved care quality standards, particularly in key indicators such as neurological assessment within the first 24 hours, dysphagia screening, pressure injury prevention, pain assessment, and documentation of independence levels at discharge. Significant associations were identified between age and both pain and Barthel Index, as well as between sex and these variables. Additionally, functional outcomes measured by the Barthel Index were inversely correlated with aspiration pneumonia, falls, and pain.