1. Snavely, Josh

Article Content

Dear Editor,


I've read with interest previous editorials in the Journal of Neuroscience Nursing (JNN) encouraging the use of nursing literature as evidence and for nurses to become more involved in publishing research.1,2 Although I agree wholeheartedly with these positions, it remains challenging for nurses to find a voice in the larger, nonnursing scientific community. This difficulty presents itself in the recently published scientific statement for in-hospital stroke care.3 Having authored on this topic,4 I was excited to read the new recommendations from the American Stroke Association (ASA) and see how they incorporated nursing research into their work.


Between 2.2% and 17% of stroke occurs during acute hospitalization.5 Until recently, there has been limited recognition of this concerning statistic. As such, there has been a lack of direction for bedside clinicians when addressing in-hospital stroke. Although the absence of previous guidance has been somewhat disappointing, I applaud the efforts of the ASA in creating these new recommendations. To their own admission, there is a limited amount of published research on this topic; however, I was dismayed to see none of the published work from JNN made it into the referenced work used for the ASA's scientific statement.4,6


For instance, our JNN article was able to show how an interdisciplinary group successfully developed and implemented an inpatient stroke response process that achieved an 11% treatment rate, nearly matching the treatment rate seen in our emergency departments.5 This was a peer-reviewed, retrospective analysis of stroke treatment for the population of interest. Figure 1 of the scientific statement3 appears to contain many of the steps in the checklist we evaluated and included as Figure 1 in our article.4 This suggests there was a strength to our early work that could have contributed to the theme of the ASA recommendations.


Nurses lead the way in program development in acute care settings. Nurses chair and lead most stroke steering committees. Nurses are the ones recognizing acute stroke and activating these inpatient code stroke events. Nurses are the ones collecting the data, evaluating the outcomes, and developing process improvement initiatives. Nurses are publishing best practices.


I encourage my fellow nurses and nurse practitioners to be persistent. Get involved in research. Don't be silent. Share your knowledge, data, and recommendations. Share your evidence for the good of our patients.




1. Olson DM. Citing relevant literature should include nursing literature. J Neurosci Nurs. 2021;53(3):115. doi: [Context Link]


2. Olson DM. Behind closed doors. J Neurosci Nurs. 2020;52(1):1. doi: [Context Link]


3. Nouh A, Amin-Hanjani S, Furie KL, et al. Identifying best practices to improve evaluation and management of in-hospital stroke: a scientific statement from the American Heart Association. Stroke. 2022;53(4):e165-e175. doi: [Context Link]


4. Snavely J, Thompson H, Bridges E, Fathi J. Impact of a structured response and evidence-based checklist on in-hospital stroke outcomes. J Neurosci Nurs. 2020;52(3):136-142. doi: [Context Link]


5. Cumbler E, Murphy P, Jones WJ, Wald HL, Kutner JS, Smith DB. Quality of care for in-hospital stroke: analysis of a statewide registry. Stroke. 2011;42(1):207-210. doi: [Context Link]


6. Droegemueller CJ, Kashyap B, Huna Wagner RL, et al. A successful quality improvement project for detection and management of acute stroke in hospitalized patients. J Neurosci Nurs. 2020;52(4):186-191. doi: [Context Link]