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  1. Kitko, Lisa
  2. Hupcey, Judith E.


Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Patients who sustain a sudden ischemic stroke can benefit from the administration of intravenous recombinant tissue plasminogen activator (rt-PA). rt-PA may reduce disability, yet few patients arrive in emergency departments in time to be eligible for rt-PA administration. The purpose of this study was to discover factors that influence patients' decision-making process when seeking treatment for acute-stroke symptoms. Qualitative inquiry using grounded-theory methods was used to elicit descriptions of the decision-making process. The primary purpose of grounded theory is to generate explanatory models of human behavior that are grounded in the data. A purposive sample of 10 clinically stable patients or their caregivers were interviewed after acute ischemic stroke. Data were analyzed and broken down into descriptive themes following the grounded-theory approach. Distinct themes emerged for patients who presented for treatment early and late. Five themes emerged for patients who presented late for treatment: lack of knowledge, fear of hospitals, denial, living alone, and preexisting health concerns. The theme that emerged from the group that presented early for treatment was previous history or knowledge of stroke. The most significant implication for practice identified in this study is that nurses must take a leading role in educating the public regarding symptoms, risk factors, and available treatments for stroke.