Acute Ischemic Stroke: An Evidence-Based Approach
D. M. Greer (Editor), Hoboken, NJ: Wiley, 2007, 235 pages, $135.95, ISBN 978-0-470-06807-6.
This concise, yet comprehensive text is a must read for advanced practice neuroscience nurses, especially those who work in rural or community settings, where access to specialist neurologists might be limited. The systematic, balanced examination of evidence for current medical diagnostic testing and intervention is this book's main asset. Dr. Greer states that for a long time, interventions for ischemic strokes were either "quite hazardous" or offered "little benefit." He wanted to show that "the evidence has taken us a great distance, but has sometimes raised more questions than it has answered" (p. vii). The evidence presented here was developed from the physicians' perspective, yet neuroscience nurses dedicated to advancing their specialty knowledge will benefit from the logical unfolding and thorough explanations of important concepts in each chapter.
Copen and Lev's discussion in Chapter 2 covers a wide range of diagnostic imaging technologies. Beginning with basics about noncontrast computed tomography (CT) and magnetic resonance imaging (MRI) scans, the authors proceed to specifics about perfusion and permeability imaging, and their explanations make this mysterious content clear and comprehensible. The chapters are well researched and well written, with extensive reference lists for further reading. In all, the chapters cover therapies such as intravenous thrombolysis, antithrombolytics, endovascular approaches, surgical options, and nonthrombolytic therapies.
Advanced practice neuroscience nurses, such as nurse practitioners (NPs) or clinical nurse specialists (CNSs), who work in rural or community settings and who lack regular contact with academic neurologists yet have clinical responsibilities to improve care and outcomes for patients with acute ischemic strokes will welcome the clarity with which this content is presented. Most important, they will appreciate Rosenthal and Schwamm's discussion of telemedicine in Chapter 10 as one way to increase access to care for patients in rural or underserved areas. In county, state, or city hospitals, where changes in practice are approved by a politically appointed board using the "lowest bid" approach to budgeting, telemedicine can provide true access to specialists when time must be spent wisely. Chapter 10 explains how to make that access to excellence possible.
Neuroscience NPs and CNSs are now being employed in some facilities in lines that were previously established for neurology residents. This book would help those advanced practice nurses understand medical diagnostic thinking and treatment options for acute ischemic strokes. For doctorally prepared neuroscience nurses equipped to conduct clinical nursing research, ideas for nursing research abound. I had the impression that I was hiking to the top of a mountain with caring, knowledgeable guides who purposely and generously pointed out multiple areas for future inquiry. Neuroscience nurses who know their field well will be prompted to think of the currently unsolved or unexplored issues suitable for clinical nursing research.
Evidence-based practice would not have been possible without theories that guided past clinical practice. History has shaped evidence and theories more than many might believe. Twenty-five years ago technology was quite primitive. Most neurologists, neurosurgeons, and neuroscience nurses relied on detailed serial clinical exams to determine whether the patient was responding to treatment. Now, serial Q6H CT or daily MRI scans acquire and store data about brain tissue to provide those answers and that evidence. I note this trend with grief because it is not mentioned in this book and its implications are unsettling. Yet, this minor note is not enough to detract from the overall excellence of this text, which is well written, timely, and comprehensive. I highly recommend this extremely valuable book as a good cover-to-cover read for neuroscience nurses, especially those in advanced practice roles.
Reviewed by Debra R. Hanna, PhD RN CNRN, Assistant Professor of Nursing, Molloy College, Rockville Centre, NY.