Bj week 5

2

The Critical Role of Nurses in Improving Medication Adherence for Stroke Patients

Student’s name

Institution affiliation

NU700: Advanced Nursing Practice

Professor Smith

March 25, 2024

The Critical Role of Nurses in Improving Medication Adherence for Stroke Patients

As nurses, we witness firsthand the challenges patients face attempting to take medications as ordered. Some forget doses, others cannot afford them, and many just don't understand the significance of the medications. For stroke survivors, though, taking medication is not about obeying doctor's orders—it is quite literally a matter of life and death. Take Mr. Johnson, for example, a 68-year-old stroke survivor whom I cared for. Even after multiple education sessions, he often missed his blood thinners, proclaiming, "I feel fine." Two months later, he had a second, more severe stroke. Cases such as his are all too common, unfortunately. Studies show that almost half of all stroke patients do not take their medications as directed, which puts them at a much higher risk of repeat strokes (Zhang et al., 2024). This is not a mere statistic—it is a crisis that can be addressed by nurses. This article will explore why medication compliance among stroke patients is necessary, how they are obstructed, and the significant contribution nurses can offer to increase compliance.

The Problem: Why Medication Adherence Matters for Stroke Patients

A Silent Epidemic with Deadly Consequences

Stroke is the fifth leading cause of death and a primary cause of disability in the US (Centers for Disease Control and Prevention [CDC], 2023). Many survivors are unaware that risk of recurrence of stroke is highest in the first year following a stroke—and staying off medication significantly raises that risk. Middleton et al. (2024) discovered that research indicated that medication non-adherence was linked with a 30% higher risk of recurrence of stroke and with a sharp increase in hospitalization rates.

Barriers to Adherence

Based on my own experience, nonadherence reasons are mixed but prevalent

1. “I don't feel sick, so why take pills?”

Stroke patients do not have recurrent symptoms and thus may be unaware of needing chronic medication.

2. Cognitive Impairment

Memory loss and disorientation after a stroke may lead to the patient forgetting to recall dosages.

3. Financial Constraints

Zhang et al. (2024) found that 1 in every 5 stroke patients omit doses due to financial concerns.

4. Complex Medication Regimens

Stroke patients are typically on 10 or more medications a day, which leads to frustration and mistakes.

Evidence-Based Nursing Interventions

1. Personalized Nurse-Led Education

Repeated research proves that education initiated by nurses improves compliance. Gibson et al. (2021) found that patients suffering from a stroke who received personalized, nurse-initiated education were 35% more likely to be compliant. Nurses should provide clear, concise explanations, as opposed to handing a patient a pillbox, and apply the teach-back method, in which patients explain information in their own words. Cognitively impaired patients may benefit from visual aids such as color-coded charts of medication.

2. Simplifying Medication Schedules

Middleton et al. (2024) found that patients suffering from stroke were three times more likely to adhere to medications when regimens were simplified. Nurses can collaborate with doctors and pharmacists to encourage once-daily dosages or combined pills wherever possible.

3. Leveraging Technology

Research by Cassier-Woidasky et al. (2024) revealed that automated reminders like text messages and pill alarms decreased missed doses by 50%. Patients can be assisted by nurses in setting up medication reminders on their mobile phones. For elderly patients, the suggestion of simple battery-powered pill alarms is very effective.

The Nurse’s Role in Driving Change

1. Be a Patient-Provider Liaison: Physicians may not always have an understanding of the challenge that patients face in adhering to complicated regimens. Nurses should advocate for simpler drug schedules and mediate patient concerns.

2. Overcome Financial Barriers: Most patients are unwilling to acknowledge that they cannot afford their drugs. Nurses must directly inquire about financial issues and refer patients to prescription assistance programs.

3. Involve Family Members: Recovery from a stroke is teamwork. Educating family members and caregivers can immensely enhance compliance.

4. Follow Up Relentlessly: One of the quickest and easiest checks, a one-week post-discharge phone call check-in, will identify early compliance issues.

Conclusion

Medication nonadherence in stroke patients is not only a clinical issue—it is an issue of people. Every dose that is not taken is one patient who can't, won't, or doesn't know how to take their medications. Fortunately, nurses can make this change. Through the combination of compassion and evidence-based practice—such as individualized education, regimen simplification, technology support, and follow-up—nurses can avoid future strokes, save lives, and promote patient health. Mr. Johnson's second stroke may have been prevented.

References

Cassier-Woidasky, A. K., Middleton, S., Dale, S., Coughlan, K., D’Este, C., McInnes, E., ... & Pfeilschifter, W. (2024). Quality in Acute Stroke Care (QASC) Germany: improving efficiency in stroke care with nurse-initiated FeSS-protocols.  Neurological Research and Practice,  6(1), 48. https://link.springer.com/article/10.1186/s42466-024-00352-1

CDC. (2024). Stroke Facts. Center for Disease Control and Prevention (CDC). https://www.cdc.gov/stroke/data-research/facts-stats/index.html

Gibson, J., Coupe, J., & Watkins, C. (2021). Medication adherence early after stroke: using the Perceptions and Practicalities Framework to explore stroke survivors’, informal carers’ and nurses’ experiences of barriers and solutions.  Journal of Research in Nursing,  26(6), 499-514. https://journals.sagepub.com/doi/pdf/10.1177/1744987121993505

Middleton, S., Cassier-Woidasky, A. K., & Dale, S. (2024). Ademuyiwa, I. Y., & Okubadejo, N. U. (2021). Effect of a nurse-led secondary stroke prevention intervention on medium-term stroke outcome in a teaching hospital in Nigeria: a quasi-experimental study. Journal of Clinical Sciences, 18(3), 168-173. https://journals.lww.com/jocs/_layouts/15/oaks.journals/downloadpdf.aspx?an=01971469-202118030-00008

Zhang, W., Mei, Z., Feng, Z., & Li, B. (2024). Effects of a nurse-led ehealth programme on functional outcomes and quality of life of patients with stroke: A pooled analysis of randomized controlled trials.  Frontiers in Public Health,  12, 1395270. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1395270/pdf