My Working DayImelda Noone, the first and only advanced nursing practitioner in stroke care, explains what her role involves
I am the advanced nursing practitioner (ANP) in stroke care at St Vincent's University Hospital in Dublin. My position is unique, as I am the first and only ANP in stroke care in Ireland.
My duties include the holistic assessment and management of patients with stroke, and communicating with patients and their families to increase their knowledge of the disease. I also provide patients with education on stroke in a bid to ensure that secondary prevention measures are put in place once they are discharged.
As an ANP, I also participate in educating nursing staff and other healthcare professionals through role modelling, mentoring and facilitating the exchange of knowledge at the bedside, in the classroom and in the community.
My working day begins at 7.30am when I visit the emergency department with the consultant physician and a medical team. We then assess all the patients aged over 65 who have been admitted with a diagnosed stroke in the previous 24 hours.
Stroke is a very challenging area and I feel very fortunate to be part of a professional, dedicated and hardworking group of people. I work as part of a 10-person team, all of whom I liaise with regularly.
The stroke team includes the consultant physician, two doctors, a physiotherapist, an occupational therapist, a speech and language therapist, a medical social worker, a dietitian, a nursing specialist and myself. We are very much a multidisciplinary team.
Some 10,000 people experience a stroke each year in Ireland and St Vincent's admits 250-300 of them. About 90 per cent of the stroke patients we deal with are aged over 65, and more than two-fifths are over 80. We also treat much younger stroke patients. People as young as 18 have been admitted to the hospital with stroke. Smoking and diabetes are among the causes of this, and the oral contraceptive pill can also cause stroke in young women.
The burden of stroke is expected to increase in the years ahead due to the rapid rise in Ireland's elderly population.
Getting involved with patients early is important as it ensures we can carry out a comprehensive assessment of their condition.
Stroke can be a devastating, disabling disease, so I try to meet patients and their relatives as early and as often as possible to answer their questions and to pick up further information about our patients.
The consultant physician and I also meet stroke patients who have been discharged home in the outpatients department. We do this to ensure appropriate secondary prevention is in place and to arrange any further rehabilitation they might require.
My job also involves the co-ordination of the TIA (transient ischaemic attack) clinic. This is a weekly outpatients clinic for people seen in the emergency department who do not require immediate admission.
Unfortunately, there are some limitations to our service and at present there is an inadequate number of dedicated beds to provide both acute care and rehabilitation for all stroke patients in the hospital.
I recently participated in a national audit of stroke services by the Irish Heart Foundation, which is the largest study of stroke to take place in Ireland. The audit showed that there are only five people who are specialists in stroke and that I am the only ANP in the field in Ireland.
I think having an ANP in stroke would be advantageous to any hospital treating the disease. I hope we will see more people in the position as the need for stroke care grows in years to come.
In conversation with Steven Carroll