Abstract

Background: Thrombolysis treatment is a licensed therapy for acute ischemic stroke within 4.5 hours of stroke onset. The International Guideline sets the door-to-needle (DTN) time is <60 minutes. achieving dtn of 60 minutes or less is tricky and challenging to healthcare organizations due multifactorial reasons. it an important study because timely administration the therapy can improve patient’s outcomes identified barriers must address appropriately.
Aim: The aim of this study was to explore the views and practices of emergency room (ER) nurses on and “enablers” and “barriers” that affect the DTN time in thrombolysis treatment for acute ischemic stroke using ethnographical research approach.
Method: An ethnographic research method was employed to obtain enriched information and deeper understanding of emergency nurses’ practices in delivering timely administration of the thrombolytic therapy in one acute hospital in the Kingdom of Saudi Arabia. Twenty-five samples were participated in the study using a semi-structured interview. The researchers attended every stroke code activation and spent 200 hours during their field work activities.
Results: The enabling practices of timely administration of “tissue plasminogen activator (tPA)” in stroke therapy are mainly dependent on the following success factors: (1) intensive knowledge, (2) skill and (3) positive attitude of nurses toward stroke care; (4) organized system and technology in managing stroke patients in the emergency room, (5) working collaboratively with the team; and (6) well-defined nursing roles in assessing and monitoring stroke patients. On the other hand, the barriers include factors that pertain to patient, staffing, physician, education, resource, and teamwork.
Conclusion: A strong leadership and management commitment are vital to ensure that the existing strategies to address the barriers in timely administration of tPA are closely monitored, evaluated, and sustained.