Nursing interventions implemented in the emergency department for acute stroke victims

scoping review


  • Ana Catarina Ferreira Health School of the Polytechnic Institute of Viseu, Viseu, Portugal | Centro Hospitalar do Baixo Vouga, E.P.E., Local Health Unit of Aveiro, Portugal
  • Inês Filipa Silva Centro Hospitalar do Baixo Vouga, E.P.E., Local Health Unit of Aveiro, Aveiro, Portugal
  • Mauro Mota Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal | Health School of the Polytechnic Institute of Viseu, Viseu, Portugal | Hospital Nossa Senhora da Assunção, Local Health Unit of Guarda, Seia, Portugal
  • Olivério Ribeiro Health School of the Polytechnic Institute of Viseu, Viseu, Portugal | Health Sciences Research Unit: Nursing (UICISA: E)



nursing, nursing care, stroke, emergency service, hospital


Introduction: The cerebrovascular accident (CVA) is a medical emergency with a negative impact on people's lives. Interventions administered in the Emergency Service, in addition to being decisive to minimize late complications resulting from stroke, favor the quality of care provided to the person in the most acute phase of the clinical condition.

Objective: To map the nursing technologies implemented for adult victims of acute stroke, in the context of the Emergency Service.

Methods: A Scope Review was carried out according to the Joanna Briggs Institute methodology. Search strategy defined in PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, JBI Database of Systematic Reviews and Reports, SciELO, LILACS and BDENF – Nursing databases. Two independent researchers performed a selection of studies, extraction and data synthesis, based on the objectives and defined research questions. The results are found using a diagram (PRISMA flow diagram), evidence tables and a narrative.

Results: Articles with defined eligibility criteria, published between 2011 and 2021, were included. They resulted from quantitative and qualitative studies, literature reviews and scientific statements based on guidelines. Effective nursing actions implemented for the victim of acute stroke in the context of the Emergency Service were mapped. Initial, screening, activation of rapid response stroke protocols, stroke risk assessment, stabilization, monitoring, invasive nursing procedures, administration of intravenous treatment, preparation and follow-up to carry out assessment of invasive medical tests and procedures, detection early complications, transfer/transfer of care, collaboration in the distance care service, and interventions in the domain of quality, as being nursing practices implemented in the Emergency Service for the victim of acute stroke. The nursing team plays a preponderant role in the care of people with acute stroke in the context of the Emergency Service. The early recognition of stroke signs and symptoms is crucial for assistance, prompt and adequate treatment and, consequently, the survival of the person victim of an acute stroke.

Conclusion: Continuing education, implementation of protocols based on scientific guidelines and research studies will contribute to a better nursing practice in the care of acute stroke victims in the Emergency Service.


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American Heart Association, American Stroke Association (2021). Stroke-symptoms. AHA/ASA

Alexandrov, A. W., Palazzo, P., Biby, S., Doerr, A., Dusenbury, W., Young, R., Lindstrom, A., Grove, M., Tsivgoulis, G., Middleton, S., & Alexandrov, A. V. (2018). Back to basics: Adherence with guidelines for glucose and temperature control in an american comprehensive stroke center sample. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 50(3), 131–137.

Anderson, S. et al. (2008). Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services. Health Research Policy and Systems, 6 (7), p. 1-12. https://doi: 10.1186/1478-4505-6-7.

Ashcraft, S., Wilson, S. E., Nyström, K. V., Dusenbury, W., Wira, C. R., Burrus, T. M., & American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council (2021). Care of the patient with acute ischemic stroke (prehospital and acute phase of care): Update to the 2009 comprehensive nursing care scientific statement: A scientific statement from the American Heart Association. Stroke, 52(5), e164–e178.

Barnard, S. (2011). Nursing dysphagia screening for acute stroke patients in the emergency department. Journal of Emergency Nursing 37(1), 64-67.

Bergman, K., Kindler, D., & Pfau, L. (2012). Assessment of stroke: A review for ED nurses. Journal of Emergency Nursing, 38(1), 36–42.

Campbell, B., De Silva, D. A., Macleod, M. R., Coutts, S. B., Schwamm, L. H., Davis, S. M., & Donnan, G. A. (2019). Ischaemic stroke. Nature reviews. Disease Primers, 5(1), 70.

Campbell, B., & Khatri, P. (2020). Stroke. Lancet (London, England), 396(10244), 129–142. 6736(20)31179-X

Leite Costa, A. C., Preto, L. S. R., Barreira, I. M. M., Mendes, L. A., Araújo, F. L., & Pinto Novo, A. F. M. (2020). Triagem e ativação da via verde do Acidente Vascular Cerebral: Dificuldades sentidas pelos enfermeiros. Revista Portuguesa de Enfermagem de Reabilitação, 3(2), 96–101.

Portugal, Ministério da Saúde. (2014). Despacho n.º 10319/2014 do Ministério da Saúde. Diário da República: II Série, N.º 153, p. 20673.

Direção-Geral da Saúde (2001). Rede de Referenciação Hospitalar de Urgência/Emergência. Lisboa: DGS.

Ekker, M. et al. (2018). Epidemiology, etiology, and management of ischaemic stroke in young adults. The Lancet. Neurology, 17(9), 790–801.

European Stroke Organisation (ESO) Executive Committee, & ESO Writing Committee (2008). Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovascular Diseases, 25(5), 457–507.

European Stroke Organisation (2021). Stroke Action Plan Europe 2018-2030. European Stroke Organisation.

George, M. (2020). Risk factors for ischemic stroke in younger adults: A focused update. Stroke, 51(3), 729–735.

Ver Hage, A., Teleb, M., & Smith, E. (2018). An emergent large vessel occlusion screening protocol for acute stroke: A Quality improvement initiative. The Journal of Neuroscience Nursing, 50(2), 68–73.

Hankey G. J. (2017). Stroke. Lancet (London, England), 389(10069), 641–654.

Hankey, G. & Blacker, D. (2015). Is it a stroke? BMJ, 350(h56), 1 – 6.

Hathidara, M. Y., Saini, V., & Malik, A. M. (2019). Stroke in the young: A Global update. Current Neurology and Neuroscience Reports, 19(11), 91.

Hargis, M., Shah, J. N., Mazabob, J., Rao, C. V., Suarez, J. I., & Bershad, E. M. (2015). Barriers to administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers. Clinical neurology and neurosurgery, 135, 79–84.

Heiberger, C. J., Kazi, S., Mehta, T. I., Busch, C., Wolf, J., & Sandhu, D. (2019). Effects on stroke metrics and outcomes of a nurse- led stroke triage team in acute stroke management. Cureus, 11(9), e5590.

Instituto Nacional de Estatística. (2021). Estatísticas da Saúde: 2019 (pp.1-74). Lisboa: INE.

Johnson, M., Cohn, J., & Bakas, T. (2011). Emergency department nurses' perceived barriers and facilitators to caring for stroke patients. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 43(5), 238– 245.

Katan, M., & Luft, A. (2018). Global Burden of Stroke. Seminars in Neurology, 38(2), 208–211.

Kindermann, D., Mutter, R., & Pines, J. M. (2013). Emergency department transfers to acute care facilities, 2009. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US).

Kjellström, T., Norrving, B., & Shatchkute, A. (2007). Helsingborg Declaration 2006 on European stroke strategies. Cerebrovascular Diseases, 23(2-3), 231–241.

Knight-Greenfield, A., Nario, J., & Gupta, A. (2019). Causes of acute stroke: A Patterned approach. Radiologic Clinics of North America, 57(6), 1093–1108.

Lees, K. R., Bluhmki, E., von Kummer, R., Brott, T. G., Toni, D., Grotta, J. C., Albers, G. W., Kaste, M., Marler, J. R., Hamilton, S. A., Tilley, B. C., Davis, S. M., Donnan, G. A., Hacke, W., ECASS, ATLANTIS, NINDS and EPITHET rt-PA Study Group, Allen, K., Mau, J., Meier, D., del Zoppo, G., De Silva, D. A., … Byrnes, G. (2010). Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet (London, England), 375(9727), 1695–1703.

McGowan, J., Straus, S., Moher, D., Langlois, E. V., O'Brien, K. K., Horsley, T., Aldcroft, A., Zarin, W., Garitty, C. M., Hempel, S., Lillie, E., Tunçalp, Ӧ., & Tricco, A. C. (2020). Reporting scoping reviews-PRISMA ScR extension. Journal of Clinical Epidemiology, 123, 177–179.

Middleton, S., Grimley, R., & Alexandrov, A. W. (2015). Triage, treatment, and transfer: evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke. Stroke, 46(2), e18–e25.

Morotti, A., Poli, L., & Costa, P. (2019). Acute Stroke. Seminars in Neurology, 39(1), 61–72. 1676992

Norrving, B. et al. (2013). Stroke Definition in the ICD-11 at the WHO. World Neurology, 28 (4), 1-14.

Norrving, B., Barrick, J., Davalos, A., Dichgans, M., Cordonnier, C., Guekht, A., Kutluk, K., Mikulik, R., Wardlaw, J., Richard, E., Nabavi, D., Molina, C., Bath, P. M., Stibrant Sunnerhagen, K., Rudd, A., Drummond, A., Planas, A., & Caso, V. (2018). Action Plan for Stroke in Europe 2018-2030. European Stroke Journal, 3(4), 309–336.

Munn, Z., Peters, M., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143.

Organização Mundial da Saúde. (2006). The global burden of cerebrovascular disease (pp. 1 – 67). Geneva, Switzerland: OMS.

Organização Mundial da Saúde. (2021). Classificação Internacional de Doenças: CID-11 para Estatísticas de Mortalidade e Morbidade (CID-11 MMS). Geneva, Switzerland: OMS.

Ordem dos Enfermeiros (1996). REPE – Regulamento do Exercício Profissional do Enfermeiro. Decreto-Lei n.º 161/96, de 4 de setembro (Com as alterações introduzidas pelo Decreto-lei nº 104/98 de 21 de abril).

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A.,

Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research ed.), 372, n71.

Peters, M. D., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare, 13(3), 141–146.

Peters, M.D.J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A.C., Khalil, H. (2020). Chapter 11: Scoping Reviews In: Aromataris, E., Munn, Z. (Edits). JBI Manual for Evidence Synthesis, JBI, 2020. Adelaide: JBI.

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., Tirschwell, D. L., & American Heart Association Stroke Council (2018). 2018 Guidelines for the early management of patients with acute ischemic stroke: A Guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46–e110.

Puig, J., Shankar, J., Liebeskind, D., Terceño, M., Nael, K., Demchuk, A. M., Menon, B., Dowlatshahi, D., Leiva-Salinas, C., Wintermark, M., Thomalla, G., Silva, Y., Serena, J., Pedraza, S., & Essig, M. (2020). From "Time is Brain" to "Imaging is Brain": A Paradigm Shift in the Management of Acute Ischemic Stroke. Journal of Neuroimaging, 30(5), 562–571.

Ordem dos Enfermeiros, (2019). Regulamento N.º 140/2019 da Ordem dos Enfermeiros. Regulamento das Competências Comuns do Enfermeiro Especialista. Diário da República, 2, (26), 4744-4750.

Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., Elkind, M. S., George, M. G., Hamdan, A. D., Higashida, R. T., Hoh, B. L., Janis, L. S., Kase, C. S., Kleindorfer, D. O., Lee, J. M., Moseley, M. E., Peterson, E. D., Turan, T. N., Valderrama, A. L., Vinters, H. V., … Council on Nutrition, Physical Activity and Metabolism (2013). An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44(7), 2064–2089.

Santos, A. (2017). Acolhimento com classificação de risco à pessoa idosa com suspeita de Acidente Vascular Cerebral. (Tese de mestrado. Universidade Federal da Bahia, Brasil).

Aguiar de Sousa, D., von Martial, R., Abilleira, S., Gattringer, T., Kobayashi, A., Gallofré, M., Fazekas, F., Szikora, I., Feigin, V., Caso, V., & Fischer, U. (2019). Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries. European stroke journal, 4(1), p. 13–28.

Theofanidis, D., & Gibbon, B. (2016). Nursing interventions in stroke care delivery: An evidence-based clinical review. Journal of Vascular Nursing 34(4), 144–151.

Tricco, A. C., Soobiah, C., Antony, J., Cogo, E., MacDonald, H., Lillie, E., Tran, J., D'Souza, J., Hui, W., Perrier, L., Welch, V., Horsley, T., Straus, S. E., & Kastner, M. (2016). A scoping review identifies multiple emerging knowledge synthesis methods, but few studies operationalize the method. Journal of Clinical Epidemiology, 73, 19–28.

Turc, G., Bhogal, P., Fischer, U., Khatri, P., Lobotesis, K., Mazighi, M., Schellinger, P. D., Toni, D., de Vries, J., White, P., & Fiehler, J. (2019). European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic StrokeEndorsed by Stroke Alliance for Europe (SAFE). European Stroke Journal, 4(1), 6–12.



How to Cite

Ferreira, A. C., Silva , I. F., Mota, M., & Ribeiro, O. (2022). Nursing interventions implemented in the emergency department for acute stroke victims: scoping review . Millenium - Journal of Education, Technologies, and Health, 2(10e), 193–210.



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