Integrative Review Paper

Strokes are caused by a block in the blood supply to the brain which causes a decrease in oxygen and delivery of other important supplies which facilitate proper functioning. Fifteen million cases are reported worldwide annually, although not all of these cases are mortalities, the large prevalence of strokes ranks it as the fourth leading cause of death in the United States. (Figueroa) Because of the time sensitivity associated with the lack of resources to the brain, strokes are considered a medical emergency and early recognition of symptoms can help decrease the amount of damage caused . Although strokes do not always cause death, strokes most often leave the individual with some physical and cognitive impairment.

Mariam background is 60 year old lady admitted with left sided weakness and facial droop. Once confirmed stroke using the Recognition of Stroke in the Emergency Room (ROSIER) scale. Catangui (2015) states ROSIER scale is used to distinguish whether the patient is having a stroke or stroke mimics e.g. seizures or brain tumours. Computed tomography CT brain showed ischemic stroke. Ischaemic stroke is lack of sufficient blood supply to perfuse the brain/ cerebral tissue due to narrowing or blocked arteries in the brain (Morrison, 2014). According to Stroke Association (2015) statics shows that 1520000 strokes occur in the United Kingdom.

Not only are women deliberately kept out of joining medical schools and medical practices in general, their bodies are also not typically studied in medical science and research, because instead, male bodies are more often used. This makes the male body seem dominantly normative and generalizes an idea that women’s bodies must be similar to men’s, and dangerously disregards women’s particular differences. This causes medical professionals to make decisions based on this research that may not be particularly appropriate for women, such as the fact that aspirin reduces the rate of heart attacks for men but not for women, much to many doctors’ surprise. Gender stereotypes also exist within the medical field that may prevent women from receiving the care and attention they need, as many doctors often assume women are emotional, and thus, exaggerating their symptoms, versus men who are believed to be more rational. This also affects the amount of care they receive, which sometimes is too much or too little because some procedures like cesarean sections and hysterectomies are performed too often when other options would be just as adequate, but unfortunately, women’s reproductive systems are more emphasized than other just as important aspects of their health. In other instances, they do not receive as much diagnosis or are not taken as seriously as men are, by their doctors. According to our earlier readings, men are more often to interrupt women, so men physicians can often

Medical experts emphasize that medical attention must be received within the first three hours of a stroke to repair blood flow and diminish damage.

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

and difficulty focusing. Men have a low pre-injury level of progesterone which may be why females have more severe or longer-lasting symptoms than males (article

A stroke is a form of brain attack, which is when blood and oxygen can’t get to a certain part of the brain causing cells to die. This causes permanent damage. Basically the longer you take to get to the hospital, the more damage there is.

Once you arrive at the emergency room, you experience more waiting depending on your current condition. Some of these waits depend on: length of stay, time waiting for assessment, condition, waiting for inpatient bed, and lack of resources. Finally, when you’re ready to leave the emergency department waits can occur, like waiting for an inpatient bed or a ride home (CIHI, 2012). All of these reasons impact the growing wait times, with older adults becoming more frequent in emergency departments and the increasing population of older adults these wait times are going to continue to grow causing more harm than good, if older adults are unable to receive the appropriate care in a timely matter (Cooke, Oliver, & Burns, 2012).

There are many key components in approaching access to health care: coverage, services, timeliness and workforce (Healthy People 2020, 2015). Patients who have a positive and consistent source of care will ultimately have better end results, minor discrepancies and fewer costs (Healthy People 2020, 2015). Timeliness is the health system’s capability to optimize services in a convenient manner, whether it embraces the time spent either waiting in a doctor’s office or an emergency department. At the same time for many patients it encompasses the time between analyzing the need for tests or treatment and obtaining those results. Working as an ER nurse there has been incredible long waiting times in emergency rooms secondary to the fact that people are using the ER for care and more notably as their primary care physician. Likewise prolonged Emergency department wait times can decrease patient satisfaction and notably people leave without been seen. Finally the different element of workforce is vital in contributing access to health services. Primary Care Physicians (PCPs) play an important role in providing access to health services and it has been noted that many medical students are leaning away from working in primary care (Healthy People 2020, 2015). Our ultimate goal is to direct them towards that needed profession.

Stroke is the fourth leading cause of death in the United States. Each year more than 795,000 Americans suffer from a stroke, which means that every forty seconds someone has stroke (Liebman, 2012). Although a stroke can occur at any age, strokes are frequently seen in the older adult demographics. An increase with age doubles the risk for a stroke each decade after 55 (Grysiewicz, 2008). The percentage of stroke survivors to almost fully recover from a stroke is only 10 percent; in contrast, 40 percent of stroke survivors will face moderate to severe impairment which will entail distinctive care (Perlmutter and Colman, 2005). When all strokes are analyzed according to demography of class system, approximately 60% of strokes occur in low or middle income countries (Silverman and Rymer, 2009).

According to Centers for Disease Control and Prevention, it is stated that “every 40 seconds, someone in the U.S. has a stroke” (“Stroke,” 2018). Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States, which include coronary heart disease, stroke, and other related conditions. There are various modifiable and non-modifiable risk factors associated with heart disease, such as age, family history, diet, physical inactivity, high blood pressure, and more (“2016 Community Health Assessment,” 2017). About 795,000 people suffer from stroke each year and it is more common among the elderly, ages 65 years and older, in the United States (“Stroke,” 2018). The consequences of stroke can be detrimental,

A less common type of stroke is a hemorrhagic stroke. This type of stroke occurs when the artery that supplies blood to the brain ruptures or bursts. Stroke is an expensive disease with lifetime rehabilitation costing over $140,000 per ischemic stroke with higher costs for subarachnoid hemorrhage (Alberts, et. al. 2011). Although stroke risk increases with age, strokes can occur at any age. In 2009, 34% of people hospitalized for stroke were younger than 65 years (Hall, 2012). More women than men have strokes each year, in part because women live longer. Estimates of the overall incidence of stroke in U. S. children are 6.4 per 100,000 (0-15 yrs.) with approximately half being hemorrhagic stroke (ASA, 2016). African Americans are more impacted by stroke than any other racial group within the American

Stroke is seen as a major health concern and this is due to the fact that every year, as many as 110,000 individuals suffers from strokes making it a key issue. (NHS 2014)

Throughout the course of history, the field of healthcare has always been in a state of flux; however, healthcare has also had one steady aspect and that is women have always been at a disadvantage when it comes to traversing the system. Women have and still do face many obstacles within the health care system. These obstacles include research androcentrism, medicalization, gender stereotyping, reproductive rights, differential treatment, and fertility issues, among others… These obstacles must be explored and analyzed in order to better help women navigate the healthcare system and to support women’s rights in the present and future.

Several existing problems precipitated the creation of the triage system implemented by Kathryn Angell in an effort to deliver improved medical care. The main problem was a lack of coordination in service delivery. This lack of coordination caused excessive wait times on the order of anywhere from 23 to 40 minutes to see a nurse, 40 to 50 minutes to see a doctor, and as long as 55 minutes to get a prescription filled. The practice of all nurses being involved initially in seeing all patients caused duplication of efforts, including repeating questions and examinations, and resulted in procedural bottlenecks. Additionally, there were inconsistent levels of service and extreme variation in treatment because of the different experience