Benchmark-Capstone Change Proposal: Ischemic Stroke Treatment

This capstone change proposal examines the treatment of ischemic stroke, focusing on the use of the thrombolytic agent alteplase (t-PA). The report begins with background information on ischemic stroke and a problem statement highlighting the need for improved treatment approaches. The purpose of the change model is to develop more effective interventions for diagnosis and treatment, educate patients, and analyze the effectiveness of t-PA. The PICOT statement defines the patient population, intervention, comparison, outcome, and timeline. The literature search strategy involves database searches to identify relevant articles. The report compares research questions, sample populations, and evaluates the literature, including the use of a research chart. Nursing theories, such as the theory of need and beneficence/maleficence, are applied to the use of t-PA. An implementation plan is presented, including the use of t-PA and edaravone. The report also addresses potential barriers, such as blood-brain barrier damage and safety protocols, and suggests strategies to overcome these challenges. The report concludes with references and an appendix outlining the activities timeline.

Running Head: BENCHMARK-CAPSTONE CHANGE PROPOSAL
BENCHMARK-CAPSTONE CHANGE PROPOSAL
Name of the Student
Name of the University
Author Note

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Table of Contents
Background....................................................................................................................3
Problem Statement.........................................................................................................3
Purpose of Change Model..............................................................................................3
PICOT Statement...........................................................................................................4
Literature Search Strategy..............................................................................................4
Comparison of research questions.............................................................................5
Comparison of sample population.............................................................................5
Evaluation of the Literature...........................................................................................5
Nursing Theory..............................................................................................................5
Implementation Plan with Outcomes.............................................................................6
Barriers in the planned implementation.....................................................................6
Overcoming of the barriers........................................................................................7
References......................................................................................................................8
Appendix......................................................................................................................10

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Background
An ischemic stroke is defined as the narrowing or in some cases blocking of the brain
arteries resulting in the impairment of neurological functions related to that particular area.
This situation arises at the time of thrombotic occlusion in the nerves of the brain. This type
of stroke is much more familiar than the haemorrhagic stroke ((Babkair, 2017). The central
intention of this study is to determine the need of a change model in the analysis of the
patient with ischemic stroke and also that of the use of thrombolytic agent alteplase (t-PA)
(Nascimento et al., 2016).
Problem Statement
The problem statement of this change proposal is the use of t-PA for the treatment of
the ischemic stroke patients. Research has shown that a number of trials has been performed
on the patients who are suffering from ischemic stroke but the results were not desirable. The
treatment and diagnosis of the patient with acute ischemic stroke is found to be effective with
the application of the intra-arterial treatment (Berkhemer et al., 2015). The treatment of the
disease is not that fruitful as the diagnosis and treatment of the disease is done in the animal
model, however the changes inside the human brain might not be similar to the animal model
being tested.
Purpose of Change Model
The major objective of change proposal is the development of a more effective
intervention that will help in the better treatment and diagnosis of the patient with acute
ischemic stroke. The benchmark-capstone change proposal has another objective which is to
educate the patients about the state of their disease and the procedure of the treatment. This
way the organization will be able to know the patients will be able to know the treatment

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process and lastly, the final objective of the model will be the analysis of the effectiveness of
the t-PA for the treatment of acute ischemic stroke as the earlier interventions in the treatment
of the disease is not as effective as desired (Van Den Berg et al., 2017).
PICOT Statement
P- Patients who are suffering from ischemic stroke
I-Interventions related to the problem
C- Comparison of the patients who take t-PA and those who do not take the treatment
O- Outcomes of the intervention and implementation plans
T- Timeline of about 6 weeks
Patients, who suffer from ischemic stroke and undertake the t-PA treatment process in
comparison to those who do not take the treatment have improved health interventions in
terms of overall mental and physical health over a time span of 6 weeks after the entire
treatment and follow-up.
Literature Search Strategy
The main literature search strategy employed for this study is the database search
method. This method is used in order to identify the relevant scholarly articles that show
proper data with the occurrence of ischemic stroke and also the treatment of the stroke with
various drugs (Finfield& Johnson, 2013). The search was done by the use of certain search
terminology common to the ischemic stroke and its treatment. Thereafter the article review
was done in order to have a complete knowledge about the prevailing treatment process and
the factors that the treatment process is lacking. The articles related to the use of the t-PA in
the treatment process was also searched so that the existence of new treatment process and
the scope of the use of t-PA is also reviewed (Godin et al., 2015).

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Comparison of research questions
The research questions that are being used in the literature review are the analysis of
the outcomes and also the associated factors who are already have received the intravenous
treatment of t-PA.
Comparison of sample population
The comparison in the number of sample population related to the first research
questions is less than the second question. This is due to the fact that the number of patients
who had received the intravenous injection of t-PA is very high as compared to that analysis
of the outcomes in the population. The study design involves randomized control trial which
is also way more advantageous than other study designs (McDermott, Skolarus& Burke,
2016).
Evaluation of the Literature
The assessment of the literature is done based on the research chart that contains all
information regarding the articles used in the literature review. The chart clearly defines the
main findings, analysis of the treatment process and the recommendations about the treatment
process. The evaluation of the literature clearly defines the sample population that is being
analysed as well as the interventions that are being applied for the treatment of the ischemic
stroke. The evaluation clearly states the whether the data analysis method is qualitative or
quantitative. The evaluation of the literature also involves the limitations in each article used
as it will help in the proper framing of the research questions and also in the formation of the
future questions about the research (Beel et al., 2013).
Nursing Theory
The nursing theory that can be applied to the application of t-PA in the treatment of
ischemic stroke involves the theory of need that clearly focuses on the requirements of the

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patients. This theory focuses on the physiological as well as the psychological needs of the
patients. The nurses also focus on the theory of beneficence and maleficence that states that
the nurses will do no harm to the patient and the nurse will also focus on the benefit of the
patient. This theories are relatable to the application of the t-PA drug for ischemic stroke as
the drug will help in fulfilling the needs of the patients and also it does no harm to the
patients (Oita-nhs.ac.jp, 2019).
Implementation Plan with Outcomes
The action plan in order to treat the ischemic stroke will include the application of t-
PA. It is used widely now as it helps in the mitigation of the adverse effects of the ischemic
stroke (Sun et al., 2014). This treatment can be further assisted with the use of use
ofedaravone along with t-PA. Edaravone synergises with the t-PA treatment and reduces the
ischemic white matter injury. As t-PA is the only drug which is FDA approved for treatment
of the ischemic strokes reduces the risk of intracerebral haemorrhage. t-PA does not worsen
the haemorrhage volume and it does not up-regulate the metalloproteinase present in the
matrix (Foerch et al., 2013).
Barriers in the planned implementation
The efforts to seek and prevent the damages caused during the ischemic stroke by the
use of t-PA faces certain barriers and potential limitations. For instance, during the ischemic
stroke there is damage to the blood-brain barrier. This can be affected by the presence or
absence or retinoic acid and thus, the sole application of t-PA might not be able to restore the
condition of the brain prior to the stroke (Forech et al., 2013).
Another limitation is faced while the administration of t-PA during the stroke
conditions as there are certain safety protocols that are to be followed while giving the drug
to the patients. It is the recommended treatment for the ischemic stroke however, less than

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10% of patients receive the treatment. This is also a great challenge faced at the time of the
application of the drug (Lyerly et al., 2014).
Overcoming of the barriers
The barriers can only be overcome if the drug is available to all the patients who need
the treatment. There is also a need to focus on the different kind of strokes that occur in the
adults and the infants. Thus, there is a need to develop new research methods that will bridge
the gap between the variety of the treatment of ischemic stroke among the adults and youth as
there is different level of harm caused to the brain by the stroke.

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References
Babkair, L. A. (2017). Cardioembolic Stroke: A Case Study. Critical care nurse, 37(1), 27-
39.
Beel, J., Langer, S., Genzmehr, M., Gipp, B., Breitinger, C., &Nürnberger, A. (2013,
October). Research paper recommender system evaluation: a quantitative literature
survey. In Proceedings of the International Workshop on Reproducibility and
Replication in Recommender Systems Evaluation (pp. 15-22). ACM.
Berkhemer, O. A., Fransen, P. S., Beumer, D., van den Berg, L. A., Lingsma, H. F., Yoo, A.
J., ... & van Walderveen, M. A. (2015). A randomized trial of intraarterial treatment
for acute ischemic stroke. New England Journal of Medicine, 372(1), 11-20.
Finfgeld‐Connett, D., & Johnson, E. D. (2013). Literature search strategies for conducting
knowledge‐building and theory‐generating qualitative systematic reviews. Journal of
advanced nursing, 69(1), 194-204.
Foerch, C., Rosidi, N. L., Schlunk, F., Lauer, A., Cianchetti, F. A., Mandeville, E., ...& van
Leyen, K. (2013). Intravenous tPA therapy does not worsen acute intracerebral
hemorrhage in mice. PLoS One, 8(2), e54203.
Godin, K., Stapleton, J., Kirkpatrick, S. I., Hanning, R. M., &Leatherdale, S. T. (2015).
Applying systematic review search methods to the grey literature: a case study
examining guidelines for school-based breakfast programs in Canada. Systematic
reviews, 4(1), 138.
Lyerly, M. J., Albright, K. C., Boehme, A. K., Shahripour, R. B., Houston, J. T., Rawal, P.
V., ... &Alexandrov, A. V. (2014). Safety of protocol violations in acute stroke tPA
administration. Journal of Stroke and Cerebrovascular Diseases, 23(5), 855-860.

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McDermott, M., Skolarus, L. E., & Burke, J. F. (2016). A Systematic Review of
Interventions to Increase tPA Administration. Stroke, 47(suppl_1), A181-A181.
Nascimento, K. G. D., Chavaglia, S. R. R., Pires, P. D. S., Ribeiro, S. B. F., & Barbosa, M.
H. (2016). Clinical outcomes of ischemic stroke patients after thrombolytic
therapy. ActaPaulista de Enfermagem, 29(6), 650-657.
Oita-nhs.ac.jp. (2019). Retrieved from
http://www.oita-nhs.ac.jp/journal/PDF/12_2/12_2_3.pdf
Sun, Y. Y., Morozov, Y. M., Yang, D., Li, Y., Dunn, R. S., Rakic, P., ...&Kuan, C. Y.
(2014). Synergy of combined tPA-edaravone therapy in experimental thrombotic
stroke. PloS one, 9(6), e98807.
Van Den Berg, L. A., Dijkgraaf, M. G., Berkhemer, O. A., Fransen, P. S., Beumer, D.,
Lingsma, H. F., ... & van Zwam, W. H. (2017). Two-year outcome after endovascular
treatment for acute ischemic stroke. New England Journal of Medicine, 376(14),
1341-1349.

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Appendix
Activities 1st
Week
2ndwe
ek
3rdW
eek
4thW
eek
5thWe
ek
6thW
eek
Selection of the sample
population

Data collection from
secondary sources
 
Creating layout 
Literature review   
Analysis and interpretation of
collected data
  
Findings of the data  
Identification of the barriers 
Strategies to overcome the
barrier

Fig: Timeline for the PICOT template
(Source: As created by the author)