Journal of Nursing Theory and Practice

[Role of Atrial Fibrillation in Stroke Prevalence: Implementation of CHA2DS2 – Vasc Risk Stratifi­cation Scale]

PAPP László1, VIDA Nóra2, BENGŐ Szilvia2, KIS Tamás 3, GAÁL Gabriella3, PETŐ Zsófia4

AUGUST 30, 2020

Journal of Nursing Theory and Practice - 2020;33(4)

[Introduction: Stroke is one of the leading causes of death and disability, therefore is an important public health concern. 20% of ischaemic cerebrovascular diseases are casued by cardiac-related embolism, wiith non-valvular atrial fibrillation (AF) as a major cause, and results in approximately 3-5-fold risk improvement. The aim of this study is to introduce the CHADS2-VASc scoring system, as an important tool in the estimation of stroke risk in AF patients. Recognition of AF and initiation of adequate therapy is a crucial step in the prevention of serious complications. The best-known indexes for AF’s vascular effects are HAS-BLED and CHADS2-VASc. According to European Society of Cardiology, CHADS2-VASc is recommended to use in every AF case with stroke risk, when direct anticoagulant therapy could be implemented. A nurse can work on stroke risk reduction among AF patients in various levels and competences. Primary prevention and health promotion is a responsibility for every health care worker, but at the same time, Advenced Practice Nurse could have a role either in diagnostics or initiating proper therapy.]


  1. Szegedi Tudományegyetem, Szent-Györ­gyi Albert Klinikai Központ, Sürgősségi Betegellátó Osztály, Szeged
  2. Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Neurológiai Klinika, Szeged
  3. Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Sürgősségi Betegellátó Osztály, Szeged
  4. Szegedi Tudományegyetem, Általános Orvostudományi Kar



Further articles in this publication

Journal of Nursing Theory and Practice

[Beliefs and Misconceptions about Vaccination]


[Vaccination is one of the most effective public health interventions against infectious diseases, especially against vaccine-preventable paediatric diseases. However, there are parents either delaying or refusing recommended childhood vaccination due to the fear of a ‘link’ between vaccinations and autism or other diseases. Religious objection is often used as an excuse to avoid the vaccination. Opposition to vaccination dates back to the Victorian age. Since the 18th century, fear and controversy accompanied the introduction of every new vaccine. This has been compounded, in recent years, by a decreased trust in the vaccine manufacturing or distributing institutions. Although healthcare professionals are cited as the most influential source by parents and adult population on vaccine decision-making, mistrust of vaccinations is already occurs among health workers. It is important for health professionals to be well informed, to able to persuade parents and the targeted population to vaccine.]

Journal of Nursing Theory and Practice

[Acceptance of the Advanced Practice Nurse System among the Hungarian Society]

SAIN Henrietta, BÁNFAI Bálint

[Involving advanced practice nurses into the health care system can improve the quality of patient care. Our aim was (1) to measure the acceptance of of the advanced practice nurses (APN) in the Hungarian emergency care, (2) to determine a better nomenclature for APNs, (3) highlight the similarities between APNs and the paramedics in order to increase the admission. An online survey was used between September and November 2019. The questionnaire was filled out by Hungarian people >18 years. The questionnaire contained questions related to sociodemographic data, to the acceptance of APNs, to the nomenclature, and published a brief summary of the topic. Three-hundred seventy-two people answered our questionnaire (N=372). Participants with better knowledge about the APNs (p=0.002) accepted their role more than people with worse knowledge. Healthcare professionals are more open to know the new system (p=0.018) compared to laypeople. Participants who know the competency of paramedics were more likely to accept examinations from APNs (p<0.001). Most responders suggested APN, diagnostic nurse/paramedic, and master nurse terms for the nomenclature. It could became an integrable system with sharing appropriate information and definition of the competences and formation of the legislation.]

Journal of Nursing Theory and Practice

[Popularity of Nursing Profession among Career Choices]

FERENCZY Mónika, GERÖLYNÉ Sipőcz Eszter, KOMLÓSI Kálmánné, KARÁCSONY Ilona, SZABÓ László

[The aim of the study: The aim of our study was to assess the influencing factors in career choice of students in nursing education. Our quantitative, descriptive, cross-sectional, questionnaire survey was conducted at a high school in Szombathely and on an internet forum between February 2018 and May 2018, with non-randomized targeted expert sampling. High school students currently in nursing education (N = 114) were selected and those who did not fill in the questionnaire were excluded. Data analysis was performed with Microsoft Office Excel 2016 software using descriptive statistical methods and the chi2 test (p <0.05). There was a correlation between parents’ educational attainment and their children’s intentions to continue their education (p <0.01). There was no demonstrable correlation between staying in education and satisfaction with education, practical training in demonstration room and clinical education (p> 0.05). There was no correlation between the appreciation of nursing profession and the intention to continue in the profession (p> 0.05). Nursing care choices have been strongly influenced by the desire to help sick people. The exemplary role of health care staff in education and practice is crucial and can be followed in creating the next generation of nurses.]

Journal of Nursing Theory and Practice

[The Impact of Stoma on Patient’s Relationship and Sexual Life]

ROZMANN Nóra , MERKL-ORAVECZ Mercédesz , TÓTHNÉ Rádai Viktória, PUSZTAI Dorina , SZUNOMÁR Szilvia

[To become a sufferer of some serious illness or chronic condition leaves a mark on the life of any person. In the case of patients with stoma, this is especially true, as in addition to the underlying disease that causes stoma, this changed life situation can cause additional difficulties and obstacles. The aim of our study was to assess the impact of the presence of a stoma on patients ’relationship and sexual lives. We further aimed to compare this group of patients with the relationship and sexual habits of the non-stoma group. Our research was a quantitative, descriptive cross-sectional study, the target group was individuals with a stoma aged 16–61 years and those without a stoma (control group) living in a relationship. Data collection was performed using an anonymous, online questionnaire. For statistical analysis we used SPSS 22.0 and Microsoft Excel 2007, in addition to descriptive statistics, we performed χ2-trial analysis. The level of significance was determined to be p <0.05 with a 95% confidence interval. 80% of those with a stoma whose sex life had been changed were affected by the presence of a stoma bag. The remainder of those with a stoma, although their sexual habits did not change, were mentioned by 33% as a disturbing factor during intercourse (p=0.01). In terms of sexual satisfaction, 32% of the patients without stoma (n=60) and 36% of the patient with stoma (n=50) were satisfied with their sexual life, a difference between the two group was not significant (p=0.604). Overall, the stoma bag affects sexual harmony, which affects postoperative sexual habits]

Journal of Nursing Theory and Practice

[Assessing the Nutritional Status of the Elderly using Standard Status Scales]


[Aims of the study: assess the nutritional status of elderly patients in hospital wards. A prospective, cross-sectional, quantitative study was conducted in a department of a county hospital. In a non-randomized, targeted, expert sample, the target population was elderly patients over 65 years of age (N=100). Patients with cognitive dysfunction and end-stage patients were excluded from the study. According to the MNA, 46% of patients are malnourished and 47% are at increased risk. 55% of patients were at risk using the NRS 2002 method. According to the NSI, 91% of patients are at risk. Participants with incomplete(/defective) teeth (p<0.05) and over 80 (p<0.05) are effected by malnutrition (p<0.05). The correlation was significant between the swallowing problem and malnutrition (p<0.05). Conclusions: more than half of the participants are malnourished or at increased risk. Screenings take short time, but they are informative as first assessment and for follow up. ]

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Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke


Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Relationships between COVID-19 disease, nutritional status, and dysphagia, particularly in stroke patients ]

KOVÁCS Andrea, SZABÓ Pál Tamás, FOLYOVICH András

[The new coronavirus, SARS-CoV-2, which causes the COVID-19 disease can lead to severe acute respiratory distress syndrome (ARDS). It poses a serious challenge to the health care system, especially intensive care. Neurological patients, usually of advanced age and with a myriad of comorbidities, are at particular risk through the impact of the new coronavirus on their condition and nutritional capacity. Stroke is a leader in morbidity and mortality data, with a focus on dysphagia and its complications due to COVID-19 disease and acute cerebrovascular accident. In the acute phase of stroke, 30-50% of patients suffer from dysphagia, which still shows a prevalence of 10% six months later. Dysphagia results in decreased or insufficient fluid and nutrient uptake, supp­lemented by inactivity, leading to malnutrition and sarcopenia, which worsens overall condition, outcome, and rehabilitation efficiency. Screening and early detection of swallowing disorders is a fundamental issue in order to develop a personalized and timely-initiated nutritional therapy strategy. Nutritional therapy plays a key role in frequent intensive care due to COVID-19 disease, where it increases the chances of recovery and reduces the length of stay in the intensive care unit and mortality. This is especially true in critically ill patients requiring prolonged ventilation. In COVID-19 diagnosed patients, screening for dysphagia, bedside assessment, and instrumental examination, followed by swallowing rehabilitation, are of paramount importance. Stroke can also be a complication of the COVID-19 infection. Care for cerebrovascular patients has also adapted to the pandemic, “triazination” has become systemic, and dysphagia screening for stroke patients and nutritional therapy adapted to it have also shed new light. ]

Lege Artis Medicinae

[The history of acute stroke care in Hungary ]


[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

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[Systemic thrombolysis and endovascular intervention in postpartum stroke]


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