Panorama

Stroke Nursing in Scotland

Linda Campbell1� and Janet MacRae2

Key words: career pathways, career strategies, Nursing, reha-

bilitation, Scotland, Stroke

Scotland is part of the United Kingdom and has a population of

just over five million. (Fig. 1) Health policy is controlled by the

Scottish Government and in 2002, the Coronary Heart Disease

and Stroke Strategy (1) was developed as part of the health

improvement plan. Substantial investment was provided to

tackle stroke, and managed clinical networks (2) were estab-

lished in each health board area to meet developments,

implement changes, and achieve targets. Acute standards for

stroke were developed in 2004 by Quality Improvement Scot-

land (3) and these standards recommend how stroke care is

delivered. The Scottish Intercollegiate Network also produced

guidelines for acute stroke, rehabilitation after stroke and

stroke dysphagia (4).

Stroke is the third biggest cause of death in Scotland and is

the leading cause of adult disability. At any given time 13% of

hospital beds are occupied by stroke patients (5). It requires

specific skills and knowledge to ensure that skilled nursing care

is delivered to stroke patients, not only to meet their physical

needs but also their psychological, emotional, communica-

tion, and social needs. In 2001, 12 nurses with an interest in

stroke nursing got together to discuss ideas and ways to

develop and to raise the profile of stroke nursing in Scotland.

From this the Scottish Stroke Nurses Forum was created, with

the each of the mainland Health Board Areas, and three islands;

Orkney, Shetland, and the Western Isles being represented by a

nurse.

The Scottish Stroke Nurses Forum developed a definition of

stroke nursing, ‘Stroke Nursing is a specialist area of nursing

practice that focuses on meeting the holistic needs of indivi-

duals and families and the varied consequences of stroke.’ The

forum has developed from the original 12 members to a

membership of more than 200 members in 2007. Coinciding

with the increase has been a subsequent recognition that the

Forum can provide a knowledgeable and up-to-date view of

stroke nursing that contributes to National and Local Policy.

Most members are active in their local Managed Clinical

Network but the group also has members on the National

Stroke Audit Group, the National Dysphagia Project, and the

Scottish Intercollegiate Guidelines Network and on NHS

Quality Improvement Scotland.

Research projects have also been commissioned by the

Forum. In 2005, a bench marking exercise, looked at the

nursing skills mix in stroke units throughout Scotland, and

found wide variations in staffing (6). In 2006, a research

project to look at the ‘Burning Issues in Stroke Nursing’ was

commissioned and the findings of this were published in late

2008. The Scottish Stroke Nurses Forum has been supported by

Chest Heart and Stroke Scotland (a charitable organization)

and by an unconditional educational grant form Boehringer

Ingelheim. Further information can be obtained from the

Forum website.

The first stroke nursing consultant in Scotland was ap-

pointed in 2007, opening up a further rung on the stroke

nurse’s career ladder. The role of the stroke nurse consultant

was set out by the Department of Health (7). It saw the core

roles as:

� expert clinical practice,

� leadership and consultancy,

� education and training, and

� research and evaluation with service development.

In 2008, Burton et al. (8) concluded that more research is

needed into the role to identify how expectations of the stroke

nurse consultant can be further developed and supported to

meet the needs of the organization and to support their role as

stroke entrepreneurs. What is clear is that stroke nursing is

multi-faceted and requires excellent stroke nursing skills and

knowledge. Langhorne and Pollock (9) recognized that nur-

sing was one of the key elements for effective care within a

stroke unit. Specialist nursing posts in Scotland have been

recognized as providing key roles in supporting the stroke

patient and their family through-out their journey but have

been found to be of great value after discharge from hospital.

These specialist posts have a plethora of names and job

descriptions (stroke nurse, stroke liaison nurse, stroke coordi-

Correspondence: Linda Campbell�, Stroke Unit, Raigmore Hospital,

Inverness IV2 3UJ, UK. E-mail: linda.campbell8@nhs.net1NHS Highland, Inverness, UK2Stroke Unit (on behalf of the Scottish Nurses Forum), Raigmore Hospital,

Inverness, UK

& 2009 The Authors.124 & 2009 World Stroke Organization International Journal of Stroke Vol 4, April 2009, 124–126

nator, etc.) some are funded by health boards and others are

jointly projected with the board, and Chest, Heart, and

Stroke Scotland. The normal career pathway can vary however,

Fig. 2 provides a likely stroke nurse pathway in Scotland. The

commonality is that they all provide advice, support, and

information throughout the patient and their family’s stroke

journey.

There are other points that can also shape and develop

stroke nursing, personal experience of stroke being one of

these. Jane� (name changed) was working as a staff nurse in a

Stroke Unit when her husband became ill. He was 39, initially

there were questions over his diagnosis, she remembers this

vividly and how it felt being ‘in the dark.’ She knows it is cliched

but the stroke changed her husband’s life, their family life, their

No. Name1 NHS Ayrshire and Arran2 NHS Borders3 NHS Dumfries and

Galloway4 NHS Western Isles5 NHS Fife6 NHS Forth Valley7 NHS Grampian8 NHS Greater Glasgow

and Clyde9 NHS Highland10 NHS Lanarkshire11 NHS Lothian12 NHS Orkney13 NHS Shetland14 NHS Tayside

12

13

9

4

7

14

108 11

2

3

65

1

Fig. 1 Scotland’s Health Boards.

Senior Staff Nurse Post/ JuniorWard Manager (Grade 6)Stroke Unit

Specialist StrokeNurse Post (Grade7)

Clinical Ward Manager (Grade 7)Stroke Unit

Staff Nurse Post- Grade 5(Newly Qualified)

Staff Nurse Post (Grade 5)Stroke Unit

Staff Nurse Post (Grade 5)General Medicine / Other Areas

Consultant Stroke Nurse(Grade 8)

Specialist Stroke NursePost (Grade 6)

Fig. 2 Career Structure for Nursing in Scotland.

& 2009 The Authors.& 2009 World Stroke Organization International Journal of Stroke Vol 4, April 2009, 124–126 125

L. Campbell & J. MacRae Panorama

outlook, and gave her insight into what the families on the

Stroke Unit go through. Jane shares her experience with others

to help them learn and to see that recovery does happen and

how it is important to take each day as it comes. She feels that

her unique experience gives her insight and knowledge that

other stroke carers don’t have.

Stroke nursing in Scotland continues to evolve and develop.

The Scottish Stroke Nurses Forum plays a key role in this and

has developed its Strategy for Stroke Nursing in Scotland

(2006–2009) which lays out the Strategic Aims and further

development of the career pathway (10).

In conclusion, stroke nursing in Scotland is gathering pace

and recognition as a specialist field. For the stroke nurses to

continue to develop they must continue to influence the care of

stroke patients and their families through being involved in

local and national service development, research, training and

education, and expert practice (Fig. 3).

References

1 Scottish Executive. Coronary Heart Disease and Stroke Strategy.

Edinburgh: Scottish Executive, 2002.

2 MEL. Managed Clinical Networks. Edinburgh: Scottish Executive,

1999.

3 NHS Quality Improvement Scotland. Stroke Services: Care of the

Patient in the Acute Setting. Edinburgh: NHS QIS, 2004.

4 SIGN. Management of Patients with Stroke. Edinburgh: RCP, 2002.

5 Rowat R et al. Bench-marking exercise, 2006. Available at http://

www.chss.org.uk/links/ssnf/ssnf.shtml (accessed January 2009).

6 Scottish Stroke Nurses Forum. Stroke Nursing in Scotland, 2006.

Available at http://www.chss.org.uk/links/ssnf/ssnf.shtml (accessed

January 2009).

7 Department of Health. Nurse, Midwife and Health Visitor Consul-

tants: Establishing Posts and Making Appointments (HSC 1999/217).

London, The Stationary Office, 1999.

8 Burton CR, Bennet B, Gibbon B. Embedding nursing and therapy

consultantship: the case of stroke consultants. J Clin Nurs 2009;

18:246–54.

9 Langhorne P, Pollock AStroke Unit Trialists’ Collaboration. What are

the components of effective stroke unit care? Age Ageing 2002; 31:1–7.

10 SSNF. Strategy for Stroke Nursing in Scotland, 2006. Available at http://

www.chss.org.uk/links/ssnf/ssnf.shtml (accessed March 2009).

Fig. 3 Staff Nurse and Nursing Auxillary work together to provide excellent

stroke patient care.

& 2009 The Authors.126 & 2009 World Stroke Organization International Journal of Stroke Vol 4, April 2009, 124–126

Panorama L. Campbell & J. MacRae