Stroke Care Nursing: Interview with Melody Davidson, RN, MN, CNS, PCCN

My Specialty

Stroke Care Nursing: Interview with Melody Davidson, RN, MN, CNS, PCCN

Responding with urgency using the latest evidence-based care

By Keith Carlson, RN, BSN
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Melody K. Davidson, RN, MN, CNS, PCCN
Clinical Nurse Specialist for Progressive Care and Stroke Unit; Stroke Program Coordinator
Mission Hospital, Mission Viejo

Please share with us a little about your life and nursing career.  
I’ve been a nurse for 42 years and began my career in critical care. After moving to L.A. to seek my bachelor’s and master’s degrees, I continued in critical care. I’ve also worked as a clinical nurse specialist [CNS], outcomes manager, clinical professor for a few universities and program development specialist for the American Association of Critical-Care Nurses [AACN].

I’ve been at Mission Hospital for 15 and a half years and I still volunteer for the AACN and the American Association of Neuroscience Nurses [AANN].

What sparked an interest in stroke care?
I worked in critical care at the bedside for 18 years and was fortunate to serve in units treating a wide variety of conditions, including strokes.

Back in the ‘80s, I was curious if thrombolytic drugs could be used for the treatment of acute strokes, as it was used for acute myocardial infarctions. The general consensus was that it just wasn’t possible. In the ‘90s, they began to use tPA [tissue plasminogen activator] to dissolve clots in the brain in ischemic stroke patients. This was really the cusp of the definitive treatment for ischemic stroke, which happens to be the most common form of stroke that we see.

At Mission, I started in med/surg and was very happy to transfer as a CNS to the stroke unit. I then began to develop our stroke program. Six years ago, I became the stroke program coordinator.

You serve in two distinct roles. Can you tell us about them both?
I am a clinical nurse specialist and the program coordinator, and I’m able to comfortably fulfill both of my roles on the unit.

In my coordinator position, I participate in project development and serve on some hospital committees. Having this dual role, I’m able to very easily see what’s happening, talk with staff and work closely with nurses, discharge planners, case managers, NPs and physicians. As a CNS on the unit, I act as a consultant to the staff. In this capacity, I serve as a change agent, examining our protocols and keeping us current with the latest evidence-based practices in the field.

We’re really fortunate here at Mission. We have a very solid team that cares for our stroke patients and I have the responsibility of leading the stroke recertification team. As new information or guidelines are released, we work as a team to change and improve our protocols. I have the privilege of doing this along with our physicians and other talented staff members.

We work very closely with the neuro subsection in order to get the “buy in” from the neurologists and ER physicians. Since the protocols reach across disciplines, this is a very collaborative effort. In developing the new protocols, we make sure that everything we do is evidence-based. While we like to examine our protocols at least annually to determine if there are evidence-based changes that are needed, we often find that our facility is ahead of the game.

What changes have you seen in the care of stroke patients in recent years?
The biggest change is the widening of the window within which acute stroke victims can receive tPA. This window has been increased from three hours to four and a half hours after the onset of symptoms. This allows us to administer thrombolytics to more patients, thus better preserving brain tissue and neuromuscular function.

Administering intra-arterial tPA directly to the affected brain artery is also a relatively new intervention, as is the mechanical retrieval of a clot via neurointerventional radiology. These are very exciting developments.

Orange County is the only county in the nation that has a “stroke receiving system” through our county emergency services. Since April of 2009, nine hospitals have been designated as stroke receiving centers. This saves lives and preserves function for many stroke patients.

What changes do you see coming down the road?
We participated in a NIH-funded study that involved early intervention with IV magnesium in the field and we’re waiting for those results. We’ll also be taking part in a study examining the effects of paramedics using meds to significantly lower the blood pressure in certain ischemic patients in order to preserve neurological tissue.

Additionally, imaging techniques with perfusion and diffusion studies to see how much blood is getting to the affected site and how much oxygen is being absorbed by tissues may have a great impact on morbidity and mortality of stroke patients in the future.

Please share with us the challenges of your specialty area.
One of the biggest challenges is educating the public about strokes, including symptoms and available treatments. It’s frustrating that many patients don’t immediately call 911, and too many people choose to wait and then be transported to the ER by friends or family rather than by ambulance. This is upsetting to us because we could have helped these people had they accessed the EMS sooner.

A stroke can be a huge, life-changing event for an individual and their family. We want to help them preserve their function as much as possible, and timely treatment is the key. Many members of the general public think that strokes are only experienced by the elderly, but we see patients as young as 20 or 30 being treated for acute strokes. Everyone needs to understand the symptoms and the importance of timely treatment.

What about your work feeds your spirit and keeps you coming back?
When we see patients who access treatment early and actually walk out of here due to our interventions, that’s very satisfying. My grandmother had a stroke in the 1960s and lost many functions, but that is just not necessary in the 21st century. I continue to watch our fabulous staff grow in their expertise in caring for these patients. We have staff members who’ve been here for years and are extremely skilled at recognizing symptoms and notifying the neurologist so that further intervention can be implemented. Between the seasoned staff and increasing expertise, we keep our patients safe.

Can you share a story about your work that illustrates what you love about it?
We had an interesting situation a few years ago. A patient was paddle-boarding and two of our nurses happened to be doing the same thing. The patient had a stroke while in the water and began to drown. Our nurses saw what was happening, got him onto the beach and called 911. Their intervention led to his being transported quickly to Mission. He had some deficits, but did quite well and was just thrilled that he had lived. The fact that our nurses were there at just the right time is a unique aspect of the story.

Another patient had a hemorrhagic stroke from an aneurysm while at the gym. Her trainer recognized the symptoms and called 911 immediately. This woman is in her 50s, recovered remarkably well and is now on our patient advisory council, visiting stroke patients and offering them encouragement and peer support.

Are there certifications or trainings that are recommended?

Whenever someone starts here at Mission, we have educational pathways that they must follow in order to care for our stroke patients. Our nursing staff members are all certified to perform the NIH Stroke Scale and we have many other additional educational competencies. In March of this year, the AANN introduced a national stroke care certification process for nurses; they will do their first round of testing in May.

What are your broader career plans?
I’m 60 years old and looking forward to retiring in just over five years, so I’m not planning on pursing another degree! However, I will do the new stroke certification in 2014 after it receives full credentialing from the American Nurses Credentialing Center. I will also continue to volunteer for the ACCN and AANN.  

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