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We know that stroke patients are at high risk of poor cognitive, physical, and psychological outcomes. How does delirium impact their outcomes and how can we better protect patients from additional brain injury from delirium?

Episode Transcription

Kali Dayton 0:00
Green. Rosa, welcome to the podcast. Can you introduce yourself to us?

Rosa Hart, BSN, RN  Yes, thank you so much for having me today, Kali, and my name is Rosa Hart. I am the stroke nurse navigator for a large system in our area. And I, at this point, my role is to call stroke survivors after they’ve been discharged from one of our hospitals with an ischemic stroke. And when I call them, I talked to them about their medications about their modifiable risk factors like blood sugar, blood pressure, cholesterol, things like that, and identify and help them find solutions to the things that they’re struggling with to prevent stroke, but also to have the best quality of life that they can after having a stroke.

Kali Dayton 0:52
So you really need expertise on survivorship, stroke, survivorship, right, and many of the survivors have left the ICU. So they are also ICU survivors. And I want you to mentioned as well, where the project is that you’re working on right now.

Rosa Hart, BSN, RN 1:09
I am building a podcast for my system that I work for is called “Stronger After Stroke”. The first episodes aired may 1. So we already have eight episodes out, ranging from topics of sex after stroke to stroke survivor stories, as well as hearing from our experts in neuro music therapy, and migraine and how that relates to stroke as well as gender roles. And what that can look like when you can no longer perform the gender role that you found your identity in once you have a stroke if your abilities change, like how does a person find value in kind of helping them think through that in the course of those conversations,

Kali Dayton 1:59
Which is amazing. And I recommend that people share this podcast with with their survivors as they leave the hospital with the families. What a great resource. And even for ICU clinicians, I’ve always felt that this is a focus I’ve taken throughout this podcast is that if we understood what survivorship looked like, it would influence how we care for them in the initial phases of critical illness. So now with your expertise with all that you’ve seen and experienced. Why do you feel the ABCDEF bundle is so important for stroke victims?

Rosa Hart, BSN, RN 2:36
Survivors, not victims, survivors, right? If they’re a victim, then I don’t get to talk to them.

Kali Dayton 2:45
But even when I guess if we’re looking at the zooming in on, you have this big picture, you see the other side of it. But if we’re rewinding going back into the ICU and zooming in on that immediate moment when they roll in our doors, what do you wish that maybe you understood it as you care for them those moments or that clinicians now understood, understanding survivorship.

Rosa Hart, BSN, RN 3:07
So I’ll share some of my story with you because I think it really my growth and understanding of this topic. While there are elements that I did not understand until listening to your podcast about the effect of sedation, causing delirium that really blew my mind. And it had to me rethinking some things about my experience.

But my experience with ICU started in 2013, when I was working as a nurse aide, and I started in the neuro ICU, I think that was a really good thing because as I learned, a lot of people are afraid of neuro because they don’t understand it. And I didn’t know to be afraid of it. So I was just like, these are the patients I’m working with people who have strokes.

So initially, I was assisting the nurses who were caring for them while they’re doing their NIH s and they were inserting their dogs off to sleep and all that that’s part of the acute care phase of taking care of stroke patients in the ICU. And or I was holding them down as they’re trying to escape, you know.

Kali Dayton 4:19
It’s a tricky population. It really is.

Rosa Hart, BSN, RN 4:23
We would joke that sometimes people think that neuro means crazy and so good for them if that were not appropriate, but no. Um, so as I came from being a nurse aide to working as an RN on those same units, I was working night shift and night shift in the ICU. At a facility that cares for a whole lot of patients with very demanding on this staff who were responsible for the life and death, right.

And so we had a lot of patients who were unfortunately snowed on sedation. And I really want to highlight the fact that I feel like that was the choice of the lesser of two evils in a lot of situations because we had to keep them alive. And we might have this decompensating patient over here that it takes almost everybody on the unit to work collaboratively to keep them alive. And then we need to keep our other patients sedated, so they don’t take out their life.

So while we’re not watching, right, so I felt like there was a lot of moral distress on the part of the educated nurses who were trying to teach us to minimize the sedation and have those awakening trials. And I did receive a lot of education about that when I was working night shift, but it was really hard to for that to be the priority, when the priority had to be keeping somebody alive as well, you know, so

Kali Dayton 6:14
they’re not likely to be oriented, calm, compliant,

Rosa Hart, BSN, RN 6:17
right? Especially not initially, like we’re going to talk about the ABCDE F bundle. And there’s so much human interaction required in order to implement that bundle. And if you don’t have the human power to do it, if you don’t have those safe staffing ratios, it’s not physically possible to do that ideal care. And so I just want to put a plug out there for safe staffing and retention.

Kali Dayton 6:47
This is one of the biggest cards to play, right? It’s where are we increasing mortality, long term disability suffering, because we don’t have enough people to sit at the bedside and hold their hand? Yeah, and we take away the family at night. We’re taking away our resources, and we’re not providing resources because and so it’s almost like the staffing ratios expect you to snow your patients.

Rosa Hart, BSN, RN 7:09
Yes.

Kali Dayton 7:10
And that’s a huge problem. And I love that you bring up the moral distress, because once you do know, once you do know the price to be paid with these medications. And yet you’re in the situation when you have so many fires going on. And if you have impulsive, people tried to pull out their lines in a neuro setting. That may not just be delirium.

Rosa Hart, BSN, RN 7:29
Yeah.

Kali Dayton 7:30
But then you can add delirium on top of that. That’s not what you want to do. But then you’re trying to keep these life saving devices and interventions in place. You also have hard exceptions, like intracranial hypertension.

Rosa Hart, BSN, RN 7:42
Yes,

Kali Dayton 7:42
Where there is no other choice, but to deeply sedate them. But then once that’s done, it’s hard to take it off, because now you’ve got likely some delirium and agitation going on. So yeah, I think neuro has a lot of really difficult exceptions. And yet, it the A2F bundle is still so important. You still….especially…. these are vulnerable patients that are coming to you with brain injuries. They’re high risk of poor outcome. So why why is this so important to still focus on?

Rosa Hart, BSN, RN 8:11
So I got to transfer to a day shift position at a different hospital, though, it’s a comprehensive stroke center. And since we were receiving stroke patients from all across the region, we will get people in who had already received all to place the clot busting medication for acute onset of stroke, as well as we were able to serve patients with the mechanical thrombectomy.

For that surgery to pull the clot out of their brain. And so when you’re serving this patient, very specific population, you have to staff appropriately to do their q 15. Neuro checks and their every hour, NIH is for one to two days, which are extensive neuro exams that have to be completed. So in that scenario, I would enter this whole new world, I felt like of people being able to provide the level of care that I had thought was not possible.

I remember being oriented and I’m like, “Yeah, but we don’t have time to do that. Right?” And they’re like, “Oh, no, we make time and then we have a relief nurse who will come and make sure that it gets done.” And just having that level of support to empower us to implement the ABCDE F bundle was just a mind blowing that it could really be real.

So um, you know, I’m sure you talk about it on this podcast so much all the time that everybody listening knows what it is, but I’ll just go through a for assessing, preventing and managing pain. Well, if it’s a stroke patient, you don’t get to give them morphine, because you don’t get to give them any kind of sedating medication.

You need them to be I optimally alert so that they can perform this neuro tech so that you know their neuro status. And sometimes that causes pain. And that’s just part of it’s like, well, if you feeling pain, that means you know your life. I’m really sorry. That was a huge shift in thinking that in becoming a neuro nurse was it sometimes things you do for people can cause them pain, but it’s for their own good, and that intention makes a difference.

But also non pharmacological pain interventions, such as distraction in between assessments, and relaxation. And repositioning is not just something you do every two hours to say, Oh, I reposition my patient, but it really is, that is their pain relief, that is how you can provide them with some relief from all the discomfort that they are going to be experiencing. And music therapy was something that I saw as a pain intervention.

So we had a neuro specialized music therapist, who would come in and find out what their favorite music was, and teach them in their family to play it around mealtimes. So they would have that familiar stimuli that would elicit those feelings of comfort, but and also help them stay awake during the day. And then we will keep it quiet at night.

So they could sleep to help them in the midst of us not letting them sleep for two hours consecutively for a very long time. Be able to tell when it was day versus night. And so spontaneous awakening and breathing trials were not so much of an issue, because we were not knocking them out.

That was a big learning curve for me when I come in, and so many patients are unprecedented, not pro football, because we need them to be able to do their neuro assessment. And they can do that on precedents. And so that was a new thought for me. And then I learned a lot about we don’t need to give Seroquel for people to sleep in that situation. And that’s an anti psychotic, not asleep aid.

Kali Dayton 12:31
Yeah.

Rosa Hart, BSN, RN 12:31
Right. So if they’re not psychotic, we don’t need to be giving that. Just that huge learning curve for all of these meds that I thought routinely had been prescribed for people who were coming from nursing homes who were taking this every night, you know, a baseline. And so I thought that’s just what you give people who?

Kali Dayton 12:52
Absolutely when it’s so normal, especially when you’ve started your career, learning those things. I don’t think we really question it. I started my career in awaken walk and ICU. But I appreciate that. Even years after when I went to other ICUs. I didn’t ask as many questions as I should have, because it was so normal. Just you don’t question it.

But we also like we equate normality with benign. It’s always done. That’s what everyone’s doing. It must be fine, they must not be harmful. We wouldn’t even imagine that we could be damaging patients with something that everyone is doing. So then it is a shock to go into new environment and say, oh, so what I was doing before what I was taught before, wasn’t necessary, or wasn’t maybe helpful. It’s a shock.

Rosa Hart, BSN, RN 13:43
Well, and you do need, like we said that empowerment to allow that ideal standard of care. Right. So in my former environment, I did you feel like it was necessary in order to keep the most people alive as we could at the time,

Kali Dayton 14:00
because of the way that the unit was staffed with it was it was structured, you didn’t have the support to practice that higher level.

Rosa Hart, BSN, RN 14:09
Exactly. So there was a lot of Yeah, so changing environments was really enlightening for me. Let’s see. For delirium assessment, we were neuro assessing our patients so much. I don’t know if I remember it. I don’t think we had to assess for delirium, separately, because then we were just assessing them all the time.

So we did a delirium assessment, like with our neuro assessment, but in attention with so many people already having, like, add in stuff. That part of the assessment for delirium, I felt like was so unfair. Like first save a heart, like Oh, Are they gonna squeeze this? Asses this

Kali Dayton 15:03
If they pass you feel pretty confident that they don’t have it? Right? Yeah, for the most part, but, but it is important to continue on beyond the the, you know, times for right to sake because design can be so variable so elusive. Yeah. And why are you? What risk factors do stroke patients carry for delirium?

Rosa Hart, BSN, RN 15:28
So I had to talk to one of our neurologists about this, because when you and I were discussing doing this episode, I tried to do some research. And I feel like there was a whole lot of research specifically on delirium risk for stroke patients. And he said that, it was really hard to differentiate.

If it’s the ICU causing to the delirium, or if stroke is just one more burden on their reserve, in light, maybe they have COPD, or maybe they have some other kind of comorbidity that’s already depleting any of their reserve mental faculties and stroke is one more insults, that adds to the burden, putting them at a higher risk for delirium.

So, in the course of preparing to talk to you about this, I felt more and more confident that our standard of care that we give to our stroke patients, is really good information for other specialties. Because we have learned well, they had to be awake for this. And this is an Awake and Walking ICU.

When I first came there, I was orienting and a patient walked by me on a vent with PT and OT on either side, and respiratory pushing that behind over and I was like, “What is happening? Stop is scary. It’s dangerous.”

Kali Dayton 17:09
Yeah.

Rosa Hart, BSN, RN 17:10
And so I will never forget the level of shock that I experienced seeing that for the first time. And not every patient will qualify. But that was just really inspiring. And so being in that environment, seeing that it was possible, really made an impact on how I care for patients.

Kali Dayton 17:36
And your value of neuro exams and cognitive function is extremely exemplary for other specialties. My first contract leaving that Awake and Walking ICU and then go into a, quote, “normal ICU”.

I remember that first shift wanting to do an oral exam, but that was part of my ingrained habit, right, because most of my patients before had been awake. And that was just, it’s part of your head to toe assessment, nursing. 101. Right? And then I couldn’t do it. And that was one of my first concerns was, “Well, why can’t I do it? Why are they why are they sedated?” Right?

That was one of the triggering questions. One of the things that triggered that question as to why they were sedated. It was, “Well, then how do I do a neuro exam?”

Rosa Hart, BSN, RN 18:17
Exactly.

Kali Dayton 18:17
And looking back, I should have been more concerned. And I suppose I should have been concerned that no one else was concerned, like a neuro exam was not a priority. It was while they’re on a ventilator, therefore, we can’t do a neuro exam.

Now three contracts later, I was in in a facility that was practicing some level of the ABCDEF bundle, and I was being taught how to do an awakening trial. And I was told to turn sedation down just enough to see them thrash, then turn it back on. And that was again, I wondered. That was in your initial training, too. Yeah. And I know, there’s I don’t think any of us have anything to be ashamed of, right?

This is these roots are deeper than us. Right? And deeper than those nurses that trained us. This is one of the problems is that how we’ve been trained. But I remember being really confused, because one, I was pretty confident that agitation was not just the ventilator, as they said, because I had seen so many patients become a complaint on the ventilator and two, I remember wondering,

“but how do I do the neuro exam? Or what is it that doesn’t tell me anything about their neuro status?” But no one else seemed concerned. No one else was asking those questions. And so unfortunately, I didn’t have the confidence to say, “Wait a minute nursing 101 doing neuro exams.”

So then it’s amazing to think how many patients go how long without neuro exams, and so we saw during COVID and it patients had strokes and cardiovascular events because that went undetected. Yeah. And then and now we’re doing CT scans and MRIs after weeks of sedation, because we don’t know. We don’t know why they won’t wake up with it. The sedation. Is it delirium? Is it a stroke? We have no idea. So how do you as a neuro nurse, feel about patients going days to weeks without real neuro exams?

Rosa Hart, BSN, RN 20:09
Now, having seen the difference, I 100% understand how it can happen, because I lived in ICU environment. But also, I’ve seen that you can keep your patients awake, safely. But you do need to make choices like to minimize the invasive equipment that’s attached to them. That’s a limiting. Right. So how many patients are sedated because you don’t want to mess up their a line? Well, they need an a line, right? My old ICU, they thought everybody needed an a-line!

Kali Dayton 20:51
One of the results of minimizing sedation is a decrease in infection. And I think one of the reasons is because we minimize those devices. They don’t have fully centralized airlines all these things as long when sedation is minimized.

Rosa Hart, BSN, RN 21:06
exactly,

Kali Dayton 21:06
we naturally progress them.

Rosa Hart, BSN, RN 21:09
And they don’t need a dot off to you, but they can get extubated. And usually, well, that was another thing with stroke patients specifically. If they come in, and they’ve are being worked out for stroke, everybody gets a tour best, which is a swallowing exam.

Nobody gets anything by mouth, no sips of water, no nothing. Unless you have a tour best to clear you to swallow. And then if you don’t follow or don’t pass the tour best, you have to have a barium swallow study with a speech therapist. And any meds that have to be administered before then you have to have a dob hoff tube or it has to be a depository. And that was very strictly adhered to. But that’s another invasive thing that’s really hard to do with somebody who’s awake.

Kali Dayton 22:04
but I mean, the standard of care, you’re making sure that there’s no dysphasia. And your patients are obviously at higher risk of dysphasia than most.

Rosa Hart, BSN, RN 22:11
Yes, definitely.

Kali Dayton 22:15
And when you’re looking at… when we’re talking about delirium, you know, we’ve talked about the media in the ICU. But why are you concerned about delirium now with your perspective of survivorship?

Rosa Hart, BSN, RN 22:29
So, stroke survivors, we have learned, have a lot of anxiety and depression, after the stroke, whether or not they experienced a debilitating injury that would cause them disability. And a lot of that can be fear that they’re going to have another stroke, because they understood what happened to them. And that’s a real possibility. So it’s fear based in reality.

And then you have fear of not knowing what in the world is going on. So for my stroke survivors, I feel like it’s really important for us to learn as much as we can, from those who are able to share their experience, because there are so many whose communication is impacted, who may be experiencing the ICU delirium you’re talking about, but the language center of their brain is not allowing them to communicate it.

Yeah. So I’m so thankful for the stories you’ve shared of those stroke survivors who are those ICU delirium survivors who got to share how terrified they were and how confused they were and how it’s like sometimes they would know that what they were seeing was real, but they couldn’t tell what was real. And it was because of their sedation.

And we do have a lot of like you were saying intracranial hemorrhages and hemorrhagic strokes that require more sedation, they have more surgical interventions that get involved. And so I, I was really hearing, potentially, their voices and their experiences, especially if they were not able to ever verbalize that.

Kali Dayton 24:28
I’m thinking back to me took a contract in the neuro ICU and I’m thinking about these patients that are impulsive, they put lines there. Really a lot of work. That’s stressful. And this is before I really valued delirium, and I think of a patient that was on Heparin drip he’d had stroke it you know that one side that still works gets busy.

And he wasn’t my patient, but I wanted to check on him cuz he was Spanish speaking and I speak Spanish and he had his Foley catheter in his hand, balloon still inflated. I was on Heparin drip and there’s blood everywhere. And I just like, I can hear my own voice, “Noooo!!! Que haciste?!” I just in a panic.

Now thinking, you know, replaying that my mind- did he have delirium? Right? Is that what I was just thinking it was just a stroke? Or it’s just, you know, “It’s an ICU patient, so they’re confused.”— But did he have to learn? What was he really experiencing? Was that a snake that he thought when he pulled it?

You know, what was really going on. And I wish that we looked at ICU patients, like we did stroke patients, because we’re seeing a stroke patient, and we’re thinking, “We’ve got a long term big picture here. This could change their entire life, the trajectory of their life and their family, the career, we have to really hurry up with rehab, we want to give them as much cognitive function as possible, because they’re already under attack.”

And yet, so we do have this stroke going on, their cognitive function is at risk. But delirium adds another insult to it. So you can have delirium on top of stroke.

Rosa Hart, BSN, RN 26:04
Yeah.

Kali Dayton 26:05
And their cognitive outcomes are much worse. So I wish that throughout all the other specialties, another take home, right for the rest of the specialties is to think about the brain, no matter why they’re in the ICU, we need to look at the same way that their cognitive function is at risk. No matter why you’re in the ICU, you’ve got a long term impairment looming over your head unless we take action.

Rosa Hart, BSN, RN 26:29
And we had one benefit of having standard or standing orders for PT, OT, and speech therapy assessments for stroke patients that are not, I don’t know that. That’s the standard for everyone, right. And so if you’re not doing a neuro assessment and saying, “Oh, they’re cognitition seems off, we should have OT or speech come and give them a cognitive eval”, they can be discharged without ever anyone picking up on that.

And I feel like with our stroke patients, because we do have that standing order, because that’s part of the best care you give to stroke patients is setting them up for success. So with rehab, if that’s home health therapy, outpatient therapy, or acute rehab, we have a protocol for that. And we can pick up on those cognitive deficits, and have that conversation with the patient and the family in the room, in the hospital, where you’re like, “Well, you may not be able to do basic math and drive yourself safely.” And all this.

And those can be hard conversations to have when you’re talking to the head of the household who can’t hear any correction from anybody, but you have evidence right there in front of you, right. And if you send somebody home without having all that setup, beforehand, it can be, they may never get it in their life, they may be out there on the road driving around within an anoxic brain injury.

And nobody knows, because they didn’t have a head CT, because they didn’t have a stroke. So I think having our stroke protocols really is a protective factor for our stroke survivors, because they do get those brain scans. And they do identify those injured areas and those areas that need support.

Kali Dayton 28:15
And your rehab specialists are not visiting the ICU. They’re in the ICU, they are on the ICU team.

Rosa Hart, BSN, RN 28:21
Yeah, yeah.

Kali Dayton 28:22
And that’s something to also replicate and the other ICUs that those we have specialists art should be an intricate part of the assessment, the planning the intervention, but a lot of times the other specialties because we don’t think the brain is really relevant, or we think the physical function is going to be a secondary back end thing.

They just get to visit every once in a while if a patient’s not on a ventilator. And we don’t have those conversations with delirium survivors, we don’t say you’ve had an insult to your brain, this may change the rest of your life, let’s set you up with resources to help you rehabilitate at home. So that’s another way to to replicate what we do in the neuro ICU. But how great that you have a safety net for delirium victims, as well as stroke patients.

Rosa Hart, BSN, RN 29:13
Yeah. And so I’ve been really encouraged in the course of preparing to have this conversation with you, because I’ve realized how many great protective processes we have to help with delirium.

Kali Dayton 29:28
And because you already have the specialists in play, you know, maybe they’re focused on the brain. But no physical therapist is just going to focus on the brain, they’re going to look at the whole body. And so you’ve already got protective measures against ICU Acquired Weakness, if you already have physical deficits or changes from the stroke. They’re working on that right away, because the sooner you work on it, the better the outcomes, and so ICU acquired weakness is probably quickly prevented and addressed.

Rosa Hart, BSN, RN 29:53
Oh, yes, um, we have multidisciplinary rounds every morning at 945, Monday through Friday. I don’t think they do that on the weekends yet. That would be great. But everybody’s got room to improve, right?

Kali Dayton 30:07
Right.

Rosa Hart, BSN, RN 30:07
As far as ICU acquired weakness, as opposed to the weakness that would have already been caused by whatever their stroke had impacted. So if they come in with a large vessel occlusion and one side of their body is not working, and then they get all to plays. And then they get mechanical thrombectomy and revascularize. That area, it may take some time for that side to read, animate, basically, for them to regain strength in that affected side.

But um, one thing that we’re working on piloting right now is early mobility after all to place because our, the guideline has been that for patients who got off the place known as TPA, they can’t get up out of bed for 24 hours afterwards. So they have to use the bedpan or bless their hearts, the men who have to stand to urinate they get straight cath’d Bless their hearts, which tell me how straight cathing a man with an enlarged prostate is less of a bleeding risk, and then him standing at the bedside.

Kali Dayton 31:21
But if you don’t ask “why? why not? What if?”

Rosa Hart, BSN, RN 31:24
Exactly, so I’m so thankful we’re trialing this to hopefully, decrease the amount of time patients are made in mobile after all to place administration because that mobility is so important for retraining that affected side to wake up and move again.

Kali Dayton 31:45
Right and preserving the fight the side that’s not affected.

Rosa Hart, BSN, RN 31:48
Yeah, exactly.

Kali Dayton 31:49
I mean, if you want full mobility, you’ve got to have at least one strong side to support the other side. But when we leave patients in bed, we don’t give them that chance to preserve whatever they do have exactly. One nurse that I worked with, I just she’s done this for nearly 40 years now. She was one of my mentors in the Awake and Walking ICU. I’ve always idolized the kind of nurse that she is. And she splits her time between that medical surgical ICU and neuro ICU.

So here she is walking patients in multi organ failure, ARDS, high ventilator settings, on you know, on ventilators, and then in her neuro ICU, they think that she’s absolutely insane for getting her patients up to a chair. So I asked her when I started the podcast to come on and talk about that. And even just mentioning that she was in tears.

Oh, it is so painful for her. She’s so sensitive. And I think that’s why she continues in that ICU because she know that when she’s not there. Those patients won’t move. And it’s she’s one of the most hardcore passionate people about early mobility that I could see in med surg ICU.

I mean, you just there’s no way she’s taking no for an answer. And she always says the best thing for her patients. I know she’s that same way in the neuro ICU. But that wasn’t always shared. So it’s just interesting, just imagining, now exploring this with you. This is why she’s so passionate, because your patients are so vulnerable and need that kind of support.

Rosa Hart, BSN, RN 33:16
Yeah, definitely.

Speaker 2 33:17
Not just in that moment for but their whole lives depend on it, because they’ve already come in with so many risk factors for an altered quality of life after the ICU. And we can easily add to that. Or we can support them to have the best chance possible. Tell me more about your podcast. How do you recommend that our ice clinicians that are listening to this this podcast? How can they use your podcast to support stroke survivors?

Rosa Hart, BSN, RN 33:46
So I’ve really created this podcast as a tool to be used for free anywhere, there’s internet access, and every single episode has been designed as a 20 minute golden nugget of relatable information for pretty much anybody who’s experienced stroke. So I believe anyone who works in the ICU, especially those who like to see frequent fliers come in again and again and you see, like the social determinants of health are not giving them that safety net that will allow them to stay out of the hospital.

They need so much support, whether it’s mental health care, that’s not covered by insurance, or they don’t have the transportation to get to their doctor’s appointments, or they don’t have that follow up care or they don’t get their medications refilled. There’s so many social determinants of health and that place people are at higher risk of a stroke reoccurrence. So, at the before talking about the podcast, I really have to talk about the resource center that I work at.

So In this neuroscience Resource Center, it’s not just me, I’m like the only stroke centered person but we also have social workers and we have program directors who have free a neuro yoga Tai Chi and Feldenkrais classes, Brain Games, which is a free class taught by speech therapist, a vestibular support group taught by a neuro PT. I lead to stroke survivor support groups that are virtual and in person.

And I’m saying this because I think there needs to be more places like this, that provide that support where like our social workers will help people make sure their medications get paid for and filled, and get transportation to those follow up appointments. Whether that’s like for a gas card for somebody who’s giving them a ride, or helping them sign up for torque three. And I’ve really feel like that is so core to that preventative care that gives people a good quality of life.

And this is the stronger after stroke podcast is just another program that we’re offering for free, not just our patients, but expanding that reach to anyone who’s had a stroke, or cares about somebody who has a stroke, so that they can have access to the neuro specialized information. The headache specialist that I get to interview about migraine and stroke, he was like President of the American headache society.

Okay, what there’s a six month waitlist to get into C to get the question answered, well, how do I know if I’m having a stroke versus experiencing a migraine? Should I be calling 911 and getting these 1000’s of dollars of charges that are not covered? Because it’s not a stroke? Or? And he gets to answer those questions. And so the value in each episode is I feel priceless. I don’t think I’m overstating that. Because providing access to care.

Kali Dayton 37:09
and validation for your survivors. They feel like they’re not alone. Their concerns are valid, real and that there aren’t answers and support. Thank you so much for everything that you’re doing, Rosa and I will put a link to your podcast in the show notes so that everyone can check it out and especially share it with their patients and the families.

Rosa Hart, BSN, RN 37:27
Thank you so much. I really appreciate it.

Kali Dayton 37:30
Thanks for all you’re doing and we’ll keep learning from each other. Thank you so much. Okay,

Transcribed by https://otter.ai

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