Stroke nurses to take part in global trial of patient positioning policies

Nurses in acute stroke units will take part in the first global trial to gather clinical evidence on whether patients should be positioned upright or laid flat in the first 24 hours of care.

Forty units will involve 5,000 patients in the HeadPost study, which will investigate whether there is a link between patient position and outcomes.

The UK’s only nursing professor of stroke care Caroline Watkins, director of the University of Central Lancashire’s clinical trials unit, will lead the UK arm of the trial.

Professor Watkins’ research will be part of an international study, led by Craig Anderson at The George Institute for Global Health in Australia. Twenty thousand patients in Australia, Germany, Chile, China and France will be observed.

Professor Watkins said that when brain tissue dies as a result of ischaemic strokes, caused by a blood clot blocking the flow of blood to the brain, blood flow to surrounding areas of tissue will also be impaired but might be restored by laying a patient flat.

In acute intracerebral haemorrhage, pressure in the brain builds up that might be reduced by maintaining the patient in the upright position.

However, there is ‘no good evidence’ for using either position, said Professor Watkins, adding that the way nurses position patients following stroke varies between countries.

Most patients are placed upright in the UK and Australia, but in China and India they are reclined. In the United States and Switzerland, position is based on the type of stroke.

‘None of this is evidence-based,’ Professor Watkins said. ‘Whenever there is uncertainty, we need a trial.’

Stroke units will be randomly allocated one of the positions – upright or reclining. All patients who are admitted with symptoms of stroke will be monitored by nurses in that position.

Assessments

Nurses will carry out neurological assessments of the patients on admission, maintaining positions every hour for the first 24 hours and again after seven days or on discharge, whichever is sooner, and researchers will conduct follow-up interviews with patients after 90 days.

There will be an estimated 85 per cent to 15 per cent split between ischaemic and haemorrhagic patients in the trial, although the proportions will vary between countries, said Professor Watkins.

She added it will be a challenge for nurses to go against their usual policy for positioning stroke patients. Events have already been held at which nurses could discuss the trial.

What nurses have to understand is there is no evidence for what they are doing now. Some things we do because it is custom and practice,’ she said.