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May 2, 2026Brain Sciences1 citationsOpen Access

Differences in Nursing Complexity and Intensity Across Stroke Subtypes: A Retrospective Study Using Standardized Nursing Language

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MCManuele CesareAFAugusto FuscoGDGianfranco Damiani

Key Points

  • This study aims to determine how nursing complexity and intensity vary among different stroke subtypes using standardized nursing language.
  • Retrospective analysis of nursing and administrative data from an acute care hospital.
  • Classified hospitalizations as ischemic stroke, hemorrhagic stroke, or TIA using ICD-9-CM codes.
  • Measured nursing complexity by documented nursing diagnoses and nursing intensity by recorded nursing actions; analyzed data using ANOVA and Kruskal–Wallis tests.
  • Total of 728 hospitalizations included: 429 ischemic strokes, 236 hemorrhagic strokes, 63 TIAs.
  • Nursing diagnoses differed significantly (F = 5.81, p = 0.003), with TIA showing lower counts than ischemic and hemorrhagic strokes.
  • Nursing actions also differed significantly (H = 16.73, p < 0.001), highest in hemorrhagic stroke and lowest in TIA.

Abstract

Background/Objectives: Ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA) differ in terms of medical severity and prognosis; however, it remains unclear whether these differences are reflected in nursing complexity and nursing intensity when assessed using standardized nursing language. Methods: This retrospective study analyzed routinely collected nursing and administrative data from an acute care hospital. Hospitalizations were classified as ischemic stroke, hemorrhagic stroke, or TIA using ICD-9-CM codes. Nursing complexity was measured as the number of nursing diagnoses (NDs) documented within 24 h of admission, while nursing intensity was measured as the number of nursing actions (NAs) recorded during hospitalization. Group differences were tested using ANOVA and Kruskal–Wallis tests, as appropriate. Results: A total of 728 hospitalizations were included: 429 ischemic strokes, 236 hemorrhagic strokes, and 63 TIAs. Overall, 4136 NDs and 27,528 NAs were recorded. Distinct patterns emerged across stroke categories. ND counts differed significantly (F = 5.81, p = 0.003), with TIA showing lower counts than both ischemic and hemorrhagic stroke, while no significant difference was observed between ischemic and hemorrhagic stroke. NA counts also differed significantly (H = 16.73, p < 0.001), with the highest counts in hemorrhagic stroke, intermediate counts in ischemic stroke, and the lowest counts in TIA. In a sensitivity analysis standardized by length of stay, nursing intensity also differed significantly across stroke categories (H = 12.999, p = 0.002), although the pattern differed from that observed for cumulative counts. Conclusions: Nursing complexity and nursing intensity showed distinct patterns across stroke categories. While complexity was comparable between ischemic and hemorrhagic stroke and lower in TIA, intensity followed a clear gradient, highest in hemorrhagic stroke, intermediate in ischemic stroke, and lowest in TIA. Standardized nursing data may complement medical indicators by capturing additional dimensions of patient needs and care delivery in people with stroke.

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Cite This Study

Cesare et al. (2026) studied this question.

synapsesocial.com/papers/69f594e171405d493afffb7ehttps://doi.org/10.3390/brainsci16050471
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