Impact of Evidence-Based Nursing Interventions on Prognosis of Patients with Acute Cerebral Infarction

Introduction

Acute cerebral infarction (ACI), commonly referred to as ischemic stroke, is a leading cause of morbidity, disability, and mortality worldwide. It occurs due to the sudden interruption of cerebral blood flow, leading to brain tissue ischemia and subsequent neuronal damage. The management of ACI has undergone significant advancements over the past decades, including thrombolytic therapy, endovascular procedures, and intensive care strategies [1,2]. However, despite these advances, a substantial proportion of patients experience poor prognoses characterized by residual neurological deficits, cognitive decline, and decreased quality of life. The optimization of supportive care, particularly nursing interventions, is increasingly recognized as a critical component in improving outcomes for patients with ACI [3–5].

Traditional nursing care often adheres to routine clinical protocols that emphasize stabilization and symptom management based on established guidelines [6,7]. While effective for acute medical needs, such approaches may lack integration of the latest evidence and fall short in addressing individualized patient needs. In contrast, evidence-based nursing interventions (EBNIs) are grounded in current research and clinical best practices. They incorporate patient-centered strategies such as tailored health education, psychological support adapted to individual characteristics, and structured rehabilitation plans that promote not only physical recovery but also cognitive function and emotional well-being. The fundamental distinction lies in the application of evidence-informed, holistic care customized to multidimensional recovery goals [8,9]. Through systematic assessment, tailored education, and interdisciplinary collaboration, EBNIs provide a comprehensive framework to optimize the prognosis of patients with ACI. Although previous studies have addressed specific components of stroke rehabilitation – such as early mobilization or psychological support – comprehensive evidence on the integrated effects of structured EBNIs across psychological, cognitive, and functional domains in patients with acute cerebral infarction remains limited [10,11].

This study aimed to evaluate the impact of evidence-based nursing interventions on the prognosis of patients with ACI. By systematically analyzing patient outcomes and identifying key nursing practices associated with improved recovery, this research seeks to bridge existing knowledge gaps and provide actionable insights for clinical practice. We also examined the interplay between nursing interventions and patient-specific factors such as age, comorbidities, and stroke severity, to elucidate tailored strategies for optimizing care delivery.

Material and Methods

STUDY DESIGN:

A retrospective evaluation was conducted at our hospital to assess the impact of evidence-based nursing interventions on the prognosis of patients with acute cerebral infarction. The study period extended from January 2022 to December 2023. Inclusion criteria were a confirmed diagnosis of acute cerebral infarction (ischemic stroke) based on clinical presentation and neuroimaging findings (CT or MRI), a Glasgow Coma Scale (GCS) score of ≥8 to ensure adequate participation in nursing interventions and assessments, and informed consent provided by patients or their legal representatives. Exclusion criteria included non-ischemic stroke types (eg, hemorrhagic stroke, transient ischemic attacks, or other cerebrovascular events not meeting the acute cerebral infarction criteria), severe comorbid conditions (eg, advanced cancer, end-stage renal disease, severe liver failure) that could significantly interfere with study outcomes or prognosis, acute infectious diseases or sepsis that might confound the intervention results, and severe cognitive impairment (eg, advanced dementia) preventing informed consent or compliance with study protocols. A total of 256 patients were included in the study. From January to December 2022, 126 patients received routine neurology care and were assigned to the control group. In contrast, from January to December 2023, 130 patients received evidence-based nursing care and were assigned to the observation group. The research methodology, objectives, and protocols were developed in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines [12]. Informed consent was obtained from all subjects and/or their legal guardian(s). Our study was rigorously reviewed and approved by our hospital’s ethics committee and was conducted in strict accordance with established guidelines and the Declaration of Helsinki. We ensured that all research phases, from design to reporting, adhered to high ethical standards. Data confidentiality was maintained throughout, with all personal identifiers anonymized to ensure participant privacy.

CONTROL GROUP: STANDARD EMERGENCY NURSING PROTOCOL:

In the control group, patients received routine emergency care based on established clinical protocols. Upon arrival, the attending physician assessed the patient’s condition and made a diagnostic determination. Targeted medical treatment and nursing care were then provided according to the physician’s orders. Emergency nurses performed continuous electrocardiographic monitoring to track the patient’s cardiovascular status. Standard diagnostic tests, including head CT scans and coagulation function assessments, were conducted to evaluate the patient’s condition. Throughout the emergency care process, vital signs were closely monitored, and any significant changes were recorded to ensure timely intervention if necessary.

FORMATION OF THE EVIDENCE-BASED NURSING TEAM:

An evidence-based nursing team was established under the guidance of the Nursing Department, led by the head nurse. The team included deputy chief nurses, senior nurses, and nurses with at least 5 years of clinical experience. Team members underwent centralized training organized by the Nursing Department Director, covering the concept, principles, and implementation steps of EBN. External experts and experienced head nurses from other departments provided theoretical guidance and shared practical insights into EBN. This combination of education and practice improved the team’s capabilities to implement evidence-based care effectively.

IDENTIFYING EVIDENCE-BASED QUESTIONS:

The team conducted group discussions focusing on acute cerebral infarction, addressing topics such as its pathogenesis, treatment strategies, nursing measures, and factors affecting activities of daily living (ADL) and neurological recovery. The ADL score was assessed using the Modified Barthel Index (MBI), which includes 10 items related to personal care and mobility, with higher scores indicating greater independence. Evidence-based questions were defined by integrating patient-specific factors, including age, psychological condition, and disease status. Key questions centered on stroke management, nursing interventions, ADL improvement, neurological function, and rehabilitation.

EVIDENCE COLLECTION AND EVALUATION:

The team conducted literature searches using databases such as PubMed, CNKI, Wanfang Data, and VIP Journals. Retrieved evidence was evaluated for scientific validity, practicality, and relevance. The best available evidence was integrated with the nursing department’s clinical experience and patient preferences to formulate individualized nursing care plans tailored to patient needs.

EVIDENCE-BASED APPLICATIONS:

1) Health Education: Patients received tailored education based on their condition, age, profession, and literacy level. Using patient-friendly language, team members explained stroke prevention measures, triggers, treatment cooperation, and common complications to improve adherence to treatment. 2) Psychological Rehabilitation Nursing: Psychological interventions were provided based on individual personality traits, psychological characteristics, and family relationships. Techniques included active listening, music therapy, bedside discussions, and peer encouragement from patients with favorable outcomes. These measures aimed to alleviate negative emotions such as anxiety, depression, and fear, fostering a positive attitude toward recovery. Family members were also engaged to provide emotional support and assist in the psychological rehabilitation process. 3) Comprehensive Rehabilitation Nursing: Early rehabilitation interventions included passive exercises, such as limb joint flexion and extension, muscle massage, and assisted postural adjustments (eg, turning, sitting, head lifting). These activities were performed 2–3 times daily, for 15–20 minutes each session, progressing to active rehabilitation exercises. Active training included facial exercises (eg, head rotation, cheek puffing, tongue extension) and limb activities (eg, joint flexion, muscle contraction, standing, and walking), adhering to a gradual progression principle. Functional training focused on improving self-care abilities, such as using utensils, dressing, toileting, and independent mobility.

DATA COLLECTION AND OUTCOME MEASURES:

To comprehensively evaluate the psychological status, neurological function, motor ability, and quality of life in both groups, several validated assessment tools were utilized before and after the intervention. The evaluations were conducted by designated nurses responsible for the care of each patient. The specific outcome measures included the following:

Hamilton Anxiety Rating Scale (HAMA): This scale comprises 14 items scored on a 4-point Likert scale. A total score exceeding 14 indicates clinically significant anxiety.

Hamilton Depression Rating Scale (HAMD): This scale includes 17 items, also scored on a 1–4 scale. A total score greater than 17 is considered indicative of clinically significant depression.

Chinese version of the Mini-Mental State Assessment (CMMS) [13]: Cognitive function was assessed using the CMMS as published by Zhang and He (1998). The CMMS is scored from 0 to 30, with lower scores indicating poorer cognitive function. It has been widely used in clinical and research settings in China and comprises 5 domains: orientation (10 points), memory (3 points), attention and calculation (5 points), recall (3 points), and language ability (9 points).

ADL Scale: This scale assesses the level of independence in daily activities. The total score ranges from 0 to 100, with scores ≥60 indicating self-sufficiency. Higher scores denote greater independence in performing daily activities.

World Health Organization Quality of Life Assessment (WHOQOL-BREF): Quality of life was measured across 4 domains: physical health, social relationships, psychological well-being, and environmental factors. Each domain was scored on a percentage scale, and the overall score was calculated as the mean of all domain scores. Higher scores indicate better quality of life.

STATISTICAL ANALYSIS:

The statistical analysis was conducted using SPSS software (version 27.0) with rigorous attention to detail. Continuous variables following a normal distribution were compared between groups using independent t-tests, and the results were reported as mean±standard deviation. Categorical variables were summarized as frequencies and percentages. The chi-square (χ²) test was employed to evaluate independence or associations between these categorical variables, and when the conditions for the χ² test were not satisfied, Fisher’s exact test was utilized as an alternative. All statistical tests were two-sided, with a significance threshold set at a P value of less than 0.05, indicating a statistically significant difference.

Results

BASELINE CHARACTERISTICS OF THE STUDY POPULATION:

A total of 256 patients with acute cerebral infarction were enrolled in the study, meeting diagnostic criteria based on clinical presentation and neuroimaging (CT or MRI). Among them, 126 patients received routine neurology care and were assigned to the control group, comprising 85 males and 41 females, aged 38–73 years, with a mean age of 60.68±13.16 years. The observation group, consisting of 130 patients who received evidence-based nursing care, included 88 males and 42 females, aged 37–73 years, with a mean age of 60.17±12.89 years. In the control group, 90 patients exhibited unilateral limb weakness, 36 experienced unilateral limb paralysis (19 left-sided, 17 right-sided), 115 were first-time stroke cases, and 11 had recurrent strokes. Similarly, in the observation group, 91 patients showed unilateral limb weakness, 39 had unilateral limb paralysis (29 left-sided, 19 right-sided), 117 were first-time strokes, and 13 had recurrent strokes. Both groups achieved clinical stabilization within 2 days of treatment, and had no neurological complications or histories of cognitive impairment, aphasia, hepatic or renal dysfunction, hearing loss, or psychological disorders. There were no statistically significant differences between the groups in demographic or clinical characteristics (P>0.05), ensuring comparability (Table 1).

COMPARISON OF HAMD AND HAMA SCORES BEFORE AND AFTER INTERVENTIONS BETWEEN GROUPS:

The study evaluated changes in HAMD and HAMA scores before and after intervention to assess the effects of evidence-based nursing on psychological outcomes in patients. No significant differences in baseline HAMD or HAMA scores were observed between the observation and control groups (P>0.05), indicating comparability between the groups prior to intervention. After the intervention, the observation group demonstrated significantly lower HAMD and HAMA scores compared to the control group (P<0.05). Specifically, HAMD scores decreased more substantially in the observation group (10.48±2.73) than in the control group (15.17±2.92). Similarly, the reduction in HAMA scores was greater in the observation group (11.49±3.45) compared to the control group (15.92±3.31). These findings suggest that evidence-based nursing interventions are associated with a marked improvement in anxiety and depression symptoms. In both groups, within-group comparisons revealed significant reductions in both HAMD and HAMA scores following intervention (P<0.05). However, the extent of improvement was significantly greater in the observation group, as reflected by the larger inter-group differences in post-intervention scores (t=13.28 for HAMD, t=10.48 for HAMA). These results highlight the superior efficacy of evidence-based nursing interventions in alleviating psychological distress in patients (Table 2, Figure 1).

COMPARISON OF CMMS AND ADL SCORES BEFORE AND AFTER INTERVENTIONS BETWEEN GROUPS:

This study analyzed CMMS and ADL scores to evaluate cognitive function and the ability to perform activities of daily living before and after the intervention. Baseline comparisons revealed no significant differences in CMMS or ADL scores between the observation and control groups (P>0.05), indicating that both groups were comparable prior to the intervention. After the intervention, significant improvements in both CMMS and ADL scores were observed in the observation group compared to the control group (P<0.05). The CMMS scores, which reflect cognitive function, increased substantially in the observation group (25.75±3.65) compared to the control group (21.92±3.85). Similarly, ADL scores, indicative of daily living independence, improved markedly in the observation group (62.61±5.15) compared to the control group (52.30±3.82). Within-group comparisons also showed significant improvements in both CMMS and ADL scores after the intervention in each group (P<0.05). However, the magnitude of these improvements was notably greater in the observation group, as demonstrated by higher post-intervention scores and larger inter-group differences (t=8.170 for CMMS, t=18.15 for ADL). These findings show the effectiveness of evidence-based nursing interventions in enhancing cognitive function and promoting greater independence in daily living activities among patients (Table 3, Figure 2).

COMPARISON OF QUALITY-OF-LIFE DOMAINS BETWEEN OBSERVATION AND CONTROL GROUPS:

The study assessed the impact of interventions on quality of life by evaluating changes across physical, social relationships, psychological, and environmental domains, as well as overall quality of life. Baseline comparisons showed no statistically significant differences between the observation and control groups in any domain (P>0.05), ensuring the comparability of the 2 groups prior to the intervention. Post-intervention analyses revealed significant improvements in all quality-of-life domains in both groups (P<0.05). However, the observation group had markedly greater improvements than the control group (P<0.05). For instance, in the physical domain, the mean score increased to 88.12±3.58 in the observation group compared to 80.45±3.96 in the control group (t=16.27, P<0.05). Similar trends were observed across the social relationships, psychological, and environmental domains, where the observation group consistently achieved significantly higher post-intervention scores than the control group. The overall quality of life score also demonstrated substantial improvement in the observation group (89.24±4.08) compared to the control group (80.12±3.89). These findings underscore the superior effectiveness of evidence-based nursing interventions in enhancing patients’ quality of life across multiple domains. The results indicate the importance of comprehensive care strategies that address not only physical recovery but also psychological well-being, social relationships, and environmental adaptation (Table 4).

Discussion

Despite advances in ACI management, traditional nursing care often lacks individualization, scientific rigor, and integration with the latest clinical evidence. Routine protocols may overlook critical aspects such as early rehabilitation, psychological support, and complication prevention, leading to suboptimal recovery, prolonged hospitalization, and increased risk of adverse outcomes. These limitations underscore the need for structured interventions that are both evidence-based practices and patient-centered [14,15]. EBNIs, grounded in validated clinical research, are specifically designed to address these gaps by promoting early functional recovery, preventing secondary complications, and enhancing psychological well-being. Through systematic assessment, tailored education, and interdisciplinary collaboration, EBNIs provides a comprehensive framework to optimize the prognosis of patients with ACI [16,17]. Our EBNI protocol comprised 3 rigorously defined, evidence-informed modules that extend standard nursing care into a precision-oriented model. First, individualized health education was built on systematic literature reviews and patient profiling, then delivered in weekly one-on-one sessions with tailored teaching materials and comprehension assessments, replacing the control group’s single-session brochures. Second, structured psychological rehabilitation utilized evidence-based techniques – active listening, music therapy, bedside discussion, and peer support – administered daily by nurses trained in stroke-specific mental health care. Third, comprehensive rehabilitation nursing began within 24 h of admission with passive joint flexion–extension, muscle massage, and postural adjustments performed 2–3 times daily for 15–20 min, progressing under a graded-load principle to active facial exercises, limb strengthening, standing, and ambulation. These modules were overseen by a multidisciplinary EBNI team that conducted ongoing outcome evaluations and iteratively optimized care plans. By integrating validated evidence with individualized patient needs at every step – rather than relying on generic protocols – our approach delivers structured, multidimensional interventions that surpass routine emergency nursing in both rigor and clinical impact.

The significant reductions in HAMD and HAMA scores observed in the observation group compared to the control group underscore the effectiveness of EBN interventions in alleviating psychological distress. Anxiety and depression are common in patients with acute cerebral infarction, often stemming from fear of disability, reduced independence, and uncertainty about recovery. The EBN interventions employed in this study likely contributed to these improvements through tailored psychological support, health education, and consistent monitoring. Strategies such as patient-centered communication, individualized goal setting, and emotional reassurance may have helped reduce anxiety and depression by fostering a sense of control and optimism in patients. Furthermore, engaging patients’ families in the caregiving process likely provided an additional layer of psychological support, reinforcing positive behavioral changes and enhancing emotional well-being [18,19].

The observed improvements in CMMS and ADL scores highlight the effectiveness of EBN interventions in enhancing cognitive function and promoting independence in daily living activities. Cognitive decline and reduced self-care ability are common consequences of stroke, often exacerbated by limited early rehabilitation. The EBN approach likely facilitated cognitive recovery through structured early interventions, such as mental exercises, patient education, and encouragement of active participation in rehabilitation. Additionally, interventions targeting activities of daily living, including gradual reintroduction of self-care tasks and physical activity, likely contributed to improved ADL scores by enhancing neuromuscular coordination and confidence in performing routine activities. The comprehensive and personalized nature of EBN, which integrates evidence-based practices with patient-specific needs, may have played a crucial role in achieving these outcomes [20,21].

Quality of life, a multidimensional concept encompassing physical, social, psychological, and environmental well-being, was markedly improved in the observation group compared to the control group. The significant improvements across all domains suggest that EBN interventions address not only clinical recovery but also broader aspects of patient well-being. In the physical domain, early rehabilitation and active management of post-stroke complications likely contributed to enhanced physical functioning. Improvements in the psychological and social domains may have stemmed from individualized psychological counseling, education, and efforts to strengthen social relationships, such as involving family members and caregivers in the recovery process [22]. Environmental adaptations, including modifications to the care setting and promotion of a supportive environment, further enhanced patients’ overall recovery experience. These findings underscore the holistic nature of EBN, which integrates evidence, clinical expertise, and patient preferences to optimize recovery.

The superior outcomes observed in the observation group may be attributed to several mechanisms inherent in EBN interventions. First, the structured and systematic approach of EBN ensures that care is based on the latest and most reliable evidence, minimizing variability in care quality. Second, EBN emphasizes patient engagement, fostering a sense of control and active participation in the recovery process, which has been shown to enhance adherence to treatment and improve outcomes. Third, EBN interventions are tailored to individual patient needs, considering factors such as age, severity of stroke, and psychological state, which likely enhanced their efficacy. Lastly, the interdisciplinary collaboration facilitated by EBN ensures comprehensive care that addresses the multifaceted challenges faced by stroke patients [23–25].

Prior studies have highlighted the benefits of nursing-led interventions in various clinical settings [10,11,26]. Kumar et al [10] demonstrated that stroke nurse-led interventions significantly improved acute ischemic stroke outcomes by reducing treatment delays and increasing thrombolysis rates. While their study focused on hyperacute process efficiency, our findings extend the evidence base by highlighting the long-term multidimensional benefits of EBNI on psychological, cognitive, and functional recovery, underscoring the broader prognostic value of structured nursing care. Lindstad et al [11] validated the effectiveness of the PRPP cognitive strategy intervention in improving task mastery in home-based rehabilitation following brain injury. Although both studies support evidence-based personalized care, our research surpasses case-level findings by providing statistically powered, hospital-based evidence for EBNI’s comprehensive impact on cognition, ADL, and quality of life in ACI patients. Yu et al [26] found that evidence-based nursing improved psychological status, compliance, and functional recovery in ICU patients. Consistent with their conclusions, our study further confirms the efficacy of EBNI, while advancing the field by systematically evaluating its multidomain effects in a larger stroke-specific cohort using validated outcome measures.

The findings of this study have important clinical implications for stroke management. The demonstrated effectiveness of EBN interventions highlights the need for widespread implementation of evidence-based practices in clinical settings. Training nursing staff in EBN principles and fostering a culture of evidence-based practice are critical steps toward optimizing patient outcomes. Furthermore, integrating EBN into standard stroke care protocols could reduce the burden of psychological distress, cognitive decline, and dependency, ultimately improving patients’ quality of life and reducing healthcare costs. Despite the positive findings, this study has some limitations. The retrospective design may have introduced potential biases, and the study was conducted in a single center, which may limit the generalizability of the results. Future studies should consider multicenter designs and explore the long-term effects of EBN interventions. Additionally, qualitative analyses of patient and caregiver experiences could provide deeper insights into the mechanisms underlying the observed improvements.

Conclusions

This study demonstrates the significant benefits of evidence-based nursing interventions in improving psychological outcomes, cognitive function, daily living independence, and quality of life in patients with acute cerebral infarction. The findings underscore the value of integrating evidence-based practices into stroke care and highlight the potential for EBN to transform patient outcomes through comprehensive, patient-centered care strategies. Further research is needed to expand these findings and support the broader adoption of EBN in clinical practice.