Introducing Professor Sandy Middleton

Professor Sandy Middleton is the Director of Nursing Research at the Australian Catholic University. She focusses on stroke and the way research can improve care, particularly analysing the way nurses can initiate care to improve patient recovery.


Sandy MiddletonSandy, tell us about the role of stroke nurses, where they are, and how they are destined to improve Australians’ lives.

Stroke nurses provide a specialist service right across the stroke care continuum. This ranges from stroke nurse practitioners operating in pre-hospital services such as the mobile stroke ambulances; to acute stroke nurses in hospitals who form part of the ‘Code Stroke’ team to fast-track access to proven acute stroke therapies. Stroke nurses work in acute and rehabilitation stroke units and nurse practitioners run outpatient clinics. Stroke units save lives, and all patients should have equitable access to these. Every Australian hospital treating more than 75 patients per year should have a stroke unit to deliver specialist care and services in dedicated beds. The nurses who work in these units have the knowledge and expertise to care for stroke patients in a dedicated space where stroke and its after-effects can be managed. Stroke nurses are also an essential component of the inpatient and outpatient stroke rehabilitation programs. Finally, our leading stroke nurse researchers are working nationally and internationally providing evidence for the value of expert nursing care received across the entire stroke care continuum.


If we concentrate on rural and remote nursing, can you tell us how technology supports, and will evolve to support, your colleagues?

The Telestroke initiative and the use of telehealth to provide rural and regional patients with timely access to acute interventions has been improving access in several states to stroke specialists and the quality of care for people with acute stroke for several years. With this support, key regional hospitals in these states can provide stroke thrombolysis which has seen many partnerships evolve between rural and metropolitan hospital services as the stroke nurses in these centres achieve competency and develop systems of care to deliver this type of therapy and coordinate care requirements post intervention. The wider adoption and acceptance of telehealth technology advancement during the COVID 19 pandemic is sure to open this treatment option to even more centres. Our rural and remote nursing colleagues have always been disadvantaged by isolation and travel requirements but the surge in online delivery mode of education and conferences is opening up access for their specialist training needs, too.


Inspire us, Sandy, with a unique initiative that has transformed nursing, overcoming the challenges of distance and place.

The QASC (Quality in Acute Stroke Care) Europe project is an evidence translation program leading progress in nurse-initiated efforts to improve outcomes after stroke on a global scale. Our previous research has demonstrated that assistance provided to nurses to introduce clinical protocols to manage fever, hyperglycaemia and swallowing (the FeSS Protocols) within stroke units resulted in a 16 per cent reduction in death and dependency 90-days after stroke. This Australian-led program of clinical research is transforming stroke nursing practice in Europe by translating this evidence into 79 hospitals in 19 European countries. Excitingly, this project has empowered stroke nurses in Europe, extending their scope of practice and their level of autonomy. We have appointed European Country Nursing Co-ordinators in this project as ‘technical experts’ to guide participating hospitals. This has further enhanced the contribution of stroke nurses, raising their professional status in many countries and highlighting their important healthcare contributions.


Do you have some advice for the Stroke Alliance as we begin to partner with rural and remote communities to deliver our pre-hospital stroke program?

Often the perceived barriers to implementation do not ever eventuate but taking the time to examine these is a crucial phase to the project’s success. People need to feel that they have been listened to and their opinions are valued for sustainable change to occur. It’s important not to rush through the start-up phase as more time spent ironing out issues at this point can pay off at the other end.


What advice would you give your younger self?

My advice to my younger self would be if you really believe in something but the front door is closed … go around to the back door… if this is closed, go in a window! Never give up!