Olalla Pancorbo: “Everyone should be clear about the fact that, when it comes down to a stroke, time is brain"

"Everyone should be clear about the fact that, when it comes down to a stroke, time is brain."

Listening to Olalla Pancorbo talk about her work, her research, her profession, is understanding what passion means, believing what one does, and it helps to gain trust that we will ge through it because there are people who, like her, are convinced that taking care of others is very important. He confesses that, like many other colleagues in her promotion, she began studying Nursing because she could not get into Medicine, and that she thought: "I'll study one year and then I'll switch to Medicine". But after that one year, "none of the fellows did it, we stayed because we were enthusiastic about the profession," she clarifies. Since 2016 she has been a professor of the bachelor's degree in Nursing at Blanquerna-URL School of Health Sciences, which she combines with her work in the Stroke Unit at Hospital Vall d'Hebron. She is now finishing her doctoral thesis on how nursing can influence the evolution and prognosis of a patient who has suffered a stroke.

You wanted to study medicine. Did you regret not being able to do that?
Not at all. That year the cut-off grade was very high. I had a good grade, but it was not possible to get in due to the high demand that year. My second choice was Nursing and, to be honest, I first thought I would study a year and then change; I thought the same thing that 80 percent of my class, because most of them were aspiring medical students who could not get in; afterwards none of us went into Medicine. Why? The diploma captivated us.

What do you like about your profession?
I love the relationship with the patient and the care in the hospital bed. I'm also very biomedical, I like to understand what's happening internally to the patient, the physiopathological mechanisms, the different therapeutic options available, how we can improve develpoments through research...

And working with critical patients.
When I finished my bachelor's, I was working two years in the emergency room because I had worked as an assistant throughout my bachelor's, and I did a postgraduate degree to specialize in this area. Two years later, the most critical and urgent pathology really caught my eye and patients in the emergency room who, on the other hand, arrive and keep changing, didn't motivate me, I like the patient you can follow up on, the patient who's hospitalized more days, even though he's a critical and unstable patient. You don't bond with the patient in the emergency room, you only see him one or two hours, and then you don't know what happened to him.

And then you were recluted at Hospital Clinic.
Yes, I worked there for ten years in intensive care units and semi-critical units.

It must be hard...
It was what I liked. Although he's a critical patient, his life is under threat and his health is quite compromised, you can see the evolution, whether it's good or bad, but it's gratifying if you then can get him to the main floor with an improves health. I was much more motivated; the patient knows you, the family knows you, and you can work with them in different ways. In intensive care units, the patient's nursing management is much more autonomous, with greater decision-making capacity; a teamwork is established with a more multidisciplinary approach. And in the end, in nursing, the treatment of the patient is very relevant. That's why they say it's one of the most vocational, human professions.

From Clinic you went to another reference hospital, Vall d'Hebron. It was a challenge, wasn't it? They were looking for you.
A new project was wrapping up in the Stroke Unit, financed by La Marató de TV3. They were looking for a nurse with a lot of experience in critical units, trained in research to carry out the project and with high levels of expertise to train other nurses. And they thought of me. This project has given me the opportunity to grow professionally and be able to combine these three nursing responsibilities that are also very much ours - care, teaching and research - and not all job positions can tackle this altogether. Since then I have been in Vall d'Hebron Hospital in the Stroke Unit. In addition, this professional experience has also enabled me to work on my doctoral thesis, which I am about to finish.

Let's start with the project from La Marató...
The project from La Marató focuses on the "ugly duckling" of strokes. There are two types of strokes. Ischemic, which everyone knows, it's a thrombo that obstructs an artery and prevents blood from passing through the artery. This part of the brain, as it is not irrigated — blood does not reach it — loses its functionality. The advantage of a ischemic stroke is that in recent years there have been many therapeutic advances; today, we have effective treatment that greatly improves the prognosis of this type of patient. Through medication or through insertion of a catheter through the groin or arm, we have managed to access the obstructed cerebral artery, open it up and extract the thrombo that prevented the flow of blood. Recovery from this kind of stroke is usually very smooth and the patient's chances of survival is very high. But the reality is that we also have another kind of stroke, with a high mortality rate and higher disability, because there is no fully effective treatment.

How does it happen?
An artery in the brain breaks down, the blood that carries this artery exits into the brain cavity, accumulates and produces intracerebral hemorrhage. This type of stroke is primarily caused by chronic arterial hypertension, i.e. it is most common in patients with very high levels stress over time. You can live with high tension for years and years and have no symptoms, but the tension is still hurting you. This chronic arterial hypertension damages the arteries' walls and weakens them until a moment comes when they are fragile and do not hold up tension and can break. The only effective treatment today is to try to close the artery, stop the bleeding, and for a plug to be formed. The sooner we get there, the more we can prevent the bleeding from growing and affecting more brain functions, and therefore it will be much better for the patient.

In both cases, when symptoms show up, you have to run, right?
We have one sentence that the entire population must engrave in their memory: 'when it comes down to a stroke, time is brain'. This means that the longer it takes before we get to the hospital, the more neurological and disability-related consequences we will have in the long term. So the sooner we get to the hospital, the sooner the stroke is diagnosed and treated, the fewer sequels and, consequently, the fewer the chances of it causing a disability. When you have symptoms of a stroke, you don't have to go to the hospital by your own means, you hace to call SEM, because then a code of stroke is activated. This code consists of a highly coordinated healthcare circuit that allows to accelerate all healthcare processes involving the care of a patient suspicious of having a stroke. When the patient arrives at the reference hospital for a stroke, the professional team is already pre-warned and receives it directly at the emergency gate and passes it directly to the TAC to confirm the diagnosis of a stroke. With these circuits we managed to reduce many minutes in care time and we managed to diagnose and start treatment much more quickly.

And it is in this rapidity, in the case of the "bad" stroke— the ugly duckling — where the nursing work and your thesis come in, right?
Yes, previous studies had shown that dealing with blood pressure during the first hours in patients suffering from hemorrhagic stroke—when the artery breaks—is key to improving the evolution of these patients and thus making patients less disabled in the long term: ending in a wheelchair or needing a walking stick, or unable to speak... And this was the hypothesis of our project, that being very and very quick in starting this treatment and managing to control blood pressure means that bleeding does not increase and, therefore, the patients' evolution is better. My thesis is that much of the role of managing blood pressure and bringing it down so quickly is played by nursing professionals.

Why?
Because in this healthcare circuit focused on the speed of the acting time, nurses take on a key role. It was established that stroke nurses, accompanied by the neurologist team, were in charge of receiving the patient, transferring it to the TAC and, once the stroke diagnosis has been confirmed, start the treatment there, without waiting. Remember that time is brain, so the faster we start it, the better. Once the treatment has begun, comes in the nursing focus of my thesis, which is the surveillance and control of the patient "next to their bed" to ensure that blood pressure drops and the patient stays neurologically stable. The other part of the thesis is to show that not only is it important to control pressure quickly, but it is also important to keep it stable for the next few hours and avoid peaks (pressure rising and falling). And yes, it is nurses that try to keep this pressure stable for the first 24 hours and it is not always easy to achieve it in a patient where blood pressure varies greatly. It is a very nursing thesis, which highlights the real influence of our profession on the evolution and prognosis of patients.

It was very necessary to make this task visible, wasn't it?
Nursing is a profession with a great deal of road ahead in the field of research; there are not many publications led by nurses as principal authors. A call must be made to encourage nurses to publish, to lead research projects, to create national and international networks, because the more institutions participate in research projects, the more powerful they will be and the greater their impact on science. And we have to be clear that in the end any intervention or decision in the hospital has to be tested, questioned and confirmed that it works. The only way to corroborate this is through research!

You are passionate about this whole thing.
Yes, I like clinical research, particularly applied to the reality of healthcare, which allows us to improve circuits, allows us to optimise the evolution of patients, prognostics and directly benefit patients.