Raising the Bar on Stroke Care

For Tamilyn Bakas, PhD, RN, helping stroke patients is a family matter. 

Bakas, who joined UC’s College of Nursing in 2015 as the Jane E. Procter Endowed Chair and Professor, grew up in Anderson, Indiana, where she often accompanied her father and family physician David G. Jones, MD, on patient visits. In the 1970s and ’80s, her father was active in the prevention and early detection of heart disease and stroke, training his staff and Bakas to perform Doppler ultrasound tests to detect blocked or reduced blood flow in the major arteries of the neck that could increase a patient’s risk of stroke. 

"At the time, this was a new and innovative procedure,” Bakas says. "Now it's done routinely across health care settings.”

Inspired by her early experiences, Bakas earned her bachelor’s degree in nursing and then, on the advice of her father, pursued further education as an adult nurse practitioner. It was during her graduate studies while visiting patients with stroke and other chronic conditions that she found her true calling. 

"During those visits, I realized that family caregivers were the hidden patients who really needed to take better care of themselves,” Bakas says. "While I spent a majority of my time addressing patient care needs, it became evident that many family members were neglecting their own needs while providing care.”

Bakas went on to earn her doctorate in nursing from Indiana University, supported by a pre-doctoral fellowship through a National Institutes of Health (NIH) T32 institutional research training grant, which enabled her to complete her dissertation research focused on emotional distress and quality of life in family caregivers of stroke survivors. At the same time, she developed the Bakas Caregiving Outcome Scale, which measures life changes specifically as a result of providing care.  

The scale, adopted by a number of fellow researchers, marked only the beginning of an impressive and influential research resume. After Bakas earned her PhD, she conducted a qualitative study of stroke family caregivers while on the faculty at IU’s School of Nursing. 

"I wanted to get at the heart of what the family felt their particular needs and concerns were,” Bakas says. "This led to a checklist that actually became the starting point for developing a program to help families of stroke survivors as they transitioned care to the home environment.”

From 2004 to 2007, she received a K01 award from the National Institute of Nursing Research to develop the Telephone Assessment and Skill-building Kit, or TASK program—a nurse-led intervention involving eight weekly calls from a nurse to help family caregivers assess and prioritize their needs and concerns in providing care. The TASK program addresses caregiver needs in five main areas: finding information about stroke, managing emotions and behaviors of the stroke survivor, providing personal care, providing instrumental care (e.g., transportation, finances), and taking care of one’s own needs as a family caregiver. The program also trains caregivers on how to build skills in problem solving, stress management and how to communicate with healthcare providers. Based on the pilot data, Bakas found that it only cost $421 per caregiver to deliver the eight weekly calls from a nurse—an affordable intervention that can make a real difference. 

The preliminary data gathered from the pilot study allowed Bakas to apply for and receive a five-year NIH R01 grant totaling $1.9 million to test the TASK program on a much larger scale through a randomized, controlled clinical trial. Her Bakas Caregiving Outcomes Scale and caregiver checklist were incorporated into the program as well. 

"We wanted to show that our program worked beyond just having nurses call and provide a listening ear,” Bakas explains. "And we enhanced the program further to include more on nursing-home placement and end-of-life care for stroke survivors.”

It’s that passion for improving the lives of stroke family caregivers that ultimately led Bakas to UC. 

"The University of Cincinnati has one of the best stroke teams in the nation, and there are several leading stroke experts here,” Bakas notes, naming among them Joseph Broderick, MD, director of the University of Cincinnati Neuroscience Institute and of the NIH StrokeNet, an infrastructure coordinating 25 regional stroke centers across the United States to promote multi-site clinical trials. In addition, UC Medical Center is certified as an Advanced Comprehensive Stroke Center (the highest stroke certification.) Brett Kissela, MD, Albert Barnes Voorheis Chair of Neurology and Rehabilitation, and Dawn Kleindorfer, MD, are co-principal investigators of a $7 million NIH grant to continue a Greater Cincinnati/ Northern Kentucky study to highlight stroke incidents and awareness and address racial disparities in stroke. In the College of Nursing, Elaine Miller, PhD, RN, authored a major American Heart Association scientific statement on stroke rehabilitation in 2010, and has been a valued colleague for many years. 

"The potential interdisciplinary collaborators attracted me to move to the next level in my research within the strong environment here at UC,” Bakas says. She was also drawn specifically by the College of Nursing’s current focus on telehealth, including the opportunity to partner with Debi Sampsel, DNP, chief officer of innovation and entrepreneurship, and the college’s relationship with Maple Knoll Village, a retirement community in Springdale, Ohio, where nursing, medicine and engineering students collaborate on projects to improve the lives of residents. 

"Dr. Sampsel and I are on a mission to promote the use of telehealth and improve the lives of older adults,” Bakas says. "It’s a wonderful opportunity to make a difference in how people age in place.”

In addition to working directly with patients and their caregivers, Bakas is eager to share her expertise and learn from her students. "My other job here is to mentor the next generation of scholars,” says Bakas, who enjoys teaching courses on research design, instrumentation and data analysis. "I've had wonderful mentors along the way, and I want to do all that I can to not only conduct my own interdisciplinary research, but to also help other faculty members and students build their own programs of research.” 

Bakas’ enthusiasm for the future isn’t limited to her mentoring of faculty and students—she sees technology changing the very landscape of how healthcare providers and patients interact—and get results. 

"I'm really excited about where health care is headed and the increased emphasis on care transitions,” Bakas says. "Traditionally, our health care system has been very acute care focused, and now more than ever there is the need to look at what happens to our patients as they transition across healthcare environments from acute care to rehab to home. 

"As the baby boomers age, they're going to expect that more of their resources be offered through the use of technology. We need to stay on that wave of innovation. That’s what excites me most about being here at the College of Nursing, and at UC—to be able to leverage technology to support family caregivers and older adults as healthcare unfolds over the coming years.”

Written by Amanda Chalifoux