Although stroke has been recognized since the second millennium BC,1 Hippocrates, the father of medicine and ancient descriptive neurology, was first to give foundational words to describe the phenomena of stroke.2 He referred to stroke as apoplexy, which in the Greek language means to "violently strike down."2 This is a descriptive term that continues to be used today, as many people who experience stroke present with the appearance of being stuck down with the inability to get back up (at least without treatment).

At the time of Hippocrates and for centuries after, stroke was thought to strike otherwise healthy people at random, with no warning, and for no apparent reason. It would not be until 1658 when Johann Jacob Wepfer defined the etiology of stroke as bleeding in the brain or from a blockage of an intracranial or extracranial blood vessel in his publication entitled Apoplexia.2 He also described different types of stroke events, including completed and progressing stroke, transient ischemic attack, and reversible ischemic neurological deficit. However, it will take centuries for this knowledge to be incorporated into the definition of stroke beyond apoplexy.

In 1927,3 apoplexy was divided into categories based on causation-being contributed to either a blood vessel rupture or a vascular occlusion. This consequently led to the term cerebral vascular accident, commonly referred to by its abbreviation CVA.3 Having parallels to the meaning of the Greek word apoplexy, the word accident is derived from the Latin verb accidere, signifying "fall upon, befall, happen, chance."4 This definition continues with the historic thought that stroke was a rare and unfortunate incident that happens unexpectedly and unintentionally, a chance event without an apparent or deliberate cause. This also infers that the person experiencing a stroke is a victim of a nihilistic disease.

However, we now know that 80% of all strokes are potentially preventable through better control of modifiable risk factors such as hypertension, diabetes mellitus, tobacco smoking, atrial fibrillation, and hyperlipidemia.5 These risk factors are heavily influenced by health behaviors such as eating a healthy diet, maintaining a healthy weight, obtaining at least 150 minutes of exercise per week, avoiding cigarette smoke, and medication compliance.5 A 2016 article in Lancet further suggests that more than 90% of stroke can be potentially prevented worldwide based on modification of 10 risk factors and behaviors (which in addition to those already mentioned include psychosocial factors and the further refinement of previously mentioned definitions to include abdominal obesity and apolipoprotein levels).6

The underlying pathophysiology mechanisms associated with most stroke cases are progressive with temporal development. Therefore, stroke (and other types of vascular disease) should not be considered an accident-a rare, sudden and unforeseen event that occurs without expectation. This is especially true given that stroke is a leading cause of adult mortality and disability worldwide (so therefore not rare) and is, in most cases, a progressive disease of the brain or extracranial vessels. This chronicity implies that the person experiencing a stroke is implicit in the process and not an innocent victim of an ancient disease for which he/she has no control. This led to the current preferential use of the word stroke by healthcare professionals as opposed to the term cerebrovascular accident or CVA. The term stroke still implies that the person is being stuck down, although not accidently. With the advent of acute stroke therapies, starting with intravenous alteplase in 1996, stroke is no longer seen as a fatalist disease. Hence, the term "brain attack" was introduced into the lay community as a colloquial term in referring to both ischemic and hemorrhagic stroke to denote that stroke is a vascular emergency, much like a heart attack, along with the need to seek emergency care.7

To label a person a victim of stroke, experiencing stroke, or afflicted with stroke or other similar negative connotations contextually implies helplessness, pity, oppression, and the state of being trapped-when the desired state is survivorship, restoration, and growth. Being a survivor implies that a person has at least some control of his/her own life. So not only can a person take steps to prevent stroke, surviving conveys that the person is taking action to live, fighting to regain function, fighting to regain or maintain independence, fighting to thrive, and aiming progression over stagnancy. Surviving is empowerment. Therefore, a person experiencing the effects of a stroke should not be labeled a victim. Although there is no cure, most persons experiencing stroke now have a good chance for survival and recovery. Immediate treatment, supportive care, and rehabilitation can all improve the quality of life for persons experiencing stroke.

In addition, when referring to a person with a disease or disability, it is important to refer to them as an individual, such as the person with a stroke, versus referring to them by their disease, such as the "stroke patient."8 Likewise, it is important to emphasize ability and not one's disability.8 The positive expression of "Joe is partially sighted" is preferred over the more negatively worded sentence "Joe is partially blind." In addition, a person should only be referred to as a patient when under medical care or else they should be a consumer, member, person, someone with a name, or other similar term.8

A review of titles of articles published in the Journal of Neuroscience Nurses on stroke since its inception shows use of the term stroke (as opposed to "CVA"), at least in titles.9 However, there remains a proclivity to refer to patients with stroke, as stroke patients or strokes, and to focus on disabilities instead of function.

Conclusion

Linguistically, words provide structure to how we conceptualize situations, which can facilitate healing. We as nurses, in our healer and healthcare leader roles, should avoid negative connotations and use appropriate language to describe clinical phenomena and ensure that others do as well. Although stroke is often still perceived at the personal level as an unforeseen calamity, in most instances, stroke is no fortuitous accident. It is a predictable and unfortunate occurrence from long-standing health behaviors leading to chronic disease states associated with first and recurrent stroke. It is also not a rare event. Therefore, we should abnegate from using outdated terms to refer to stroke such as cerebrovascular accident or CVA, restrain from referring to those who have survived a stroke as victims or sufferers, and ensure that other language used to describe stroke and stroke treatment supports quality patient care. This extends to the avoidance of unsafe abbreviations such as t-PA and TNK when referring to alteplase and tenecteplase.10 Using professional communication and appropriate nomenclature speaks to our humanity of who we are as individual people and as nurses, as well as to our informed professionalism. It shows respect for persons, as well as reflecting emotional intelligence and empathy.

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