Creative ways to educate about stroke assessment
Is your ED certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a Primary Stroke Center? If so, eight hours of annual education is required for each nurse on the stroke team.
"But JCAHO does not mandate that the information be approved for continuing education by the state, so our options are wide open," says Diana Everley, RN, staff development specialist and former clinical educator for the ED at Deaconess Hospital in Evansville, IN. Also, the programs don’t have to be stroke-specific, she says. "They can include diabetes, atrial fibrillation, or hypertension, since all of these impact the care of the stroke patient or risk factors."
To improve stroke education for ED nurses and comply with Joint Commission requirements, do the following:
• Update nurses on new research.
At Borgess Medical Center’s ED in Kalamazoo, MI, a "stroke notebook" is updated every two weeks with new literature on stroke care, with a sign-up sheet and short test provided for nurses who read the articles.
By taking the test, the nurse is able to accrue some credit for the article, says Ken Lanphear, RN, BSN. "This is also a way for the hospital to show ongoing competency in stroke care, which is always an issue with JCAHO," he adds.
• Require nurses to be certified in the National Institutes of Health Stroke Scale (NIHSS).
At Deaconess, new ED nurses take an eight-hour stroke class and then take the exam to become certified in performing the NIHSS, says Everley. For other nurses, a four-hour recertification course for the NIHSS is held, with discussion on areas that nurses find most difficult to complete.
"We assist them in logging on to the American Stroke Association’s web site so they can complete the training module and then take the annual exam," says Everley.
• Share data.
ED nurses regularly review the data required by the Joint Commission for stroke patients, Everley reports. "The stroke team provides up-to-date data so we can relay this to the staff," she says. "We spend time explaining the data, so when they see it posted on their units each month, they actually understand it."
As a result, documentation has improved, such as dysphagia screening prior to patients being given anything to swallow. "The staff are also made aware of items that that the physician needs to document and ensure that this is done, such as the inclusion/exclusion criteria for giving t-PA [tissue plasminogen activator]," adds Everley. The classes are small, with fewer than 12 nurses, so the staff have an opportunity to ask questions, she notes.
• Make a videotape.
If they can’t attend lectures, ED nurses can watch a 50-minute videotape on stroke assessment developed by the hospital’s stroke team, says Everley. "There is a VCR in the nurse break room, and relief can be given at slow times for the nurses to watch it at work," she says. "Also, the ED has several copies so that staff can check it out and watch it at home if they prefer."
• Teach at the bedside.
There is no replacement for bedside teaching, says Christine Whelley Wilson, RN, BSN, stroke program coordinator at University of Wisconsin Hospital and Clinics in Madison. "It is the best way for nurses to learn concepts and remember them," she says.
When a stroke patient presents to the ED, the stroke team compares their assessment with the ED nurses, to see if there was anything the nurse overlooked, Wilson says. "The main reason to compare our assessments is to see if the patient is recovering or has fluctuating symptoms," she says. This might mean the patient is actually having a transient ischemic attack and may not require t-PA, Wilson explains.
• Don’t overlook nurses who work off shifts.
Instead of having nurses who work off shift attend lectures on the day shift, Wilson kept a tally of who was missing the lectures and made a point of doing one-on-one education with those nurses during their regular shift.
• Focus on a particular patient.
At Everley’s ED, actual cases of stroke patients are used for a "patient care circle" group discussion. "A staff nurse from each area describes the course of events for the patients while they were in their unit and discusses their care," she says. "The staff can receive stroke education hours for being a presenter or a participant. Lunch is offered as an added bonus."
Sources/Resources
For more information on educating nurses on stroke assessment, contact:
- Ken Lanphear, RN, BSN, Emergency Department, Borgess Medical Center, 1521 Gull Road, Kalamazoo, MI 49048. Telephone: (269). E-mail: [email protected].
- Diana Everley, RN, Staff Development Specialist, Employee Education and Development, Deaconess Hospital, 600 Mary St., Evansville, IN 47747. Telephone: (812) 450-7173. E-mail: [email protected].
- Christine Whelley Wilson, RN, BSN, Stroke Program Coordinator, University of Wisconsin Hospital and Clinics, 600 Highland Ave., Madison, WI 53792. Telephone: (608) 264-4698. E-mail: [email protected].
- For a free on-line training program on administering the National Institutes of Health Stroke Scale (NIHSS) for acute stroke assessment, go to the American Stroke Association’s on-line NIH Stroke Scale training program: (asa.trainingcampus.net).
- A NIHSS Training DVD is available for $50 including shipping. To purchase the DVD, call (800) 352-9424 or order on-line from asa. trainingcampus.net. Click on "Resources & FAQ." Under "National Institute of Neurological Disorders and Stroke," click on "Buy NIH Stroke Scale DVD Here." After viewing the stroke scale DVD, nurses may return to the site and enter scores to earn a maximum of 3.5 hours of continuing education credit.
- A training videotape on "Stroke: Acute Management in the Emergency Department — Assessment, Treatment, and Documentation" made by Wisconsin Hospital and Clinics can be downloaded at no charge at the Wisconsin Stroke Alert web site (www.strokealert.org). Click on "Resources."
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