Date of Submission

Fall 12-4-2018

Document Type

Manuscript

Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Dr. Juli C. Maxworthy

Second Advisor

Dr. Elena Capella

Abstract

The annual decrease in stroke mortality rates in the United States has slowed, but in certain populations, such as Hispanics and in southern U.S. states, mortality rates are increasing. Stroke remains the number one cause of adult disability. A previous stroke is a risk factor for a second stroke. Prompt treatment is essential for positive outcomes. Patients need to present to the hospital no more than 4.5 hours from last known well for intravenous alteplase treatment and six to 24 hours from last known well for endovascular therapy. Based on the literature, the majority of patients are not presenting to the hospital in time for treatment.

Patients should be educated in the hospital prior to discharge on Joint Commission required elements of stroke education, which include the importance of calling 911, stroke signs and symptoms, disease processes, risk factor management, and follow up. However, in 2016, 40% of Kaiser Permanente stroke survivor members reported they were not adequately educated in the required elements, despite nursing documentation of education. Increasing patient knowledge and perception of adequate education may increase the number of patients who present in time for treatment. Interventions to increase patient perception of adequate education included engagement of stroke survivor’s view of educational material, the evaluation of current educational material, the development of a fourth-grade reading level flyer, and the development of a training module for nurses working on stroke units or units with stroke-designation.

Preliminary results were not conclusive, and more data points are needed. The percentage of positive responses to the question, “Staff Explained Disease Processes,” rose from 51% (21/41) to 64% (32/50). However, the positive responses for the other two stroke-related questions for risk factors and stroke signs and symptoms decreased from 54% (23/42) to 44% (24/54) and 52% (19/36) to 47% (25/53), respectively. The overall results were not statistically significant using χ2 for analysis. Behavioral measures, which may be influenced by increased education such as arriving to the hospital in time for treatment and activation of the emergency medical system, saw no significant difference for arrival in time for treatment and, unfortunately, a statistically significant increase in arrival by private car for the month of August. Future work of the project is to continue to increase training and awareness for the nurses, obtain additional stroke survivor input, analyze the time to arrival and arrival mode data more closely, and to explore a regional stroke patient satisfaction assessment process.

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