Implementation of an in-hospital stroke simulation protocol

Nursing students led simulations to improve healthcare workers' hand hygiene compliance

BACKGROUND

Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance.

OBJECTIVE

This study aimed to assess the effect of simulation interventions led by nursing students on HCWs' HHC.

METHOD

A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel.

RESULTS

Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement.

CONCLUSION

Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.

Stroke Admission Simulation: Engaging Novice and Expert Nurses

In today's changing health care climate, clinical nurse educators are being challenged to educate nurses with a wide range of experience. This article describes the development and facilitation of a low-fidelity simulation used to educate nurses about identified gaps in standardized care during stroke admissions on a medical-surgical stroke unit at Legacy Emanuel Medical Center. The simulation was developed for use by novice and expert medical-surgical stroke nurses simultaneously. With the use of Bloom's Revised Taxonomy (Anderson et al., 2001), roles within the simulation were tailored to encourage the learning of nurses with varying levels of expertise. Overall, learners appeared to benefit from the class, which included the stroke admission simulation. Mean test scores increased from 55% pretest to 80% posttest. Additionally, 98% of learners found the simulation and lecture moderately helpful or extremely helpful. [J Contin Educ Nurs. 2024;55(3):113-119.].

Knowledge, Attitude, Skill, and Practice of Emergency Nurses Regarding the Early Management of Patients With Acute Ischemic Stroke in Beijing

INTRODUCTION

Emergency nurses play an important role in the early management of acute ischemic stroke. The purpose of this study was to evaluate the knowledge, attitudes, skills, and practice of emergency nurses in Beijing regarding the early management of acute ischemic stroke.

METHODS

This cross-sectional study enrolled emergency nurses in 26 hospitals in Beijing between August and November 2022. Correlations among knowledge, attitude, and skill/practice were evaluated by Pearson correlation analysis.

RESULTS

This study included 564 nurses (82.98% were female). The average knowledge, attitude, and skill/practice scores were 15.48 ± 2.39 (possible range, 0-22), 39.84 ± 4.89 (possible range, 9-45), and 40.59 ± 5.21 (possible range, 13-52). The knowledge was significantly positively correlated with attitude and skill/practice (all P< .001). There was also a positive correlation between attitude and skill/practice (P< .001).

DISCUSSION

These findings may facilitate the implementation of education/training programs to improve the early management of acute ischemic stroke by nurses in emergency departments.

Nursing and Institutional Responsibilities for In-Hospital Stroke

In-hospital stroke events occur less often than stroke outside of a health care facility; yet, the need for timely evaluation and treatment is the same regardless of geographic location. During hospitalization, nurses are generally the first to recognize possible symptoms of stroke and activate emergency protocols. Such actions in response to changes in patient condition are critical to optimal patient outcomes. A recent scientific statement from the American Heart Association notes that patients with in-hospital stroke are likely to experience delayed recognition of symptoms, less likely to receive intravenous thrombolysis therapy, and have worse outcomes compared with community-occurring stroke. The aim of this article is to expand upon that scientific statement to assist nurses and acute care hospitals in the United States and elsewhere with similar health care systems to create evidence-based, nurse-driven protocols for in-hospital stroke recognition and management.

Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan

Background

According to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing "Stroke Schools" to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems.

Aim

To study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018-2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the "Electronic Register of Discharged Patients" (IS ERDB) and the annual collection "Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015-2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code "Acute Impaired Cerebral Circulation" (I60-I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the "Electronic Register of Dispensary Patients" of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection "Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations". Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.

Simulation-based team training improves door-to-needle time for intravenous thrombolysis

PURPOSE

There is a clinical need for shortened door-to-needle time (DNT) for intravenous thrombolysis, but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields. Still, it is not clear if simulation improves logistics in stroke.

METHODS

To evaluate the efficiency of a simulation training programme, the DNT of participating centres was compared with the rest of stroke centres in the Czech Republic. Patients' data were prospectively collected from the nationally used Safe Implementation of Treatments in Stroke Registry. The outcome was an improvement in DNT in 2018 as compared with 2015 (after and before the simulation training). Scenarios were based on real clinical cases, and simulation courses were conducted in a standardly equipped simulation centre.

FINDINGS

Between 2016 and 2017, 10 courses were conducted for stroke teams from 9 of all 45 stroke centres. DNT data were available both in 2015 and 2018 from 41 (91%) stroke centres. The simulation training improved the DNT in 2018 as compared with 2015 by 30 min (95% CI 25.7 to 34.7) and as compared with 20 min (95% CI 15.8 to 24.3) in stroke centres without the simulation training (p=0.01). Any parenchymal haemorrhage occurred in 5.4% and 3.5% of patients treated in centres without and with simulation training (p=0.054), respectively.

CONCLUSIONS

DNT was considerably shortened nationally. It was feasible to implement simulation as a nationwide training programme. The simulation was associated with improved DNT; however, other studies should confirm that such an association is causal.

A survey and analysis of pediatric stroke protocols

Objectives Despite their comparative rarity, about 10,000 ischemic strokes occur in children every year, and no standardized method of treatment exists. Protocols have been effective at increasing diagnosis accuracy and treatment efficacy in adults, but little has been done to evaluate such tools in children. A survey was developed to identify the proportion of pediatric hospitals that have stroke protocols and analyze the components used for diagnosis and treatment to identify consensus. Materials and methods Physicians at 50 pediatric hospitals that contributed to the Pediatric Hospital Inpatient Sample in specialties involved in the treatment of stroke (i.e, neurology, neurosurgery, radiology, pediatric intensive care, and emergency medicine) were invited in a purposive and referral manner to complete and 18-question survey. Consensus agreement was predefined as >75%. Results Of 264 surveys distributed, 93 (35%) were returned, accounting for 46 (92%) hospitals. Among the respondents, 76 (82%) reported the presence of a pediatric stroke protocol at their hospital. Consensus agreement was reached in 9 components, including the use of intravenous tissue plasminogen activator (90%) and mechanical thrombectomy (77%) as treatments for acute stroke. Consensus agreement was not reached in 10 components, including the use of prehospital (16%) and emergency department (59%) screening tools and a centralized contact method (57%). Conclusions Pediatric ischemic stroke is a potentially devastating disease that is potentially reversible if treated early. Most pediatric hospitals have developed stroke protocols to aid in diagnosis and treatment, but there is a lack of consensus on what the protocols should contain.

Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

This scientific statement describes a path to optimizing care for patients who experience an in-hospital stroke. Although these patients are in a monitored environment, their evaluation and treatment are often delayed compared with patients presenting to the emergency department, contributing to higher rates of morbidity and mortality. Reducing delays and optimizing treatment for patients with in-hospital stroke could improve outcomes. This scientific statement calls for the development of hospital systems of care and targeted quality improvement for in-hospital stroke. We propose 5 core elements to optimize in-hospital stroke care: 1. Deliver stroke training to all hospital staff, including how to activate in-hospital stroke alerts. 2. Create rapid response teams with dedicated stroke training and immediate access to neurological expertise. 3. Standardize the evaluation of patients with potential in-hospital stroke with physical assessment and imaging. 4. Address barriers to treatment potentially, including interfacility transfer to advanced stroke treatment. 5. Establish an in-hospital stroke quality oversight program delivering data-driven performance feedback and driving targeted quality improvement efforts. Additional research is needed to better understand how to reduce the incidence, morbidity, and mortality of in-hospital stroke.

Use of a Transfusion Checklist by Student Nurses to Improve Patient Safety

Better education around the recognition of transfusion-associated adverse events is warranted. It is unknown if checklist use improves recognition by student nurses. This study examined whether using a checklist could improve transfusion-associated adverse event recognition behaviors. There was an increased frequency of transfusion-associated adverse event management behaviors in the checklist group, but overall recognition was no greater than other groups. A transfusion-associated adverse event checklist may increase patient safety by promoting identification behaviors.