Scholarly Project Advisor: Kim Astroth, PhD, RN.
Affiliated Organization where the project occurred: OSF St. Joesph Medical Center Bloomington IL.
Publication: Submitted to American Journal of Neuroscience Nursing.
Background
A significant element of stroke management is to prevent deterioration and medical complications, with nurses’ assessments focused on frequent evaluation of neurological status. A change in management strategy and standardizing nurse communication with assessment during bedside report can help identify progression of stroke symptoms and lead to quicker interventions, and decreased length of stay (LOS) and improved discharge disposition (DD). The aim of this project was to improve bedside nurses’ competence and confidence in performing bedside neurological assessment (BNA), with the goal to maintain or improve neurological status in hospitalized stroke patients.
Methods
The quality improvement project was a quasi-experimental pre- and post-implementation of a stroke bundle to compare ischemic stroke patient LOS and DD. Sixteen staff nurses completed an educational presentation to increase their confidence and competence of NIHSS and BNA survey was used to evaluate the nurse perceptions prior to and after the educational presentation. A retrospective chart review was undertaken for 3 months on 43 patients admitted for stroke or transient ischemic attack prior to the project. Data on 32 patient’s post-implementation was collected for three months.
Results
Scores in nursing confidence and competence each improved from 3 to 4.5/5. Nursing use of bedside report and use of bedside assessment increased after education. Patient LOS decreased in the post implementation stroke patient group z = -2.77, p < 0.006, r =-0.32. The pre-implementation patients’ group rank was 43.77; the post- implementation patients’ rank was 30.25. DD was not impacted by the project.
Conclusion
Nursing confidence and competence was improved through the educational presentation. LOS was shortened in the post implementation group; further evaluation would be necessary to support our findings. DD was not found to be impacted. Further studies of bedside report with assessment could strengthen the understanding of this approach to patient care.