Abstract NS 9: An Educational Intervention to Enhance Acute Stroke Symptom Recognition Skills Among Nursing Home Nursing Assistants

Abstract

Background: Treatment of stroke requires a coordinated effort by clinicians educated to identify and transfer presumed acute stroke patients to hospital Emergency Departments (EDs) for expedited evaluation. With the aging of the population and the increasing demand for nursing home (NH) services, the community of clinicians educated to identify acute symptoms of stroke needs to be inclusive of Nursing Assistants (CNAs) in NH settings, who provide 70 to 80% of direct-care hours to NH residents. Approximately 25% of NH residents are referred to EDs for emergency care each year. Poorly executed transitions between EDs and NHs have the potential to delay assessment and intervention in a context in which “time is brain.” Purpose: The goal of this educational intervention was to integrate evidence-based messages for acute stroke symptom recognition into NH CNA practice and to assess knowledge change by comparing stroke-related knowledge at baseline to knowledge acquired immediately post-intervention. Methods: An educational module on acute stroke symptom recognition based on the Massachusetts Department of Public Health’s “Stroke Heroes Act FAST Education Guide” was delivered live by an advanced practice nurse to a convenience sample of 39 CNAs from 4 of an urban NH’s skilled nursing units. Pre- and post-test surveys, based on the “Hip Hop Stroke” survey questions, were administered to participants and results were analyzed using descriptive statistics. Results: Mean age of participants was 43.2 years (SD = 8.1), 82.1% were female, and 74.4% were Black. Mean years of clinical experience were 12.6 (SD = 8.2). Most (94.7%) described stroke as involving the brain on the pre-test, but only 22.2% of CNAs could select all 4 signs of stroke from the eight options offered on the pre-test. Post-intervention, 100% indicated that a stroke involves the brain and 33.3% correctly selected all 4 signs of stroke. In addition, 78.6% accurately described the meaning of all 4 “FAST” letters on the post-test. Conclusions: This educational intervention improved NH CNA knowledge of stroke symptoms. While this intervention could be replicated in other NH settings, the effect of early stroke symptom recognition on the quality of the emergency care provided to NH residents, and the impact of that emergency care on stroke-related morbidity and mortality among NH residents, warrant further study. It is notable that most participants were Black, as it is well documented that racial-ethnic minorities are less likely to be aware of acute stroke symptoms and the need for urgent treatment. Further research is needed to determine the optimal design of educational interventions in at-risk populations.