The impact of education and training interventions for nurses and other health care staff involved in the delivery of stroke care: An integrative review

The impact of education/training on nurses caring for patients with stroke: a scoping review

BACKGROUND

Stroke survivors have complex needs that necessitate the expertise and skill of well-trained healthcare professionals to provide effective rehabilitation and long-term support. Limited knowledge exists regarding the availability of specialized education and training programs specifically designed for nurses caring for stroke patients.

AIM

This review aims to assess the content and methods of training for nurses caring for stroke patients, examine its impact on both nurses and patients, and identify key facilitators and barriers to its implementation.

METHODS

We conducted a comprehensive scoping review by reviewing multiple databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, Google Scholar, and Cochrane databases. Data extraction and narrative synthesis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

RESULTS

Seventeen articles were included in this review. We found that education/training not only enhanced patients' self-care abilities, nursing outcomes, and satisfaction, but also had a positive impact on the knowledge, skills, and practices of nurses. The obstacles to education/training included feasibility and cost-effectiveness, while the driving factors were management support and participation, professional education/training, and controlled environment creation.

CONCLUSIONS

This review highlights the crucial role of education/training in enhancing stroke care provided by nurses. Effective education/training integrates various educational methods and management support to overcome implementation barriers and optimize clinical practice benefits. These findings indicate the necessity of universal and consistent stroke education/training for nurses to further improve patient outcomes in stroke care.

Needs Assessment Survey for Stroke Care Core Competency-Based Training for Neuroscience Nurses

BACKGROUND

Assessment of stroke care core competency for neuroscience nurses is crucial for developing training programs to improve the quality of care for patients who have a stroke. The goal of this study was to determine the priorities for competency-based training using an importance-performance analysis of stroke care core competency among neuroscience nurses.

METHOD

A cross-sectional descriptive survey was conducted using a convenience sample of 154 neuroscience nurses. Differences in importance and performance scores were analyzed with paired t tests. The training priority was determined using the importance-performance matrix.

RESULTS

The overall performance score was significantly lower than the importance score. The highest priority areas of training were (a) principles of stroke care and (b) cardiovascular and respiratory effects.

CONCLUSION

Competency-based continuing education is needed in implementing stroke best practices for neuroscience nurses to achieve optimal competency. [J Contin Educ Nurs. 2024;55(2):63-68.].

Knowledge on Stroke Recognition and Management among Emergency Department Healthcare Professionals in the Republic of Cyprus

Stroke is a global leading cause of death and disability. Knowledge of related guidelines is crucial for emergency department (ED) staff, influencing early diagnosis and timely treatment. We investigated Greek Cypriot ED healthcare professionals' (nurses and physicians) knowledge in recognizing and managing stroke. A descriptive cross-sectional study spanned November 2019 to April 2020, encompassing four private and seven public EDs in the Republic of Cyprus. The data were collected through a self-reported questionnaire developed by the research team, consisting of 37 questions. Eight questions focused on sociodemographic and employment characteristics, twenty-eight assessed knowledge in stroke recognition and management (each item was equally weighted without deliberate prioritization), and one question addressed self-assessment of knowledge in stroke care. A total of 255 nurses (response rate (RR): 74.1%) and 26 physicians (RR: 47.3%) completed the questionnaire. The average correct response rate was 12.9 out of 28 statements (SD: 4.2), with nurses and physicians scoring 12.6 (SD: 4.1) and 15.7 (SD: 4), respectively. Work experience significantly influenced stroke knowledge, with all groups demonstrating superiority over those with less than one year of experience. Participants with previous training scored an average of 1.45 additional correct answers while educational attainment did not significantly influence stroke knowledge. Investigating stroke knowledge among emergency department nurses and physicians in the Republic of Cyprus revealed significant deficits. This study stresses targeted interventions, including education, yearly examinations, workshops with hands-on training, and repeated training, to address these gaps and enhance the overall stroke care capabilities of the healthcare professionals.

Exploring radiographers' perceptions and knowledge about patient lead shielding: a cross-sectional study in Greece and Cyprus

The present study aimed to explore radiographers' knowledge, clinical practice and perceptions regarding the use of patient lead shielding in Greece and Cyprus. Qualitative data were analyzed using conceptual content analysis and through the classification of findings into themes and categories. A total of 216 valid responses were received. Most respondents reported not being aware of the patient shielding recommendations issued by the American Association of Physicists in Medicine (67%) or the guidance issued by the British Institute of Radiology (69%). Shielding-related training was generally not provided by radiography departments (74%). Most of them (85%) reported that they need specific guidance on lead shielding practices. Also, 82% of the respondents said that lead shielding should continue to be used outside the pelvic area when imaging pregnant patients. Pediatric patients are the most common patient category to which lead shielding was applied. Significant gaps in relevant training have been identified among radiographers in Greece and Cyprus, highlighting the need for new protocols and provision of adequate training on lead shielding practices. Radiography departments should invest in appropriate shielding equipment and adequately train their staff.

Evaluating remote facilitation intensity for multi-national translation of nurse-initiated stroke protocols (QASC Australasia): a protocol for a cluster randomised controlled trial

BACKGROUND

Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS Protocols) in 19 Australian stroke units resulted in reduced death and dependency for stroke patients. However, a significant gap remains in translating this evidence-based care bundle protocol into standard practice in Australia and New Zealand. Facilitation is a key component for increasing implementation. However, its contribution to evidence translation initiatives requires further investigation. We aim to evaluate two levels of intensity of external remote facilitation as part of a multifaceted intervention to improve FeSS Protocol uptake and quality of care for patients with stroke in Australian and New Zealand acute care hospitals.

METHODS

A three-arm cluster randomised controlled trial with a process evaluation and economic evaluation. Australian and New Zealand hospitals with a stroke unit or service will be recruited and randomised in blocks of five to one of the three study arms-high- or low-intensity external remote facilitation or a no facilitation control group-in a 2:2:1 ratio. The multicomponent implementation strategy will incorporate implementation science frameworks (Theoretical Domains Framework, Capability, Opportunity, Motivation - Behaviour Model and the Consolidated Framework for Implementation Research) and include an online education package, audit and feedback reports, local clinical champions, barrier and enabler assessments, action plans, reminders and external remote facilitation. The primary outcome is implementation effectiveness using a composite measure comprising six monitoring and treatment elements of the FeSS Protocols. Secondary outcome measures are as follows: composite outcome of adherence to each of the combined monitoring and treatment elements for (i) fever (n=5); (ii) hyperglycaemia (n=6); and (iii) swallowing protocols (n=7); adherence to the individual elements that make up each of these protocols; comparison for composite outcomes between (i) metropolitan and rural/remote hospitals; and (ii) stroke units and stroke services. A process evaluation will examine contextual factors influencing intervention uptake. An economic evaluation will describe cost differences relative to each intervention and study outcomes.

DISCUSSION

We will generate new evidence on the most effective facilitation intensity to support implementation of nurse-initiated stroke protocols nationwide, reducing geographical barriers for those in rural and remote areas.

TRIAL REGISTRATION

ACTRN12622000028707. Registered 14 January, 2022.

Stroke care in Armenia: Recent developments

Introduction

Armenia is an upper-middle-income country with a population of nearly 3 million. Stroke is one of its major public health problems and ranks as the sixth leading cause of death, with a mortality of 75.5 per 100,000.

Methods and results

Until recently, modern stroke care was not available in Armenia. During the past 8 years substantial advances have been made in building medical infrastructure and delivering acute stroke care. This manuscript describes contributors to this progress, including extensive and long-term collaboration with international stroke experts, the development of hospital-based stroke teams, and a funding commitment for stroke care by the government.

Conclusion

The results of acute stroke revascularization procedures during the past 3 years are reviewed and found to meet international standards. Future directions are discussed including the immediate need to expand acute stroke care to underserved parts of the country by adding primary and comprehensive stroke centers. An active educational program for nurses and physicians and the TeleStroke system development will help support this expansion.

Factors impacting-stillbirth and neonatal death audit in Malawi: a qualitative study

Background

Over one million babies are stillborn or die within the first 28 days of life each year due to preventable causes and poor-quality care in resource-constrained countries. Death audit may be a valuable tool for improving quality of care and decreasing mortality. However, challenges in implementing audit and their subsequent action plans have been reported, with few successfully implemented and sustained. This study aimed to identify factors that affect stillbirth and neonatal death audit at the facility level in the southern region of Malawi.

Methods

Thirty-eight semi-structured interviews and seven focus group discussions with death audit committee members were conducted. Thematic analysis was guided by a conceptual framework applied deductively, combined with inductive line-by-line coding to identify additional emerging themes.

Results

The factors that affected audit at individual, facility and national level were related to training, staff motivation, power dynamics and autonomy, audit organisation and data support. We found that factors were linked because they informed each other. Inadequate staff training was caused by a lack of financial allocation at the facility level and donor-driven approaches to training at the national level, with training taking place only with support from funders. Staff motivation was affected by the institutional norms of reliance on monetary incentives during meetings, gazetted at the national level so that audits happened only if such incentives were available. This overshadowed other benefits and non-monetary incentives which were not promoted at the facility level. Inadequate resources to support audit were informed by limited facility-level autonomy and decision-making powers which remained controlled at the national level despite decentralisation. Action plan implementation challenges after audit meetings resulted from inadequate support at the facility level and inadequate audit policy and guidelines at the national level. Poor documentation affected audit processes informed by inadequate supervision and promotion of data usage at both facility and national levels.

Conclusions

Given that the factors that facilitate or inhibit audits are interconnected, implementers, policymakers and managers need to be aware that addressing barriers is likely to require a whole health systems approach targeting all system levels. This will require behavioural and complex intervention approaches.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08578-y.

Effect of clinician information sessions on diagnostic testing for Chagas disease

Background

Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened.

Methodology/Principal findings

We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11).

Conclusion/Significance

In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition.

Chagas disease is a potentially fatal neglected disease of poverty. It is endemic in continental Latin America with an estimated 300,000 cases in the United States, primarily among low-income people who have immigrated to the US from Latin America. Few Chagas screening programs have been established in the US. Existing recommendations for Chagas disease testing and treatment are rarely followed for many reasons including a paucity of knowledge among providers. We aimed to determine if the number of Chagas tests performed increased after information sessions at a community health center. A secondary aim was to determine if there was a difference in number of tests performed by provider type. We found that the number of T. cruzi serologies performed in the ten months after information sessions increased significantly over that in the ten preceding months. Chagas testing increased across departments, though Chagas diagnostics were an extra and unmitigated time burden on clinicians. Increasing provider knowledge is a major step to increase diagnosis and treatment of this neglected disease, when clinicians are motivated by their inherent prosocial preferences including altruism i.e., by the positive impact of their work on patients’ lives.

Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study

BACKGROUND

The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake.

METHODS

Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups.

RESULTS

Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols.

CONCLUSIONS

Despite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ( ACTRN12614000939695 ).

Clinical academic research internships for nurses, midwives and allied health professionals: a qualitative evaluation

BACKGROUND

Nurses, midwives and allied health professionals are integral to research, yet rarely engage simultaneously in research and clinical practice. Clinical academic internships offer a route for accessing academic research training.

AIM

To determine facilitators and barriers to nurses' participation and engagement in research internships, and to suggest improvements for future programmes.

DISCUSSION

The experiences of ten health professional research interns were explored, using a method based on a synthesis between grounded theory and content analysis. Four categories emerged: integrating clinical and research aspirations; support - or lack of it; the hidden curriculum; and the legacy effect. Respondents identified facilitators and barriers to engagement in these categories, including unforeseen challenges.

CONCLUSION

Formal support is necessary but is insufficient for fostering engagement and maximising benefits. Participation must be supported by colleagues and enabled by institutional structures. The potential effects of internships on engagement with research is considerable but requires collaboration between all stakeholders.

IMPLICATIONS FOR PRACTICE

Deeper institutional engagement is needed so that internship opportunities are fully supported by all colleagues and practically enabled by institutional structures. Future schemes should attempt to promote opportunities to collaborate through group projects to reduce researchers' isolation.

In-service training to enhance the competence of health and social care professionals: A document analysis of web-based training reports

OBJECTIVE

To identify and describe what professional competencies have been addressed by in-service training for health and social care professionals and what kind of teaching and evaluation methods have been used.

DESIGN

Cross-sectional descriptive study.

METHODS

A document analysis design was used to explore 7817 in-service training project documents relating to 203 projects carried out from 2002 to 2020. The project data were obtained from the websites run by the relevant health and social care organizations.

RESULTS

The most frequent competencies that were addressed were health promotion and clinical skills (17%), preventing social problems (16%) and promoting the wellbeing of children and families (15%) and older adults (14%). The main target groups were general health and social care professionals (19%). A total of 222 training interventions were used by the 203 projects and the most frequently used methods were conventional classroom education (56%), followed by coaching and orientation (12%) and theme days (9%). Only 38% of the projects measured the effects of the training and the main method was collecting feedback from participants. We also found that collaboration between projects was necessary to ensure that training was not duplicated and transparent reporting played a central role in that process.

CONCLUSIONS

In order to achieve successful in-service training for health and social care professionals, projects needed to recognize topical competence needs and provide the most appropriate training methods. Collaboration and transparent reporting helped to avoid duplication in training.

An Online Training Intervention on Prehospital Stroke Codes in Catalonia to Improve the Knowledge, Pre-Notification Compliance and Time Performance of Emergency Medical Services Professionals

Strokes are a time-dependent medical emergency. The training of emergency medical service (EMS) professionals is essential to ensure the activation of stroke codes with pre-notification, as well as a rapid transfer to achieve early therapy. New assessment scales for the detection of patients with suspected large vessel occlusion ensures earlier access to endovascular therapy. The aim of this study was to evaluate the impact on an online training intervention focused on the Rapid Arterial oCclusion Evaluation (RACE) scoring of EMS professionals based on the prehospital stroke code in Catalonia from 2014 to 2018 in a pre-post intervention study. All Catalonian EMS professionals and the clinical records from primary stroke patients were included. The Kirkpatrick model guided the evaluation of the intervention. Data were collected on the knowledge on stroke recognition and management, pre-notification compliance, activated stroke codes and time performance of EMS professionals. Knowledge improved significatively in most items and across all categories, reaching a global achievement of 82%. Pre-notification compliance also improved significantly and remained high in the long-term. Increasingly higher notification of RACE scores were recorded from 60% at baseline to 96.3% in 2018, and increased on-site clinical care time and global time were also observed. Therefore, the online training intervention was effective for increasing EMS professionals' knowledge and pre-notification compliance upon stroke code activation, and the wide adoption of a new prehospital scale for the assessment of stroke severity (i.e., the RACE scale) was achieved.

Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial

Background

Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition.

Objective

This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics.

Methods

A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a “Declaration of no objection.” Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague.

Results

The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12).

Conclusions

Use of an e-learning module shows promising results in teaching the NIHSS to paramedics.

Can a multicomponent multidisciplinary implementation package change physicians' and nurses' perceptions and practices regarding thrombolysis for acute ischemic stroke? An exploratory analysis of a cluster-randomized trial

BACKGROUND

The Thrombolysis ImPlementation in Stroke (TIPS) trial tested the effect of a multicomponent, multidisciplinary, collaborative intervention designed to increase the rates of intravenous thrombolysis via a cluster randomized controlled trial at 20 Australian hospitals (ten intervention, ten control). This sub-study investigated changes in self-reported perceptions and practices of physicians and nurses working in acute stroke care at the participating hospitals.

METHODS

A survey with 74 statements was administered during the pre- and post-intervention periods to staff at 19 of the 20 hospitals. An exploratory factor analysis identified the structure of the survey items and linear mixed modeling was applied to the final survey domain scores to explore the differences between groups over time.

RESULT

The response rate was 45% for both the pre- (503 out of 1127 eligible staff from 19 hospitals) and post-intervention (414 out of 919 eligible staff from 18 hospitals) period. Four survey domains were identified: (1) hospital performance indicators, feedback, and training; (2) personal perceptions about thrombolysis evidence and implementation; (3) personal stroke skills and hospital stroke care policies; and (4) emergency and ambulance procedures. There was a significant pre- to post-intervention mean increase (0.21 95% CI 0.09; 0.34; p < 0.01) in scores relating to hospital performance indicators, feedback, and training; for the intervention hospitals compared to control hospitals. There was a corresponding increase in mean scores regarding perceptions about the thrombolysis evidence and implementation (0.21, 95% CI 0.06; 0.36; p < 0.05). Sub-group analysis indicated that the improvements were restricted to nurses' responses.

CONCLUSION

TIPS resulted in changes in some aspects of nurses' perceptions relating to the evidence for intravenous thrombolysis and its implementation and hospital performance indicators, feedback, and training. However, there is a need to explore further strategies for influencing the views of physicians given limited statistical power in the physician sample.

TRIAL REGISTRATION

ACTRN12613000939796, UTN: U1111-1145-6762.

Guía para un Plan de egreso en personas con secuelas por Enfermedad Vascular Cerebral

Introducción: Las personas que sufren un Evento Vascular Cerebral (EVC), generalmente quedan incapacitadas para la realización de sus actividades básicas, lo que conlleva a una dependencia. Por consiguiente, es importante la elaboración de un plan de egreso con amplia información sobre los cuidados que facilite al profesional de enfermería brindar educación para la salud, dirigida a familiares y enfermos sobre el cuidado en el hogar tras un EVC. Métodos: El procedimiento utilizado para esta propuesta constó de tres fases, en las cuales se realizó una revisión de la literatura, una delimitación con base en el tema central, para finalmente, elaborar el plan de egreso que aquí se presenta. Resultados: En la primera fase se analizaron 39 estudios, 16 de tipo cualitativo, 11 cuantitativos, ocho Guías de práctica clínica, tres mixtos y dos tesis; posteriormente, en la segunda fase se estableció la delimitación del tema con base en el criterio de evidencia científica y los diagnósticos enfermeros de la NANDA, y finalmente; en la tercera fase, se prescribieron las principales intervenciones de cuidado a implementar tras el egreso de pacientes con EVC. Discusión y conclusiones: El plan de egreso forma parte del cuidado integral y humanizado, requiere llevarse a cabo de forma habitual para facilitar el diálogo sobre las incertidumbres, dudas y angustias presentes, frecuentemente, en el cuidador primario y enfermo tras su egreso. A su vez, las guías de cuidado contribuyen a establecer el plan de egreso al enfermo, con el propósito de disminuir los reingresos hospitalarios, prevenir complicaciones y mejorar su calidad de vida, además de poder seguir innovando la práctica clínica de enfermería.

Impact of a Training Intervention on the Pain Assessment in Advanced Dementia (PAINAD) Scale in Noncommunicative Inpatients

BACKGROUND

Public hospitals in Catalonia (Spain) recommend using the Spanish version of the Pain Assessment in Advanced Dementia (PAINAD-Sp) scale for assessing pain in adult patients unable to self-report. However, since its inclusion in Catalonian nursing care plans in 2010, there have been no training programs for nurses, contributing to its current underuse.

AIMS

The aim of this study was to assess the impact of a nurse training intervention on the PAINAD-Sp scale in noncommunicative inpatients unable to self-report.

DESIGN

Before-after study.

SETTINGS

Two public hospitals in Catalonia (Spain).

PARTICIPANTS/SUBJECTS

Four hundred and one nurses participated in the training course and 219 patients received PAINAD-Sp assessments.

METHODS

We used a before-after study design, evaluating the use of the PAINAD-Sp scale over two 6-month periods before and after an online training intervention for nurses in February 2017, in two public hospitals. Data were collected from patient records in each center. The primary outcome was the number of patients receiving PAINAD-Sp assessments during admission. Secondary outcomes were the number of assessments undertaken per patient during admission, the total (0-10) and item-specific (0-2) PAINAD-Sp score, and pharmacologic treatment administered.

RESULTS

There were 401 nurses who took part in the training program. Over the study period, 219 patients received PAINAD-Sp assessments: 29 in the preintervention period and 190 in the postintervention period (p < .001). Administration of analgesics and antipyretics decreased (p < .001) after the intervention, whereas use of hypnotic drugs and sedatives increased.

CONCLUSIONS

Theoretical and practical training may be an effective way to improve nurses' approach to identifying, assessing, and managing pain in patients unable to self-report.

Nursing students' misunderstandings when learning about stroke care: A phenomenographic study

BACKGROUND

Considering the prevalence and complexity of a stroke, it is necessary to think about how undergraduate nursing students are developing knowledge for stroke care.

AIM

To obtain a vision of nursing students' learning, exploring difficulties concerning understanding stroke care delivery.

DESIGN

A phenomenographic research approach.

LOCATIONS AND PARTICIPANTS

This research is based on written exam papers (n = 126) from third-year nursing students enrolled in the 2015-16 academic year in two Nursing Schools in Spain.

RESULTS

The analysis revealed four conceptions in which students demonstrated difficulties understanding stroke care delivery: 1) limitation of the neurological assessment to the level of consciousness and use of the Glasgow Coma Scale; 2) association of haemorrhagic stroke with hypovolaemia; 3) justification of the need for appropriate patient positioning and postural changes based solely on preventing pressure ulcers; and 4) assertion that strength exercises help improve spasticity.

CONCLUSIONS

Empirical identification of these conceptions among undergraduate nursing students, together with agreed definitions of learning outcomes, in the subject of stroke care delivery will allow educators to design evidence-based teaching-learning strategies.

Neuro-Interventional Management of Acute Ischemic Stroke

Restoration of cerebral blood flow is the most important step in preventing irreversible damage to hypoperfused brain cells after ischemic stroke from large-vessel occlusion. For those patients who do not respond to (or are not eligible for) intravenous thrombolysis, endovascular therapy has become standard of care. A shift is currently taking place from rigid time windows for intervention (time is brain) to physiology-driven paradigms that rely heavily on neuroimaging. At this time, one can reasonably anticipate that more patients will be treated, and that outcomes will keep improving. This article discusses in detail recent advances in endovascular stroke therapy.