Authors (including presenting author) :
Li R(1), Mok M(1), Ho HS(1)(2), Tsoi SCT(2)(4), Leung YWN(2)(3)
Affiliation :
(1) Department of Medicine,Pamela Youde Nethersole Eastern Hospital
(2) Nethersole Clinical Simulation Training Centre, Pamela Youde Nethersole Eastern Hospital
(3) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
(4) Nursing Services Division, Pamela Youde Nethersole Eastern Hospital
Introduction :
Compared with community-onset stroke, in-patient stroke was less well-recognized. Delay in in-hospital stroke recognition and diagnosis may cause lower rates of thrombolysis, leading to worse stroke outcome. In 2021, an ‘In-patient Stroke Emergency Care Simulation Training Program’ was piloted for nursing staff in Pamela Youde Nethersole Eastern Hospital.
Objectives :
To enhance awareness of signs and symptoms of in-patient stroke; and introduce the workflow of in-patient stroke investigation and management.
Methodology :
Two half-day simulation training sessions were held, with a high fidelity trained actor portraying various stroke vignettes in the presence of stroke neurologist and nurses. Debriefing of individual performance was held immediately afterwards. ‘Pre-course’ and ‘post-course’ questionnaires with survey scales were used to compare the efficacy of training, with a focus on (1) awareness in acute stroke identification; (2) immediate nursing management and workflow for in-patient stroke; and (3) self-perceived readiness to manage in-patient stroke.
Result & Outcome :
Among the 19 of 20 participants who completed the questionnaires, 57.2% had 5-years-or-above nursing experience, and 88.9% have managed patients with in-patient stroke before. Prior to the simulation, 26.3% or less were aware of signs and symptoms of stroke, and only 10.5% felt they could confidently identify a case. 15.8% knew of the immediate nursing management, calling mechanism for in-patient stroke, and the essential information to relay to stroke nurse upon encountering a case. After the simulation, 84.2% felt confident in identifying a stroke, with 63.4% able to correctly tell the important clinical signs in the ‘BE-FAST’ acronym. All participants felt they were familiar with the management algorithm upon encountering an in-patient stroke, including when and what to inform stroke nurse, and how to prepare a patient for stroke investigation and treatment. 95% were able to identify the correct time window for intravenous thrombolytic therapy. The overall confidence in managing an in-patient stroke also increased from 15.8% to 89.5%.
In conclusion, stroke management simulation training was effective in enhancing nursing staff’s awareness and readiness in approaching in-patient stroke. This may improve quality of in-patient stroke management and outcome of these patients.
