Introduction Inadequate health literacy is a pervasive problem with major implications for reduced health status and health disparities. Despite the role of focused education in both primary and secondary prevention of stroke, the effect of health literacy on stroke education retention has not been reported. We examined the relationship of health literacy to the retention of knowledge after recommended stroke education.
Background and Purpose: The Joint Commission mandates that certified Primary Stroke Centers provide patient education addressing stroke warning signs, use of 911 for access to emergent care, personal risk factors, medications prescribed, and follow-up after discharge. The patient’s retention of this information is imperative for reducing secondary stroke occurrence and morbidity. This study evaluated the Acute Ischemic Stroke (AIS) patient’s ability to retain the stroke education information provided near the time of hospital discharge. Methods: A prospective hospital-based cohort study was comprised of AIS patients who were admitted to the stroke unit at an urban core hospital located in Jacksonville, Florida. Diagnosis of AIS was confirmed by a Neurologist and by a CT or MRI. All participants received Joint Commission mandated stroke education administered by a nurse during their hospitalization. The patient education included verbal instructions with the use of illustrative handouts. Stroke education retention was evaluated near the time of hospital discharge using a five-question survey. The level of health literacy was assessed by the Short Version-Test of Functional Health Literacy in Adults (S-TOFLHA). Results: Of 189 consecutive patients screened between October 2009 and June 2010, 100 (53%) consented to participate. Seventy patients were excluded due to severe cognitive impairment, and 18 eligible patients refused to participate. The average age was 60 years old, 57% were male, 56% African American, 43% resided within the urban core, and 75% earned less than $25,000 per year. A total of 59% of patients had low to marginal health literacy. Retention of stroke knowledge was lacking even with standard stroke post education; 12% could name all 5 warning signs, 43% knew their personal risk factors, 85% knew to call 911 for warning signs of stroke, 76% knew their medications prescribed for stroke prevention, and 53% knew their type of stroke. Conclusion: Current methods of educating hospitalized AIS patients may not adequately prepare the hospitalized stroke survivor with basic knowledge on stroke prevention. Alternative methods of education will need to be developed for AIS patients in urban core hospitals. By using the Patient-Centered Care model and principles of adult learning, this study has the potential to lead to changes in educational interventions, nursing practices, and communication.
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Introduction: The National Institutes of Health Stroke Scale (NIHSS) quantifies physical impairment caused by stroke. Emergency Medicine (EM) physicians must be competent to perform the NIHSS as scale cut points are utilized to identify patients with acute ischemic stroke who may be candidates for thrombolytic therapy. Simulation is a teaching method that integrates imitation of real life scenarios into educational exercises. This study discerned if standardized patient simulation can be adopted into an educational exercise aimed at training EM residents to adequately perform the NIHSS. Methods: This preliminary study was completed with EM residents, in various years of training, from a single academic center. All residents attended a lecture on performance of the NIHSS. Each resident then performed the NIHSS on 2 patients with chronic, fixed neurological deficits. Residents were observed by a NIHSS certified healthcare professional who gave immediate feedback on examination technique. Data was analyzed with basic statistics using means and standard deviations (± SD). Results: Twenty eight EM residents, 7 NIHSS certified healthcare professionals (1 Neurologist, 5 Neurology residents, 1 nurse), and 7 patients participated in the trial. Mean certifier NIHSS score of patients was 2.7 (SD ±1.6). Resident score exactly correlated with certifier score in 11/56 examinations (20%), was within ±2 points of the certifier score in 28 examinations (50%), and within ±3 or 4 in 17 examinations (30%). Average time to complete one patient examination was 5 minutes 36 seconds (SD ±1 min 3 sec). In a post exercise survey, all residents rated this training experience as being beneficial to their medical training. Conclusions: An educational format incorporating didactic and return demonstration aimed at training a large group of EM residents to competently perform the NIHSS is practical. Immediate feedback on examination technique and a relatively short time to complete the educational exercise are advantages of this format compared to on-line training modules often used to educate physicians. Further refinement of this exercise is necessary before it can be used for the purpose of NIHSS certification.
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