Client Outcome Measurements from a Rural Stroke Project Clinic
Authors:   , Schmidt Sally 
Published: February 2023

Client outcome measurements obtained from a rural stroke clinic were the focus of this investigation Neuman's (1995) System Model and the Stroke Risk Profile Appraisal Function Model (Wolf, D'Agostino, Belanger, & Kannel, 1991) based on the Framingham Heart Study provided the theoretical frameworks for this investigation. A retrospective, descriptive, comparative, time series design involving a secondary analysis of data collected by a nurse practitioner was used. The sample participants attended a rural make clinic site three times within an 18-month period (N = 154) More females (n = 109) than males (n = 45) participated to the study. The participants' mean age was 79.70 (SD = 2.87) at the initial clinic visit. One participant was African American and all other participants were Caucasian. All clients (N = 154) were referred by the nurse practitioner for follow-up professional medical care. Thirty-three percent of the participants sought follow-up care after the initial clinic visit. In comparison, 47% sought follow-up care after the second clinic visit. Systolic blood pressure (equal to or greater than 140 mmHg), atrial fibrillation, and carotid artery disease were identified as the most frequently occurring stroke risk factors. Since atrial fibrillation has been recognized in the literature as a significant risk factor for stroke (Wolf, Abbott, & Kannel, 1991), the nurse practitioner was instrumental in providing counseling for clients to seek follow-up care with a physician where atrial fibrillation was diagnosed. The least frequently occurring risk factors were smoking. Left ventricular hypertrophy, and stress. Males and females were similar in comparison to risk factor frequency Mean systolic blood pressures decreased over the three clinic visits. First visit mean systolic blood pressure was 145.41 mmHg, second visit mean systolic blood pressure was 143.79, and third visit mean systolic blood pressure measurement was 141.84. Paired sample t-tests revealed a significant difference (t = 2.08, p = .04) between participants' first systolic blood pressure measurement and their third systolic blood pressure measurement. The less powerful nonparametric Wilcoxon Matched-Pairs Signed-Ranks Test also detected a significant difference (Z= -2.23, p = .03) between participants' first and third systolic blood pressure measurements. However, a repealed measures ANOVA comparing systolic blood pressures measured over three clinic visits was not significant. Interestingly, paired sample t-tests on diastolic blood pressure revealed statistically significant differences between participants' first and second (t = 2.24, p = .03), second and third (t = 2.13, p = .03), and first and third (t = 4.01, p = .03) clinic visit diastolic blood pressure measurements. These findings related to diastolic blood pressure measurements may be of significance in health conditions other than stroke. A significant difference (t = 2. 19, p = .03) between male participants' first systolic blood pressure measurement (M = 145.71 mmHg) and their third systolic blood pressure measurement (M = 138.71 mmHg) were found. No significant differences among female participants' systolic blood pressure measurements were reported. Although significant differences were found in systolic blood pressure and diastolic blood pressure, paired sample I-tests did not reveal significant differences between participants' first and second, second and third, or first and third clinic visit stroke risk appraisal scores. The investigation results suggest that a stroke risk project clinic assists health care professionals to identify stroke risk factors among rural populations. In addition, the client education and nurse practitioner interventions may minimize some stroke risk factors and influence positive outcomes.