Table 2 External Data: Importance of the Nurse Role in Patient Education/Level of Evidence Full APA Citation Research Purpose Study Design Sample (Setting) Data Collection/ Measures Analysis/ Outcomes Strengths/ Limitations of Study Quality Aslani, Z., Alimohammadi, N., Taleghani, F., & Khorasani, P. (2016). Nurses’ empowerment in self-care education to stroke patients: An action research International Journal of Community Based Nursing & Midwifery, 4(4), 329-338. The purpose of this study was to evaluate if there was a link between the level of nurse and patient outcomes. Action research design 23 nurses who from an inpatient unit. group and individual interviews were conducted until data was saturated. Nurses felt they were better prepared to answer questions with concise answered after the educational session Based on the results of this research, the study was able to support the importance of providing additional education for nurses in their primary field of work. Limitations included nurse resistance to change due to increased workload and lack of nurse Level 6 Low quality
understanding related to the research process. Blauer, C., Frei, I. A., Schnepp, W., & Spirig, R. (2015). Implementation of a nurse-led education programme for chronic heart failure patients during hospitalisation and strategies supporting their self-management at home: A practice development project in the context of the Swiss healthcare system. International Practice Development Journal, 5(1). The purpose of this was to see if creating nurse led education programs could meet the need of patients. Mixed method design 15 CHF patients that received CHF education from nurses at the time of Recorded interviews Patients were well equipped for the transition home, but the patients individual living situations were not accounted for and were unprepared to deal with challenges. Patients felt they were prepared for transition home. Some limitations to this study was the sample size was limited and the education did not anticipate challenges patients experienced in their home environment. Level 6 Low quality discharge .
Håkanson, C., Sahlberg-Blom, E., Ternestedt, B., & Nyhlin, H. (2011). Learning to live with irritable bowel syndrome. The influence of a group-based patient education programme on peoples' ability to manage illness in everyday life. Scandinavian Journal Of Caring Sciences, 25(3), 491-498. To find a relationship between group based education and of a chronic disease. Evaluative research design 51 patients with irritable bowel that in the group visits Two were used to gather data. The first one was prior to group education and the second was sent out about 2-3 months following the education. Statistical analysis with software. Positive outcomes were reported via patient survey. Limitations were as not having a controlled group and there was a high dropout rate from the first survey to the second. Level 6 Low quality Sherman, J.R. (2016). An initiative to improve patient education by clinical nurses. MEDSURG Nursing, 25(5), 297-333. The purpose of this study was to review simulations about patient education to see if nurses developed a better design. 66 RN’s that were going through annual training. Utilized tests to identify areas of that were evaluated by statistical analysis. Reviewers collected 66 from RN’s. The simulations found statistically significant improvements to nurses’ Level 6 Low quality t improvement .
Sowtali, S. N., & Harith, S. (2014). Educational Needs among Stroke Patients Admitted to Hospital Universiti Sains Malaysia: Preliminary Findings. Sains Kesihatan Malaysia, 67-73. The purpose of this study was to gather basic about the types of needs among stroke patients admitted to Hospital Sains in order to get A survey in the format of a study design. 41 stroke patients and with CT scan were chosen from the Universiti Malaysia Medical and Surgical floor between to 2012. A consisting of five domains related to stroke; each domain contains questions that reflect a topic related to stroke was given to the patients prior to discharge. The results showed a perceived need from the patients for more education needed on general information about stroke, and on prevention and causes of strokes; needs on the risk factor management of stroke; needs on treatment of stroke from medicine, surgery and traditional medicine aspects; need to know for all listed post-stroke problems, including the post-stroke diet management. Data obtained were analyzed using SPSS 20.0 descriptively. Ethical clearance Strengths included were the highlighted points that stroke patients were more interested to know about prevention, causes and risk factors of stroke. The limitations to this study were the difference of medical history background might impact the degree of educational needs; only one stroke patient had no previous medical disease prior to stroke; and there is still 3 Moderate quality was determined based on content validity and internal consistency for questionnaire using Cronbach’s alpha.
to help design further correlation was obtained from HUSM Human Ethical Committee prior to study. an uncertainty whether single morbidity or multiple morbidities had impact on the stroke education needs. Yonaty, S., & Kitchie, S. (2012). The Educational Needs of Newly Diagnosed Stroke Patients. Journal of Neuroscience Nursing, 44(5), E1-E9. To determine if there is a change in the perceptions of what individuals newly diagnosed with stroke perceive as important to learn about stroke during different times of Descriptive study design. 71 newly stroke patients from two hospitals in the A questionnaire with eight domain related to stroke; each domain contains questions that reflect a topic related to stroke. Initial questionnaire given within 24-72 hours of admission, again upon Analysis through descriptive statistics, tests, and repeated measures ANOVA. The outcomes determined the medical knowledge and medication treatment were rated the most Satisfaction levels were below level 4 on Likert’s scale; making the overall perception of education not satisfactory. Limitations of the primary researcher being the only one involved in selection of patient participation, some patients 3 High quality was based on content validity, internal for using alpha, no were
their stroke recovery. discharge, and 2 weeks post discharge. important to learn; however, treatments with herbal or alternative medicine and dietary habits were the least important to learn about. unable to complete second questionnaire due to early discharge, only two designated stroke centers, the study was self-reporting, and the number of patients could have been larger. violated, reading level was at a grade 6, eligibility and sampling followed. Table 5 External Data: Benefits & Effectiveness of Education CINAHL MEDLINE Cochrane Stoke education 782 435 13 Patient education 69,386 26,282 122
Benefits of education 2,672 1,287 5 Effectiveness of education 2,637 2,039 35 1&2 225 67 85 1&3 16 3 100 1&4 22 17 117 2&3 539 210 4 2&4 605 448 17 3&4 67 40 1 6 External Data: Benefits & Effectiveness of Education/Level of Evidence Full APA Citation Research Purpose Study Design Sample (Setting) Data Collection/ Measures Analysis/ Outcomes Strengths/ Limitations Level of Study Quality
Ing, M. M., Linton, K. F., M. A., & Nakagawa, K. (2015). Investigation of stroke needs (INVISION) study: Stroke awareness and education. Hawai’i Journal of Medicine & Public Health, 74(4), Retrieved from The purpose of this study was to assess the overall and of current inpatient stroke A design. 21 of 10 patients who were recently with and (11 during the follow-up visits were at the Queen's Medical Data was collected by two trained research staff members conducted interviews with caregivers and patients utilizing scripted questions developed by the research team. The scripted questions consisted of The interview data was transcribed and content analysis was performed. The content was placed into codes that grouped the data into recurrent and prominent themes across participants. The researchers developed a codebook to display the broad themes that were apparent; based on the frequency, emotion, and extensiveness of the narrative. The two authors then discussed and created the final analysis codebook. The analysis codebook revealed three themes Strengths of the study show that the qualitative methods that were utilized to capture the complexity of stroke education and awareness experienced by specific individual patients and their caregivers. Limitations for this study include the small number of participants limits the generalization of the results, limiting the participation selection due to geographic locations of the Level 6 Low quality caregiver effective practices .
Center; which is located on Oahu, the largest hospital in Hawaii. questions with a focus on nine major subjects related to strokes. presented as concerns; lack of stroke knowledge or awareness, need for stroke education, and fear of stroke recurrence due to inefficient education while hospitalized. This study suggests a need for increased continuity and communication with health-care providers to address the evolving educational and practical needs of stroke patients and their caregivers after hospital discharge. Hawaiian Islands made it difficult to expand to other areas within the Hawaiian Islands, limitations of participants due to language barriers due to the caregivers and patients being required to speak English in order to participate in this study, which could have possibly overlooked certain populations due to the narrative properties of the qualitative study. ended
Sanders, K., Schnepel, L., Smotherman, C., Livingood, W., Dodani, S., Antonios, N., ... Silliman, S. (2014). Assessing the impact of health literacy on education retention of stroke patients. Preventing Chronic Disease, 11, 1-10. The purpose of this study was to assess the of patient’s health literacy to stroke education outcomes, following stroke education in an acute stroke unit at a hospital in Florida. A secondary intention of the study was to assess the between patient and other A prospective qualitative study. The sample consisted of 100 patients who were admitted to the hospital stroke unit with a diagnosis of acute ischemic stroke at the University of Florida Health in Florida. Participants were identified and recruited by the treating neurologist or a stroke unit nurse manager. Health literacy levels were measured by using the short form of Test of Functional Health Literacy in Adults Standard Joint Commission patient education protocols were utilized to provide patients with appropriate standardized stroke education. The post stroke care educational outcomes and knowledge retention was assessed for each participant upon discharge through the Statistical analyses and modeling were conducted using SAS version 9.3. Continuous variables were described by using means, standard deviations (SDs), and medians. Category variables were analyzed using Pearson χ or Fisher Exact tests, when appropriate. Univariate and multivariable analyses were used to identify factors independently associated with Stroke Patient Education Retention (SPER) score. For univariate analysis, the differences in the SPER scores among the 3 S-TOFHLA groups were assessed using the nonparametric For multivariate analysis, analysis of covariance (ANCOVA) was used to model the data and estimate the least squared means. Even after receiving the Joint Commission standardized recommended Strengths for this study was the link formed between heath literacy and educational retention for stroke patients. Thus determining the need for education based on literacy levels. The limitations to this study was the lack of evidence validating the stroke patient educational outcomes, such as long-term retention and patient adherence or compliance to medical treatments. The other limitations the authors recognized was the small sample size for such a large population, to be able to detect the effect of many demographic factors on stroke occurrence. Level 6 Low quality
associated with the patient’s levels of health literacy and to explore their to outcomes in ischemic stroke patients at the time of their hospital discharge. utilization of a questionnaire that consisted of a series of 5 questions that were derived from the Joint stroke performance measures on stroke education. The effect of health literacy on the Stroke Patient Education Retention scores was assessed by using univariate and multivariate analyses. education, only 12% of the patients could identify all 5 warning signs for a stroke, 43% could name all of their personal risk factors, and fewer than half could identify the type of stroke they suffered. The study showed ineffective education of patients; all of which can be influenced by health literacy and knowledge retention, which was the focus of the study. The patients’ inadequate health literacy had a significantly lower stroke education retention rate than patients with marginal or adequate literacy. The analysis displayed an overwhelming connection between health literacy and stroke education outcomes.
be helping transport patients to the proposed weekly education. The Neurologists are a key stakeholder as they guide the treatment for individuals suffering from a stroke to ensure timely administration of life saving medications, procedures, and testing are in correlation with The Joint Commission and Centers for Medicaid and Medicare (CMS) guidelines. The team of neurologists ensure that the most current evidence-based are promoted within the organization remaining on the cutting edge of treatment therapies for the stroke population. They promote educational opportunities for organizational members ensuring everyone has the ability to remain informed; while also guiding educational information provided to patients and their family members. The Director of Research Medical Center’s quality department provides necessary matrix and data information regarding the stroke patients. with her, the quality department is vital to the overall success and stability of the program by ensuring all essential and vital concepts are provided the attention to detail necessary for overall program success. Their department also provide assistance with chart audits and nursing quality compliance. This data will help support whether the interventions that were implemented were effective in improving patient understanding of their diagnosis and expected outcomes. Physical, occupational, and speech therapies ensure a personalized comprehensive evaluation is completed and their recommendations guide treatments dedicated to the safety of the patient. Their therapy programs are imperative to build patient strength and mobility enhancing their quality of life. These therapies also provide education to the patient and their family regarding any new physical deficits and how to work with or overcome the loss of these essential functions.
The Commission. (2014). Why choose comprehensive stroke center certification? Retrieved from . The Joint Commission. (2017). Comprehensive Stroke Certification:Standardized Performance Measures. Retrieved from . Litchman, J.H., Leifheit-Limson, E.C., Jones, S.B., Wang, Y., & Goldstein, L.B. (2013). Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries. Stroke, 44, 3429-3435. DOI: 10.1161/STROKEAHA.113.003165 Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. Polit, D. F., & Beck, C. T. (2017). Evidence-based nursing: Translating research evidence into practice. In Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Research Medical Center. (2017). About us..
Roussel, L, Thomas, P. L., & Harris, J. L. (2016). Management and leadership for nurse administrators. (7th ed.). Burlington, MA: Jones & Bartlett Learning. Sanders, K., Schnepel, L., Smotherman, C., Livingood, W., Dodani, S., Antonios, N., ... Silliman, S. (2014). Assessing the impact of health literacy on education retention of stroke patients. Preventing Chronic Disease, 11, 1-10. . Sherman, J.R. (2016). An initiative to improve patient education by clinical nurses. MEDSURG Nursing, 25(5), 297-333. Sowtali, S. N., & Harith, S. (2014). Educational needs among stroke patients admitted to Hospital Universiti Sains Malaysia: Preliminary findings. Jurnal Sains Kesihatan Malaysia, 12(1), 67-73. . Tamura-Lis, W. (2013). Teach-back for quality education and patient safety. Urologic Nursing, 33(6), 267-298. Yonaty, S., & Kitchie, S. (2012). The Educational Needs of Newly Diagnosed Stroke Patients. Journal of Neuroscience Nursing, 44(5), E1-E9. doi:10.1097/jnn.0b013e31826663f2 Appendix A Permission Granting the Use of Johns Hopkins Nursing Evidence-Based Practice Model “We are happy to give you permission to use the model and tools as you described. The zipped file of the tools are located here -