Designation as a stroke center requires that all clinical and nonclinical hospital employees receive training on how to recognize a stroke and take appropriate actions. This was the challenge JFK Medical Center, a 500-bed acute care and rehab facility in Edison, NJ, undertook in 2007 when it pursued designation as a comprehensive stroke center by the New Jersey Health and Senior Services and a primary stroke center by The Joint Commission.
Why do nonclinical staff members need stroke education? A security officer, for example, might encounter a patient or family member exhibiting behaviors consistent with stroke. The officer must be able to recognize the signs and symptoms of stroke and how to promptly summon qualified patient care providers.<.P>
Direct patient care providers need more in-depth education, depending on their roles and the amount of care they provide to stroke patients.
Reaching far and wide
Educating an entire hospital is a daunting task. Donna Kozub, BSN, RN-BC, was assigned responsibility for educating non-licensed nursing department personnel, known as patient care technicians (PCT), in 2007. Kozub's target audience members were those who had the most contact with stroke patients. PCTs who had little or no direct contact with stroke patients (e.g., pediatric unit staff members) received basic education, but those who had more contact needed additional training, she explains. There were no specific mandates from accrediting bodies regarding the hours of education required, only that staff members must be educated. Length and content was to be determined by the educators.
Kozub began by searching the literature for education specific to non-licensed personnel. "I really relied heavily on the American Stroke Association's division of the American Heart Association's wonderful Web site. Part of it is designed for the community, which was a big help when writing at a level appropriate for our PCTs."
Kozub also relied on an interdisciplinary subcommittee of the Stroke Certification Team to help design the education. Members of the subcommittee included nurse managers, speech pathologists, and the neurovascular nurse clinician.
"We looked at it from not only a content perspective, but how to make the information meaningful for the PCTs so that they could apply it not only to their patients, but to their families and themselves as well," Kozub explains.
Nurse managers identified specific duties of PCTs so that education could be geared to helping them fulfill their responsibilities. The clinical director of speech pathology and audiology provided essential elements of curriculum related to communication with aphasic patients.
The senior speech pathologist gave input on topics related to dysphagia, and the neurovascular nurse clinician served as a clinical expert to evaluate completeness and accuracy of content.
Teaching strategies
All employees watched a one-hour stroke video. Kozub developed a three-hour stroke education program consisting of two one-and-a-half-hour modules for PCTs from the targeted patient units.
The first module was entitled "Care of the Stroke Patient," which Kozub offered frequently. "I tried to make it personal and fun," she says. "There were lively discussions about how stroke risk factors were affecting their own lives and the lives of their families."
The second module was entitled "Care of the Patient with Dysphagia" and was presented by the senior speech pathologist. During module two, learners could sample various diet consistencies and learned appropriate patient feeding techniques.
PowerPoint, lectures, discussions, handouts, and demonstrations were primary teaching strategies. Participants were evaluated with a written test after each module. Tests were graded at the end of each class and certificates presented to those who successfully completed the program.
"Most PCTs passed the written test without problems," says Kozub. "They were so proud, and I was proud of them."
Ongoing education
Although the classroom setting had many advantages, it also meant that program administrators had to offer modules frequently so everyone could attend, take time to grade tests, and keep manual records.
Since stroke education is required annually, changes had to be made to increase efficiency. In 2008, Kozub made the decision to move to a computer-based learning (CBL) strategy. "Although I love the energy of the classroom setting, it just wasn't practical to offer this type of education annually in the classroom," she says.
The advantages of CBL were easy access, around-the-clock training, and the ability to print test scores and confirmation of attendance. Disadvantages included the inability of participants to share experiences and practice hands-on feeding techniques and administrators not being able to perform demonstrations.
However, Kozub says the training worked just as well. Test scores with CBL were as good as when the content was presented in the classroom setting, and transfer of knowledge to the patient care setting remained high in both 2007 and 2008. Nurse managers expressed satisfaction with the CBL training since outcomes remained consistently high and scheduling was less of an issue.
Kozub hopes to develop an interactive education program that allows instant feedback when learners are asked to answer questions during the program. This technology could also allow learners to review specific slides and revisit challenging questions.
CBL training is now incorporated into orientation for PCTs hired for targeted units. The hospital also has used specific facets of the training to develop stroke competencies for PCTs. This initiative not only facilitated transfer of knowledge to the patient care setting, but enhanced the self-esteem and pride of the PCTs working with such a special patient population.
JFK Medical Center achieved stroke designation from The Joint Commission and the New Jersey Health and Senior Services. Education will continue to play a pivotal role in maintaining these designations.
This article was adapted from one that originally appeared in the November 2009 issue of The Staff Educator, an HCPro publication.