Education in Stroke Prevention
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Slide 1 :
DR. THERESA GREEN RN PhD CALGARY STROKE PROGRAM UNIVERSITY OF CALGARY, FACULTY OF NURSING ESP: Education in Stroke Prevention
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09/05/2009 copyright Theresa Green Background Stroke is the number 4 killer and number one disabler of adults in Canada, with approximately 1200 deaths annually in Alberta Canada, attributable to stroke In 2003, stroke resulted in provincial costs of $500 million annually in health care costs, social services, and lost wages Typically energy and resources in ambulatory stroke clinic settings are directed towards diagnosis and treatment, not prevention Motivational interviewing and stages of change are approaches to increasing knowledge and effecting behaviour changes
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09/05/2009 copyright Theresa Green Purpose To examine the impact of one-on-one brief (15-20 min) nurse/patient interviews on knowledge acquisition and retention about the nature of stroke, transient ischemic attacks, warning signs, and risk factors; and the influence on lifestyle behaviour changes To determine the efficacy of patient-specific nursing interventions provided in our Stroke Prevention Clinic (SPC) aimed at reducing risk of stroke
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09/05/2009 copyright Theresa Green Research Method Randomized, parallel-group single blind study design Convenience sample of 200 participants with stroke or TIA recruited from the stroke prevention clinic situated in a tertiary acute care hospital Participants allocated to an education-counseling interview (ECI) or a control group Knowledge questionnaire administered at time of initial visit and at 3 months post-visit. Assessor was blinded to group assignment.
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09/05/2009 copyright Theresa Green Nursing Intervention The study nurse used motivational interviewing techniques during each patient encounter Patient & nurse identified a health behaviour needing change and barriers and facilitators to change ECI participants mapped their individual risk factors on a stage of change model Brief, patient-specific analysis of personal stroke risk factors with discussion of appropriate lifestyle and risk management strategies; appointment at next lifestyle class
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09/05/2009 copyright Theresa Green ‘SMARTS’ MOTIVATIONAL INTERVIEWING Specific: the details of the individual’s goal Measurable Action Oriented: an activity the individual will do Realistic: small enough to be achievable in a foreseen amount of time Time-oriented: goal fits within the individual’s life now Sabotage: identifying obstacles and planning for them…
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09/05/2009 copyright Theresa Green The Stages of Change Pre-contemplation (Not yet acknowledging that there is a problem behaviour that needs to be changed) Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change) Preparation/Determination (Getting ready to change) Action/Willpower (Changing behaviours) Maintenance (Maintaining the behaviours change) and Relapse (Returning to older behaviours and abandoning the new changes)
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09/05/2009 copyright Theresa Green Demographics Note: smoking: current smoker; obesity: 15+ lbs overweight *t-test; † x2
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09/05/2009 copyright Theresa Green Knowledge Acquisition & Retention *X2 McNemar’s test comparing two proportions ‡ adjusted for baseline score using analysis of covariance
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09/05/2009 copyright Theresa Green Shift from Passive to Active SOC †: number of participants with identified risk factor; ‡: number of participants who identified risk factor as a reduction goal; * p value set at 0.05.
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09/05/2009 copyright Theresa Green Interpretation A nursing-directed lifestyle education class was shown to increase the patients’ knowledge score between baseline and 3 months There was an overall significant difference in achieving a passive to active stage of change in lifestyle modifications Individual stage of change was not significantly impacted by the intervention
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09/05/2009 copyright Theresa Green Nursing Implications Education, follow-up support, and counseling are necessary to ensure successful acquisition of knowledge about the nature of stroke, risk factors, and warning signs Timing and method of delivery of patient education and patient readiness to change are important components of successful lifestyle modification interventions
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09/05/2009 copyright Theresa Green Nursing Implications Nursing staff can effectively influence knowledge acquisition in stroke patients, even with time constraints in busy ambulatory clinic settings Large group classes may be limited in influencing readiness to change - it may be more effective for nursing professionals to provide one-on-one or small group interventions
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PowerPoint Slide Presentation on Motivational interviewing and stages of change are approaches to increasing knowledge and effecting behavioural change. This study examined the application of this approach on stroke knowledge acquisition and changing individual lifestyle risk factors in an outpatient clinic.
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