Volume 26, Issue 4 ,2005

Codman Award Paper: Self-efficacy of staff nurses for health promotion counselling of patients at risk for stroke
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Abstract

The effect of nurses’ confidence to counsel patients at risk of stroke in selected health promotion areas: smoking cessation, exercise and nutrition was examined. Bandura’s (1986) self-efficacy and Knowles’ adult learning theories provided the theoretical underpinnings for the study. This was a quasi-experimental design in which neuroscience nurses (N=23) from a quaternary hospital completed questionnaires prior to, immediately after, and 2 months post completion of a self-directed learning manual (SDL). The researcher-designed manual was designed to enhance learning about the risk factors for stroke and the importance of stroke prevention. Along with reflective activities and pre-post test, strategies for counseling high-risk, stroke-prone individuals in the areas of smoking cessation, exercise, and nutrition were also integrated.

The Health Promotion Counseling Self-Efficacy Scale (Tresolini, Saluja, and Stritter, 1995), consisting of 10 self-efficacy subscales relating to self-confidence in knowledge and ability to counsel in health promotion areas, was used to capture the nurses’ self-report of self-efficacy. Using a 5-point Likert Scale, nurses also rated their amount of agreement or disagreement about health promotion counseling in practice. Overall, self-efficacy levels for both knowledge and counseling increased significantly (p<.01) from pre-to immediately post completion of the manual, and decreased slightly at two-month follow-up. This pattern was evident in all health promotion areas measured except for knowledge in exercise (p=.015). Nurses’ attitudes about aspects of health promotion practices correlated significantly (p<05) at two-month follow-up with all health promotion areas. Results of this study support the usefulness of a self-directed learning manual as a teaching strategy for health promotion counseling of individuals at risk of stroke.

Keywords: professional education, self-directed learning, self-efficacy, stroke prevention

Conférence du prix Codman

Abrégé

L’effet de confiance des infirmières et infirmiers pour conseiller des patients à risque de maladie cardio-vasculaire dans des milieux de promotion de la santé tels que la cessation de l’usage du tabac, l’exercice et la nutrition ont été examinés. Les théories de Bandura (1986) sur l’auto efficacité et de Knowles sur l’apprentissage d’adulte procurent les bases théoriques de cette étude. Ceci était un devis quasi-expérimental dans lequel des infirmières/infirmiers en science neurologique (N=23) d’un hôpital de niveau quaternaire ont complété un questionnaire avant et immédiatement après, et 2 mois suivant l’achèvement d’un manuel autodirigé. Le manuel construit par le chercheur a été désigné afin d’accroître l’apprentissage des facteurs de risque pour les maladies cardio-vasculaires et sur l’importance de la préventions des maladies cardio-vasculaires. Accompagnés d’activités à réflexion et de pré et post-test, des stratégies pour conseiller les individus à hauts risques et sujets aux maladies cardiovasculaires dans des contextes de cessation de fumer, d’exercice et de nutrition ont également été intégrés.

L’échelle d’auto efficacité de la promotion de la santé (Tresolini, Saluja, and Stritter, 1995), consiste de 10 sous échelles d’auto efficacités reliées à la confiance en soi de ces connaissances et habilités à conseiller dans des contextes de la promotion de la santé, a été utilisé afin de capturer l’auto rapport d’auto efficacité des infirmières/infirmiers. Utilisant une échelle de 5 point de Likert, les infirmières/infirmiers ont également évalué leur niveau d’accord ou de désaccord pour les conseils de promotion de la santé dans leur pratique. En général, le niveau de connaissances d’auto efficacité et pour conseiller ont augmenté de façon significatif (p p<.01) du moment avant et immédiatement après avoir compléter le manuel tandis que le niveau de connaissances a diminué quelque peu 2 mois après. Ce phénomène fut évident dans tous les contextes de promotion de la santé mesurés excepté pour les connaissances en exercice (p=.015). Une corrélation significative (p<05) fut observée entre les attitudes des infirmières/infirmiers et différents aspects de leurs pratiques en promotion de la santé. Les résultats de ces études soutiennent l’importance de l’utilisation d’un manuel autodirigé comme stratégie d’enseignement dans la promotion de la santé pour conseiller les gens à risques de maladies cardiovasculaires.



Research to practice: Nursing stroke assessment guidelines link to clinical performance indicators
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Abstract

Stroke is the fourth leading cause of death in Canada and, each year, approximately 50,000 Canadians will suffer a stroke with a range of severities from mild, short duration symptoms to significant long-term disability or death. Of these 50,000 patients, at least 20,000 are hospitalized. Earlier this year, a core set of evidence-based performance indicators were identified by a national consensus panel that may be used to determine the quality of care provided to stroke patients in hospital during the acute phase of illness. Nurses play a critical role in stroke care across the continuum and recently published stroke assessment guidelines for nurses clearly describe key approaches to assessment and/or screening of stroke survivors. Many of the nursing assessments and/or screening actions recommended in the guidelines have direct or indirect associations with the recent performance indicators. This article describes where those relationships exist and the role nurses may play in determining overall performance for acute stroke patient care delivery during the hospitalization phase of the stroke continuum of care.



Research corner: Study synapses
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Distinguishing between true and quasi-experimental studies and the benefits of one group, within subjects designs: A discussion of the research design used in: Self-efficacy of staff nurses for health promotion counselling of patients at risk for stroke.



Ontario regional stroke centres: Survey of neurological nursing assessment practices with acute stroke patients
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Abstract

A survey to explore which neurological stroke assessment scales were being used by nurses at all nine regional stroke centres (RSCs) in Ontario, and education strategies for implementation of the new scales was conducted in 2004. Findings revealed that nurses are moving away from reliance on the Glasgow Coma Scale (GCS) towards use of more standardized stroke severity scales to facilitate assessment, documentation, and care planning with acute stroke survivors. Scales used include the Canadian Neurological Scale and the National Institutes of Health Stroke Scale. Consistency in use between nurses was identified as an implementation challenge that was best addressed through integration of the scale into the process of care and documentation and bedside education.