Abstract 2954: Evaluating the Retention of Stroke Education Provided to the Hospitalized Patient with Acute Ischemic Stroke in an Urban Hospital

Background and Purpose: The Joint Commission mandates that certified Primary Stroke Centers provide patient education addressing stroke warning signs, use of 911 for access to emergent care, personal risk factors, medications prescribed, and follow-up after discharge. The patient’s retention of this information is imperative for reducing secondary stroke occurrence and morbidity. This study evaluated the Acute Ischemic Stroke (AIS) patient’s ability to retain the stroke education information provided near the time of hospital discharge. Methods: A prospective hospital-based cohort study was comprised of AIS patients who were admitted to the stroke unit at an urban core hospital located in Jacksonville, Florida. Diagnosis of AIS was confirmed by a Neurologist and by a CT or MRI. All participants received Joint Commission mandated stroke education administered by a nurse during their hospitalization. The patient education included verbal instructions with the use of illustrative handouts. Stroke education retention was evaluated near the time of hospital discharge using a five-question survey. The level of health literacy was assessed by the Short Version-Test of Functional Health Literacy in Adults (S-TOFLHA). Results: Of 189 consecutive patients screened between October 2009 and June 2010, 100 (53%) consented to participate. Seventy patients were excluded due to severe cognitive impairment, and 18 eligible patients refused to participate. The average age was 60 years old, 57% were male, 56% African American, 43% resided within the urban core, and 75% earned less than $25,000 per year. A total of 59% of patients had low to marginal health literacy. Retention of stroke knowledge was lacking even with standard stroke post education; 12% could name all 5 warning signs, 43% knew their personal risk factors, 85% knew to call 911 for warning signs of stroke, 76% knew their medications prescribed for stroke prevention, and 53% knew their type of stroke. Conclusion: Current methods of educating hospitalized AIS patients may not adequately prepare the hospitalized stroke survivor with basic knowledge on stroke prevention. Alternative methods of education will need to be developed for AIS patients in urban core hospitals. By using the Patient-Centered Care model and principles of adult learning, this study has the potential to lead to changes in educational interventions, nursing practices, and communication.

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Abstract TP375: Using Characteristics of Secondary Ischemic Stroke Events to Improve Stroke Education Initiatives

Stroke ◽

10.1161/str.51.suppl_1.tp375 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amanda Dirickson ◽

Suzanne Stone

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Stroke Prevention ◽

Small Vessel Disease ◽

Secondary Stroke Prevention ◽

Stroke Treatment ◽

Vessel Disease ◽

Acute Stroke Treatment ◽

Stroke Education ◽

Toast Classification

Purpose: While it is common practice for nursing to perform the duty of stroke education,it is not common to use secondary stroke event data to determine what aspect of stroke education should be emphasized for the greatest impact on secondary stroke prevention. The purpose of this descriptive study is to exam the characteristics of secondary stroke events using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria so future educational initiatives can be customized to the needs of the local high risk population. Methods: The team collected data characteristics on all ischemic stroke admissions with previous admitting diagnosis of acute ischemic stroke. The strokes were further characterized using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification to determine any emerging patterns of both risk factors and etiological types. Conclusions: A total of n=51 admissions were previous adult stroke survivors, (M=30, F=21). Pre-morbid risk factors were as follows: hypertension=78%, type 2 diabetes=39%, hyperlipidemia =54%, smoking=8%, atrial fibrillation=24%. TOAST classification results: Large Vessel Atherosclerosis=14%, Cardioembolic =17%, Small Vessel Disease=3%, Other Known Cause=2%, Cryptogenic=15%. Summary: The results reveal a striking pattern of the presence of premorbid hypertension. While the TOAST classification did not have a single dominant type, but nearly equal distribution of large vessel atherosclerosis, cardioembolic, and small vessel disease etiologies. Not surprising, the decline in stroke mortality is felt to be due to improved blood pressure control, but in discharge stroke education, hypertension is not necessarily emphasized over other perhaps less impactful risk factors. Yet, the most recent acute ischemic stroke clinical guidelines gave providers a first-time recommendation to start or restart antihypertensive therapy in stable patients with BP > 140/90. Nursing has enough encouragement to take the lead on hypertension prevention education in appropriate stable patients ready for discharge. The next goal will be to develop a multimedia educational effort in patient stroke education on hypertension as a risk factor for secondary stroke prevention in this Comprehensive Stroke Center.

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Abstract TP353: Implementing a Nurse Driven Patient Education Program to Improve Understanding of Stroke Signs and Symptoms and Personal Risk Factors Post-discharge

Stroke ◽

10.1161/str.48.suppl_1.tp353 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jennifer Coyle ◽

Carolyn Szlachta ◽

Lori Merkel ◽

Giuliana Labella ◽

Stephanie Casey

Keyword(s):

Risk Factors ◽

Patient Education ◽

Stroke Risk ◽

Signs And Symptoms ◽

Patient Specific ◽

Patient Understanding ◽

Stroke Risk Factors ◽

Personal Risk ◽

Personal Risk Factors ◽

Improve Patient

Purpose: Nurse led patient education programs to improve patient understanding of the signs and symptoms (s/s) of a stroke and their personal stroke risk factors can play a significant role in preventing secondary stroke. No such initiatives could be found for an urban academic medical center in the United States when conducting a literature search, despite a Healthy People 2020 edict to address stroke awareness in adults. The goal of this project was to improve patient understanding of s/s of stroke as well as personal risk factors, and to ensure smooth patient transitions to the community. Method: A tool was developed for charge nurses to use when providing education to patients. The tool included patient demographic information and patient specific stroke risk factors. The previously used script for phone calls included signs and symptoms but was modified to include personal risk factors and corresponding behavior modification. All patients, discharged to home with a diagnosis of stroke or transient ischemic attack (TIA), were called within two weeks of discharge per the Joint Commission Comprehensive Stroke Center recommendation. Two attempts were made to reach each patient and a detailed log was maintained to track patient’s response to questions. Results: In the two months prior to the project being initiated, there were 37 patients reached via phone who had been discharged home from the stroke unit with a diagnoses of stroke or TIA. Of the 37 called, there were 5 who were unaware of the s/s of a stroke. For the two months since beginning the intervention, 42 successful calls were made to patients discharged home. Of these 42, only 2 patients did not know the s/s of stroke or their personal risk factors (p value: 0.16). Conclusions: This project allowed for a new approach to patient focused, nurse led education to improve patient understanding of the s/s of a stroke and individual risk factors. There was a ten percent improvement in the number of patients with an understanding of the s/s of a stroke. An encouraging outcome from this project was an improvement in RN Communication scores on patient’s HCAHPS surveys in the two months since starting the intervention.

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Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II)

Journal of Occupational Rehabilitation ◽

10.1007/s10926-006-9044-1 ◽

2006 ◽

Vol 16 (3) ◽

pp. 272-295 ◽

Cited By ~ 253

Author(s):

P. M. Bongers ◽

S. Ijmker ◽

S. van den Heuvel ◽

B. M. Blatter

Keyword(s):

Risk Factors ◽

Upper Limb ◽

Work Related ◽

Personal Risk ◽

Effective Interventions ◽

Personal Risk Factors

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Cumulative Risks from Stressor Exposures and Personal Risk Factors in the Workplace: Examples from a Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115850 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5850

Author(s):

Mary A. Fox ◽

Richard Todd Niemeier ◽

Naomi Hudson ◽

Miriam R. Siegel ◽

Gary Scott Dotson

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Scoping Review ◽

Multiple Stressors ◽

Cumulative Risk ◽

Real Life ◽

Personal Factors ◽

Exposure Limits ◽

Personal Risk ◽

Personal Risk Factors

Protecting worker and public health involves an understanding of multiple determinants, including exposures to biological, chemical, or physical agents or stressors in combination with other determinants including type of employment, health status, and individual behaviors. This has been illustrated during the COVID-19 pandemic by increased exposure and health risks for essential workers and those with pre-existing conditions, and mask-wearing behavior. Health risk assessment practices for environmental and occupational health typically do not incorporate multiple stressors in combination with personal risk factors. While conceptual developments in cumulative risk assessment to inform a more holistic approach to these real-life conditions have progressed, gaps remain, and practical methods and applications are rare. This scoping review characterizes existing evidence of combined stressor exposures and personal factors and risk to foster methods for occupational cumulative risk assessment. The review found examples from many workplaces, such as manufacturing, offices, and health care; exposures to chemical, physical, and psychosocial stressors combined with modifiable and unmodifiable determinants of health; and outcomes including respiratory function and disease, cancers, cardio-metabolic diseases, and hearing loss, as well as increased fertility, menstrual dysfunction and worsened mental health. To protect workers, workplace exposures and modifiable and unmodifiable characteristics should be considered in risk assessment and management. Data on combination exposures can improve assessments and risk estimates and inform protective exposure limits and management strategies.

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Personal risk factors associated with heat-related illness among new conscripts undergoing basic training in Thailand

PLoS ONE ◽

10.1371/journal.pone.0203428 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0203428 ◽

Cited By ~ 3

Author(s):

Rudchanu Nutong ◽

Mathirut Mungthin ◽

Panadda Hatthachote ◽

Supak Ukritchon ◽

Worarachanee Imjaijit ◽

...

Keyword(s):

Risk Factors ◽

Basic Training ◽

Factors Associated ◽

Personal Risk ◽

Personal Risk Factors

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Evaluating Relationships Among Personal Risk Factors, Ambient Oxidant Exposure, and Chronic Respiratory Illness

Susceptibility to Inhaled Pollutants ◽

10.1520/stp22836s ◽

2008 ◽

pp. 174-174-8

Author(s):

JD Hackney ◽

WS Linn

Keyword(s):

Risk Factors ◽

Respiratory Illness ◽

Personal Risk ◽

Personal Risk Factors

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Work-Related Musculoskeletal Symptoms among Loggers in the Ark-La-Tex Region

Journal of Agromedicine ◽

10.1080/1059924x.2019.1567423 ◽

2019 ◽

Vol 24 (2) ◽

pp. 167-176

Author(s):

Rodriguez ◽

Casanova ◽

Levin ◽

Gimeno Ruiz de Porras ◽

Douphrate

Keyword(s):

Risk Factors ◽

Environmental Conditions ◽

Lower Extremities ◽

Musculoskeletal Symptoms ◽

Work Related ◽

Personal Risk ◽

Industrial Sectors ◽

Lower Back ◽

Related Risk ◽

Personal Risk Factors

Background: The U.S. logging sector is among the most dangerous industrial sectors, with high fatality and non-fatal injury rates. Limited research has addressed work-related musculoskeletal disorders among logging machine operators (LMOs). The purpose of this study was to estimate the 12-month prevalence of musculoskeletal symptoms and the associated work-related risk factors among LMOs in the Arkansas, Louisiana, and Texas (Ark-La-Tex) logging region.Methods: A self-administered 93-item questionnaire with six different sections: (1) demographics, (2) lifestyle and medical background, (3) work experience, (4) job training, (5) occupational heat-related stress, and (6) occupational injuries and MSS was administered to LMOs (n = 88) using Qualtrics Mobile Survey Software®. Poisson regression models were used to estimate crude prevalence ratios (PR), adjusted PR [aPR], and corresponding 95% confidence intervals (95% CI).Results: Regarding organizational, ergonomic, and handling equipment occupational factors and 12-month MSS prevalence, the adjusted model controlled for age, BMI, smoking status, and drinking status. For organizational, the most problematic factors for the lower back were performing a task over and over (63.2%) and working very fast, for short periods (60.0%). For ergonomics, the most problematic factor for the lower extremities was awkward or cramped conditions (58.1%) and for the lower back was bending/twisting back awkward (55.9%). Last, for handling equipment, the most problematic for both the lower back and lower extremities was handling or grasping small objects (57.1%).Conclusion: Our findings revealed associations between work-related MSS and specific job factors (e.g., organizational, ergonomic, handling equipment, etc.), extreme environmental conditions or environmental, and personal risk factors. In particular, study findings suggest lower back and lower extremities MSS are associated with the a majority of job-related risk factors, lower extremities with extreme environmental conditions, and neck and upper back with personal risk factors.

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