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Summary of Neurological Assessment by Nurses Using the National Institutes of Health

Stroke Scale: Implementation of Best Practice Guidelines

The purpose of this article is to evaluate the effectiveness of a program instituted by

Registered Nurses of Ontario (RNOA) advance nursing clinical practice fellowship group in

2004. The intention of this fellowship was to provide an opportunity for the development of

expertise in stroke assessment and establish recommendations for neurological nursing

assessment at The Ottowa Hospital (TOH) (Gocan & Fisher, 2008, p. 31-32). there is also

discussion by Gocan and Fisher about the current evidence and best practice guidelines (BPG)

for neurological assessment; the National Institutes of Health Stroke Scale (NIHSS) and its

significance in care of acute stroke survivors, and the overall experiences application and

evaluation of BPG in clinical nursing practice (Gocan & Fisher, p. 33).

The fellowship initiative was aimed at developing and promoting nursing knowledge and

expertise as well as improving patient care and outcomes by engaging a fellow in self-directed

learning experiences focused on developing clinical leadership and BPG implementation,

knowledge, and skills. The goals also included establishing recommendations for neurological

nursing assessment at TOH (Gocan & Fisher, 2008, p. 33).

The importance of this study to nursing practice is yet another example of utilizing BPG

to elicit improved patient outcomes. With BPG and evaluation of clinical practices currently

employed, there is no reason that any nursing obstacle or perceived patient problem cannot be

enhanced with better practices. As with TOH, by standardizing the assessment and creating a

uniform “language” of stroke assessment between multidisciplinary team members on the unit

has lead to optimized stroke survival and quality of life (Gocan & Fisher, 2008, p. 33-34).

The main assumptions presented by Gocan and Fisher (2008) are, among others, due to
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focal brain ischemia occurs as soon as blood flow is interrupted priority stroke treatment

“include stabilization and improvement of cerebral perfusion to ischemic tissue” (Gocan &

Fisher, 2008, p. 32). They go on to note “An estimated 25% of patients may have neurological

worsening during the first 24 to 48 hours after stroke” (Gocan & Fisher, p. 32). As CT scan

evidence of brain ischemia may not be evident for 24 hours after stroke, the early stages of

management require constant expert assessment to identify correlations between patient history

of the event, imaging studies and clinical findings” (Gocan & Fisher, p. 32). Gocan and Fisher

cite the Agency for Health Care Policy and Research (AHCPR) guidelines for post-stroke

rehabilitation as a basis for this assumption. The AHCPR “clinical practice guideline number 16

recommends the use of standardized, valid assessment tools to evaluate the patients stroke

related impairments and functional status”(Gocan & Fisher, p. 33). This guideline also

recommended results be used to assess outcome probability, appropriate level of care, and

intervention development (Gocan & Fisher, p. 33).

As a result of this program, neurologists at TOH reported increased satisfaction with

consistency of communication of stroke assessment for their individual patients and in care

planning at multidisciplinary rounds (Gocan & Fisher, 2008, p. 38). “Based on the one year self-

assessed competency evaluation, quality improvement audits, and ongoing feedback, a

sustainability plan has been developed at TOH to help nurses maintain needed neurological

assessment knowledge and skills. Ongoing educational activities have been offered to meet

learning needs” (Gocan & Fisher, p. 38). Gocan & Fisher also note “clinical decision-making,

and multidisciplinary communication have been promoted using NIHSS components across the

continuum of care” (Gocan & Fisher, p. 38). Finally, it is noted that the “NIHSS added

consistency to assessment across the continuum of care form initial assessment in the emergency
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room to acute care, rehabilitation and discharge planning in the community. In this project,

nursing leadership played a significant role in narrowing the gaps in practice related to

implementing best practices in neurological assessment and optimizing stroke survivor care”

(Gocan & Fisher, p. 38).

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References

Gocan, S., & Fisher, A. (2008). Neurological assessment by nurses using the National Institutes

of Health Stoke Scale: Implementation of best practice guidelines. Canadian Journal of

Neuroscience Nursing, 30(3), 31-42.

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