Abstract A103: Standardizing the National Institute of Health Stroke Scale Through Simulations Improves Nurse Confidence

Abstract

Introduction: The NIHSS is a tool utilized in assessing stroke patients and standardizing communication across providers. Nurses reported practice inconsistencies at handoffs with one another. Literature recommends training due to the subjective nature of some of the NIHSS assessment items. Previous NIHSS education was computer-based training without opportunity for hands-on practice or feedback. The purpose of this quality improvement project was to enhance nurse confidence and consistency in NIHSS administration and handoff communication by adding interdisciplinary simulation-based education. Methods: This project was completed at a comprehensive stroke center in central Texas using a pre/post evaluation. Participants were surveyed via an electronic questionnaire developed by the investigative team to measure confidence. The class consisted of a variety of standardized stroke patients. Participants administered the NIHSS assessment under the supervision of an instructor. Statistical analysis was done using the Paired t-test for pre/post comparisons. Effect sizes were calculated using Cohen’s d z . Artificial intelligence was used in assisting with analyzing open ended text. Results: A total of 134 nurses across all cohorts participated in this project. Nursing confidence in NIHSS administration increased from 3.4 to 4.1 (p<0.001). Teamwork/interdisciplinary confidence increased from 3.8 to 4.25 (p<0.001). Thematic analysis of open-ended feedback revealed four core learning areas: scoring clarification, intubated patient assessment, understanding of ataxia, and sensory/extinction differentiation. Analysis also revealed seven key satisfiers: hands-on practice, interactivity, informative content, confidence building, feedback and explanation received, scenario variety, and supportive environment. Conclusion: In conclusion, these findings highlight the value of simulation-based training in addressing the intricacies of a stroke assessment. Simulation-based NIHSS training produced meaningful, statistically significant increases in nurses’ confidence administering the NIHSS and collaborating with interdisciplinary teams. Findings support integrating experiential, team-based simulation to reinforce assessment consistency and strengthen handoff communication.

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