The Model Development for Stroke Prevention in Hypertensive Patients by Registered Nurse at Tambon Health Promoting Hospital, Kalasin Province

Abstract

Stroke has a higher incidence, causing disability and is the leading cause of death. High blood pressure is one of the major risk factors for stroke. This study is action research that applied the ideas of Kemmis and McTaggart to develop a model for stroke prevention in hypertensive patients. The sample group consisted of 3 groups: (1) The curriculum development, which were 1) Five physicians and professional nurses specializing in stroke; 2) One hundred fifteen people registered nurses in sub-district health promoting hospitals. (2) Curriculum assessment, 50 registered nurses in 50 sub-district hospitals (3) Stroke prevention services, hypertensive patients with heart disease and stroke screening results (CVD risk) at a high level (more than 20 percent) and received services according in 50 sub-districts, totaling 138 people. It was divided into phase 1, pre-research preparation, survey, and situational analysis of stroke problems. Phase 2 was carried out, consisting of 4 processes PAOR: plan, act, observe and reflect. Phase 3, conclusion and evaluation. Collected data from questionnaires physical examination and the results of screening for the risk of heart disease and stroke by Thai CVD risk score. Data were analyzed with descriptive statistics. Presents the frequency, percentage, mean, standard deviation. Inferential statistics to compare systolic blood pressure, CVD risk scores before and after with Paired t-test. Comparison of CVD risk level before and after using Stuart-Maxwell test, the statistical significance level at 0.05. Results: 1) Development of a training curriculum to enhance the competency of professional nurses in stroke. Focus on providing patients access to Stroke Fast Track services within 270 minutes. 2) Training in 50 nurses, 12 hours of training courses including lectures and practice. The mean of knowledge after training statistically significantly higher than before (P-value<0.001). 3) Stroke prevention services, the follow-up of hypertensive patients who had CVD risk screening >20% and received stroke prevention services found that the systolic blood pressure, CVD risk score after the operation was significantly decreased (P-value<0.001). Also, the proportion of CVD risk level after was decreased significantly. Therefore, the potential of registered nurse at Tambon Health Promoting Hospital should be developed in providing services to prevent stroke by the appropriate course and provide intensive services among patients with higher CVD risk including monitoring, evaluating, and referring patients to the Stroke Fast Track system in a time to prevent disability and die.