2024 American Academy of Neurology Abstract Website

Phoebe Chen¹, Samhita Nanduri², Gabriel Sneh³, Sarah Braun⁴, Monica Appiah⁵, Maxwell Asare⁵, Melody Asukile⁴, Mashina Chomba⁶, Meron Gebrewold⁷, Kasakula Kaunda⁴, Michael Kinkata⁴, Jessica Mwanza⁸, Royce Mwenya⁴, Muchinka Peele⁹, Alexandra Peloso⁴, Jane Singoyi⁴, Jonathan Quarton¹⁰, Stefan Baral¹¹, Gretchen Birbeck¹², Rebecca Gottesman¹³, Izukanji Sikazwe¹⁴, Peter Winch¹¹, Albert Akpalu⁵, Lucy Sykes¹⁵, Morgan Prust¹, Deanna Saylor³
¹Yale University School of Medicine, ²Drexel University College of Medicine, ³Johns Hopkins University School of Medicine, ⁴University Teaching Hospital, Lusaka, Zambia, ⁵Korle Bu Teaching Hospital, ⁶University of Zambia, ⁷Addis Ababa University, ⁸Special Hope Network, ⁹G-Speech Therapy Centre, ¹⁰Kingston Health Sciences Centre, ¹¹Johns Hopkins University Bloomberg School of Public Health, ¹²University of Rochester/CHET, ¹³National Institute of Neurological Disorders and Stroke, ¹⁴Centre for Infectious Disease Research in Zambia, ¹⁵Royal Hampshire County Hospital

Objective:

Describe the impact of a new stroke nurse training program at the University Teaching Hospital in Lusaka, Zambia.

Background:

Stroke units, which rely heavily on specialized nursing care, are the global standard of stroke care and are associated with improved outcomes. However, they are largely absent in resource-limited settings.

Design/Methods:

Prior to opening Zambia’s first-ever stroke unit in October 2023, two one-week stroke nurse training workshops were conducted in September 2023. These utilized training materials adapted from the Wessex Ghana Stroke Partnership, which were co-designed by multidisciplinary team members in Ghana and the UK. Individual semi-structured interviews were conducted with Zambian nurses who had completed training; these were analyzed thematically.

Results:

All nurses interviewed (n=18 of 30 trained) rated their training very positively, reporting feeling empowered with new knowledge and skills and developing improved communication with patients, caregivers, and stroke doctors. Specifically, nurses reported their clinical practice had changed from skill-building in the following areas: (1) turning and repositioning patients more frequently; (2) aspiration prevention through implementation of formal nurse-led swallow screenings; (3) increased mobilization of patients through implementation of nurse-led mobility assessments and nurse-/caregiver-led exercises; and (4) improved incontinence management by reducing catheter use and more frequent diaper changes. Despite increased workload, nurses felt motivated and proud to pioneer a new standard of care for stroke patients in Zambia. Nurses suggested implementing monthly continuing medical education, periodic performance evaluations, Stroke Nurse of the Month incentives, and nurse exchange visits to established stroke centers in the future.

Conclusions:

Implementation of a stroke nurse training program previously successfully utilized in Ghana was also highly successful in Zambia, demonstrating the potential to empower nurses with new stroke care clinical competencies and skills. Further evaluation is needed to determine if knowledge and skills are retained long-term and result in improved patient outcomes.