COVID-19, stroke education, stroke nursing



  1. Paletz, Laurie


ABSTRACT: INTRODUCTION: During the COVID-19 pandemic, hospitals still have to meet external regulations while delivering compassionate patient care. This reflections article provides a solution for certified stroke programs to continue to meet stroke certification requirements. One area of focus, in this article, is stroke education. Because of "shelter-in-place orders," there were no visitors permitted at the bedside, yet we know that high-quality poststroke education is important to improve outcomes. The purpose of this reflections article is to share what has worked at my institution. INNOVATIONS: We found that calling family members to engage them in stroke education was a great option. They seemed engaged, took notes, and asked questions. Nurses document details from these phone encounters in the patient's medical record. Many people placed the call on speaker so other family members could listen to the education session. While family members were at home, telehealth nursing has its own set of challenges. Although telehealth is not a perfect solution, it was one we found most reasonable and found it to work well through this unprecedented time. SUMMARY: These strategies are being shared to promote dissemination of innovative nursing interventions that will help to continue providing loved ones with the information and education they deserve to receive even during the COVID-19 pandemic.


Article Content

During the COVID-19 pandemic, hospitals still had to meet external regulations while delivering compassionate patient care.1 As a certified comprehensive stroke program, we are always updating our clinical practice guidelines with the most current evidence. Achieving stroke certification requirements presented both challenges and opportunities for neuroscience nurses. One particular area of concern we faced was performing high-quality poststroke education important to improve outcomes.2 The purpose of this reflections article is to share what has worked at my institution.


Stroke workflows changed drastically during the COVID-19 pandemic. Like many hospitals, new policies suddenly restricted or eliminated visitors (family members, loved ones, and care partners). As visitation halted, we no longer had the luxury of family education at the bedside. Many patients were unable or cognitively inept to process information surrounding causative events such as risk factors, medications, and interventions or were unwilling to be educated around their personal stroke risk factors, medications, and discharge instructions. During the pandemic, the Centers for Disease Control and Prevention recommended the use of alternative mechanisms for patient and visitor interactions and videoconference, including video-call applications on cell phones or tablets, which is 1 option.3 In Virginia,4 telehealth for stroke education showed feasibility in providing effective stroke education through telehealth, with this suggesting an overlooked route for providing patient education at a distance.


Action Plan

With the new Centers for Disease Control and Prevention recommendations, stroke education via telephone became a viable option for poststroke education. Because of "shelter-in-place orders," most family members and care partners were at home and easy to reach. This was helpful as one of the many areas that we identified as a challenge was educating patients, specifically patients who are cognitively impaired. Loved ones reported feelings of delight when updated on the patient's progress and asked to participate in the decisions and also when they receive education.


Although family members were absent from the bedside with COVID-19 restrictions, telehealth nursing elevated options of communication, but not without challenges. The phone number listed in the chart did not always align with the phone number listed in the chart, or it was disconnected. In telephoning family members during the day, the likelihood of reaching family members increased. The patient's family and friends eagerly engaged by taking notes and asking questions. The nurses document details from these phone encounters in the patient's medical record. Many of these conversations occurred on speaker phone over the phone so that other family members could listen to the education session. Appropriate educational materials were mailed to the patient's address with encouragement to read for further understanding We included our team's phone numbers for family to call with questions after reading through the information. Although telehealth is not a perfect solution, it proved a valuable option to use during unprecedented times.


Benner et al3 identified several ethical themes central to good nursing practice. Promoting patient advocacy and staying present with a patient and family who are suffering are important aspects of our practice. Telehealth nursing was not invented in response to COVID-19, but the pandemic may have accelerated the rate of adoption.5,6 One of the foundations of patient-centered care is based on respect for the patient's preferences, values, and the right to actively participate in decision making.



There are numerous nursing innovations that came about during the COVID-19 pandemic.7 Although poststroke telehealth nursing is still in its infancy, families are reporting they appreciate the time we are taking to educate them and answer questions. Even when visitation is once again permitted, we plan to continue telehealth nursing as a viable method of poststroke education. Future plans include evaluating the program by looking at patient and family satisfaction scores, looking at our phone call data to be sure this meets the needs of the community we serve, and exploring other options to enhance and personalize telecommunication with family. Even during challenging times, patients and their loved ones deserve to receive high-quality information and education. Our nurses are there to meet the demand.




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