Needs Assessment for Using a Stroke Scale in Kenyan Hospitals

Abstract

Purpose/Aims. The purpose of this project was to conduct a needs assessment for the use of the National Institute of Health Stroke Scale (NIHSS) at an urban and rural hospital in Kenya. The specific aims were: 1) Describe the patient demographics, clinician perspectives, and current stroke care practices at both hospitals; 2) Describe the facilitators and barriers of implementing the NIHSS at both hospitals; 3) Create a program implementation and evaluation plan to address the needs that are identified at both hospitals; and, 4) Compare and contrast the findings from the urban and rural hospitals. Background, Stroke is a leading cause of death in sub-Saharan Africa (SSA) and the burden of stroke in this region is increasing. Despite the known benefits of the use of systematic stroke protocols (which include the gold standard NIHSS to assess stroke severity) in developed countries, their use is virtually nonexistent in Kenya and is urgently needed. Methodology. The setting for the study was an urban Mater Misericordiae Hospital in Nairobi and a rural Sagam Community Hospital in the western region of Kenya. Data on clinician and stroke population demographics and current stroke care practices (Aim I) was collected using an anonymous online Survey Monkey® questionnaire completed by 80 nurses, physicians and clinical officers working at both hospitals. Facilitators and barriers to using the NIHSS (Aim II) are determined via questions from the anonymous online survey. Results. Results from Aims I and II are used to develop an implementation and evaluation plan for the use of NIHSS for each hospital (Aim III). Other than demographic differences evidenced by scarcity of physicians in the rural hospital, clinicians from both hospitals expressed similar desires for improved stroke assessment and reported similar facilitators and barriers for NIHSS implementation (Aim IV). Note that the scarcity of physician providers in the rural hospital was compensated for by the availability of clinical officers (nurse practitioner and physician assistant equivalents). Conclusion. Clinician desire for improved stroke assessment and the facilitators and barriers for NIHSS implementation were not only similar between urban and rural hospital settings in Kenya, but also similar to those identified in stroke studies in developed countries. This finding is promising because it highlights the possibility for multinational discourse for establishing standardized protocols to improve stroke management in Kenya, a country with a significant stroke burden. In addition, this DNP quality improvement project highlights the global reach of a DNP student.