Does the Implementation of an Acute Stroke Nursing Assessment Guideline Improve Nurses’ Confidence in Performing In-Hospital Acute Stroke Care?

By Ma Shui Wan Tina, RN (HK, New York, Ohio), BSN (New York), Master of Nursing (HK), Neurology Centre


- To conduct an evidence-based nursing guideline for acute stroke assessment in HKSH

- To assess effectiveness of guideline in improving nurses’ confidence and stroke assessment competence

- To give recommendations to hospital-wide implementation if appropriate

- To explore future development of HKSH comprehensive neurological nursing training


4-17% of all acute stroke occur when patients are staying in the hospital. In-hospital acute stroke are more severe, under-recognized or under-reported. The evaluation times for patients are more than twice the recommended benchmark. The challenge is faced by all stroke centres worldwide.

HKSH is a primary stroke centre with good performance of acute stroke care for community onset strokes.However, it was learned that the hospital did not perform as well for hospitalized patients who suffer from acute stroke.In 2016 and 2017, multiple patients were not scheduled to have CT brain imaging completed according to the recommended benchmark. The project was conducted to identify whether a nursing assessment guideline based on the Rosier Scale Stroke Assessment can be set up to improve nurses’ confidence and competence in performing in-hospital acute stroke care.


Nurses who work in clinical departments were recruited to an one-hour training on acute stroke management, Rosier Scale Stroke Assessment and other diagnostic assessment. At the beginning of the training session, each participant filled out a pre-test questionnaire on stroke competence questions and self-rated confidence level for performing acute stroke care. By the end of the session, participants worked on three acute stroke or stroke mimics case studies. Then they were given a post-test questionnaire to rate their competence and confidence.


The Acute Stroke Nursing Assessment Guideline is an effective standardized tool with evidence for nurses to refer to at the bedside in the midst of medical emergency. The project proved that neurological nursing education can effectively improve nurses’ confidence and acute stroke assessment competence.


The guideline should be widely implemented in HKSH with continuous monitoring to find gaps for improvement.

However, challenges of implementing training to nurses in special case that presents with atypical presentation cannot be neglected. The Neurology Centre should develop comprehensive neurological nursing training and explore collaboration with the hospital’s rapid response team and School of Nursing.