The neurological assessment can be challenging for new nurses to complete. Accuracy is critical when completing a neurological assessment for a suspected cerebral vascular accident (CVA). Neurological emergencies such as a CVA need to be identified quickly in order for appropriate intervention to be completed. Without hands-on experience with CVA assessment tools, even experienced nurses may lack the skills needed to accurately assess a patient with a possible CVA. Practice in the classroom using a student serving as a standardized patient may assist in the development of neurological assessment skills.
A classroom activity was created to allow students hands-on practice with neurological assessments for patients with multiple types of CVAs. The goal of the activity was to allow students to a create mock scenario based on a preassigned patient case that involved a specific area of the brain, then present the scenario to the class. A class of 32 students with one faculty member completed the activity over a period of 120 minutes. The scenario included the students performing a neurological assessment to identify symptoms of a CVA. The activity is low cost and can be completed by one faculty member. The activity began with the creation of small groups of three to four students. The students were then assigned a patient scenario that included the type of CVA they were to mimic when performing the neurological assessment using a nationally accepted rapid CVA assessment tool. The rapid assessment tool used was the National Institute of Health Stroke Scale by the National Institute of Neurological Disorders and Stroke (2016). Examples of the type of strokes the students were assigned included an ischemic frontal lobe stroke, ischemic parietal lobe stroke, and ischemic occipital lobe stroke.
Students were expected to review the clinical manifestations of the assigned stroke type in their textbook to correlate the clinical symptoms that would be present on the rapid CVA assessment. Each student group would present their scenario to the class. One student played the role of the patient and portrayed the specific symptoms of the assigned CVA, while the other classmates served as the bedside nurses performing the stroke assessment. The other students in the classroom not actively participating in the mock scenario were to use the rapid CVA assessment tool to complete a neurological assessment. As a result of this activity, students were able to assess student standardized patients who had symptoms of multiple stroke types. At the end of each stroke scenario, discussion would ensue with the entire class about their score on the rapid CVA assessment tool and the type of stroke that was evolving. To ensure that a successful activity is complete, it is essential to provide students with a copy of the stroke tool, resources to review CVA symptoms, and enough time to create the scenario. This hands-on activity can be implemented in the classroom or campus laboratory setting, allowing for neurological assessment practice prior to encountering similar situations in clinical practice.
Matthew J. Fox, MSN, RN-BC
Susan Farus-Brown, DNP, APRN, CNP,
Ohio University Zanesville
- National Institute of Neurological Disorders and Stroke. (2016). NIH stroke scale. Bethesda, MD: Author.