Karen Jephson

Healthy eating tools to help secondary stroke prevention for community patients

Background

I have worked as a community neurological rehabilitation nurse for nine years. Over the years, I thought that there must be a better way of helping patients and their families to learn about stroke and how to reduce their risks of it happening again. Three years ago, I put together a secondary stroke prevention (SSP) package which contains a wealth of information about stroke and prevention. In addition, there is an assessment form which enables patients to identify their own potential risk factors and devise a plan to address them, and an information leaflet about how to sustain change.   

My project is simple but hopefully effective. The project follows on from a dissertation that I completed last year which was part of an MSc in Health Promotion. The dissertation question concerned patients and families views on the SSP package.

 

If patients want the information or help it should be re-enforced at every appropriate opportunity to empower patients to make and maintain healthy lifestyles

 

National and local guidelines advise that patients should be informed how to reduce their risks of further strokes happening and offered ownership of treatment and decisions. Many people that have had a stroke are anxious it will happen again. SSP is not a ‘one off’ event. If patients want the information or help it should be re-enforced at every appropriate opportunity to empower patients to make and maintain healthy lifestyles.

One of the areas for improvement that was identified was that food education could be enhanced by additional tools. Printed information routinely given to patients and families is sometimes without pictures or has too much information for post-stroke patients or does not specifically relate to stroke.

 

One of the areas for improvement that was identified was that food education could be enhanced by additional tools

 

I wanted to put something simple together to bridge the gap to work alongside existing tools. I am hoping that these additional tools will complement the current SSP package, that patients and their families will like them and that they will help them to understand healthy eating and stroke prevention.

Aims and objectives

  • The main aim was to improve information for post-stroke patients and their families in the community and to empower them by equipping them with information regarding food and nutrition to act upon to reduce their risk of a secondary stroke
  • Ascertaining exactly how my mentor might be able to help and support over the timeline of the project (given distance, different professional nurse backgrounds and work commitments)
  • Negotiating if any of the project could be done in work time 
  • Scoping and recapping what tools and information were already out there and what other similar teams are using or not (looking at other teams nationwide and national organisation info available - e.g. The Stroke Association, The British Heart Foundation, NHS ‘5 a day’ and Heart UK); to not duplicate any existing tools - but adapt them and work alongside them
  • To review MSc work and look at comments that patients said about visual food tools
  • Including this project as part of my appraisal and PDP - emphasising its importance as a service quality enhancer
healthy eating close up edited

Activity to Date

  •  Successfully communicated via the phone with my mentor, which worked well most of the time given work life priorities and timings
  • It had originally been agreed that I could have an hour or two every couple of weeks for this project. This was then changed by new manager to more workable two whole days for the whole project, in work time
  • I spent time revisiting my MSc work to remind myself what ‘works well’ in terms of education for post-stroke patients, and reviewed current relevant national guidelines
  • I looked at other resources that I might be able to utilise (local NHS library colleagues, university colleagues and local Food Partnership colleagues)
  • Liaised with specialist librarian regarding patient information  
  • Collected all relevant information to begin to put some ideas and prototypes of tools together. I focussed on exactly what visual tools I would like to develop that can be included in the secondary stroke prevention (SSP) package. These included ones created by me and a ‘library’ of others already available to utilise for patients and their families

Outputs to date

  • I negotiated some time out of my working day to put aside for this project
  • I managed to put together some of the tools that I initially wanted to include
  • I ascertained that although there is a huge amount of information ‘out there’ about healthy eating, there is still a small gap relating to stroke prevention with diagrams and images
  • I liaised with the Stroke Association and the British Heart Foundation (BHF). The BHF agreed that I could use their diagrams as I wished as long as I referenced them. The Stroke Association agreed for me to add their logo to my tools

 

[...] although there is a huge amount of information ‘out there’ about healthy eating, there is still a small gap relating to stroke prevention with diagrams and images

 

  • I strived to continue with this project (most of it in my own time), despite work pressures with constant staff sickness and managerial change alongside personal upheavals in my home life
  • I have made a positive start to the continual improvement of the SSP package
  • I have also added additional resources to the electronic iPAD which is now an integral part of the SSP package - which is a bonus - and not something that I intentionally set out to achieve
  • I have fitted in something else above and beyond what I do in my daily work as a nurse

Lessons learned

  • To be realistic in what was achievable in such a short space of time
  • To realise that most of this work was achieved by completing in my own time - not in work time
  • To appreciate the value of supportive colleagues (my mentor) even though they were from an entirely different nurse background
  • To appreciate that although change in management is disruptive it is sometimes beneficial and advantageous. My new line manager acknowledged the importance of this work and indeed the whole ethos of the Celebrating Nursing Practice project. To me this made a big difference.
  • In an overwhelming nursing world of business to not lose sight of the aim of the project and why I was doing it and why it mattered

 

open book

Reflections on impact

  • I am hoping that the food education tools will be of benefit by offering colourful information that is not too overwhelming to post-stroke patients and their families. They are simple A4 sheets which mainly contain pictures and diagrams with some words. Once I have completed all of the sheets intended to be included in the project I will use them with patients and their families for a period of six months then I will ask for their feedback. 
  • The feedback will be via an informal questionnaire - just a few straightforward questions to ascertain if they found them useful or not, which ones were most useful and why, and ideas for improvements. I would then take this information forward to re-fashion the tools if necessary
  • I will also ask work colleagues their thoughts and views on the tools

The way forward

  • Other local teams involved in SSP will be offered the information and I will liaise with the National Stroke Nurse Network group to disseminate the tools if appropriate 
  • I will liaise with my local acute sector to discuss the tools with them 
  • I am already working alongside third sector colleagues in the Stroke Association - at local ‘Life after stroke’ classes where educational sessions are held on an informal basis
National and local guidelines advise that patients should be informed how to reduce their risks of further strokes happening and offered ownership of treatment and decisions
  

Sustaining momentum

I believe that investment in prevention is part of the way forward in our nursing world today. I anticipate that these tools will be used daily, because they are much needed and have the ability to help people help themselves. I am passionate about secondary stroke prevention, helping people to reduce their risks of having another stroke, and it is central to my work as a neuro rehab nurse caring for stroke patients once they are back at home.