Doctor of Nursing Practice (DNP)
First Committee Member
Second Committee Member
Aaron Bellow Jr.
Third Committee Member
Number of Pages
PURPOSE: Transient ischemic attacks (TIA) are a health problem that affects many people each year. A local Las Vegas organization allowed this DNP student to develop and implement an intervention to increase the perceived ability of providers to manage low-risk TIAs in specialized urgent care facilities. The aim was to raise the comfort level of providers at on-demand medicine also known as urgent care. Additional goals were to increase awareness of stroke and TIA symptoms and educate providers on the new TIA guidelines.
METHODS: This quality improvement DNP study used a convenience sample of 30 providers. Eleven participants completed the project. The study included education on the new definition of a TIA, stroke diagnosis, mimics, FAST (face dropping, arm weakness, speech difficulty, time to call 911) exam, ROSIER (recognition of stroke in the emergency room) scale, and management. A Likert survey was used before instruction and had seven questions on perceived comfort level, education was then provided by power-point presentation due to pandemic COVID-19, and a post Likert survey was used after the presentation. The questions were the same as the pre Likert survey. Continuing medical hours were also offered.
RESULTS: The eleven participants that completed the project all showed improvement on identifying a stroke versus a TIA, using a FAST exam, identifying mimics of a TIA, using a ROSIER scale, knowing which labs and diagnostic tools to order, ordering imaging for TIA, and ordering outpatient tests, medications, and appropriate referral for a patient experiencing a TIA. The survey demonstrated they were least comfortable with ordering outpatient tests, prescriptions, and referrals after the education.
CONCLUSION: Even though the provider’s comfort level increased, ongoing education should be completed with all providers to ensure TIA, strokes, and modifiable risks are identified to avoid a devastating stroke and even death. This project was implemented during the height of a pandemic. Providers in urgent care took on additional responsibilities and increased stress. The project was completed online to comply COVID-19 guidelines, and in-person class might have been more beneficial.
CLINICAL RELEVANCE: The quality improvement project increased the comfort level of all providers to identify and manage transient ischemic attacks on low-risk patients in specialized urgent care facilities. This project also helped the investigator to understand obstacles providers face when managing TIAs outpatient to include increased workloads due to pandemic, availability to tests, and referrals. Better management of patients presenting with TIA in urgent care could improve patient’s quality of life, decrease death, and allow them to modify risks to avoid a stroke or even death.
Cerebral vascular accidents; CVA; Mini-strokes; TIA; Transient ischemic attacks
University of Nevada, Las Vegas
Johnson, Zandra Kay, "Transient Ischemic Attacks Evaluation and Management in Specialized Urgent Care Facilities" (2021). UNLV Theses, Dissertations, Professional Papers, and Capstones. 4155.
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