Title : Empowering nurses to recognize early stroke signs: Evaluating the impact of a ‘Code White’ alert training program in a Mumbai multispecialty hospital
Abstract:
Introduction: Stroke is a critical global health issue and a leading cause of mortality and long-term disability. According to the World Health Organization (WHO), approximately 15 million people worldwide experience strokes annually. Of these, around 5 million die, and many survivors live with lasting disabilities, imposing a significant burden on families and communities. In India, stroke accounts for 3.5% of Disability-Adjusted Life Years (DALY), marking it as a prominent Non-Communicable Disease (NCD). While common risk factors include hypertension, diabetes, heart disease, and genetic predisposition, lifestyle choice such as poor diet, obesity, physical inactivity, stress, and tobacco use also play a major role. Rapid lifestyle, behavioural, demographic, and technological shifts have further heightened stroke prevalence. Fortunately, stroke risk can often be mitigated through simple lifestyle changes.
Background for the Study: Globally, stroke ranks just behind ischemic heart disease as a leading cause of death. In 2016, stroke was responsible for 5.5 million deaths and 116.4 million DALYs, with 80.1 million cases and 13.7 million new cases reported that year. Developing countries bear a considerable share of this burden, accounting for over two-thirds of strokerelated deaths. In India alone, there were 6,94,144 stroke-related deaths and 11,75,778 new cases in 2016. By 2050, more than 80% of the projected 15 million new stroke cases will likely occur in low- and middle-income countries, with Indian stroke incidence estimated between 116 and 163 cases per 100,000 people. A stroke occurs when the brain’s blood supply is reduced or interrupted, depriving brain cells of essential oxygen and nutrients. Without immediate intervention, stroke can lead to irreversible brain damage, long-term disability, paralysis, or even death. Although stroke is uncommon in individuals under 40, recent trends show a concerning rise in cases among individuals as young as 30, creating new challenges for healthcare providers. To support early stroke detection, healthcare teams have implemented early identification protocols, including an "Alert Code White" system. Increasing awareness among healthcare providers and the general public about recognizing early stroke warning signs is crucial. Prompt activation of Code White can help reduce stroke's impact, ultimately alleviating its significant healthcare burden.
Need for the Study: Recognizing early warning cues of stroke is vital for nurses to ensure patient safety, improve outcomes, and fulfil their professional obligations. Timely recognition and intervention in stroke cases can make a significant difference in the quality of care provided to patients.
Problem Statement: Effect of Educational program on “Early warning Cues” on Stroke among Nurses, with a view to develop High-risk alert system “Code white” in multispecialty Hospital in Mumbai.
Objectives:
- To compare Pretest and postest Score Before and after implementation educational program on “Early warning Cues” on Stroke among Nurses.
- To develop High-risk alert system “Code white”.
Hypothesis:
- H0: There will be no significant difference in pretest and post-test scores before and after implementation of educational program on “Early warning Cues” in Stroke among Nurses.
- H1: There will be significant difference in pretest and post-test scores before and after implementation of educational program on “Early warning Cues” in Stroke among Nurses.
Methodology: Pretest and post-test Design was used in this Study. This study aimed to evaluate the effectiveness of a planned teaching program on nurses' knowledge of "Early Warning Cues" of stroke, with the objective of raising awareness about the high-risk alert system, "Code White." Conducted in a multispecialty hospital, the study involved an initial assessment (pre-test) of the nurses' knowledge. Following this, 300 nurses participated in a structured educational session focused on identifying early stroke symptoms and appropriately activating Code White. After the teaching session, a post-test was administered to assess knowledge gained. The results were then analysed to determine the impact of the program on enhancing nurses' awareness and preparedness to respond to early stroke warning signs.
Results: The analysis revealed a significant improvement in knowledge levels among nursing staff, as indicated by the difference between pre-test and post-test scores. This finding demonstrates that the planned teaching program effectively enhanced nurses' understanding of early warning cues of stroke and the importance of activating Code White. The increased post-test scores highlight the program's impact on raising awareness and equipping staff with the knowledge necessary to respond promptly to early signs of stroke. The Shapiro-Wilk test was conducted to check for data normality. The results indicated that the data is not normally distributed. Consequently, the non-parametric Wilcoxon Signed-Rank Test was applied for Inferential Statistics.
Limitations: This study is limited to Nurses working in the hospitals.
Conclusion: The study findings clearly indicate that the planned teaching program significantly improved nurses' knowledge of early warning cues of stroke and their understanding of the "Code White" alert system. The notable increase in post-test scores demonstrates the program's effectiveness in enhancing awareness and preparedness among nursing staff. By equipping nurses with the necessary knowledge to identify early stroke symptoms and promptly activate the high-risk alert, this program contributes to timely interventions, potentially reducing the risk of severe stroke outcomes. These results suggest that structured educational sessions on stroke warning signs can play a vital role in strengthening hospital protocols and improving patient care.
