Medical and Dental Consultantsí Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 1195   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

  Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 5  |  Page : 729-734

Awareness of risk factors and warning signs of stroke among nursing students: Results from questionnaire


Department of Medical Nursing, Ege University Faculty of Nursing, Turkey

Date of Submission01-Apr-2019
Date of Acceptance01-Aug-2020
Date of Web Publication20-May-2021

Correspondence Address:
Dr. O Usta Yesilbalkan
Ege University Faculty of Nursing, Izmir
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_181_19

Rights and Permissions
   Abstract 


Background: It is important to inform nursing students about stroke and improve their role in the clinic. Aims: We aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students. Therefore, we aimed to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students. Materials and Methods: The descriptive and cross-sectional study was carried out between December 2017 and March 2018 with intern students at the faculty of nursing of a university. The sample consisted of 173 students. The data were collected by researchers using “Student Information Form” and “Information Form about Stroke”. The ethical and institutional permission were obtained to conduct the research. Results: Hypertension (96.5%) for risk factors, weakness (98.8%) for warning signs, blood pressure control (96.5%) for prevention measures were the most commonly identified factors. Approximately half of the students had a good level of awareness/knowledge of risk factors (53.2%) and warning signs (53.8%) for stroke. The majority of students (84.4%) had a good level of awareness/knowledge of prevention measures. Ninety-five percent of the students stated that calling an ambulance would be the first appropriate action. Conclusion: Students had a good knowledge of some of the warning signs and risk factors about stroke. Therefore, it is recommended that this subject should be emphasized more in course contents.

Keywords: Awareness/knowledge, nursing student, risk factor, stroke, warning


How to cite this article:
Kankaya H, Yesilbalkan O U. Awareness of risk factors and warning signs of stroke among nursing students: Results from questionnaire. Niger J Clin Pract 2021;24:729-34

How to cite this URL:
Kankaya H, Yesilbalkan O U. Awareness of risk factors and warning signs of stroke among nursing students: Results from questionnaire. Niger J Clin Pract [serial online] 2021 [cited 2022 Sep 29];24:729-34. Available from: https://www.njcponline.com/text.asp?2021/24/5/729/316458




   Introduction Top


Stroke is defined as a condition that is a focal (or at times global) neurological impairment of sudden onset, and lasting more than 24 hours (or leading to death) and of presumed vascular origin.[1] Stroke can be classified into either ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage or unspecified.[1] Stroke is the second-leading cause of death with approximately 6.5 million deaths every year. Also, it ranked fifth among causes of death when considered separately from other cardiovascular diseases.[2] According to data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS)-Centers for Disease Control and Prevention (CDC), stroke prevalence in adults is 2.9% in the United States.[3] In a recent study conducted by the Ministry of Health of Turkey, stroke incidence and prevalence were reported as 69.6 and 310/100,000 populations.[4] According to the Turkish Health Statistics and World Health Organization, cerebrovascular diseases have the third place in loss of disability adjusted life years (DALYs) estimates with a rate of 5.9% and are the second leading cause of death in Turkey.[4] A majority of the stroke burden is observed in developing countries (75.2% of all stroke-related deaths and 81.0% of the associated DALYs lost).[5]

A review on the stroke epidemiology in south, east, and south-east asia showed that hypertension is the most frequent risk factor, followed by diabetes mellitus and smoking. Ischemic stroke occurs more frequently than hemorrhagic stroke. There are variations in the stroke epidemiology between countries in South, East, and South-East Asia.[5] The most common underlying etiology of ischemic stroke is cardiac embolism in Turkey.[6]

Stroke is a preventable public health problem and it is one of the important causes of morbidity and mortality world over.[7] Therefore, the knowledge and awareness of modifiable risk factors of stroke can prevent mortality and morbidity, it can decrease the possible stroke and lower health care costs.[8]

It was found that the level of participants' knowledge was insufficient in a majority of studies evaluating the warning signs and risk factors related to stroke.[7],[9],[10],[11],[12],[13]

Nurses have an important role in decreasing the mortality and disability of patients with stroke. In this context, nursing students should be informed about stroke and improve their roles in clinical and practice. Besides, it is important to determine the knowledge/awareness of the nursing students employed in clinics who are more likely to encounter patients with stroke such as emergency or intensive care after graduation.

The aim of this study was to assess the nursing students' awareness/ knowledge of stroke risk factors and warning signs.


   Subjects and Methods Top


Study design

This cross-sectional study was conducted from December 2017 to March 2018, at a Faculty of Nursing in Turkey. The study population consisted of 173 students. The inclusion criteria for the students were as follows: (1) being an intern nursing student (2) being volunteered to participate in this study- a verbally consent (3) being over the age of 18 years (4) can speak and understand Turkish (5) had no prior episode of stroke or transient ischemic attack (tia).

Data collection

Data were collected by using “Student Information Form” and “Questionnaire Form About Stroke”. First, the students were informed about the aims of the study and the questionnaires and were asked to fill out the following forms.

Student Information Form: This form had 9 questions about students' socio-demographic characteristics.

Questionnaire Form About Stroke: The form was designed by Usta Yeşilbalkan et al. who was also the author of this study, especially for the current study-based on literature.[14],[15],[16],[17],[18],[19] We described “good”, “moderate”, and “poor” knowledge of stroke risk factors, warning signs and prevention measures according to the distribution of percentiles of correct answers. More than 80% correct answer as good level, between 70%-80% correct answer as moderate level, less than 70% correct answer as poor level were determined. The classification was designed for the studies-based on literature.[11],[14]

Statistical analysis

Statistical evaluation was done using The SPSS 22.0 software. Data were presented as percentages, mean, and standard deviation (SD). The Chi-square test analysis was used to detect the statistical significance between some characteristics and awareness of stroke. The data results were evaluated at a 95% level of reliability and P < 0.05 was evaluated as statistically significant.

Ethical consideration

Written approval was obtained from Ege University Health Sciences Scientific Research and Publication Ethics Committee (349-2017), the institution consent and verbal informed consent from participants were obtained. This was conducted in consideration of Decleration of Helsinki.


   Results Top


Characteristic's of the students

A total of 173 students (150 women, 23 men) participated in this study. The mean age of the participants was 22.36 ± 1.02 [Table 1].
Table 1: Characteristic's of the students

Click here to view


The students' awareness of risk factors and warning signs of stroke

The majority of students (94.8%, n = 164) expressed the brain as the organ affected by stroke. The students' awareness of risk factors and warning signs of stroke were listed in [Table 2].
Table 2: The students' awareness of risk factors, warning signs and prevention measures of stroke

Click here to view


Hypertension (96.5%, n = 167), suffering previous stroke/TIA (92.5%, n = 160), heart diseases (MI or angina) (90.2%, n = 156) were the most commonly identified risk factors. The blood diseases (55.5%, n = 96) and sex (57.2%, n = 99) were the least commonly identified [Table 2].

Weakness of one side of the body (98.8%, n = 171), slurred speech (97.7%, n = 169), numbness or weakness in the face (97.1%, n = 168) were the most commonly identified warning signs. Visual problems (79.2%, n = 137) and severe headache (79.8%, n = 138) were the least identified warning signs [Table 2].

The Students' awareness of stroke prevention

The majority of students (90.8%, n = 157) stated that stroke could be prevented. The most identified prevention measures were blood pressure control (96.5%, n = 167), regular doctor check (96.0%, n = 166), avoid of stress (96.0%, n = 166). Regular medicine use (79.8%, n = 138) and maintaining the ideal weight (86.1%, n = 149) were the least defined prevention measures [Table 2].

Level of awareness regarding the risk factors, warning symptoms and prevention measures of stroke

[Table 3] shows the awareness level of the students about stroke warning signs, risk factors, and prevention measures. Approximately half of the students (53.2%, n = 92; 53.8%, n = 93) had a good level of awareness about risk factors and warning signs for stroke. The majority of participants (84.4%, n = 146) had a good level of awareness about prevention measures.
Table 3: Level of awareness regarding the risk factors and warning symptoms and prevention measures of stroke

Click here to view


The first action to be taken by the students

The question, “What do you do at first when you realize that you or someone else is having an acute stroke ?” was answered as “I call the ambulance (95.4%, n = 165)”, “I take the patient to hospital (7.0%, n = 12)”, “I call one of the family members (1.7%, n = 3)”, “I call the doctor (1.7%, n = 3)”, “I apply cold water to the head (1.2%, n = 2)”, and “I give medicine to patient (0.6%, n = 1)” [Table 4].
Table 4: Information and sources of information about stroke

Click here to view


Sources of information about stroke

Most of the participants (68.2%, n = 118) stated that they had been informed about the stroke before. The information sources about stroke were books (37.0%, n = 64), academy (27.7%, n = 48), Internet (18.5%, n = 32), patients with stroke and relatives (10.4%, n = 18), television (0.6%, n = 1), relatives (0.6%, n = 1) and newpaper (0.6%, n = 1) [Table 4].

The question, “What are your suggestions for community education about stroke?” was answered as “Early symptoms-findings (82.1%, n = 142)”, “Risks factors (80.3%, n = 139)”, “Prevention (70.5%, n = 122)”, and “First intervention for stroke (64.2%, n = 111)” [Table 4].

Awareness of risk factors, warning signs and prevention measures according to demographic characteristics

[Table 5] shows the awareness of the students about warning signs, risk factors and prevention measures according to some characteristics. No relationship between “encounter with a stroke person”, “to practicum of Neurology clinic before” and level of awareness of stroke (about risk factors, warning signs, and prevention measures) (P > 0.05).
Table 5: Awareness of risk factors, warning signs and prevention measures according to demographic characteristic

Click here to view



   Discussion Top


In the literature, studies evaluating the public's awareness of stroke are common.[7],[9],[12],[14],[20],[21] However, there are only a few studies on stroke awareness of nursing students.[11],[13] Therefore, it would be speculated that our study is the first to assess the awareness/knowledge of stroke risk factors and warning signs among nursing students in Turkey.

The results showed that about half of the students (53.2%) had a good level of knowledge/awareness of risk factors for stroke. These results were also consistent with the study about nursing students by Islam et al.,[11] which showed that nearly half of the students (42.4%) had a high and very high level of awareness of stroke risk factors. The study by Mason-Whitehead et al.[13] found that the majority of nursing students' stroke (risk factors) knowledge was partially acceptable.

As an important stroke risk factor, hypertension was one of the most commonly identified risk factor in this study. A study with hospital clinical workers found that hypertension was the most common identified risk factor of stroke (66.3%).[22] Our findings supported the results in other studies.[7],[12],[23],[24],[25]

Similar to the results of risk factors, nearly half of the students (53.8%) had a good level of knowledge of warning signs for stroke. But contrary to our results, Islam et al.[11] reported that 63.2% of participants had very low awareness of stroke warning signs. Nevertheless, the rates were similar to each other. Considering that they consist of fourth year nursing students in both groups and percentages, it could be speculated that the rates are similar.

Weakness (98.8%), slurred speech (97.7%), numbness or weakness in the face (97.1%) were the most commonly defined warning signs in our research. Our results were in accord with Obembe et al.'s[23] study in which slurred speech, weakness and numbness were the most commonly recognized warning signs. Due to fact that weakness, slurred speech and numbness are stroke symptoms that are well known to both health professionals and the community, similar results were frequently found in other studies.[7],[12],[23],[25],[26],[27]

In this study, most of the students (94.8%) correctly defined that the brain was affected in stroke. In another study by Park et al. (2017),[24] the majority (74.3%) of the high school students correctly defined that the brain was affected in stroke before education about stroke. Another study with university students revealed that 86.2% participants were able to recognize stroke.[28] The knowledge regarding the organ injured in stroke in our study was better when compared to the other studies with the public results.[7],[20],[25] The difference in the findings of these studies might be that the participants in our study were nursing students who had formal education.

The majority of the students (95.4%) stated that the first action in stroke should be to call the ambulance. The results were consistent with the studies by Park et al.[24] and Milner et al.[26] which were revealed that the majority of the participants (79.8%; 80.8%) identified to call the ambulance as the first appropriate action in stroke. Another study with university students revealed that the most frequent response to an attack of stroke was transferring the patients to a hospital (59.8%).[22] In Obembe et al.'s[23] study, nearly half of the students (44.8%) proposed taking a person to the hospital, %29.6 of them defined that they would call a doctor in the event of a stroke. In another study, many students (39.0%) proposed taking the person with stroke to the hospital, many students (31.1%) stated that they would call a doctor in event of a stroke.[12] When compared with our study, it could be speculated that the low rates in these studies was caused by the general student and staff population attendance.

The television and literature were found to be common source of taking information for the students in some studies.[12],[23] Our results showed that the most common sources of information about stroke were textbooks (37.0%) and internet (18.5%). According to these results, it could be speculated that the sources of information were similar.

In the first three years of our education system, all theoretical courses are given to students before being an intern nursing student. Because of the students participating in the research are intern nursing students, it was expected that the knowledge and awareness results about stroke would be better than our findings. The students who do not update their knowledge adequately over time may be the possible reason, causing lower results.

Stroke is a chronic and preventable disease. It is necessary to increase the knowledge and awareness of warning signs, risk factors, and prevention measures to achieve this. The previous studies reveal the necessity of this.[7],[21],[29],[30],[31] Similar to these results, in our study, the most of students suggested “warning signs” (82.1%), “risk factors” (80.3%), “prevention” (70.5%), and “first action for stroke” (64.2%) for community education.

It is very important to know and recognize the risk factors, warning signs, act quickly, manage, and prevent the stroke. Nurses have a key role about preventing stroke and reducing morbidity in survivors. In connection with this, nurses are required to improve and update their knowledge and awareness about stroke during their education period.

In conclusion, it was determined that the students' knowledge/awareness of warning signs and risk factors about stroke were good. But it was lower than expected. However, it was concluded that their knowledge/awareness of prevention measures was better. Therefore, it could be speculated that this subject should be emphasized more in course contents.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
The WHO STEPwise approach to stroke surveillance. Geneva: World Health Organization; 2005. [cited 2018 Aug 20] Available from: http://www.who.int/ncds/surveillance/steps/Manual.pdf.  Back to cited text no. 1
    
2.
Benjamin JE, Blaha JM, Chiuve ES, Cushman M, Das RS, Deo R, et al. Heart disease and stroke statistics-2017 update. A Report from the American Heart Association. Circulation 2017;135:e146-603.  Back to cited text no. 2
    
3.
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019;139:e56-528.  Back to cited text no. 3
    
4.
Ince B, Necioglu D. Organization of stroke care in Turkey. Int J Stroke 2017;12:105-7.  Back to cited text no. 4
    
5.
Venketasubramanian N, Woo Yoon B, Pandian J, Navarrod JC. Stroke epidemiology in South, East, and South-East Asia: A Review. J Stroke 2017;19:286-94.  Back to cited text no. 5
    
6.
Benbir Senel G, Elmali AD, Mehrvar K, Farhoudi M, Aboutalebi M, Rezaei M, et al. A survey from Turkey and Iran on comparison of risk factors and etiology in ischemic stroke. Iran J Neurol 2019;18:176-8.  Back to cited text no. 6
    
7.
Evci ED, Memis S, Ergin F, Beser E. A population-based study on awareness of stroke in Turkey. Eur J Neurol 2007;14:517-22.  Back to cited text no. 7
    
8.
Flemming KD, Brown RD. Secondary prevention strategies in ischemic stroke: Identification and optimal management of modifiable risk factors. Mayo Clin Proc 2004;79:1330-40.  Back to cited text no. 8
    
9.
Sloma A, Backlund LG, Strender LE, Skånér Y. Knowledge of stroke risk factors among primary care patients with previous stroke or TIA: A questionnaire study. BMC Fam Pract 2010;11:47.  Back to cited text no. 9
    
10.
Maasland L, Koudstaal PJ, Habbema JD, Dippel DW. Knowledge and understanding of disease process, risk factors and treatment modalities in patients with a recent TIA or minor ischemic stroke. Cerebrovasc Dis 2007;23:435-40.  Back to cited text no. 10
    
11.
Islam S, Geum Oh E, Wha Lee T, Kim S. Stroke management awareness and behavior among nursing students in Bangladesh. Open J Nurs 2017;7:1-14.  Back to cited text no. 11
    
12.
Komolafe MA, Obembe AO, Olaogun MO, Adebiyi AM, Ugalahi T, Dada O, et al. Awareness of stroke risk factors and warning signs in Nigerian adolescents compared with adults. J Stroke Cerebrovasc Dis 2015;24:687-93.  Back to cited text no. 12
    
13.
Mason-Whitehead E, Ridgway V, Barton J. Passed without a stroke: A UK mixed method study exploring student nurses' knowledge of stroke. Nurse Educ Today 2013;33:998-1002.  Back to cited text no. 13
    
14.
Usta Yesilbalkan O, Karadakovan A, Vural Dogru B, Akman P, Ozel E, Bozturk Y. Awareness of risk factors and warning signs of stroke among caregivers of patient with and not with Stroke: Results from questionnaire. J Pak Med Assoc 2019;69:1114-8.  Back to cited text no. 14
    
15.
Stroke Risks. American Heart Association and American Stroke Association; 2016. [cited 2018 Jun 15]. Available from: http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/Understanding-Stroke-Risk_UCM_308539_SubHomePage.jsp.  Back to cited text no. 15
    
16.
Duque AS, Fernandes L, Correia AF, Calvinho I, Cardoso G, Pinto M, et al. Awareness of stroke risk factors and warning signs and attitude to acute stroke. Int Arch Med 2015;8:1-18.  Back to cited text no. 16
    
17.
Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.  Back to cited text no. 17
    
18.
Mi T, Sun S, Du Y, Guo S, Cong L, Cao M, et al. Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China. Brain Behav 2016;6:e00461.  Back to cited text no. 18
    
19.
Robinson TG, Reid A, Haunton VJ, Wilson A, Naylor AR. The face arm speech test: Does it encourage rapid recognition of important stroke warning symptoms? Emerg Med J 2013;30:467-71.  Back to cited text no. 19
    
20.
Pandian JD, Jaison A, Deepak SS, Kalra G, Shamsher S, Lincoln DJ, et al. Public awareness of warning symptoms, risk factors, and treatment of stroke in northwest India. Stroke 2005;36:644-8.  Back to cited text no. 20
    
21.
Farrag MA, Oraby MI, Ghali AA, Ragab OA, Nasreldein A, Shehata GA, et al. Public stroke knowledge, awareness, and response to acute stroke: Multi-center study from 4 Egyptian governorates. J Neurol Sci 2018;384:46-9.  Back to cited text no. 21
    
22.
Shehata HS, Ahmed SM, Abdelalim AM, El Sherbiny N. Knowledge and attitude towards stroke among workers in Cairo University Hospitals. Egypt J Neurol Psychiatry Neurosurg 2016;53:54-9.  Back to cited text no. 22
  [Full text]  
23.
Obembe AO, Olaogun MO, Bamikole AA, Komolafe MA, Odetunde MO. Awareness of risk factors and warning signs of stroke in a Nigeria university. J Stroke Cerebrovasc Dis 2014;23:749-58.  Back to cited text no. 23
    
24.
Park H, Jeong J, Lee H, Lee SH, Suk SH. Stroke awareness in Korean high school students. Acta Neurol Belg 2017;117:455-9.  Back to cited text no. 24
    
25.
Menon B, Swaroop JJ, Deepika HKR, Conjeevaram J, Munisusmitha K. Poor awareness of stroke--A hospital-based study from South India: An urgent need for awareness programs. J Stroke Cerebrovasc Dis 2014;23:2091-8.  Back to cited text no. 25
    
26.
Milner A, Lewis WJ, Ellis C. Knowledge of stroke risk factors and early warning signs of stroke among students enrolled in allied health programs: A pilot study. J Allied Health 2008;37:e296-315.  Back to cited text no. 26
    
27.
Adelman EE, Meurer WJ, Nance DK, Kocan MJ, Maddox KE, Morgenstern LB, et al. Stroke awareness among inpatient nursing staff at an academic medical center. Stroke 2014;45:271-3.  Back to cited text no. 27
    
28.
Monteleone VF, Pramio C, Silva ES, Cunha M P da, Cortez LER. University students' knowledge and perceived adequate conduct in cases of acute stroke. Biosci J 2018;34:790-801.  Back to cited text no. 28
    
29.
Bay JL, Spiroski AM, Fogg-Rogers L, McCann CM, Faull RL, Barber PA. Stroke awareness and knowledge in an urban New Zealand population. J Stroke Cerebrovasc Dis 2015;24:1153-62.  Back to cited text no. 29
    
30.
Saengsuwan J, Suangpho P, Tiamkao S. Knowledge of stroke risk factors and warning signs in patients with recurrent stroke or recurrent transient ıschaemic attack in Thailand. Neurol Res Int 2017;2017:8215726. doi: 10.1155/2017/8215726.  Back to cited text no. 30
    
31.
Worthmann H, Schwartz A, Heidenreich F, Sindern E, Lorenz R, Adams HA, et al. Educational campaign on stroke in an urban population in Northern Germany: Influence on public stroke awareness and knowledge. Int J Stroke 2013;8:286-92.  Back to cited text no. 31
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Subjects and Methods
   Results
   Discussion
    References
    Article Tables

 Article Access Statistics
    Viewed970    
    Printed12    
    Emailed0    
    PDF Downloaded145    
    Comments [Add]    

Recommend this journal