Clinical Nurses’ Competence in Stroke Assessment: Knowledge, Practice, and Associated Factors in the Use of the National Institute of Health Stroke Scale

Tian Yan; Jonathan Laranang

doi:10.69569/jip.2025.819

Authors

Tian Yan Mariano Marcos State University, Ilocos Norte, Philippines
Jonathan M. Laranang Mariano Marcos State University, Ilocos Norte, Philippines

DOI:

https://doi.org/10.69569/jip.2025.819

Keywords:

Cardiovascular Diseases (CVDs), Clinical nurses, NIHSS, Nursing knowledge and practice, Stroke assessment

Abstract

Stroke remains a leading cause of death and long-term disability worldwide, necessitating rapid and accurate assessment to improve patient outcomes. The National Institutes of Health Stroke Scale (NIHSS) is a standard tool for assessing neurological deficits in stroke patients. This study aimed to assess clinical nurses' knowledge and practice of the NIHSS and to analyze the relationships among sociodemographic characteristics, knowledge, and practice. A descriptive-correlational study design was conducted in September 2025 among 276 clinical nurses from Siping Central Hospital and Jilin Provincial Brain Hospital in China. A self-designed questionnaire was used to collect nurses' sociodemographic data, knowledge of the NIHSS, and practice. Results showed that clinical nurses had high knowledge and practice of the NIHSS. Educational background and number of training sessions were significantly correlated with knowledge, while years of service were significantly correlated with practice. Furthermore, knowledge and practice were significantly positively correlated, indicating that nurses with high knowledge were more adept at applying the NIHSS in clinical practice. These results emphasize the importance of ongoing education and systematic training to maintain nurses' competence in standardized stroke assessment.

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References

Aprecia, J.M., Reyes, L.M., & Duque, M.A. (2022). Quantitative descriptive–correlational research in nursing: Applications and challenges. Journal of Nursing Research and Practice, 6(2), 45–52. https://doi.org/10.17605/OSF.IO/YRZ68

Brott, T., Adams, H., Olinger, C., Marler, J., Barsan, W., Biller, J., Spilker, J., Holleran, R., Eberle, R., Hertzberg, V., Rorick, M., Moomaw, C., & Walker, M. (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke, 20(7), 864–870. https://doi.org/10.1161/01.STR.20.7.864

Chinese Stroke Association. (2023). National guidelines for stroke nursing practice in China. Beijing Medical Press. (In Chinese).

Comer, R.R., Staggers, N., & Clark, L. (2023). E-learning interventions to improve NIH Stroke Scale application among nurses: A randomized controlled trial. Journal of Neuroscience Nursing, 55(2), 112–118. https://doi.org/10.1097/JNN.0000000000000673

Feigin, V.L., Brainin, M., Norrving, B., Martins, S., Sacco, R.L., Hacke, W., Fisher, M., Pandian, J.D., & Lindsay, P. (2022). World Stroke Organization (WSO): Global stroke fact sheet 2022. International Journal of Stroke, 17(1), 18–29. https://doi.org/10.1177/17474930211065917

Ibrahim, N., Qalawa, S.A., Mohamed, N.A., et al. (2025). An in-depth analysis of nurses’ knowledge, practice, and attitude towards neurological examination and the challenges: “Bridging the gap”. BMC Nursing, 24, 213. https://doi.org/10.1186/s12912-025-02766-x

Jauch, E., Saver, J., Adams, H., Bruno, A., Connors, J.J., Demaerschalk, B., Khatri, P., McMullan, P., Qureshi, A., Rosenfield, K., Scott, P., Summers, D., Wang, D., Wintermark, M., & Yonas, H. (2013). 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, 44(3), 870–947. https://doi.org/10.1161/STR.0b013e318284056a

Li, Y., Wang, Q., & Liu, J. (2024). Evaluating stroke assessment competency among nurses: A multi-center observational study. Journal of Clinical Nursing, 33(2), 215–224. https://doi.org/10.1111/jocn.17125

Middleton, S., McElduff, P., Ward, J., Grimshaw, J., Dale, S., D’Este, C., Cheung, N.W., Quinn, C., Evans, M., Cadilhac, D., & Levi, C. (2011). Implementation of evidence-based treatment protocols to manage fever, hyperglycemia, and swallowing dysfunction in acute stroke (QASC): A cluster randomized controlled trial. The Lancet, 378(9804), 1699–1706. https://doi.org/10.1016/S0140-6736(11)61485-2

Suppan, M., Stuby, L., Harbarth, S., & Carron, P.N. (2021). Effect of e-learning and video cases on NIHSS knowledge retention among emergency nurses. Stroke, 52(5), e213–e215.

Tu, W.-J., Zhao, Z., Yin, P., Cao, L., Zeng, J., Chen, H., Wang, W., Xu, T., & Wang, L. (2023). Estimated burden of stroke in China in 2020. JAMA Network Open, 6(3), e231455. https://doi.org/10.1001/jamanetworkopen.2023.1455

Wang, L., Zhou, Y., & Chen, X. (2023). Gaps in stroke training and competency among nurses in county-level hospitals in China. Nursing Open, 10(2), 899–908. https://doi.org/10.1002/nop2.1694

World Health Organization. (2023). Cardiovascular Diseases (CVDs): Key facts. World Health Organization. https://tinyurl.com/2nvecueh

Zhang, L., Chen, R.-h., Zhong, X.-m., Xu, M.-y., Sun, Y.-n., & Yao, Q. (2025). Nurses’ knowledge-attitude-practice of the importance of quality control of nursing documents and the influence of intensive training: A study from a tertiary hospital in China. BMC Medical Education, 25, 604. https://doi.org/10.1186/s12909-025-07168-w

Zhao, Y., Chen, Y., & Sun, W. (2024). The effects of a structured stroke training program on Chinese nurses’ assessment accuracy. Journal of Clinical Nursing, 33(1–2), 101–110. https://doi.org/10.1111/jocn.17109

Zhou, M., Wang, H., & Li, Z. (2020). Stroke burden and health system challenges in rural China: A cross-sectional study. BMC Health Services Research, 20(1), 134.