Development of a Simulation-Based Educational Intervention to Improve Nursing Competencies for Stroke Care in Southwestern Uganda

Abstract

Stroke is one of the leading causes of disability worldwide, and its prevalence is increasing in low- and middle-income countries (LMIC) like Uganda, presenting nursing care challenges. Simulation-based learning has been used successfully to train nurses in general care in LMIC but has not been applied to training for stroke care. In this study, we aimed to develop a simulation based stroke care education intervention for nurses involved in care for patients with stroke at a large hospital in southwestern Uganda. Methods: Between February 2024 and March 2025, we used the iterative design to develop an educational intervention for stroke care. We engaged stroke care content experts through in-depth qualitative interviews (n=14), generated content, and developed the first version of the intervention. Transcripts were derived, reviewed and coded to generate themes and categories using inductive content analytic approach. We then tested, analyzed and refined the intervention through three repetitive exposures of the intervention to final year Bachelor of Nursing students (n=20), with improvements after every exposure. That were grouped in teams of 5 students. Results: Qualitative data from content experts revealed three thematic areas of patient care including admission of a stroke patient, care for a stroke patient during their hospital stay and discharge of a stroke patient as key content for consideration during intervention development. This content was integrated into the “Uganda Simulation-Based Nursing Stroke Care intervention”. Post-exposure qualitative interviews with final year Bachelor of Nursing students revealed great satisfaction with the intervention, improved preparedness and ease to assess stroke patients. There were also high teamwork scores and improved clinical skills. To maintain efficiency with stroke care competencies, they preferred at least three exposures to the intervention per year. Conclusion: With diverse stakeholders, we used an iterative approach to develop a context specific, simulation-based stroke educational intervention. Future work will examine the feasibility, acceptability, and effectiveness of this intervention among nurses working with stroke patients and its effect on the patient outcomes