INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION

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1 INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION Supporting Interprofessional Education through Shared Learning Opportunities APRIL 2007

2 Interprofessional Learning Objectives for Stroke Care Introduction 2007, Heart and Stroke Foundation of Ontario and Hamilton Health Sciences. All rights reserved. No portion of this resource may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without prior written permission from the Heart and Stroke Foundation of Ontario and Hamilton Health Sciences. Published by: Heart and Stroke Foundation of Ontario 2300 Yonge, Street, Suite 1300 P.O. Box 2414 Toronto, ON M4P 1E4 Tel: ; Fax: This resource was prepared with input from a number of health professionals who have reviewed the information to ensure its suitability. However, the information contained herein is for reference only and should not be relied upon exclusively. The Heart and Stroke Foundation of Ontario and Hamilton Health Sciences and other contributing organizations and health professionals assume no responsibility or liability arising from the reader s failure to become informed about the practice guidelines applicable to their area or profession. In addition, the Heart and Stroke Foundation of Ontario and Hamilton Health Sciences assume no responsibility or liability arising from any error in or omission from this publication or from the use of any information or advice contained in this publication. No endorsement of any product or service is implied if other agencies or persons distribute this material. Funding for the development of this Guide was provided by the Ministry of Health and Long-Term Care and the Heart and Stroke Foundation of Ontario. The development and pilot testing phases of the project were completed by the Regional Stroke Program of Hamilton Health Sciences, in Central South Ontario. Interprofessional Learning Objectives for Stroke Care Introduction,

3 Why would the Interprofessional Learning Objectives for Stroke Care be of interest to you? If you are a registered health professional working with stroke survivors who wishes to identify what knowledge, skills, attitudes, and values are important to the provision of best practice stroke care OR If you are interested in identifying learning areas of interest/priority that may inform a professional development learning plan or interprofessional team learning activity If you are an educator with interest and/or responsibility for providing continuing education for staff who work with stroke survivors OR OR If you are a manager of health care services that provide care to stroke survivors and support continuing education and interprofessional education in your program you may find the Interprofessional Learning Objectives for Stroke Care Tools essential to guiding your personal learning and continuing education activities. The objectives of the Interprofessional Learning Objectives for Stroke Care resource are to: Give healthcare professionals working with stroke survivors a framework for learning. Establish guidelines for knowledge and skill development related to stroke care for all eight regulated health professionals. Form the foundation for learning plans for ongoing individual professional development. Support self-directed learning. Support interprofessional education and collaborative practice through shared learning opportunities. Support knowledge translation and the integration of best available evidence into practice. Interprofessional Learning Objectives for Stroke Care Introduction,

4 A number of tools have been developed to assist individual practitioners and clinical teams, educators and managers with using the Interprofessional Learning Objectives for Stroke Care. For more information on the development of the learning objectives, the process undertaken, evaluation findings and recommendations, see the Interprofessional Learning Objectives for Stroke Care Report. The tools include: Shared Learning Objectives Discipline-Specific Learning Objectives Self-Evaluation Tool: an assessment tool to help users gauge their progress in each learning area. Learning Plan Template: a tool for tracking/monitoring CE activities and informing managers of educational goals. PowerPoint Presentation: provides an overview of the project, the Learning Objectives, and recommendations for use based on the pilot experience. Intended to assist educators or identified facilitators with introducing the resource to clinical teams and key stakeholders. All of these tools are available at SECTION 1: INTRODUCTION The Interprofessional Learning Objectives for Stroke Care are learning objectives related to stroke across 16 key learning areas and relevant to eight regulated health disciplines. The Shared Learning Objectives identify the knowledge, skills and values that are important to all health professionals who provide care to stroke survivors in various settings across the continuum of care, regardless of discipline. The Discipline-Specific Learning Objectives identify the knowledge, skills and values that are important for each of the health professions. The eight professional groups include: nursing, physiotherapy, occupational therapy, social work, speech-language pathology, registered dietetics, registered respiratory care and pharmacy. Interprofessional Learning Objectives for Stroke Care Introduction,

5 The shared and discipline-specific learning objectives were developed across 16 Learning Areas related to stroke care: Principles of Stroke Care Anatomy and Physiology of Stroke Cardiovascular and Respiratory Effects Psychosocial Effects Communication Independence in Mobility and Prevention of Complications of Immobility Routine Activities of Daily Living Instrumental Activities of Daily Living Cognitive, Perceptual and Behavioural Changes Following Stroke Sexuality Nutrition Dysphagia Skin Care Continence Management Primary and Secondary Stroke Prevention Transition Management SECTION 2: SHARED LEARNING OBJECTIVES FOR STROKE CARE Shared learning objectives for stroke care are core learning objectives that are intended to articulate the knowledge, skills and value base that is important to all health professionals working with stroke survivors across the continuum, regardless of discipline. These shared learning objectives form the foundation for the development of discipline-specific learning objectives for regulated health professionals. This section provides a description of each of the 16 learning areas related to stroke care as outlined above. See Shared Learning Objectives for Self-Evaluation Tool to review the specific shared learning objectives. Learning Area 1: Principles of Stroke Care Rehabilitation defined: impairment, activity and participation Enablement: principles and practice Client -centered care: principles and practice, setting client-centered goals Evidence-based practice Interdisciplinary team models Cultural competency Interprofessional Learning Objectives for Stroke Care Introduction,

6 Learning Area 2: Anatomy and Physiology of Stroke What is stroke Assessment and diagnostics How stroke affects the body: functions controlled by the brain Common effects of stroke Basics of medical management: medications, co-morbidities (e.g., hypertension, diabetes) Learning Area 3: Cardiovascular and Respiratory Effects Impact of stroke on cardiac and respiratory systems Cardiac conditioning Airway management Learning Area 4: Psychosocial Effects Initial reaction Common emotions experienced post-stroke Psychosocial issues faced by the stroke survivor and his/her caregiver Caregiver coping Depression and emotional changes post-stroke Social support programs (e.g., funding, caregiver relief) Learning Area 5: Communication Specific communication impairments: speech (apraxia, dysarthria), language (aphasia), social interaction impairments, cognitive-communication deficits Communicating with a stroke survivor Essential characteristics of successful communication partners Post-stroke problems that make communication difficult Communication strategies (e.g., alternative/ augmentative strategies to enhance communication ability) Learning Area 6: Independence in Mobility and Prevention of Complications of Immobility Positioning Handling Moving the stroke survivor Functional mobility: transfers, wheelchair, bed, stairs Adaptive devices Interprofessional Learning Objectives for Stroke Care Introduction,

7 Learning Area 7: Routine Activities of Daily Living Grooming: set up, physical guidance, encouraging use of the affected limb, cueing, encouraging effort Bathing: assistive devices, set up, transfers Dressing: positioning, set up, cueing and guiding, adaptive devices and clothing Toileting: using a commode, assistive devices Feeding and eating: positioning and assistive devices Environmental assessment/adaptations Learning Area 8: Instrumental Activities of Daily Living Financial management, banking Shopping Household management Meal preparation Medication management Driving, community mobility, reintegration Returning to work or leisure activities Environmental assessment/adaptation Learning Area 9: Cognitive, Perceptual and Behavioural Changes Following Stroke Cognition defined Attention and concentration impairments Memory impairment Executive functioning impairments Impulsivity Impaired insight and judgment: what you can do to help Perseveration, inability to sequence and impaired problem-solving ability Apraxia Visual/perceptual problems: time awareness, visual and auditory neglect, body neglect, body processing, body scheme neglect and apraxia Vision problems Changes in personality Loss of emotional control, withdrawal, aggression, amotivation, frustration, social judgment, confusion, disinhibition, uncooperative behaviour Safety issues Learning Area 10: Sexuality Sexuality defined Changes in sexuality and relationships post stroke Interprofessional Learning Objectives for Stroke Care Introduction,

8 Sensitivity to allow discussion of issues related to sexuality Learning Area 11: Nutrition Reducing the risk of dehydration and malnutrition after stroke Alternative feeding methods Therapeutic diet Learning Area 12: Dysphagia Dysphagia: defined Feeding strategies: proper positioning of the stroke survivor Reducing the risk of aspiration Dysphagia diet The importance of dental/oral hygiene Education regarding risks and dysphagia management Learning Area 13: Skin Care Risks of skin breakdown Preventing skin breakdown Learning Area 14: Continence Management Normal bladder/bowel function and age-related changes that affect continence Continence problems Symptoms of bladder/bowel dysfunction Incontinence due to cognitive, language and mobility problems Psychosocial reaction to incontinence Bladder retraining/bowel management Reducing the risk of urinary tract infections Learning Area 15: Primary and Secondary Stroke Prevention Primary stroke prevention Secondary stroke prevention Five main warning signs of stroke Transient ischemic attacks Risk factors for stroke Lifestyle modification to prevent stroke: healthy eating, smoking cessation, exercise Learning Area 16: Transition Management Transition management Stroke survivor care needs and the discharge planning process Interprofessional Learning Objectives for Stroke Care Introduction,

9 Facilitating effective transitions along the continuum of care Community services SECTION 3: DISCIPLINE-SPECIFIC LEARNING OBJECTIVES FOR STROKE CARE Discipline-specific learning objectives were developed for 16 learning areas that are important for eight regulated health professions working with stroke survivors across the continuum. The professions, in alphabetical order, are: Nursing Occupational Therapy Pharmacy Physiotherapy Registered Dietetics Respiratory Therapy Social Work Speech-Language Pathology Table 1 presents an overview of the interdisciplinary learning objectives for stroke care by each of these regulated professions. See Discipline Specific Self-Evaluation Tools to review the discipline specific learning objectives. Interprofessional Learning Objectives for Stroke Care Introduction,

10 Table 1: Overview of Interprofessional Learning Objectives for Stroke Care by Regulated Profession Learning Area Nursing Occupational Therapy Pharmac y Registered Dietetics Respiratory Therapy Social Work 1. Principles of Stroke Care No No No No No No No No 2. Anatomy and Physiology of Yes Yes Yes Yes Yes Yes No Yes Stroke 3. Cardiovascular and Respiratory Yes Yes Yes Yes Yes Yes No Yes Effects 4. Psychosocial Effects Yes Yes Yes Yes Yes Yes Yes Yes 5. Communication Yes Yes Yes Yes Yes Yes Yes Yes 6. Independence in Mobility and Prevention of Complications of Immobility 7. Routine Activities of Daily Living 8. Instrumental Activities of Daily Living Yes Yes No Yes No No No Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes Yes Yes No Yes Yes 9. Cognitive, Perceptual and Yes Yes Yes Yes Yes Yes Yes Yes Behavioural Changes Following Stroke 10. Sexuality Yes Yes Yes Yes No Yes Yes Yes 11. Nutrition Yes Yes No Yes Yes No Yes Yes 12. Dysphagia Yes Yes Yes Yes Yes No Yes Yes 13. Skin Care Yes Yes Yes Yes Yes No No Yes 14. Continence Management Yes Yes Yes Yes Yes No Yes No 15. Primary and Secondary Stroke Yes Yes Yes Yes Yes Yes No No Prevention 16. Transition Management Yes Yes Yes Yes Yes Yes Yes Yes Physiotherapy Speech- Language Pathology Interprofessional Learning Objectives for Stroke Care Introduction,

11 SECTION 4: TOOLS Self-Evaluation Tool The Self-Evaluation Tool incorporates all of the learning objectives across the 16 learning areas into one document. There is a modifiable Self-Evaluation Tool for the Shared Learning Objectives and one for each discipline for the Discipline-Specific Objectives. Individuals or groups may print only the learning areas of interest to simplify the process and time to complete. The tool is available at and can be modified. The Learning Plan Template The results of the self-evaluation will enable professionals to identify their learning needs and incorporate these into a learning plan. Using this learning plan, individual professionals can regularly review their learning activities and progress. This can be done in collaboration with an expert resource person, such as a mentor/preceptor, educator, or clinical lead where possible. Learning Plans may be incorporated into established evaluation activities, for example, linked with professional college requirements, peer mentoring activities and organizational learning evaluation processes. The Learning Plan Template is available at Interprofessional Learning Objectives for Stroke Care Introduction,

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