Stroke: Screening results challenge stereotypes

Nurse shares tips for getting management to approve screening

Bonnie Nevels, a registered nurse and occupational health nursing administrator for the U.S. Postal Service in Oklahoma City, OK, thought she knew which of her employees would be at risk for stroke — that is, until she implemented a screening program for the shift workers at her site.

"The results were not what we expected," says Nevels, BScN, RN, who organized the screening with another nurse who specializes in community education.

The American Stroke Association, a division of the American Heart Association, warns that strokes are becoming more common in people younger than 65. But Nevels assumed that in the population of shift workers at her Oklahoma City location would be lower risk — mostly young, healthy, and engaged in physical activity rather than sedentary desk jobs.

"I learned a lot myself," says Nevels, who explained that many in her apparently healthy employee population found they had work to do to bring their blood pressure, cholesterol, and triglyceride levels within safe parameters.

Selling the idea of screening

Nevels also learned a lot about selling a stroke screening program to management and to employees.

"The challenge is finding an avenue to bring your educational materials to the workers, get the screening done at little or no costs, and keep your product line going [so that production is not interrupted by the screening]," she explains. "So how do you sell it to management? You make it personal. You have to tell them, 'Stroke does not discriminate. It happens to people as young as 44, so it could be you.'"

And, she adds, pointing out that if one person's life or health is saved by being screened for stroke risk, "that's huge."

She advises occupational health nurses to look for ways to introduce the idea within the framework of information networks already in place.

"I knew our managers have to do service talks [to employees] once a month, and I said, 'Hey, this can serve as one of them,' and the managers were delighted to let me come in and talk about stroke," she says. "The service talks are only 10 minutes, so I had to be creative and make them interested. So we gave away things — people will always show up if you are giving things away — and then we delivered the information, making it as personal as possible."

She says she asked employees if they knew or were related to anyone who'd suffered a stroke, then explained how screenings could prevent them from having strokes. She concluded by telling them they'd have to come back at another time for the screenings.

"I told them that if they had an interest, we'd come back, do a blood pressure and cholesterol test, and take a family history," she explains. "Then, they'd get a one-on-one interview to discuss the results with a nurse."

She stresses that she emphasized to the employees that their one-on-one would NOT be with her.

"They would not want to talk with me [as their company nurse] if they had a 500 cholesterol level," she points out. So she contacted a local nursing school and got volunteers to come do the fingersticks and tests, and to discuss the results. She advised the nursing students on what to say when some results were particularly serious, but did not herself talk to the employees about their results.

Employees whose results were worrisome were advised to see their physicians, and counseled on diet and exercise.

"We had one manager who we really believe averted, if not death, then a life-altering event," she says. He was found to be hypertensive and have high cholesterol and triglyceride levels. The screening results led to a fitness program that, six months later, had lowered his blood pressure, cholesterol and triglyceride levels, and his weight by 20 pounds.

Stereotypes challenged

Nevels says before she saw the results of the screenings in her shift workers, she assumed that the night shift would be less healthy because night workers tend to eat more vending machine food; that daytime employees would be healthier because they had more healthy food choices; and that, overall, the shift workers would be healthier than managers because they are on their feet and performing physically.

"All that went out the window," she says. Night shift, she concludes, is not a higher risk population because they are busier than the day shift, apparently counteracting the vending machine food theory. And the 40- to 50-year-olds were at higher levels of risk than she'd anticipated for such an active group.

"It didn't have anything to do with eating out at restaurants during the day versus eating out of vending machines at night," she says.

Employees in general "had an 'Oh my God' reaction to what they learned," says Nevels. "We asked management if we'd disturbed their product line, and they said we had not, so they were happy."

Changes that resulted include that the plant changed its policy on calling 911. Previously, if an employee went down, coworkers were required to notify a manager before calling 911. Now, with employees educated as to the signs of stroke (see box on warning signs below), if an employee shows signs of stroke, his or her coworkers can use the closest available phone to call 911 before finding a manager.

Warning signs of stroke

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause
  • Source: American Stroke Association

    "Time is brain," says Nevels, quoting the Stroke Association's mantra.

    Nevels says her experience with screening is that it took on average 10 minutes per employee, including the one-on-one consultation.

    "My advice to occupational health nurses is to outsource it as much as possible, and stay cheap by going to a college of nursing for help," she adds.

    Bonnie R. Nevels, BScN, RN, OHN Administrator, United States Postal Service, 3030 NW Expressway, Ste 1042, Medical Unit, Oklahoma City, OK 73198 Phone: (405) 553-6183.