Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Carol Thompson

Clinical Mentor

Dr. Nicholas Welker

Committee Member

Dr. Jennifer Dent


PURPOSE: The purpose of this Quasi-experimental study was to examine the effect of a simulation-based educational NIHSS workshop on nursing accuracy and inter-rater reliability upon use of the National Institutes of Health Stroke Scale (NIHSS).

METHODS: This study was conducted in the Neurological/Neurosurgical Intensive Care Unit (ICU) at Baptist Health, a comprehensive stroke center located in Lexington, KY. The sample included 26 eligible nurses employed in the aforesaid unit. Nurses completed the NIHSS on a patient actor in a simulated scenario (this session was videotaped), a one-on-one debriefing with review of the videotape was conducted afterward, and then the nurse completed the NIHSS on a patient actor in a second scenario.

RESULTS: Four participants scored the patient correctly in scenario one, and nineteen participants scored the patient correctly in scenario two. However, the results were not deemed statistically significant (P=.287, Fisher’s Exact Test). Variability of scoring did improve from scenario 1 to scenario 2 (SD=1.74 and 0.53, respectively). Inter-rater reliability among participants was also shown to increase in scenario 2, with noted differences in five items on the NIHSS.

CONCLUSION: NIHSS simulation-based education was shown to improve accuracy of scoring (SD=1.74 pre-intervention and SD=0.53 post-intervention) and inter-rater reliability (significant results seen in five distinct scale items) of participants. More research is needed to determine if simulation-based NIHSS education has an effect on patient outcomes.