Stroke is a leading cause of death and disability in older adults in the United States. Stroke survivors are often discharged from the hospital with complicated medication regimens and health conditions. This can lead to an unplanned hospital readmission post-discharge if patients and their caregivers are unable to manage this complex medical condition. Readmission within 30-days of discharge can result in increased disability, mortality, and increased healthcare costs. Healthcare providers are challenged with identifying patients at risk for unplanned readmission (UPR) and ways to improve discharge practices and patient outcomes. As educators, nurses play in important role in providing resources to stroke survivors and caregivers to understand and manage their new diagnosis and prevent UPRs.

The dissertation explored ways to improve current discharge practices in effort to improve stroke survivor outcomes and reduce UPRs. A state of the science paper explored how caregiver burden affects UPRs and interventions to reduce this burden and prevent readmissions. Subsequently, a need to identify causes for readmission and those at risk was explored in a paper using the readily available Get with the Guidelines®- Stroke registry elements. Results led to the development of an individualized, theory-based, educational intervention study focused on improving patient self-efficacy for medication regimen adherence and decreasing the incidence of UPRs. Although the small sample size did not produce statistically significant results, findings suggests that individualized medication adherence education can improve self-efficacy for medication adherence, actual medication adherence, and the incidence of UPRs warranting future studies.

Date of publication

Fall 12-14-2020

Document Type

Dissertation (Local Only Access)



Persistent identifier


Committee members

Beth Mastel-Smith, PhD; Barbara Haas, PhD; Osama A. Shoair, PhD


PhD- Nursing