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Lin S, Xie S, Zhou J, Tu Q, Wang C, Chen L. Stroke survivors', caregivers' and nurse coaches' perspectives on health coaching program towards hospital-to-home transition care: A qualitative descriptive process evaluation. J Clin Nurs 2023; 32:6533-6544. [PMID: 36424709 DOI: 10.1111/jocn.16590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 08/19/2023]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of stroke survivors, caregivers and nurse coaches on a health coaching program during hospital-to-home transitional care. BACKGROUND Stroke is a major public health problem that seriously affects the health and safety of people in China. Nurse-led health coaching is a promising support option in enabling smooth hospital-to-home transition for stroke survivors and family caregivers. A qualitative study is valuable for gaining insight into their perspectives on using this program. DESIGN An exploratory, descriptive qualitative process evaluation was conducted parallel with a former randomised controlled trial. Data were obtained from 26 stroke survivors, 33 caregivers and four nurse coaches with semi-structured interviews. The inductive reflexive thematic analysis approach was used for data analysis. The COREQ checklist was followed in reporting this study. RESULTS Seven themes were generated from the data: (1) the applicability of individualised health coaching sessions, (2) driving self-efficacy to establish self-care skills, (3) the key role of nurse coaches, (4) coordination among healthcare teams during the transition, (5) adequate community and social support, (6) insufficient rehabilitative services after discharge and (7) perceived extra workload for nurse coaches. CONCLUSIONS The study captured perspectives on a nurse-led health coaching program towards hospital-to-home transition care from stroke survivors, caregivers and nurse coaches. Individualised health coaching sessions and driving self-efficacy were perceived as facilitators for empowering the self-care skills of stroke survivors and caregivers. The key role of nurse coaches in coordinating healthcare teams and adequate community and social support were detected as the power frame of the program's implementation. However, health system obstacles, such as insufficient rehabilitative services and the high workload of nurses, still need to be addressed to ensure the sustainability of health coaching intervention in transitional care. RELEVANCE TO CLINICAL PRACTICE The study suggested the feasibility of implementing nurse-led health coaching to smooth post-stroke hospital-to-home transitional care. The findings also highlighted the importance of qualitative process evaluation when implementing evidence-based interventions in health care. TRIAL REGISTRATION The trial was registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12619000321145).
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Affiliation(s)
- Shuanglan Lin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shiqi Xie
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Jianrong Zhou
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Qiang Tu
- Faculty of Medicine and Health, Sydney University, Camperdown, New South Wales, Australia
| | - Chunli Wang
- The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Liping Chen
- Nursing College of Chongqing Medical University, Chongqing, China
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Vandewalle L, Duchi F, Verhelle K, Vanacker P. Suboptimal lipid management in patients with acute ischemic stroke. Clin Neurol Neurosurg 2023; 229:107717. [PMID: 37079961 DOI: 10.1016/j.clineuro.2023.107717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Lipid-lowering drugs are among the most widely used drugs in cardiovascular prevention. Statins are often abandoned due to side effects, or under dosed, leading to unreached LDL-cholesterol goals and increased occurrence of cardiovascular events. METHODS We included hospitalized patients with an ischemic stroke or transient ischemic attack. Of 92 patients, low density lipoprotein cholesterol (LDL-C) levels and lipid lowering therapy at admission and discharge were assessed. Based on their cardiovascular risk before the current event according to the most recent European guidelines, LDL-C targets were determined. Low, moderate, high and very high risk corresponded with LDL-C targets below 116, 100, 70 and 55 mg/dL respectively. RESULTS Before current event, 59 (64%) were very high, 21 (23%) high, 11 (12%) moderate and 1 low risk patients and eight patients were treated with low, 23 moderate, and 21 high intensity lipid-lowering therapy. Upon admission, 75 patients had insufficiently managed LDL-cholesterol levels, yet 39 of them were taking lipid lowering therapy. Only eight of the 21 patients on high intensity lipid lowering therapy reached their LDL-C target. During hospitalization 40 patients were switched to a high-intensity statin. Thirty-three patients switched from no treatment or a lower-intensity to a moderate-intensity lipid lowering therapy. Three were dismissed with low-intensity lipid lowering therapy, and five in association with Ezetimibe. Three patients had documented statin-intolerance. CONCLUSION In this study, LDL-cholesterol was insufficiently managed according to international guidelines for prevention of ischemic stroke. Further optimization of lipid management in primary and secondary prevention and the use of higher intensity lipid lowering therapy in clinical practice is mandatory.
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Affiliation(s)
- L Vandewalle
- Department of Neurology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium; Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Neurosciences, Experimental neurology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - F Duchi
- Department of Clinical Pharmacy, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - K Verhelle
- Department of Clinical Pharmacy, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - P Vanacker
- Department of Neurology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium; Research Group on Translational Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Antwerp University Hospital, Neurovascular Reference Center, Department of Neurology, Drie Eikenstraat 655, 2650 Edegem, Belgium.
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Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, Packer TL, Lofters AK, Hahn-Goldberg S, McCarthy LM, Guilcher SJT. Medication self-management interventions for persons with stroke: A scoping review. PLoS One 2023; 18:e0285483. [PMID: 37200316 DOI: 10.1371/journal.pone.0285483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported in the literature on interventions related to medication self-management for adults (aged 18+) with stroke. Electronic databases (Ovid Medline, Ovid Embase, EBSCO CINAHL, Ovid PsycINFO, Web of Science) and grey literature were searched to identify relevant articles. For inclusion, articles were required to include an adult population with stroke undergoing an intervention aimed at modifying or improving medication management that incorporated a component of self-management. Two independent reviewers screened the articles for inclusion. Data were extracted and summarized using descriptive content analysis. Of the 56 articles that met the inclusion criteria, the focus of most interventions was on improvement of secondary stroke prevention through risk factor management and lifestyle modifications. The majority of studies included medication self-management as a component of a broader intervention. Most interventions used both face-to-face interactions and technology for delivery. Behavioural outcomes, specifically medication adherence, were the most commonly targeted outcomes across the interventions. However, the majority of interventions did not specifically or holistically target medication self-management. There is an opportunity to better support medication self-management post-stroke by ensuring interventions are delivered across sectors or in the community, developing an understanding of the optimal frequency and duration of delivery, and qualitatively exploring experiences with the interventions to ensure ongoing improvement.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- University of Waterloo School of Pharmacy, Kitchener, ON, Canada
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya L Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- OpenLab, University Health Network, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Kusumaningrum NSD, Asmara FY, Nurmalia D. Healthcare professionals' opinions regarding health coaching for patients with diabetes: A pilot exploration in Indonesia. BELITUNG NURSING JOURNAL 2022; 8:67-74. [PMID: 37521073 PMCID: PMC10386796 DOI: 10.33546/bnj.1970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/12/2021] [Accepted: 01/21/2022] [Indexed: 08/01/2023] Open
Abstract
Background Diabetes management is applied for the entire patients' lives, so it requires lifelong sustainable self-management actions to have a positive impact. Integrated care as coaching intervention is considered a program that facilitates and supports patients in managing diabetes more effectively and optimally. However, there are limited studies regarding this program in Indonesia. Objective This study aimed to explore the opinions of healthcare professionals concerning the importance of health coaching for patients with diabetes in Indonesia. Methods An invitation letter via email was distributed individually to participants from the three provinces of Java, Indonesia, between June and August 2020. The open-ended questions that consist of two sections were developed to explore the matter related to health coaching for patients with diabetes. A descriptive analysis of the participants' answers was used to explain the data comprehensively and accurately reveal the complete information. Results A total of seven healthcare professionals from four professions participated in the study. Based on healthcare professionals' opinions, this study revealed that the most common reason health coaching needs to be implemented is related to self-management in dealing with diabetes. Health coaching as a tailored-intervention strategy in diabetes self-management requires a multidisciplinary approach and considers the local wisdom to achieve the expected goals in all aspects of patients' lives. Thus, health coaching as an integral part of diabetes self-management is considered an appropriate program to cope with this problem. Conclusion Health coaching for patients with diabetes is useful and reasonable to implement among patients with appropriate strategies, especially in Indonesia and beyond.
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Affiliation(s)
| | - Fatikhu Yatuni Asmara
- Maternity and Pediatric Division, Department of Nursing, Faculty of Medicine, Diponegoro University, Indonesia
| | - Devi Nurmalia
- Fundamental Nursing Division, Department of Nursing, Faculty of Medicine, Diponegoro University, Indonesia
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Kamoen O, Maqueda V, Yperzeele L, Pottel H, Cras P, Vanhooren G, Vanacker P. Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke. Acta Neurol Belg 2020; 120:91-97. [PMID: 31701472 DOI: 10.1007/s13760-019-01218-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/09/2019] [Indexed: 12/22/2022]
Abstract
Despite recent advances in acute stroke care, the risk of recurrent stroke remains high. On behalf of the Belgian Stroke Council (BSC), a nurse-led self-management program was developed, using a personal coach and digital platform with the aim of improving cardiovascular risk factor control in patients after ischemic stroke. The program was implemented in four Belgian hospitals. The stroke coach provided one educational session during hospitalization. After discharge, the patient received tips and tricks concerning a healthy lifestyle through the customized platform. The stroke coach set up video appointments through the platform at regular intervals. Primary endpoint of our study was the change in SCORE (Systematic COronary Risk Evaluation: High and Low cardiovascular Risk Charts) risk at baseline and 6 months compared with a historical control group who received standard care. A total of 147 patients were included for a follow-up period of 6 months. The mean SCORE in the intervention group showed a statistically significant reduction of 3.2 (p < 0.001) at 6 months. However, comparison between control and intervention groups was non-significant (p = 0.55). Secondary endpoints are promising with a medication adherence of 96%. Reported quality of life also improved (p < 0.001). No significant improvement in the modified Rankin scale (mRS) was observed (p = 0.720). Five percent of patients suffered a recurrent stroke. Our project consisting of a coached lifestyle intervention and digital platform shows promise in improving stroke recurrence rates, therapeutic adherence and quality of life in a Belgian healthcare setting.
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Affiliation(s)
- Olivia Kamoen
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium.
| | - V Maqueda
- Department of Neurology, Sint-Lucas Hospital, Brugge, Belgium
| | - L Yperzeele
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Born Bunge Institute, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - H Pottel
- Public Health and Primary Care, KU Leuven Kulak, Kortrijk, Belgium
| | - P Cras
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Born Bunge Institute, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - G Vanhooren
- Department of Neurology, Sint-Jan Hospital, Brugge, Belgium
| | - P Vanacker
- Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Department of Neurology, Groeninge Hospital, Kortrijk, Belgium
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Hariawan H, Soedirham O, Bakar A. The Individual Coaching Improves Spiritually Muslim Patients Hospitalized. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i1.8568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Inpatients who are attached in intravenous devices tend to experience physical discomfort. This condition can lead to the decrease in performing Salat as a Muslim prayer. The purpose of this study was to determine the effect of individual coaching on knowledge, attitude, and practice of Salat among Muslim inpatient. This study used quasi-experimental design.Mehods: The samples were 36 Muslim inpatients. The data were collected by self-constructed questionnaire and analyzed by using Independent t-test and Mann Whitney test with α ≤ 0.05.Results: Before giving intervention, the means of pretest score in both groups were 14.33+2.17 and 14.39+2.28 for knowledge, 26.17+2.31 and 26.50+3.17 for attitude, and 10.00+2.91 and 10.50+3.45 for practice. There was no significant difference scores of knowledge (p=0.941), attitude (p=0.924), and practice (p=0.635) between two groups before giving intervention. However, after giving intervention, these scores have changed to 19.00+1.72 and 14.89+2.29 for knowledge, 26.97+2.25 and 26.61+2.81 for attitude, 15.33+3.80 and 10.50+3.45 for practice and there was higher significance scores of knowledge (p=0.000), attitude (p=0.003), and practice (p=0.000) after giving intervention.Conclusions: Coaching is the suitable method to increase Muslim inpatients knowledge, attitude, and ability to practice Salat. This study recommends the nurse to do coaching as a nursing intervention in helping patient to perform Salat
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Olson DM, Juengst SB. The Hospital to Home Transition Following Acute Stroke. Nurs Clin North Am 2019; 54:385-397. [DOI: 10.1016/j.cnur.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Efficacy and Usability of eHealth Technologies in Stroke Survivors for Prevention of a New Stroke and Improvement of Self-Management: Phase III Randomized Control Trial. Methods Protoc 2019; 2:mps2020050. [PMID: 31200541 PMCID: PMC6632173 DOI: 10.3390/mps2020050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of severe and long-term disability in developed countries. Around 15 million people suffer a stroke each year, being most of them ischemic due to modifiable risk factors. Adequate self-management abilities may help to manage the consequences of stroke, but it is unknown which specific intervention could be effective to booster these self-management abilities. OBJECTIVE To evaluate the improvement of self-management in chronic stroke survivors using decision support and self-management system (STARR). METHODS A randomized, prospective, parallel group, open, and the unicentric pilot trial will be performed. Stroke survivors and their caregivers will be randomly allocated to STARR management or standard of care. Main inclusion criteria are mild to moderate disabled first stroke adult survivor, living at home, able to cope and follow the guidelines and devices, without socio-familial exclusion. All will get a conventional treatment in the acute and subacute phase; however, in the chronic period, cases will use the developed STARR App and Decision Support System. Measurements will be performed at baseline, at 3 months, and at 6 months. Outcome measures are patient-report outcome measure of self-management competency, physical function, risk factor reduction, healthcare resource utilization, knowledge of the condition, mood, and social isolation. DISCUSSION If effective, the results of this study will enable stroke patients and their caregivers to deal better with the everyday life obstacles of stroke, improve the adherence of the treatment, improve the control of cardiovascular risk, and, in consequence, reduce the recurrence of secondary strokes, the number of complications, the number of consultations, and readmissions; to ultimately reduce the health systems costs. Taking into consideration that the number of stroke survivors is increasing around the world, a large number of individuals could profit from this intervention.
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Yun D, Choi J. Person-centered rehabilitation care and outcomes: A systematic literature review. Int J Nurs Stud 2019; 93:74-83. [DOI: 10.1016/j.ijnurstu.2019.02.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/15/2022]
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