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Hyvärinen S, Jarva E, Mikkonen K, Karsikas E, Koivunen K, Kääriäinen M, Meriläinen M, Jounila-Ilola P, Tuomikoski A, Oikarinen A. Healthcare professionals' experience regarding competencies in specialized and primary stroke units: A qualitative study. JOURNAL OF VASCULAR NURSING 2024; 42:26-34. [PMID: 38555175 DOI: 10.1016/j.jvn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 04/02/2024]
Abstract
AIM To describe healthcare professionals' experience of needed competence in patient stroke care within specialist and primary healthcare. BACKGROUND Healthcare professionals who provide stroke care need multifaceted, multi-professional skills; ongoing training is important for competent stroke care. DESIGN A descriptive qualitative study. METHODS Six focus group interviews with semi-structured interviews were conducted in October and November 2020. Healthcare professionals (n = 25) working in stroke care units in both specialist and primary healthcare settings were interviewed. The interviews were recorded, transcribed and analyzed inductively by content analysis. The study was conducted, and results were reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS Five main categories were identified: clinical competence; multiprofessional networking competence; competence in interaction skills; emotional and psychoeducational support competence; and self-management and development competence. CONCLUSION Competence in stroke care includes both in-depth and wide-ranging professional competences that require ongoing development. Utilizing various education models and collaborative learning approaches can help meet the requirements for developing competence in stroke care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Satu Hyvärinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI- 90014 University of Oulu, Oulu, Finland.
| | - Erika Jarva
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI- 90014 University of Oulu, Oulu, Finland.
| | - Kristina Mikkonen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Eevi Karsikas
- Oulu University Hospital, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | | | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Merja Meriläinen
- Oulu University Hospital, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | | | | | - Anne Oikarinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FI- 90014 University of Oulu, Oulu, Finland.
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Wong AKC, Bayuo J, Wong FKY, Kwok VWY, Tong DWK, Kwong MK, Yuen BMK, Fong CS, Chan ST, Chan RSY, Li WC. Sustaining telecare consultations in nurse-led clinics: Perceptions of stroke patients and advanced practice nurses: A qualitative study. Digit Health 2023; 9:20552076231176163. [PMID: 37214656 PMCID: PMC10192665 DOI: 10.1177/20552076231176163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
Objective The ongoing pandemic has accentuated the use of telecare services; however, only limited progress has been made in understanding the barriers and facilitators to using these services. In order to move towards sustaining such essential services, the present study aimed to ascertain the experiences of stroke survivors and healthcare providers regarding the utilization of a post-stroke telecare service in Hong Kong. Methods Interpretive description was employed for this study. Semi-structured discussions and interviews were undertaken with nine stroke survivors and four stroke nurses who delivered the telecare services. The principles of thematic analysis were inductively followed to analyse the data. The Standards for Reporting Qualitative Research checklist was used to guide the reporting of the data. Results Three themes emerged: (a) pre-existing post-discharge service pathways; (b) push factors/facilitators for telecare usage; and (c) barriers to telecare usage. Overall, the telecare service was considered a significant alternative and one that complements conventional face-to-face follow-ups. Stroke survivors were motivated to use the service because it was convenient and flexible. However, significant barriers exist, including technical issues and a lack of guidelines and training opportunities for healthcare providers. Conclusions Although telecare is still evolving, several factors drive stroke survivors to use the service. Attention needs to be paid to the emerging barriers to improve long-term usage of the service. Clear guidelines are needed to underpin the development and implementation of telecare services.
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Affiliation(s)
| | - Jonathan Bayuo
- School of Nursing, The Hong Kong
Polytechnic University, Hung Hom, Hong Kong
| | | | | | - Danny Wah Kun Tong
- Hospital Authority Head
Office, Hospital Authority Building, Homantin, Hong Kong
| | | | | | | | | | - Rinis Sin Yi Chan
- School of Nursing, The Hong Kong
Polytechnic University, Hung Hom, Hong Kong
| | - Wah Chun Li
- Queen Elizabeth Hospital, Homantin,
Hong Kong
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Saragih ID, Saragih IS, Tarihoran DETAU, Sharma S, Chou FH. A meta-analysis of studies of the effects of case management intervention for stroke survivors across three countries. J Nurs Scholarsh 2023; 55:345-355. [PMID: 36310396 DOI: 10.1111/jnu.12822] [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: 03/18/2022] [Revised: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE A stroke survivor who is discharged to home care faces many challenges during the transition from the hospital to home, including managing their care at home and engaging in rehabilitation and recovery. Case management was developed to ease the transition from hospital to home and help people with stroke cope with their care management challenges. However, the effects of case management intervention remain inconclusive. Case management was designed to direct care and may represent a novel method for reducing the burden of care. This study was designed to evaluate the effects of case management interventions on mental health outcomes, activities of daily living capacity, physical function, and social function among stroke survivors. DESIGN Systematic review and meta-analysis. METHODS This study included studies examining the impacts of case management interventions for stroke survivors that were published in English and identified by searching eight databases, from database inception to February 20, 2022. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to pool effect sizes using a random-effects model (in Stata 16.0). The revised Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the methodological quality of each study. FINDINGS The inclusion criteria were satisfied by eight studies (including a total of 1119 stroke survivors). Case management had positive effects on mental health (SMD: 0.26; 95% CI: 0.07 to 0.45, p = 0.001) and activities of daily living (SMD: 0.68; 95% CI: 00.37 to 0.99, p < 0.001). However, no significant effects were observed for either physical function or social function. CONCLUSION Case management appears to enhance the mental health and activities of daily living among stroke survivors. CLINICAL RELEVANCE Case management interventions hold promise as efficient, cost-effective, and accessible strategies to positively influence care for stroke survivors. This intervention strategy could be applied to the hospital-to-home transition to guide care among this population.
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Affiliation(s)
| | | | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana Jakarta, Indonesia.,School of Nursing Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sapna Sharma
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Topics Mentioned by Stroke Patients during Supportive Phone Calls-Implications for Individualized Aftercare Programs. Healthcare (Basel) 2022; 10:healthcare10122394. [PMID: 36553918 PMCID: PMC9777582 DOI: 10.3390/healthcare10122394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
By understanding stroke as a chronic disease, aftercare becomes increasingly important. For developing aftercare programs, the patients' perspective regarding, for example, stroke-related symptoms and interactions with the healthcare system is necessary. Records from a local stroke pilot program were used to extract relevant topics from the patients' perspective, as mentioned during a phone call two months after hospital discharge. Data from 157 patients with ischemic stroke or transient ischemic attack (TIA) were included. "Rehabilitation" was mentioned by 67.5% of patients, followed by "specialist physician", "symptoms", and "medication". Compared with severely disabled patients, those with no relevant disability at hospital discharge mentioned "symptoms" significantly more often. Regarding rehabilitation, "outpatient care" was mentioned more often by patients in an inpatient setting, and 11.8% without rehabilitation mentioned "depression". Patients in single-compared to multi-person households differed, for example, in the frequency of mentioning "specialist physicians" and gradually "outpatient care". A multivariate model yielded associations between the disability at discharge and the probability of mentioning relevant topics afterward. This study provided insights into the patients' perspective and identified topics that need attention while accompanying stroke and TIA patients after discharge. Further, the degree of disability at discharge might be helpful for planning individual aftercare.
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Wang S, You J, Lin J, Fu X, Ning M, Mo Y, Yang S. Effects of the nurse-led program on disabilities improvement in patients with ischemic stroke. Medicine (Baltimore) 2022; 101:e30652. [PMID: 36123853 PMCID: PMC9478287 DOI: 10.1097/md.0000000000030652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To evaluate whether the nurse-led program can improve disabilities in patients with ischemic stroke for more than 6 months. This is a randomized, open-label study. Participants in the usual-care group received the usual care that included verbal stroke-related education and secondary prevention. Participants in the active group received the usual care plus the nurse-led program intervention. The disability was evaluated using National Institutes of Health Stroke Scale (NIHSS). The Mental Health Inventory-5 (MHI-5) was used to assess mental health status (MHS). The median duration since ischemic stroke was 8.4 and 8.6 months, respectively. At baseline, there was no difference in the median NIHSS value and the NIHSS category between these 2 groups. After 6 months' follow-up, the median NIHSS value was lower in the active group (4.1 vs 6.3). The proportion of patients with NIHSS of 1 to 4 was higher (50.0% vs 28.6%) while the proportion of patients with NIHSS of 5 to 12 (24.1% vs 51.8%) was lower in the active group. After multivariate regression analysis, the nurse-led program was negatively associated with increased NIHSS category (odds ratio of 0.70 and 95% confidence interval of 0.62-0.88). In the group with MHI-5 less than median, the nurse-led program was not associated with NIHSS category. While in the group with MHI-5 greater than median, the nurse-led program was associated decreased NIHSS category, with a significant interaction (P value = .03). In ischemic stroke patients for more than 6 months, the nurse-led program improves disabilities, which might be related to MHS improvement.
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Affiliation(s)
- Suping Wang
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
- *Correspondence: Suping Wang, Department of Nursing, Hainan Geriatric Hospital, Haikou, 571100, Hainan, China (e-mail: )
| | - Jingyan You
- Department of Nursing, Hainan Western Central Hospital, Hainan, China
| | - Jing Lin
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
| | - Xiumei Fu
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
| | - Min Ning
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
| | - Yuzhu Mo
- Department of Nursing, Hainan Western Central Hospital, Hainan, China
| | - Shoujiao Yang
- Department of Nursing, Hainan Western Central Hospital, Hainan, China
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van Diemen T, Verberne DPJ, Koomen PSJ, Bongers-Janssen HMH, van Nes IJW. Interdisciplinary follow-up clinic for people with spinal cord injury: a retrospective study of a carousel model. Spinal Cord Ser Cases 2021; 7:86. [PMID: 34580276 DOI: 10.1038/s41394-021-00451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Explorative retrospective cohort study. OBJECTIVE Secondary health conditions (SHCs) are common in people with spinal cord injury (SCI). To date, little is known about the effectiveness of long-term follow-up care in preventing SHCs. The objective of this study was to explore the therapeutic content of an interdisciplinary follow-up clinic by retrospective analyses of provided recommendations and collected data concerning SHCs. SETTING Rehabilitation center Sint Maartenskliniek, The Netherlands. METHODS All people with SCI, who visited one or more outpatient interdisciplinary follow-up clinics between January 2012 and October 2020 were included in this study. Treatment information was retrieved from their medical records. RESULTS The 264 participants of the follow-up clinic received, after their first visit, an average of 3.9 recommendations regarding SHCs. Most recommendations were preventive in nature (43%), and were related to physical SHCs (61%). Most recommendations were followed by the participants (34% out of 40% that could be determined) and half of the underlying problems were solved (31% out of 62%). The bodyweight and respiratory function remained stable over time. CONCLUSION Participants of the interdisciplinary follow-up clinics received extensive recommendations on a variety of subjects, which most likely, reflects the interdisciplinary approach. Recommendations were followed-up to a large extent, resulting in solving half of the underlying SHCs. This way, worse SHCs were prevented by the recommendations. This findings, together with the stability of respiratory function and bodyweight, suggests the added value of the interdisciplinary follow-up clinic to usual care. More prospective research is necessary to investigate the (cost-)effectiveness.
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Affiliation(s)
- Tijn van Diemen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Daan P J Verberne
- Department of Neurorehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Patrick S J Koomen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Ilse J W van Nes
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
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