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Bourne G, Das D, Jacobson JO, Sadeghi N. Risk of Knowledge Gaps Among Nononcologists Caring for Patients With Cancer: The Example of Immune Checkpoint Inhibitors. JCO Oncol Pract 2024:OP2400252. [PMID: 38913960 DOI: 10.1200/op.24.00252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/14/2024] [Accepted: 05/10/2024] [Indexed: 06/26/2024] Open
Affiliation(s)
- Garrett Bourne
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Devika Das
- The University of Alabama at Birmingham, Birmingham, Alabama
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Fowler K, Mayock P, Byrne E, Bennett K, Sexton E. "Coming home was a disaster, I didn't know what was going to happen": a qualitative study of survivors' and family members' experiences of navigating care post-stroke. Disabil Rehabil 2024:1-13. [PMID: 38265039 DOI: 10.1080/09638288.2024.2303368] [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: 07/01/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. METHODS In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. RESULTS The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. CONCLUSION Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors.
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Affiliation(s)
- Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Cottrell K, Chapman HM. Acquired brain injury (ABI) survivors' experience of occupation and activity during their inpatient stay: a scoping review. Disabil Rehabil 2023:1-25. [PMID: 37982380 DOI: 10.1080/09638288.2023.2281601] [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: 05/17/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE This review aimed to characterise and map: (1) what type of evidence and what dominant study characteristics are available regarding acquired brain injury (ABI) survivors' experience of occupation and activity in hospital? (2) How are occupation and activity conceptualised in the literature? (3) How are ABI survivors experiencing occupation and activity while in hospital? (4) What factors create barriers or opportunities for engagement in occupations or activity in hospital? (5) Are there any knowledge gaps identified? MATERIALS AND METHODS A scoping review was conducted examining literature published between 2017 and 2022. Relevant studies were systematically retrieved from electronic databases. RESULTS Thirty-four publications were included. There were more quantitative studies (n = 18). Much of the research has been conducted outside of the UK. The populations studied were principally stroke (n = 22). The concept of activity rather than occupation predominates. Patients spend their time alone and inactive. Structural and contextual barriers for engaging in activity are identified. Qualitative study designs exclude ABI survivors with communication or cognitive impairment. CONCLUSIONS There is a paucity of research with ABI survivors in hospitals in the UK. Alternative methodological approaches such as ethnography would ensure those with communication or cognitive impairment are not excluded from research. Implications for rehabilitationRehabilitation professionals, especially occupational therapists, need to lead acquired brain injury (ABI) research in acute hospital settings in the UK.Conceptualisation of meaningful activity and occupation needs a clearer focus in ABI research.Qualitative studies frequently exclude participants with cognitive or communication impairments so methodologies that are more inclusive and representative of brain injury survivors are needed.
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Affiliation(s)
| | - Hazel M Chapman
- Faculty of Health, Medicine and Society, University of Chester, Chester, UK
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Atama T, Leclair L, Pooyania S, Barclay R. Stroke Survivors and their Physiotherapists' Perceptions of Recovery: A Multiple Methods Approach. Physiother Can 2023; 75:377-386. [PMID: 38037584 PMCID: PMC10686302 DOI: 10.3138/ptc-2021-0068] [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: 07/01/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/02/2023]
Abstract
Purpose This multiple-methods study examined perceptions of recovery among stroke survivors and their physiotherapists at discharge from an in-patient rehabilitation program. Method The Functional Independence Measure (FIM) and Chedoke McMaster Stroke Assessment Activity Inventory scores were collected from chart review and the following outcome measures were completed by interview: Stroke Impact Scale (SIS) global recovery, Hospital Anxiety Depression Scale, and Montreal Cognitive Assessment. Physiotherapists also completed the SIS global recovery for each participant. Spearman and Pearson correlations between SIS recovery and observed measures were completed. The stroke survivors had a short interview about their perception of recovery and what recovery meant to them, and their physiotherapists answered two written questions about each participant's recovery. Responses were coded and categorized based on the International Classification of Functioning. Results A total of 31 stroke survivors with a mean age of 66.6 years (SD 10.7) and six physiotherapists participated. Nineteen stroke survivors were interviewed. The stroke survivors' SIS recovery scores correlated with FIM-motor change (rs = 0.36 p = 0.04) and the SIS-recovery scores reported by the physiotherapists (r = 0.51; p < 0.01). In relation to the factors related to recovery, the physiotherapists' focus was therapeutic mainly considering motor recovery while the stroke survivors' responses were broad, including being able to achieve recovery goals and nutrition. However, both perceived recovery to include functional activities. Conclusions SIS global recovery question helps to measure the overall perceived percentage of recovery. However, the complete picture of recovery is only possible with the stroke survivors' and physiotherapists' perceptions of recovery and what recovery means to them.
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Affiliation(s)
- Tolu Atama
- From the:
From the: Department of Physiotherapy, Health Sciences Centre, Shared Health, Winnipeg, Manitoba, Canada
| | - Leanne Leclair
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sepideh Pooyania
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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5
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Firth N, Hayward KS, Bernhardt J, Ray R, Barker RN. Stroke survivors' perspectives on decision-making about rehabilitation and the prospect of taking recovery-promoting drugs: A qualitative study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100297. [PMID: 37448649 PMCID: PMC10338145 DOI: 10.1016/j.rcsop.2023.100297] [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: 04/19/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives To investigate factors which influence stroke survivors' decision-making about their rehabilitation and the prospect of taking recovery-promoting drugs, to enhance their recovery. Methods Seventeen stroke survivors who had undertaken stroke rehabilitation, and three spouses, participated in focus groups and individual interviews in northern Queensland, Australia. Inductive thematic analysis of the interview data was conducted in accordance with Braun and Clarke's six-phase process. Results Two specific, pivotal decision points during participants' stroke recovery process were identified: 1) overall, when deciding what rehabilitation they would undertake and hypothetically what recovery-promoting drugs they would take, and 2) on a daily basis, when deciding whether to participate in rehabilitation and take recovery-promoting drugs on any given day. Six themes which described factors influencing their decision-making were: 'My options for rehabilitation and recovery-promoting drugs'; 'The costs of rehabilitation and recovery-promoting drugs'; 'My recovery goals'; 'What I can deal with today'; 'The people my rehabilitation and recovery-promoting drugs affect'; and 'Fitting rehabilitation and recovery-promoting drugs into my life.' These themes were applicable at either one or both of the identified decision points. Conclusion Factors that influence stroke survivors' decision-making, overall and on a day-to-day basis, need to be considered to ensure they can make the best decisions for themselves to achieve their full recovery potential. Understanding the conditions under which a stroke survivor would take a recovery-promoting drug will contribute to the development of dosing protocols to which stroke survivors could adhere.
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Affiliation(s)
- Nerida Firth
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Kathryn S. Hayward
- Departments of Physiotherapy and Medicine, University of Melbourne, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Ruth N. Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
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Prior SJ, Mather CA, Campbell SJ. Redesigning Rural Acute Stroke Care: A Person-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1581. [PMID: 36674336 PMCID: PMC9864304 DOI: 10.3390/ijerph20021581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care. Semi-structured interviews, aimed at gaining insight into experiences of healthcare staff and users, were conducted. Thematic analysis revealed three global themes (communication, holistic care, and resourcing) that demonstrated some consistency between healthcare staff and user experience, highlighting that some needs and expectations were not being met. Results of this experiential study provide important perspectives for delivering needs-based improvements in service provision for acute stroke care. Overall, this study showed that systems of stroke care in rural areas could be improved by utilizing a redesign approach including healthcare staff and users in the development of solutions for health service improvement.
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Affiliation(s)
- Sarah J. Prior
- Tasmanian School of Medicine, Rural Clinical School, University of Tasmania, Burnie, TS 7320, Australia
| | - Carey A. Mather
- Australian Institute of Health Service Management, University of Tasmania, Launceston, TS 7250, Australia
| | - Steven J. Campbell
- School of Nursing, University of Tasmania, Launceston, TS 7250, Australia
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Crubezy M, Corbin S, Hyvert S, Michel P, Haesebaert J. Studying both patient and staff experience to investigate their perceptions and to target key interactions to improve: a scoping review. BMJ Open 2022; 12:e061155. [PMID: 36216415 PMCID: PMC9557797 DOI: 10.1136/bmjopen-2022-061155] [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: 11/03/2022] Open
Abstract
OBJECTIVE The improvement of patient experience (PE) is related to the experience of staff caring for them. Yet there is little evidence as to which interactions matter the most for both patients and staff, or how they are perceived by them. We aimed to summarise the interactions and the perceptions between patients and staff from studies by using both patient and staff experience data in healthcare institutions. DESIGN Scoping review. METHODS We conducted a scoping review, including studies dealing with PE and staff experience. Two authors independently reviewed each title/abstract and the selected full-text articles. A list of variables (objective, study design, data sources, tools used, results, interactions, perceptions and actions) was charted and summarised using a narrative approach including both qualitative and quantitative data. Studies were grouped according to their objective and the key interactions summarised according to this stratification. The perceptions of patients and staff were identified in the results of selected studies and were classified into four categories: commonalities and disagreements of perceptions, patients' perceptions not perceived by professionals and professional's perceptions not perceived by patients. RESULTS A total of 42 studies were included. The stratification of studies by type of objective resulted in six groups that allowed to classify the key interactions (n=154) identified in the results of the selected studies. A total of 128 perceptions related to interaction between patient and staff were reported with the following distribution: commonalities (n=35), disagreements (n=18), patients' perceptions not perceived by professionals (n=47) and professional's perceptions not perceived by patients (n=28). We separated positive and negative perceptions, which resulted in seven scenarios, each with actions that can be carried out for one or both populations to overcome barriers. CONCLUSION The study of both patient and staff experience allowed the identification of actions that can be taken to change the perceptions of patients and staff.
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Affiliation(s)
- Marion Crubezy
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- Département des Études et de la Recherche, Institut d'études KPAM, Paris, France
| | - Sara Corbin
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
| | - Sophie Hyvert
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
| | - Philippe Michel
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- Direction Qualité Usagers et Santé Populationnelle, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
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Wilkinson M. Hyperacute stroke and the specialist nursing impact: exploring the cause and context of feelings of secondary traumatic stress - a qualitative inquiry. J Res Nurs 2022; 27:343-354. [PMID: 35832877 PMCID: PMC9272500 DOI: 10.1177/17449871211018739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Secondary traumatic stress (STS) has been defined as the stress resulting from helping or wanting to help a traumatised or suffering person. The hyperacute nature of stroke specialist nurses' work places them at risk of developing STS. AIMS To explore the factors that are influential in stroke specialist nurses' experience of STS development within hyperacute practice. METHODS This study is qualitative with a narrative design. Data were collected from a purposive sample of stroke specialist nurses (20 female and 2 male) working in hyperacute services during the years 2016 and 2017. Data were analysed using Polkinghorne's approach. RESULTS This research identified four themes: exposure to acute suffering and death- young presentations; moral distress; interactions with relatives and problematic healthcare systems. CONCLUSION The findings from this study suggest that stroke specialist nurses are exposed to multiple triggers which are commensurate with the potential for STS development. The findings contribute a new understanding of the emotional burden of hyperacute specialist stroke nursing that has implications for patient safety and satisfaction, services provision and staff well-being.
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Affiliation(s)
- Mark Wilkinson
- Stroke Nurse Consultant, Department of Stroke Medicine,
Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
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9
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Lafiatoglou P, Ellis-Hill C, Gouva M, Ploumis A, Mantzoukas S. A systematic review of the qualitative literature on older individuals' experiences of care and well-being during physical rehabilitation for acquired brain injury. J Adv Nurs 2021; 78:377-394. [PMID: 34397112 PMCID: PMC9291982 DOI: 10.1111/jan.15016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/24/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
Aims To acquire an in‐depth understanding of how older individuals diagnosed with acquired brain injury (ABI) experience their well‐being and care when undergoing physical rehabilitation. Design Systematic literature review. Data sources The electronic databases of PubMed, CINAHL, APA PsycInfo, ASSIA and SCOPUS were searched from 2005 to 2020. Extensive reference checking was also conducted. Review methods A systematic review was conducted following PRISMA guidelines, including predominantly qualitative studies. Studies’ quality was appraised using the critical apraisal skills programme (CASP) tool. Results Seventeen studies met the inclusion criteria. Following methods of thematic synthesis, four overarching interpretive themes were identified: (a) Rehabilitation processes and their impact on older individuals’ well‐being; (b) Identity and embodiment concerns of older individuals during rehabilitation; (c) Institutional factors affecting older individuals’ care and well‐being experiences; and (d) Older individuals’ participation in creative activities as part of rehabilitation. Conclusion Organizational and structural care deficiencies as well as health disparities can adversely impact older individuals’ autonomous decision‐making and goal‐setting potentials. The discrepancy between older individuals’ expectations and the reality of returning home along with the illusionary wish to return to a perceived normality, can further negatively affect older individuals’ sense of well‐being. Constructive communication, emotional support, family involvement in rehabilitation and creating a stimulating, enriching social environment can humanize and facilitate older individuals’ adjustment to their new reality following ABI. Impact There is a lack of qualitative research on older individuals’ ABI rehabilitation experiences, especially traumatic brain injury incidents. Further study should consider patients’ concerns over their involvement in decision‐making and goal setting about their care. Overall, this review reveals the need to examine further the significance of humanizing care and the factors that affect older individuals’ sense of well‐being.
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Affiliation(s)
| | | | - Mary Gouva
- Department of Nursing, University of Ioannina, Ioannina, Greece
| | - Avraam Ploumis
- Department of Medicine, University of Ioannina, Ioannina, Greece
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Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. Holding space and transitional space: stroke survivors' lived experience of being on an acute stroke unit. A hermeneutic phenomenological study. Scand J Caring Sci 2021; 35:104-114. [PMID: 32065418 PMCID: PMC7984029 DOI: 10.1111/scs.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/01/2022]
Abstract
Despite substantial reorganisation of stroke unit provision in the United Kingdom, limited qualitative research has explored how stroke survivors experience the acute stroke unit. This hermeneutic phenomenological study used accounts from four stroke survivors who experienced one of two acute stroke units. Through detailed analysis, the acute stroke unit emerged as a meaningful space, in two distinct but interconnected forms. As holding space, the unit was understood to offer protection and safe haven, as the stroke survivors looked to cope and respond to the temporal, bodily, biographical disruption and significant vulnerability brought about by stroke and by being in hospital. Holding was fulfilled by different people (including their fellow stroke survivors) and reflected a human response to human need and existential vulnerability. This space, and the practices within it, functioned to hold them intimately but also at a distance from their prestroke lifeworld. As such, the acute stroke unit holding space was intertwined with how it supported, encouraged or provoked transition. In the transitional space of the acute stroke unit, stroke survivors described how they survived the hospital-healthcare space, stroke unit and poststroke space. This paper articulates how transition was meaningfully signified through its absence or presence, as they transformed, relinquished or re-asserted their 'self', and in one case, recovered whilst 'in there'. The findings of this study provide phenomenological insight into stroke survivors' lived experience, the meaningful holding and transitional contribution of the unit, and how these spatial forms were intertwined. These insights are discussed in relation to the existing evidence base and stroke unit provision.
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Affiliation(s)
| | - Vinette Cross
- School of Health SciencesUniversity of BrightonEastbourneUK
- Centre for Health and Social Care ImprovementSchool of Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Pirjo Vuoskoski
- School of Health SciencesUniversity of BrightonEastbourneUK
- Present address:
Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Graham Stew
- School of Health SciencesUniversity of BrightonEastbourneUK
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O Connor E, Dolan E, Horgan F, Robinson K, Galvin R. A protocol for a qualitative synthesis exploring people with stroke, family members, caregivers and healthcare professionals experiences of early supported discharge (ESD) after stroke. HRB Open Res 2020; 3:79. [PMID: 34136748 PMCID: PMC8185577 DOI: 10.12688/hrbopenres.13158.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
Early supported discharge (ESD) facilitates a person with a stroke to be discharged from the acute hospital environment earlier than conventional care to continue their rehabilitation within the home with members of the multi-disciplinary team. A number of quantitative studies have highlighted benefits of ESD including a reduction in the length of inpatient stay, cost savings, as well as reducing long term dependency. This systematic review and qualitative synthesis explores the perspectives and experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals involved in the delivery of the service. A comprehensive literature search will be completed in the following databases CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service will be included. Methodological quality will be appraised using the ten-item Critical Appraisal Skills Programme checklist for qualitative research by two independent reviewers with a third reviewer involved should differences of opinion arise. Findings will be synthesised using thematic synthesis. It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services. PROSPERO registration: CRD42020135197 - 28/04/2020.
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Affiliation(s)
- Elaine O Connor
- School of Allied Health, University of Limerick, Castletroy, Limerick, Ireland
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Eamon Dolan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Castletroy, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, University of Limerick, Castletroy, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick, Ireland
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12
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Zusevics KL, Kaemmerer NN, Lang J, Link J, Bluma DD. A Unique Approach to Quality Improvement Within the Stroke System of Care Utilizing Developmental Evaluation. Health Promot Pract 2020; 22:224-235. [PMID: 32285693 DOI: 10.1177/1524839919894305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is a significant cause of death that requires multiple systems of care to work together to prevent incidence and improve patient outcomes. The Wisconsin Coverdell Stroke Program partnered with a Model Hospital to understand and improve the stroke system of care in one community. Developmental evaluation (DE) is an approach in which evaluators collaborate closely with project stakeholders to examine complex processes and systems within changeable contexts to develop interventions to improve outcomes. DE was used to assess this community's stroke systems across the care continuum through process mapping with Model Hospital staff and through key stakeholder interviews with Model Hospital and emergency medical services staff, patients, and caregivers. Process mapping identified how patients and health care data flow through the system of care and highlighted areas where streamlining could improve the movement of patients and data across the care continuum. Interviews with stakeholders unveiled challenges and successes about how patient data are accessed and shared across the care continuum, and ideas for improving systems to be more efficient and supportive of stroke prevention and patient outcomes. Overall, DE was valuable in gaining an in-depth understanding of this complex environment to develop strategies to enhance stroke systems of care.
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Affiliation(s)
| | | | - Joshua Lang
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jessica Link
- Wisconsin Division of Public Health, Madison, WI, USA
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13
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Wijekoon S, Wilson W, Gowan N, Ferreira L, Phadke C, Udler E, Bontempo T. Experiences of Occupational Performance in Survivors of Stroke Attending Peer Support Groups. The Canadian Journal of Occupational Therapy 2020; 87:173-181. [PMID: 32115988 DOI: 10.1177/0008417420905707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Survivors of stroke often experience environmental isolation and decreased occupational performance after discharge from the hospital. Peer groups benefit psychological, social, and cognitive functioning, though few studies have examined their influence on occupational performance of survivors of stroke. PURPOSE. This study explores the experiences of occupational performance in survivors of stroke attending an outpatient peer support group. METHOD. An interpretive qualitative study using semi-structured interviews was conducted with seven survivors of stroke attending an outpatient peer support group. Data was thematically analyzed. FINDINGS. Four themes related to the experience of peer support on occupational performance emerged: finding hope to return to meaningful occupation, a place for belonging, problem-solving occupational concerns, and finding purpose beyond oneself. IMPLICATIONS. This research adds to the existing literature that peer support groups help survivors of stroke reengage in meaningful occupations, manage their stroke experience, and move positively through recovery.
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Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. The acute stroke unit as a meaningful space: The lived experience of healthcare practitioners. Health Place 2019; 57:12-21. [PMID: 30849691 DOI: 10.1016/j.healthplace.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/08/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022]
Abstract
This hermeneutic phenomenological study was undertaken in response to the recent re-organization of stroke unit provision in the United Kingdom. Through the analysis of four acute stroke unit practitioners' subjective accounts, the acute stroke unit emerged as a dynamic, meaningful space, where they experienced authenticity and belonging. The findings showed how these practitioners navigated their way through the space, thriving, and/or surviving its' associated vulnerabilities. They offer a different gaze on which to attend to the complexity and challenge that is interwoven with health professionals' flourishing, the spatiality of healthcare practice, and perhaps other demanding places of work.
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Affiliation(s)
- Kitty Maria Suddick
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
| | - Vinette Cross
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom
| | - Pirjo Vuoskoski
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
| | - Graham Stew
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
| | - Kathleen T Galvin
- School of Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, East Sussex, BN20 7UR, United Kingdom.
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Fulop NJ, Ramsay AIG, Hunter RM, McKevitt C, Perry C, Turner SJ, Boaden R, Papachristou I, Rudd AG, Tyrrell PJ, Wolfe CDA, Morris S. Evaluation of reconfigurations of acute stroke services in different regions of England and lessons for implementation: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background
Centralising acute stroke services is an example of major system change (MSC). ‘Hub and spoke’ systems, consisting of a reduced number of services providing acute stroke care over the first 72 hours following a stroke (hubs), with a larger number of services providing care beyond this phase (spokes), have been proposed to improve care and outcomes.
Objective
To use formative evaluation methods to analyse reconfigurations of acute stroke services in different regions of England and to identify lessons that will help to guide future reconfigurations, by studying the following contrasting cases: (1) London (implemented 2010) – all patients eligible for Hyperacute Stroke Units (HASUs); patients admitted 24 hours a day, 7 days a week; (2) Greater Manchester A (GMA) (2010) – only patients presenting within 4 hours are eligible for HASU treatment; one HASU operated 24/7, two operated from 07.00 to 19.00, Monday to Friday; (3) Greater Manchester B (GMB) (2015) – all patients eligible for HASU treatment (as in London); one HASU operated 24/7, two operated with admission extended to the hours of 07.00–23.00, Monday to Sunday; and (4) Midlands and East of England – planned 2012/13, but not implemented.
Design
Impact was studied through a controlled before-and-after design, analysing clinical outcomes, clinical interventions and cost-effectiveness. The development, implementation and sustainability of changes were studied through qualitative case studies, documentation analysis (n = 1091), stakeholder interviews (n = 325) and non-participant observations (n = 92; ≈210 hours). Theory-based framework was used to link qualitative findings on process of change with quantitative outcomes.
Results
Impact – the London centralisation performed significantly better than the rest of England (RoE) in terms of mortality [–1.1%, 95% confidence interval (CI) –2.1% to –0.1%], resulting in an estimated additional 96 lives saved per year beyond reductions observed in the RoE, length of stay (LOS) (–1.4 days, 95% –2.3 to –0.5 days) and delivering effective clinical interventions [e.g. arrival at a Stroke Unit (SU) within 4 hours of ‘clock start’ (when clock start refers to arrival at hospital for strokes occurring outside hospital or the appearance of symptoms for patients who are already in-patients at the time of stroke): London = 66.3% (95% CI 65.6% to 67.1%); comparator = 54.4% (95% CI 53.6% to 55.1%)]. Performance was sustained over 6 years. GMA performed significantly better than the RoE on LOS (–2.0 days, 95% CI –2.8 to –1.2 days) only. GMB (where 86% of patients were treated in HASU) performed significantly better than the RoE on LOS (–1.5 days, 95% CI –2.5 to –0.4 days) and clinical interventions [e.g. SU within 4 hours: GMB = 79.1% (95% CI 77.9% to 80.4%); comparator = 53.4% (95% CI 53.0% to 53.7%)] but not on mortality (–1.3%, 95% CI –2.7% to 0.01%; p = 0.05, accounting for reductions observed in RoE); however, there was a significant effect when examining GMB HASUs only (–1.8%, 95% CI –3.4% to –0.2%), resulting in an estimated additional 68 lives saved per year. All centralisations except GMB were cost-effective at 10 years, with a higher net monetary benefit than the RoE at a willingness to pay for a quality-adjusted life-year (QALY) of £20,000–30,000. Per 1000 patients at 10 years, London resulted in an additional 58 QALYs, GMA resulted in an additional 18 QALYs and GMB resulted in an additional 6 QALYs at costs of £1,014,363, –£470,848 and £719,948, respectively. GMB was cost-effective at 90 days. Despite concerns about the potential impact of increased travel times, patients and carers reported good experiences of centralised services; this relied on clear information at every stage. Planning change – combining top-down authority and bottom-up clinical leadership was important in co-ordinating multiple stakeholders to agree service models and overcome resistance. Implementation – minimising phases of change, use of data, service standards linked to financial incentives and active facilitation of changes by stroke networks was important. The 2013 reforms of the English NHS removed sources of top-down authority and facilitative capacity, preventing centralisation (Midlands and East of England) and delaying implementation (GMB). Greater Manchester’s Operational Delivery Network, developed to provide alternative network facilitation, and London’s continued use of standards suggested important facilitators of centralisation in a post-reform context.
Limitations
The main limitation of our quantitative analysis was that we were unable to control for stroke severity. In addition, findings may not apply to non-urban settings. Data on patients’ quality of life were unavailable nationally, clinical interventions measured changed over time and national participation in audits varied. Some qualitative analyses were retrospective, potentially influencing participant views.
Conclusions
Centralising acute stroke services can improve clinical outcomes and care provision. Factors related to the service model implemented, how change is implemented and the context in which it is implemented are influential in improvement. We recommend further analysis of how different types of leadership contribute to MSC, patient and carer experience during the implementation of change, the impact of change on further clinical outcomes (disability and QoL) and influence of severity of stroke on clinical outcomes. Finally, our findings should be assessed in relation to MSC implemented in other health-care specialties.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Angus IG Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - Rachael M Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, School of Population Health & Environmental Sciences Research, King’s College London, London, UK
| | - Catherine Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Simon J Turner
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | | | - Anthony G Rudd
- Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Pippa J Tyrrell
- Stroke and Vascular Centre, University of Manchester, Manchester Academic Health Science Centre, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | - Charles DA Wolfe
- Department of Population Health Sciences, School of Population Health & Environmental Sciences Research, King’s College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
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16
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Killington M, Fyfe D, Patching A, Habib P, McNamara A, Kay R, Kochiyil V, Crotty M. Rehabilitation environments: Service users' perspective. Health Expect 2019; 22:396-404. [PMID: 30632258 PMCID: PMC6543154 DOI: 10.1111/hex.12859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/31/2018] [Accepted: 12/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Design of rehabilitation environments is usually “expert” driven with little consideration given to the perceptions of service users, especially patients and informal carers. There is a need to engage with consumers of services to gain their insights into what design aspects are required to facilitate optimum physical activity, social interaction and psychological responses when they are attempting to overcome their limitations and regain function. Research design Qualitative exploratory study. Method Interviews were conducted with patients (n = 54) and informal carers (n = 23), and focus groups with rehabilitation staff (n = 90), from the three metropolitan South Australia rehabilitation health services, comprising different building and environmental configurations. Thematic analysis was assisted by the use of NVivo 11 qualitative software, with pooled data from all interviews and focus groups undergoing open, axial and finally selective coding. Results Four major themes were identified as follows: (a) choice can be an Illusion in a rehabilitation ward; (b) access to outside areas is a priority and affects well‐being; (c) socialization can be facilitated by the environment; and (d) ward configuration should align with the model of care. Discussion and Conclusion Participants who encountered the most restrictive environments accepted their situation until probed to consider alternatives; those who enjoyed the most choice and access to facilities showed the greatest enthusiasm for these affordances. Future architectural designers should therefore consider the perceptions of a wide range of consumers with varying experiences to ensure they understand the complex requirements of patients and that the ward design facilitates the optimum rehabilitation model of care.
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Affiliation(s)
- Maggie Killington
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,Flinders University, Bedford Park, South Australia, Australia
| | - Dean Fyfe
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Allan Patching
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Paul Habib
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Annabel McNamara
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,Flinders University, Bedford Park, South Australia, Australia
| | - Rachael Kay
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Venugopal Kochiyil
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia.,Flinders University, Bedford Park, South Australia, Australia
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17
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Lamontagne ME, Richards C, Azzaria L, Rosa-Goulet M, Clément L, Pelletier F. Perspective of patients and caregivers about stroke rehabilitation: the Quebec experience. Top Stroke Rehabil 2018; 26:39-48. [PMID: 30320537 DOI: 10.1080/10749357.2018.1534453] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The unique perspectives of patients and caregivers on their experiences as users of rehabilitation services help identify areas for improvement for the continuum from acute care to community integration. OBJECTIVE This study reports perceptions of persons with stroke and their caregivers in an existing continuum of stroke care, social services, and rehabilitation in the Province of Quebec. METHODS A total of 10 focus groups were held, 5 with persons with stroke (n = 37, mean age 59.6 years (SD = 11.6); 21 men) and 5 others with caregivers (n = 31; mean age 58.8 years (SD = 15.1); 8 men). Discussions were transcribed and were the object of thematic content analysis using Nvivo. RESULTS Participants expressed their general satisfaction toward the care received in inpatient, hospital, and rehabilitation settings. The information received about acute care, however, was deemed insufficient and fragmented, and access of rehabilitation services was often perceived to be difficult. In the community integration phase of the continuum, most participants stated that they had experienced poor accessibility to services of any kind. CONCLUSIONS Persons with stroke and their relatives' perspectives about the services that they obtained throughout the rehabilitation continuum vary importantly according to the services examined. Adopting a continuum perspective is helpful to target priorities for improvement.
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Affiliation(s)
- Marie-Eve Lamontagne
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | - Carol Richards
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | - Leila Azzaria
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
| | | | - Louise Clément
- c Ministère de la santé et des services sociaux du Québec , Québec , QC , Canada
| | - France Pelletier
- a Center for Interdisciplinary Research in Rehabilitation and Social Integration , Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale - site Institut de réadaptation en déficience physique de Québec (CIUSSS-CN - IRDPQ) , Québec , QC , Canada
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18
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Perry C, Papachristou I, Ramsay AIG, Boaden RJ, McKevitt C, Turner SJ, Wolfe CDA, Fulop NJ. Patient experience of centralized acute stroke care pathways. Health Expect 2018; 21:909-918. [PMID: 29605966 PMCID: PMC6186538 DOI: 10.1111/hex.12685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background In 2010, Greater Manchester (GM) and London centralized acute stroke care services into a reduced number of hyperacute stroke units, with local stroke units providing on‐going care nearer patients’ homes. Objective To explore the impact of centralized acute stroke care pathways on the experiences of patients. Design Qualitative interview study. Thematic analysis was undertaken, using deductive and inductive approaches. Final data analysis explored themes related to five chronological phases of the centralized stroke care pathway. Setting and participants Recruitment from 3 hospitals in GM (15 stroke patients/8 family members) and 4 in London (21 stroke patients/9 family members). Results Participants were impressed with emergency services and initial reception at hospital: disquiet about travelling further than a local hospital was allayed by clear explanations. Participants knew who was treating them and were involved in decisions. Difficulties for families visiting hospitals a distance from home were raised. Repatriation to local hospitals was not always timely, but no detrimental effects were reported. Discharge to the community was viewed less positively. Discussion and conclusions Patients on the centralized acute stroke care pathways reported many positive aspects of care: the centralization of care pathways can offer patients a good experience. Disadvantages of travelling further were perceived to be outweighed by the opportunity to receive the best quality care. This study highlights the necessity for all staff on a centralized care pathway to provide clear and accessible information to patients, in order to maximize their experience of care.
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Affiliation(s)
- Catherine Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | | | - Angus I G Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - Ruth J Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK.,National Institute of Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Simon J Turner
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Charles D A Wolfe
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK.,National Institute of Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK.,National Institute of Health Research, Collaboration for Leadership in Applied Health Research and Care South London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
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Kivunja S, River J, Gullick J. Experiences of giving and receiving care in traumatic brain injury: An integrative review. J Clin Nurs 2018; 27:1304-1328. [PMID: 29396883 DOI: 10.1111/jocn.14283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To synthesise the literature on the experiences of giving or receiving care for traumatic brain injury for people with traumatic brain injury, their family members and nurses in hospital and rehabilitation settings. BACKGROUND Traumatic brain injury represents a major source of physical, social and economic burden. In the hospital setting, people with traumatic brain injury feel excluded from decision-making processes and perceive impatient care. Families describe inadequate information and support for psychological distress. Nurses find the care of people with traumatic brain injury challenging particularly when experiencing heavy workloads. To date, a contemporary synthesis of the literature on people with traumatic brain injury, family and nurse experiences of traumatic brain injury care has not been conducted. DESIGN Integrative literature review. METHODS A systematic search strategy guided by the PRISMA statement was conducted in CINAHL, PubMed, Proquest, EMBASE and Google Scholar. Whittemore and Knafl's (Journal of Advanced Nursing, 52, 2005, 546) integrative review framework guided data reduction, data display, data comparison and conclusion verification. RESULTS Across the three participant categories (people with traumatic brain injury/family members/nurses) and sixteen subcategories, six cross-cutting themes emerged: seeking personhood, navigating challenging behaviour, valuing skills and competence, struggling with changed family responsibilities, maintaining productive partnerships and reflecting on workplace culture. CONCLUSIONS Traumatic brain injury creates changes in physical, cognitive and emotional function that challenge known ways of being in the world for people. This alters relationship dynamics within families and requires a specific skill set among nurses. RELEVANCE TO CLINICAL PRACTICE Recommendations include the following: (i) formal inclusion of people with traumatic brain injury and families in care planning, (ii) routine risk screening for falls and challenging behaviour to ensure that controls are based on accurate assessment, (iii) formal orientation and training for novice nurses in the management of challenging behaviour, (iv) professional case management to guide access to services and funding and (v) personal skill development to optimise family functioning.
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Affiliation(s)
- Stephen Kivunja
- Susan Wakil School of Nursing & Midwifery (Sydney Nursing School), The University of Sydney, Camperdown, NSW, Australia
| | - Jo River
- Susan Wakil School of Nursing & Midwifery (Sydney Nursing School), The University of Sydney, Camperdown, NSW, Australia
| | - Janice Gullick
- Susan Wakil School of Nursing & Midwifery (Sydney Nursing School), The University of Sydney, Camperdown, NSW, Australia
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20
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Simpson EK, Ramirez NM, Branstetter B, Reed A, Lines E. Occupational Therapy Practitioners' Perspectives of Mental Health Practices With Clients in Stroke Rehabilitation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018; 38:181-189. [PMID: 29495909 DOI: 10.1177/1539449218759627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Following a stroke, depression and anxiety may negatively affect recovery and decrease quality of life. Occupational therapy (OT) practitioners are distinctly qualified to address both the physical and psychosocial sequelae of a stroke, including clients' mental and emotional health. This study explored the ways in which OT practitioners address the mental health needs of clients post stroke. A sequential explanatory mixed-methods design was used to collect both survey and focus group data. In all, 754 OT practitioners across the United States completed an online survey, and 10 practitioners participated in focus groups. Practitioners considered their clients' mental health needs to be a priority (68.17%); however, only 56.64% were satisfied with the care they provided related to mental and emotional health. They identified barriers that included limited time, increased productivity standards, expectations related to physical recovery, and poor educational preparation. Practitioners are motivated to improve their provision of mental health services to clients post stroke. To address the conflict between practice realities and professional values, education programs should better integrate curricular components that focus on physical and mental health.
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Affiliation(s)
| | | | | | - Aileen Reed
- 1 Midwestern University, Downers Grove, IL, USA
| | - Evan Lines
- 1 Midwestern University, Downers Grove, IL, USA
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21
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Prior SJ, Campbell S. Patient and Family Involvement: A Discussion of Co-Led Redesign of Healthcare Services. J Particip Med 2018; 10:e5. [PMID: 33052119 PMCID: PMC7489197 DOI: 10.2196/jopm.8957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 12/30/2022] Open
Abstract
The involvement of patients and their families in the redesign of healthcare services is an important option in providing a service that addresses the patients’ needs and improves health outcomes. However, it is a resource-intensive approach, and it is currently not clear when it should be used, and what should be the reasoning behind this decision. Some health systems of international standing have created a patient engagement program as a selling point. This paper discusses how co-led redesign can be beneficial in improving health service and more effectively engaging patients. Potential barriers for patient involvement are discussed. Patient involvement can be integrated into the health system at three main levels of engagement: direct care, organizational design and governance, and policy-making. The aim of this paper is to describe how co-led redesign is compatible with different levels of patient involvement and to address the challenges in delivering a co-led redesign in healthcare. Co-led redesign not only involves the collection of quantitative data for assessing the current systems but also the collection of qualitative data through patient, family, and staff interviews to determine the barriers to patient satisfaction. Co-led redesign is a resource-rich process that requires expertise in data collection and a clinical group that is devoted to implementing recommended changes. Currently, a number of countries have utilized co-led redesign for many different types of healthcare services. Resource availability and cost, process time, and lack of outcome measures are three major limiting factors.
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Affiliation(s)
- Sarah Jane Prior
- Rural Clinical School, Faculty of Health, University of Tasmania, Burnie, Australia.,Health Service Innovation Tasmania, Faculty of Health, University of Tasmania, Hospital Campus, Burnie, Australia
| | - Steven Campbell
- School of Health Sciences, Faculty of Health, University of Tasmania, Newnham, Australia
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22
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2017; 41:396-404. [DOI: 10.1080/09638288.2017.1393698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
- Clinic of Neurorehabilitation, TBI unit, Rigshospitalet, Hvidovre, Denmark
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23
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Luker J, Murray C, Lynch E, Bernhardsson S, Shannon M, Bernhardt J. Carers' Experiences, Needs, and Preferences During Inpatient Stroke Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2017; 98:1852-1862.e13. [DOI: 10.1016/j.apmr.2017.02.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/30/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022]
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24
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Kenah K, Bernhardt J, Cumming T, Spratt N, Luker J, Janssen H. Boredom in patients with acquired brain injuries during inpatient rehabilitation: a scoping review. Disabil Rehabil 2017; 40:2713-2722. [DOI: 10.1080/09638288.2017.1354232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katrina Kenah
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Bernhardt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Toby Cumming
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
| | - Neil Spratt
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Julie Luker
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience & Mental Health, Heidelberg, VIC, Australia
- International Centre for Allied Health Evidence, Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | - Heidi Janssen
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, NSW, Australia
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25
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Ryan T, Harrison M, Gardiner C, Jones A. Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team. J Adv Nurs 2017; 73:2351-2360. [PMID: 28378452 DOI: 10.1111/jan.13313] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 11/27/2022]
Abstract
AIMS To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team. BACKGROUND Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care. DESIGN This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis. METHOD Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team. RESULTS One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care. CONCLUSIONS Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge.
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Affiliation(s)
- Tony Ryan
- School of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| | - Madeleine Harrison
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- School of Nursing & Midwifery, University of Sheffield, Sheffield, UK
| | - Amanda Jones
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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26
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Miles A, Watt T, Wong WY, McHutchison L, Friary P. Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting. Gerontol Geriatr Med 2016; 2:2333721416665523. [PMID: 28680937 PMCID: PMC5486486 DOI: 10.1177/2333721416665523] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022] Open
Abstract
Objective: Where swallowing difficulties are chronic or progressive, or a patient is palliative, tube feeding is often not deemed appropriate. Instead, patients continue to eat and drink despite the risks of pneumonia and death. There is currently little evidence to guide clinical practice in this field often termed “risk feeding.” This qualitative study investigated staff, patient, and family member perceptions of risk feeding practices in one New Zealand hospital. Method: Twenty-nine staff members and six patients and/or their family were interviewed. Results: Thematic analysis revealed four global themes: supporting practice, communication, complexity of feeding decisions, and patient and family-centered care. Staff described limited education and organizational policy around risk feeding decisions. Communication was considered a major factor in the success. Conclusion: Feeding decisions are complex in the hospital environment. The themes identified in this study provide a foundation for hospital guideline development and implementation.
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Affiliation(s)
| | | | | | - Louise McHutchison
- The University of Auckland, New Zealand.,Hutt Valley District Health Board, Lower Hutt, New Zealand
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27
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Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc 2015; 8:433-42. [PMID: 26445548 PMCID: PMC4590569 DOI: 10.2147/jmdh.s68764] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
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Luker J, Lynch E, Bernhardsson S, Bennett L, Bernhardt J. Stroke Survivors' Experiences of Physical Rehabilitation: A Systematic Review of Qualitative Studies. Arch Phys Med Rehabil 2015; 96:1698-708.e10. [PMID: 25847387 DOI: 10.1016/j.apmr.2015.03.017] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/17/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report and synthesize the perspectives, experiences, and preferences of stroke survivors undertaking inpatient physical rehabilitation through a systematic review of qualitative studies. DATA SOURCES MEDLINE, CINAHL, Embase, and PsycINFO were searched from database inception to February 2014. Reference lists of relevant publications were searched. All languages were included. STUDY SELECTION Qualitative studies reporting stroke survivors' experiences of inpatient stroke rehabilitation were selected independently by 2 reviewers. The search yielded 3039 records; 95 full-text publications were assessed for eligibility, and 32 documents (31 studies) were finally included. Comprehensiveness and explicit reporting were assessed independently by 2 reviewers using the consolidated criteria for reporting qualitative research framework. Discrepancies were resolved by consensus. DATA EXTRACTION Data regarding characteristics of the included studies were extracted by 1 reviewer, tabled, and checked for accuracy by another reviewer. All text reported in studies' results sections were entered into qualitative data management software for analysis. DATA SYNTHESIS Extracted texts were inductively coded and analyzed in 3 phases using thematic synthesis. Nine interrelated analytical themes, with descriptive subthemes, were identified that related to issues of importance to stroke survivors: (1) physical activity is valued; (2) bored and alone; (3) patient-centered therapy; (4) recreation is also rehabilitation; (5) dependency and lack of control; (6) fostering autonomy; (7) power of communication and information; (8) motivation needs nurturing; and (9) fatigue can overwhelm. CONCLUSIONS The thematic synthesis provides new insights into stroke survivors' experiences of inpatient rehabilitation. Negative experiences were reported in all studies and include disempowerment, boredom, and frustration. Rehabilitation could be improved by increasing activity within formal therapy and in free time, fostering patients' autonomy through genuinely patient-centered care, and more effective communication and information. Future stroke rehabilitation research should take into account the experiences and preferences of stroke survivors.
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Affiliation(s)
- Julie Luker
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Elizabeth Lynch
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Susanne Bernhardsson
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia; Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; Närhälsan Hönö/Öckerö Rehabilitation, Region Västra Götaland, Sweden
| | - Leanne Bennett
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Howells A, Morris R, Darwin C. A Questionnaire to Assess Carers’ Experience of Stroke Rehabilitation. Top Stroke Rehabil 2015; 19:256-67. [DOI: 10.1310/tsr1903-256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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O’Brien CL, Moore G, Rolley JX, Ski CF, Thompson DR, Lautenschlager NT, Gonzales G, Hsueh YS(A, Castle D. Exploring Health Care Providers’ Perceptions of the Needs of Stroke Carers: Informing Development of an Optimal Health Program. Top Stroke Rehabil 2014; 21:421-31. [DOI: 10.1310/tsr2105-421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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31
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Hewitt G, Sims S, Greenwood N, Jones F, Ross F, Harris R. Interprofessional teamwork in stroke care: Is it visible or important to patients and carers? J Interprof Care 2014; 29:331-9. [PMID: 25158116 DOI: 10.3109/13561820.2014.950727] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 'mechanisms' (processes) of interprofessional teamwork, was used to identify positive and negative 'indicators' of teamwork. Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.
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Affiliation(s)
- Gillian Hewitt
- Cardiff School of Social Sciences, Cardiff University , Cardiff , UK and
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Sims S, Hewitt G, Harris R. Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis. J Interprof Care 2014; 29:20-5. [DOI: 10.3109/13561820.2014.939745] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hewitt G, Sims S, Harris R. Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care. J Interprof Care 2014; 28:501-6. [PMID: 25051092 DOI: 10.3109/13561820.2014.939744] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Realist synthesis offers a novel and innovative way to interrogate the large literature on interprofessional teamwork in health and social care teams. This article introduces realist synthesis and its approach to identifying and testing the underpinning processes (or "mechanisms") that make an intervention work, the contexts that trigger those mechanisms and their subsequent outcomes. A realist synthesis of the evidence on interprofessional teamwork is described. Thirteen mechanisms were identified in the synthesis and findings for one mechanism, called "Support and value" are presented in this paper. The evidence for the other twelve mechanisms ("collaboration and coordination", "pooling of resources", "individual learning", "role blurring", "efficient, open and equitable communication", "tactical communication", "shared responsibility and influence", "team behavioural norms", "shared responsibility and influence", "critically reviewing performance and decisions", "generating and implementing new ideas" and "leadership") are reported in a further three papers in this series. The "support and value" mechanism referred to the ways in which team members supported one another, respected other's skills and abilities and valued each other's contributions. "Support and value" was present in some, but far from all, teams and a number of contexts that explained this variation were identified. The article concludes with a discussion of the challenges and benefits of undertaking this realist synthesis.
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Affiliation(s)
- Gillian Hewitt
- Cardiff School of Social Sciences, Cardiff University , Cardiff , UK and
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Hole E, Stubbs B, Roskell C, Soundy A. The patient's experience of the psychosocial process that influences identity following stroke rehabilitation: a metaethnography. ScientificWorldJournal 2014; 2014:349151. [PMID: 24616623 PMCID: PMC3927748 DOI: 10.1155/2014/349151] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/19/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Patient experience is increasingly being recognised as a key health outcome due to its positive correlation with quality of life and treatment compliance. The aim of this study was to create a model of how patient's experiences of rehabilitation after stroke influence their outcome. METHODS A metaethnography of qualitative articles published since 2000 was undertaken. A systematic search of four databases using the keywords was competed. Original studies were included if at least 50% of their data from results was focused on stroke survivors experiences and if they reflected an overarching experience of stroke rehabilitation. Relevant papers were appraised for quality using the COREQ tool. Pata analysis as undertaken using traditional processes of extracting, interpreting, translating, and synthesizing the included studies. RESULTS Thirteen studies were included. Two themes (1) evolution of identity and (2) psychosocial constructs that influence experience were identified. A model of recovery was generated. CONCLUSION The synthesis model conceptualizes how the recovery of stroke survivors' sense of identity changes during rehabilitation illustrating changes and evolution over time. Positive experiences are shaped by key psychosocial concepts such as hope, social support, and rely on good self-efficacy which is influenced by both clinical staff and external support.
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Affiliation(s)
- E. Hole
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| | - B. Stubbs
- School of Health and Social Care, University of Greenwich, London SE10 9LS, UK
| | - C. Roskell
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| | - A. Soundy
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
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Sadler E, Daniel K, Wolfe CDA, McKevitt C. Navigating stroke care: the experiences of younger stroke survivors. Disabil Rehabil 2014; 36:1911-7. [PMID: 24467678 DOI: 10.3109/09638288.2014.882416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Although stroke is associated with ageing, a significant proportion of strokes occur in younger people. Younger stroke survivors have experienced care available as inappropriate to their needs. However, insufficient attention has been paid to how the social context shapes their experiences of care. We investigated this question with younger stroke survivors in Greater London, UK. METHOD We conducted in-depth interviews with individuals aged between 24 and 62 years. Interviews were analysed thematically, with interpretation informed by Bourdieu's concepts of field, capital and habitus. RESULTS In the acute care setting it was implicit for participants that expertise and guidance was to be prioritised and largely this was reported as what was received. Individuals' cultural capital shaped expectations to access information, but health care professionals' symbolic capital meant they controlled its provision. After discharge, professional guidance was still looked for, but many felt it was limited or unavailable. It was here that participants' social, cultural and economic capital became more important in experiences of care. CONCLUSIONS The field of stroke shaped younger stroke survivors' experiences of care. Navigating stroke care was contingent on accessing different forms of capital. Differences in access to these resources influenced longer term adjustment after stroke. IMPLICATIONS FOR REHABILITATION Stroke care can be conceptualised as a temporal field of social activity and relationships which shapes variations in experiences of care among younger stroke survivors, and differences in expectations of support at different time points after stroke. On entering the field of stroke participants reported needing health care professional guidance and expertise to manage the acute event, yet difficulties accessing information in hospital limited the agency of some individuals wanting to take an active role in their recovery. After discharge from hospital variations in experiences of care among participants were more evident, with a number still seeking professional guidance, and requiring the capital and agency to navigate the field of stroke. Despite international efforts to improve the quality of acute care, effective models of community stroke care still need to be developed.
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Affiliation(s)
- Euan Sadler
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London , London , United Kingdom and
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Morris R, Morris P. Participants' experiences of hospital-based peer support groups for stroke patients and carers. Disabil Rehabil 2011; 34:347-54. [PMID: 21992465 DOI: 10.3109/09638288.2011.607215] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim was to examine stroke patients', carers' and volunteer supporters' experiences of peer support groups during hospital rehabilitation. METHODS Semi-structured interviews and questionnaires were analysed by inductive thematic analysis. Participants also answered a standardised Therapeutic Factors Inventory (TFI). RESULTS Five superordinate themes emerged for patients, carers and volunteer supporters. Three themes related to group processes; 'practical issues' (five subthemes), 'staff presence', 'similarity-difference', and comparison with other group members. 'Value of peers' (five subthemes) described beneficial outcomes. The 'similarity-difference' theme and four subthemes under 'value of peers' were related to items from the TFI which drew agreement from most participants. The supporters had some unique themes; two were concerned with group organisation, one was the experience of 'being helpful to others' and one described the experiences of training. As well as its links with themes, agreement with TFI items revealed experiences that did not emerge as themes; feeling secure, expressing emotions and increased independence. CONCLUSIONS Participation in the group was experienced as beneficial by participants. Benefits included helpful information, advice, making new connections and increased awareness of stroke. Participants identified important group processes such as upward and downward comparison. Responses to the TFI suggested that attendance brought therapeutic gains.
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Affiliation(s)
- Reg Morris
- Clinical Psychology, School of Psychology, Cardiff University, Cardiff, UK.
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37
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Fleming J, Sampson J, Cornwell P, Turner B, Griffin J. Brain injury rehabilitation: The lived experience of inpatients and their family caregivers. Scand J Occup Ther 2011; 19:184-93. [DOI: 10.3109/11038128.2011.611531] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Schouten L, Murray C, Boshoff K. Overcoming the long-term effects of stroke: qualitative perceptions of involvement in a group rehabilitation programme. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.4.198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Carolyn Murray
- School of Health Sciences, University of South Australia, Adelaide
| | - Kobie Boshoff
- School of Health Sciences, University of South Australia, Adelaide, Australia
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Morris R. The psychology of stroke in young adults: the roles of service provision and return to work. Stroke Res Treat 2011; 2011:534812. [PMID: 21423559 PMCID: PMC3056452 DOI: 10.4061/2011/534812] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 12/23/2010] [Accepted: 01/09/2011] [Indexed: 01/23/2023] Open
Abstract
Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. "Hidden" cognitive impairments, a disrupted sense of self, and the incongruity of suffering an "older person's" disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.
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Affiliation(s)
- Reg Morris
- School of Psychology, Cardiff University, and Cardiff and Vale University Local Health Board, Archway House, 77 TY Glas Avenue, Llanishen, Cardiff CF14 5DX, UK
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40
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Peoples H, Satink T, Steultjens E. Stroke survivors' experiences of rehabilitation: a systematic review of qualitative studies. Scand J Occup Ther 2010; 18:163-71. [PMID: 20701431 DOI: 10.3109/11038128.2010.509887] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim was to obtain the best available knowledge on stroke survivors' experiences of rehabilitation. The increase in demands for accountability in health care and acknowledgement of the importance of client participation in health decisions calls for systematic ways of integrating this perspective. METHODS AND MATERIALS A systematic review of qualitative studies was performed. A literature search in MEDLINE, CINAHL, PsycINFO, and EMBASE was conducted. Suitability for inclusion was based on selected criteria: published qualitative studies written in English from 1990 to 2008 on stroke survivors' experiences of rehabilitation in a clinical setting. Data analysis entailed extracting, editing, grouping, and abstracting findings. RESULTS Twelve studies were included. One theme, "Power and Empowerment" and six subcategories were identified: 1) Coping with a new situation, 2) Informational needs, 3) Physical and non-physical needs, 4) Being personally valued and treated with respect, 5) Collaboration with health care professionals and 6) Assuming responsibility and seizing control. DISCUSSION The synthesis showed that stroke survivors' experiences of rehabilitation reflected individual and relational aspects of power and empowerment. The capacity to assume power and empowerment was a dynamic rather than a progressive issue, and enabling empowerment was a matter of weighing contrasting issues against each other, e.g. the right to decide versus the right not to decide.
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Affiliation(s)
- Hanne Peoples
- Department of Occupational Therapy, Hvidovre Hospital, Denmark.
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Bamm EL, Rosenbaum P, Stratford P. Validation of the measure of processes of care for adults: a measure of client-centred care. Int J Qual Health Care 2010; 22:302-9. [DOI: 10.1093/intqhc/mzq031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Hasson H, Arnetz JE. A comparative study of nursing staff, care recipients’ and their relatives’ perceptions of quality of older people care. Int J Older People Nurs 2010; 5:5-15. [DOI: 10.1111/j.1748-3743.2009.00186.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Strudwick A, Morris R. A qualitative study exploring the experiences of African-Caribbean informal stroke carers in the UK. Clin Rehabil 2010; 24:159-67. [DOI: 10.1177/0269215509343847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To explore the experiences of African-Caribbean informal stroke carers in the UK. Design: Qualitative methodology. Setting: Three urban locations in southern England. Participants: Nine African-Caribbean informal stroke carers providing support to a relative with stroke for at least six months. Method: Semi-structured interviews were used to explore both predetermined and unexpected topics relating to any aspects of the carers’ experiences. Interview transcriptions were analysed using inductive thematic analysis. Results: Several themes resembled those identified in previous qualitative studies with informal stroke carers from other ethnic backgrounds. However, new themes emerged which were related to the carers’ ethnicity and cultural values. These themes were ‘understanding of individual needs’, ‘battle’, ‘independence from services’, ‘faith in God’, ‘family ties’ and ‘avoiding institutionalised care.’ Conclusions: This small-scale study provides an insight into African-Caribbean stroke carers’ own perspectives. These have much in common with those of other ethnicities, but also exhibit important areas of difference. Several themes indicate issues with existing service provision. Stereotypical assumptions about informal stroke carers based on ethnicity appear to be unwarranted; there is diversity within ethnic groups. Individual contexts of ethnicity, culture and religious beliefs shape expectations and perceptions. Several themes signpost service attributes that are perceived as relevant to acceptability by African-Caribbean stroke carers. Recruitment challenges could be addressed in future projects with ethnic minority carers by collaborative planning and the development of individual relationships with key informants.
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Affiliation(s)
- Anna Strudwick
- Forest of Dean Community Mental Health Team for Older People, Cinderford,
| | - Reg Morris
- Cardiff University /South Wales Clinical Psychology Training Programme, Cardiff, UK
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Asplund K, Jonsson F, Eriksson M, Stegmayr B, Appelros P, Norrving B, Terént A, Åsberg KH. Patient Dissatisfaction With Acute Stroke Care. Stroke 2009; 40:3851-6. [DOI: 10.1161/strokeaha.109.561985] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Riks-Stroke, the Swedish Stroke Register, was used to explore patient characteristics and stroke services as determinants of patient dissatisfaction with acute in-hospital care.
Methods—
All 79 hospitals in Sweden admitting acute stroke patients participate in Riks-Stroke. During 2001 to 2007, 104 876 patients (87% of survivors) responded to a follow-up questionnaire 3 months after acute stroke; this included questions on satisfaction with various aspects of stroke care.
Results—
The majority (>90%) were satisfied with acute in-hospital stroke care. Dissatisfaction was closely associated with outcome at 3 months. Patient who were dependent regarding activities of daily living, felt depressed, or had poor self-perceived general health were more likely to be dissatisfied. Dissatisfaction with global acute stroke care was linked to dissatisfaction with other aspects of care, including rehabilitation and support by community services. Patients treated in stroke units were less often dissatisfied than patients in general wards, as were patients who had been treated in a small hospital (vs medium or large hospitals) and patient who had participated in discharge planning. In multivariate analyses, the strongest predictor of dissatisfaction with acute care was poor outcome (dependency regarding activities of daily living, depressed mood, poor self-perceived health).
Conclusions—
Dissatisfaction with in-hospital acute stroke care is part of a more extensive complex comprising poor functional outcome, depressive mood, poor self-perceived general health, and dissatisfaction not only with acute care but also with health care and social services at large. Several aspects of stroke care organization are associated with a lower risk of dissatisfaction.
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Affiliation(s)
- Kjell Asplund
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Fredrik Jonsson
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Marie Eriksson
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Birgitta Stegmayr
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Peter Appelros
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Bo Norrving
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Andreas Terént
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
| | - Kerstin Hulter Åsberg
- From Riks-Stroke (K.A., F.J., M.E.), Department of Medicine, University Hospital, Umeå, Sweden; Epidemiologic Center (B.S.), National Board of Health and Welfare, Stockholm, Sweden; Department of Neurology (P.A.), University Hospital. Örebro, Sweden; Department of Neurology (B.N.), University Hospital, Lund, Sweden; Department of Medicine (A.T.), Akademiska University Hospital, Uppsala, Sweden; Department of Medicine (K.H.Å.), Enköping Hospital, Enköping, Sweden
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Bamm EL, Rosenbaum P. Family-Centered Theory: Origins, Development, Barriers, and Supports to Implementation in Rehabilitation Medicine. Arch Phys Med Rehabil 2008; 89:1618-24. [DOI: 10.1016/j.apmr.2007.12.034] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 11/26/2007] [Accepted: 12/13/2007] [Indexed: 12/01/2022]
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46
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Hart S, Morris R. Screening for depression after stroke: an exploration of professionals' compliance with guidelines. Clin Rehabil 2007; 22:60-70. [PMID: 18048484 DOI: 10.1177/0269215507079841] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE National guidelines recommend screening for poststroke depression, but compliance is low. This research studied staff compliance in stroke units using the theory of planned behaviour to investigate influences upon screening. DESIGN The study used a questionnaire based on a semi-structured interview and measuring the theory of planned behaviour components. SETTING Sixteen stroke units throughout the UK were included. SUBJECTS Seventy-five health care professionals in stroke services participated. MAIN MEASURES A postal questionnaire with 7-point rating scales and open-ended questions was used. RESULTS Response rates were low, but the 75 returns demonstrated poor compliance for screening, despite positive attitudes towards it. Five variables, including three of the theory of planned behaviour components, predicted intention to screen: perceived control over screening, perceived expectations of others (direct and indirect normative beliefs), awareness of guidelines and screening being part of routine assessment. Perceived expectations of others, perceived control and awareness of guidelines also differentiated those intending to screen from 'non-intenders'. Being knowledgeable about screening, having screening in the job role and belief in its clinical value were additional facilitating factors, while time pressure and concerns about screening tests were barriers. Profession and psychology input were not associated with screening. CONCLUSIONS The theory of planned behaviour provides a framework for understanding screening intentions. Both individual and organizational factors were associated with screening. Compliance may be enhanced by: training to increase knowledge and skills, providing evidence of the utility, increasing awareness of guidelines, support from colleagues and integrating mood assessment into job roles and routine assessment.
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Affiliation(s)
- Sharon Hart
- Bristol Clinical Psychology Training Programme, Bristol, UK
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