The role of nursing in the rehabilitation of stroke survivors: an extended theoretical account

'Physical well-being is our top priority': Healthcare professionals' challenges in supporting psychosocial well-being in stroke services

BACKGROUND

Following stroke, a sense of well-being is critical for quality of life. However, people living with stroke, and health professionals, suggest that well-being is not sufficiently addressed within stroke services, contributing to persistent unmet needs. Knowing that systems and structures shape clinical practice, this study sought to understand how health professionals address well-being, and to examine how the practice context influences care practice.

METHODS

Underpinned by Interpretive Description methodology, we interviewed 28 health professionals across multiple disciplines working in stroke services (acute and rehabilitation) throughout New Zealand. Data were analysed using applied tension analysis.

RESULTS

Health professionals are managing multiple lines of work in stroke care: biomedical work of investigation, intervention and prevention; clinical work of assessment, monitoring and treatment; and moving people through service. While participants reported working to support well-being, this could be deprioritised amidst the time-oriented pressures of the other lines of work that were privileged within services, rendering it unsupported and invisible.

CONCLUSION

Stroke care is shaped by biomedical and organisational imperatives that privilege physical recovery and patient throughput. Health professionals are not provided with the knowledge, skills, time or culture of care that enable them to privilege well-being within their work. This has implications for the well-being of people with stroke, and the well-being of health professionals. In making these discourses and culture visible, and tracing how these impact on clinical practice, we hope to provide insight into why well-being work remains other to the 'core' work of stroke, and what needs to be considered if stroke services are to better support people's well-being.

PATIENT OR PUBLIC CONTRIBUTIONS

People with stroke, family members and people who provide support to people with stroke, and health professionals set priorities for this research. They advised on study conduct and have provided feedback on wider findings from the research.

Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis

Introduction

The power of action research to create change by anchoring research results in practice was challenged in an action research project at a specialized rehabilitation unit for persons with acquired spinal cord injury. Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for the practicing of nursing. We aimed to raise awareness of the mechanisms that govern barriers by exploring these barriers as experienced by nurses in their effort to change their practice to improve patient participation.

Method

We used Fairclough's critical discourse analysis drawing on Foucault's practical systems; ethics (identity, relation to oneself), power (action, relation to others), and knowledge (representation, aspects of the world), which he combines with discourse-analytical concepts.

Results

Our discourse analysis of the empirical data at micro-level uncovers the nature of barriers to change in practice. In addition, our analysis at macro-level unveils how these practices are embedded in larger historical, societal, and institutional discourses. This identified two current discourses: a biomedical discourse and a biopsychosocial discourse. In the light of these two discourses, the nurses at micro-level saw themselves as strong agents for the best rehabilitation by acting in accordance with the biopsychosocial discourse. But they were unable to find the time and space to do so due to tasks, structures, and practices specified by an organization dominated by the biomedical discourse.

Nursing theories in the care of stroke patients: a scoping review

OBJECTIVES

to map and synthesize nursing theories and conceptual frameworks that have been applied in the practice of nursing care for stroke patients in hospital settings.

METHODS

a scoping review was conducted in October 2022 using the MEDLINE (accessed via PubMed), CINAHL, Scielo, and Web of Science databases, following The Joanna Briggs Institute guidelines.

RESULTS

nine studies incorporated six nursing theories and three conceptual frameworks, which were employed to enhance stroke patient care. The objective of these theories and conceptual frameworks was to facilitate the identification of the patient's psychobiological, psychosocial, and psychospiritual needs, elucidate the nurse's role and expand their perspective on rehabilitation, and acknowledge the survivor's process of transition.

FINAL CONSIDERATIONS

this mapping exercise identified major nursing theories, middle-range theories, and conceptual frameworks applied to the care of stroke patients.

The role of nurses in inpatient geriatric rehabilitation units: A scoping review

AIMS

(1) To review and synthesize research on the contributions of nurses to rehabilitation in inpatient geriatric rehabilitation units (GRUs), and (2) to compare these reported contributions to the domains of international rehabilitation nursing competency models. The roles and contributions of nurses (e.g. Registered Practical Nurses, Registered Nurses and Licensed Practical Nurses) in GRUs are non-specific, undervalued, undocumented and unrecognized as part of the formal Canadian rehabilitation process.

DESIGN

Arksey and O'Malley's methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used.

METHODS

Six databases were searched for relevant literature: MEDLINE, PsychINFO, CINAHL, EMBASE, SCOPUS and Nursing and Allied Health. English articles were included if they examined nursing roles or contributions to inpatient geriatric rehabilitation. Integrated synthesis was used to combine the qualitative and quantitative data, and thematic analysis was used for coding. Three sets of international competency models were amalgamated to explore how different nurse roles in geriatric rehabilitation were portrayed in the included literature.

RESULTS

Eight studies published between 1991 and 2020 were included in the review. Five main geriatric rehabilitation nursing roles were generated from synthesis of the domains of international rehabilitation nursing competency models: conserver, supporter, interpreter, coach and advocate.

CONCLUSIONS

Nurses working in inpatient geriatric rehabilitation are recognized more for their role in conserving the body than their roles in supporting, interpreting, coaching and advocacy. Interprofessional team members appear to be less sure of the nurses' role in the rehabilitation unit. Nurses themselves do not acknowledge the unique rehabilitation aspects of care for older adults. Enhancing formal education, or adding continuing education courses, to facilitate role clarity for nurses in geriatric rehabilitation could improve nurses' and interprofessional healthcare team members' understandings of the possible contributions of nurses working in rehabilitation settings.

The Role of Nursing Staff Regarding Goal Setting and Achieving in Geriatric Rehabilitation: A Focus Group Study

PURPOSE

The aim of this study was to explore and clarify the role of nursing staff in geriatric rehabilitation on supporting patients in goal setting and achieving, through reflecting on rehabilitation interventions.

DESIGN

A descriptive qualitative study was conducted.

METHODS

We conducted four online focus group interviews with 23 members of the nursing staff working in geriatric rehabilitation. They reflected on six interventions, preclassified into three types: setting goals in the admission phase, increasing patient participation in order to personalize the rehabilitation trajectory, and supporting patients in working on short-term goals. Data were analyzed using thematic content analysis.

RESULTS

Setting goals in the admission phase is primarily the task of the multidisciplinary team rather than the nursing staff. Interventions to increase patient participation align with the coordinating role of nursing staff in the rehabilitation team. Working on short-term goals is of great value to patients.

CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING

The connection between the patient's personal goals and professional treatment aimed at functional recovery can be enhanced by strengthening the position of nursing staff working in geriatric rehabilitation.

CONCLUSION

Members of nursing staff in geriatric rehabilitation see themselves playing a coordinating role in the multidisciplinary team, supporting the patient in goal work. Interventions aimed at advancing patient participation and providing support for short-term goals reinforce this role.

Nurse-led telerehabilitation intervention to improve stroke efficacy: Protocol for a pilot randomized feasibility trial

BACKGROUND

The prevalence of stroke continues to rise in low-middle income countries. The continual rise in stroke cases and increasing prevalence on post-acute needs represent a crucial call for increased accessibility and utilization of rehabilitation services.

AIM

The primary objective of the study is to test the feasibility of a nurse-led telerehabilitation intervention in improving self-efficacy among stroke survivors. The findings of the trial are intended for use in a future larger study.

METHODS

Participants would be recruited at the University of Ghana Hospital and randomized into an intervention group and a control group. Participants aged ≥ 18 years, diagnosed of stroke at most 12months prior the recruitment and requiring moderate level of assistance would be considered for eligibility. Participants in the intervention group will receive individualized and comprehensive nurse-led rehabilitation therapies in physical, emotional, cognitive and nursing education domains for 6 months, in addition to treatment as usual (TAU). The control group will only receive treatment as usual. Follow-up evaluations will occur immediately, 30 days and 90 days after the intervention.

DISCUSSION

Providing stroke rehabilitation services in low-resource settings presents a significant challenge due to limited infrastructure and a lack of trained healthcare professionals. The current study has the potential of contributing to the growing body of evidence on the impact of telerehabilitation services in mitigating these challenges in low-resource settings.

TRIAL REGISTRATION

PACTR202210685104862, Pan African Clinical Trial Registry.

Interventions for improving psychosocial well-being after stroke: A systematic review

BACKGROUND

Up to one third of all stroke patients suffer from one or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocial well-being after stroke. Currently it is not known which interventions are effective and what aspects of these interventions are most effective to improve psychosocial well-being after stroke.

OBJECTIVE

To identify potentially effective interventions - and intervention components - which can be delivered by nurses to improve patients' psychosocial well-being after stroke.

METHODS

A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019-April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data.

RESULTS

In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, and medication management. Active information and physical exercise were identified as effective methods of delivery.

DISCUSSION

The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being.

FUNDING AND REGISTRATION

This study was supported by the Taskforce for Applied Research SIA (RAAK.PUB04.010). This review was not registered.

Supporting older patients in working on rehabilitation goals: A scoping review of nursing interventions

BACKGROUND

Nurses are consistently present throughout the rehabilitation of older patients but are apprehensive about performing goal-centred care in the multidisciplinary team.

OBJECTIVES

The aim of this review was to explore working interventions on setting goals and working with goals designed for nurses in geriatric rehabilitation, and to describe their distinctive features.

METHODS

We performed a scoping review. We searched MEDLINE and CINAHL through August 4, 2021. Search terms related to the following themes: nurses, rehabilitation, geriatric, goal and method. We used snowballing to find additional. From the selected studies, we systematically extracted data on means, materials and the nursing role and summarized them in a narrative synthesis, using intervention component analysis.

RESULTS

The study includes 13 articles, describing 11 interventions which were developed for six different aims: improving multidisciplinary team care; increasing patient centredness; improving disease management by patients; improving the psychological, and emotional rehabilitation; increasing the nursing involvement in rehabilitation; or helping patients to achieve goals. The interventions appeal to four aspects of the nursing profession: assessing self-care skills incorporating patient's preferences; setting goals with patients, taking into account personal needs and what is medically advisable; linking the needs of the patient with multidisciplinary professional treatment and vice versa; and thus, playing an intermediate role and supporting goal achievement.

CONCLUSIONS

The interventions show that in goal-centred care, the nurse might play an important unifying role between patients and the multidisciplinary team. With the support of nurses, the patient may become more aware of the rehabilitation process and transfer of ownership of treatment goals from the multidisciplinary team to the patient might be achieved. Not many interventions were found meant to support the nursing role. This may indicate a blind spot in the rehabilitation community to the additional value of its contribution.

Design and Development of Kardex and Nursing Reports in the Rehabilitation Hospital

Introduction

A nursing rehabilitation Kardex and reports could act as a framework to facilitate and organize rehabilitation programs.

Objectives

This study aimed to design a special Kardex and a structure to rehabilitation nursing reports.

Methods

This study was carried out in two phases consisting of literature review and Delphi method in Rofideh Rehabilitation Hospital, Tehran, Iran. In the first phase, a diverse literature review was done. PubMed, Elsevier, Web of Science, and Google Scholar as a search engine were searched using the keywords of Kardex, "nursing report," "nursing note," "nursing rehabilitation," "nursing Kardex" from 2010 to 2020. After a literature review, the first draft of the Kardex was made. In the next step, using the Delphi method, the initial Kardex was sent to rehabilitation nursing experts in four rounds, and their comments were applied on that.

Results

The rehabilitation nursing Kardex was prepared after four rounds. The Kardex content included "Evaluation of nutritional needs," "Requirements for daily living," "Patients' education," "Examination of bedsores," "Fall prevention," and "communication with rehabilitation departments (physiotherapy, occupational therapy, and speech therapy)."

Conclusion

Rehabilitation Kardex and nursing report sample can be used as a suitable tool to promote patients' independence in rehabilitation centers.

Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation

Introduction

Persons with spinal cord injury have experienced a life‐changing event, and they need to engage in the rehabilitation process to adjust to their current situation and future living conditions. Due to the highly contextual and varying psychological and physical ability to participate from patient to patient during rehabilitation, this is difficult for the injured person and for health professionals to support. Therefore, the aim of the study was to develop and facilitate patient participation by engaging nursing staff and from this engagement in the process, disclose methods to support participation.

Methods

The processes conducted were based on an action research approach, from problem identification to the development, test and evaluation of four new nursing initiatives. The initiatives were developed by eight nursing staff members who participated actively as co‐researchers in a 2‐year study conducted at a Spinal Cord Injury Centre in Denmark from 2016 to 2018. Data evolved from workshops, transcriptions of meetings and written evaluations and was further analysed using Ricoeur's phenomenological‐hermeneutic approach.

Results

Action research processes facilitated the development of four communicative initiatives and a shift in the nursing staff's support of the patient. In a collaborative process, the nursing staff acted as participants in the patient's rehabilitation. Awareness of the patient's perspective facilitated a caring, attentive and engaged approach from the nursing staff, which promoted rehabilitation tailored to the individual.

Conclusion

Patient participation was enhanced when nursing staff actively participated in the development of initiatives and a culture supporting a person‐to‐person approach involving the patient and themselves as equal participants in the collaborative rehabilitation process.

Patient or Public Contribution

Eight nursing staff members from the rehabilitation centre participated throughout the study as co‐researchers. Patients participated in observations and as informants in interviews during the first phase to identify challenges to patient participation. Patients also participated in testing the nursing initiatives during the action phase (Phase 3). Furthermore, a former patient was a member of the advisory board.

The physical environment is essential, but what does the design and structure of stroke units look like? A descriptive survey of inpatient stroke units in Sweden

BACKGROUND

The design of the physical environment is a critical factor in patient care and is known to influence health, well-being, clinical efficiency, and health-related outcomes. To date, there has been no general review of the physical environment of modern Swedish stroke units.

AIM

To explore the physical environment of inpatient stroke units in Sweden and describe the design and structure of these units.

METHODS

This was a cross-sectional study. Data were collected in Sweden from April to July 2021 via a survey questionnaire.

RESULTS

The layout of the stroke units varied broadly, such as the number of single-bed and multi-bed rooms. More than half the stroke units comprised spaces for rehabilitation and had an enriched environment in the form of communal areas with access to computers, games, books, newspapers, and meeting places. However, they offered sparse access to plants and/or scenery.

CONCLUSIONS

Healthcare environments are an essential component of a sustainable community. From a sustainability perspective, healthcare facilities must be built with high architectural quality and from a long-term perspective. Research on the physical environment in healthcare should contribute to improved quality of care, which can be achieved through building healthcare facilities that support the performance of care and recovery. Therefore, mapping of areas of interest for further investigation is crucial.

Nurses' and occupational therapists' experiences of conducting a home-based psychosocial intervention following stroke: a qualitative process evaluation

Background

Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses’ and occupational therapists’ experiences of conducting the intervention.

Methods

Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis.

Results

The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues.

Conclusion

Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses’ and occupational therapists’ understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care.

Trial registration

ClinicalTrials.gov, NCT 02338869, registered 10/04/2014.

Does the physical environment matter? - A qualitative study of healthcare professionals' experiences of newly built stroke units

Purpose: Organized care in specialist stroke units is fundamental for achieving better outcomes for persons with stroke. Although the importance of the physical environment for health and well-being is well recognized, research regarding how environmental features can influence stroke care is limited. The aim was to elucidate healthcare professionals’ experiences of the physical environment in newly built stroke units with respect to stroke care.Methods: Healthcare professionals (n = 42) representing eight professions participated in semi-structured, face-to-face interviews. Qualitative content analysis was used.Results: The physical environment both facilitated and restricted the professionals’ ability to provide stroke care. Five categories were identified: “Working towards patient engagement in single rooms”, “Hampered rehabilitation in an environment not always adapted to patients’ difficulties”, “Addressing patients’ psychosocial needs in the environment”, “Ensuring patient safety by using the environment in accordance with individual needs”, and “Collaboration and task fulfilment—a challenge due to care unit design”.Conclusions: The healthcare professionals viewed the physical environment mainly in relation to stroke patients’ specific needs, and several environmental features were considered poorly adapted to meet these needs. The physical environment is essential to high-quality care; thus, the process of planning and designing stroke units should be based on existing evidence.

Goal-setting in geriatric rehabilitation: Can the nursing profession meet patients' needs? A narrative review

STUDY OBJECTIVE

To provide an overview of patients' needs concerning goal-setting, and indications of how those needs can be met by nurses.

METHODS

A narrative review. Pubmed and Cinahl were searched through March 1, 2020 for: patients' experiences concerning goal-setting and the role of nursing in rehabilitation. Additional articles were found through snowballing. A total of 22 articles were reviewed on patients' experiences, and 12 on the nursing role.

RESULTS

Patients need to be prepared for collaborating in goal-setting and to receive an explanation about their part in that process. The multiplicity of disciplines may cloud patients' understanding of the process. The nurse's planning of the rehabilitation process should be aimed at resolving this issue. Goals need to be meaningful, and patients need support in attaining them. The interpretive, integrative, and consoling functions of Kirkevold's nursing role are suitable to meet these needs.

CONCLUSIONS

Both the literature about patients' needs regarding goal-setting and the nursing role make clear that the way nurses work in rehabilitation can gain in clarity. Strengthening the role of nurses will improve the goal-setting process for patients. Interprofessional collaboration, clear work procedures, continuity of care, time and trust, and the physical environment all are important to reinforce this role.

Registered nurses' role experiences of caring for older stroke patients: a qualitative study

BACKGROUND

With China's population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses' experiences of caring for older stroke patients.

METHODS

A qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data.

RESULTS

Two main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people's needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment.

CONCLUSIONS

Sustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses' lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services

Background

Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project.

Methods

Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis.

Results

The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule.

Conclusions

This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06467-4.

Experiences and views of receiving and delivering information about recovery in acquired neurological conditions: a systematic review of qualitative literature

OBJECTIVE

To review and synthesise qualitative literature relating to the views, perceptions and experiences of patients with acquired neurological conditions and their caregivers about the process of receiving information about recovery; as well as the views and experiences of healthcare professionals involved in delivering this information.

DESIGN

Systematic review of qualitative studies.

DATA SOURCES

MEDLINE, Embase, AMED, CINAHL, PsycINFO, Web of Science and the Cochrane library were searched from their inception to July 2019.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data from the included studies and assessed quality using an established tool. Thematic synthesis was used to synthesise the findings of included studies.

RESULTS

Searches yielded 9105 titles, with 145 retained for full-text screening. Twenty-eight studies (30 papers) from eight countries were included. Inductive analysis resulted in 11 descriptive themes, from which 5 analytical themes were generated: the right information at the right time; managing expectations; it's not what you say, it's how you say it; learning how to talk about recovery and manage emotions; the context of uncertainty.

CONCLUSIONS

Our findings highlight the inherent challenges in talking about recovery in an emotional context, where breaking bad news is a key feature. Future interventions should focus on preparing staff to meet patients' and families' information needs, as well as ensuring they have the skills to discuss potential recovery and break bad news compassionately and share the uncertain trajectory characteristic of acquired neurological conditions. An agreed team-based approach to talking about recovery is recommended to ensure consistency and improve the experiences of patients and their families.

Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis

AIMS

To explore the beneficial effects of virtual reality (VR) interventions on upper- and lower-limb motor function, balance, gait, cognition and daily function outcomes in stroke patients.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES

English databases (PubMed, EMBASE, the Cochrane Library, CINAHL, Web of Science, Physiotherapy Evidence Database, ProQuest Dissertations and Theses) and Chinese databases (Chinese BioMedical Literature Service System, WANFANG, CNKI) and the Clinical Trial Registry Platform were systematically searched from inception until December 2019. Additionally, reference lists of the included studies were manually searched.

REVIEW METHODS

The methodological quality of studies was scored with the Cochrane 'risk-of-bias tool' and PEDro scale from the Physiotherapy Evidence Database by two independent evaluators.

RESULTS

In total, 87 studies with 3540 participants were included. Stroke patients receiving VR interventions showed significant improvements in Fugl-Meyer assessment of Upper Extremity, Action Research Arm Test, Wolf Motor Function Test, Fugl-Meyer Assessment of Lower Extremity, Functional Ambulation Classification, Berg Balance Scale, Time Up and Go, Velocity, Cadence, Modified Barthel Index and Functional Independence Measure. However, differences between VR intervention and traditional rehabilitation groups were not significant for Box-Block Test, 10 m Walk Test, Auditory Continuous Performance Test, Mini-Mental State Examination and Visual Continuous Performance Test.

CONCLUSION

This review suggests that VR interventions effectively improve upper- and lower-limb motor function, balance, gait and daily function of stroke patients, but have no benefits on cognition.

IMPACT

This review identified the positive effects of VR-assisted rehabilitation on upper- and lower-limb motor function, balance, gait and daily function of stroke patients. And, we verified the duration of VR intervention affects some health benefits. The benefit of VR on cognitive function requires further investigation through large-scale multicentre RCTs.

Healthcare professionals' competence in stroke care pathways: A mixed-methods systematic review

BACKGROUND

The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals' competence development in stroke care is a necessity to ensure high-quality patient care.

OBJECTIVES

To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences.

DESIGN

A mixed-methods systematic review.

METHODS

The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases-CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation.

RESULTS

Competence in care processes, clinical competence, competence in using self-management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals' competence.

CONCLUSIONS

Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals' competence. Further research on healthcare professionals' stroke care competence will be needed to respond to changing healthcare demand.

RELEVANCE TO CLINICAL PRACTICE

We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals' competence development.

The effects of a dialogue-based intervention to promote psychosocial well-being after stroke: a randomized controlled trial

Objective:

To evaluate the effect of a dialogue-based intervention targeting psychosocial well-being at 12 months post-stroke.

Design:

Multicenter, prospective, randomized, assessor-blinded, controlled trial with two parallel groups.

Setting:

Community.

Subjects:

Three-hundred and twenty-two adults (⩾18 years) with stroke within the last four weeks were randomly allocated into intervention group (n = 166) or control group (n = 156).

Interventions:

The intervention group received a dialogue-based intervention to promote psychosocial well-being, comprising eight individual 1–1½ hour sessions delivered during the first six months post-stroke.

Main measures:

The primary outcome measure was the General Health Questionnaire-28 (GHQ-28). Secondary outcome measures included the Stroke and Aphasia Quality of Life Scale-39g, the Sense of Coherence scale, and the Yale Brown single-item questionnaire.

Results:

The mean (SD) age of the participants was 66.8 (12.1) years in the intervention group and 65.7 (13.3) years in the control group. At 12 months post-stroke, the mean (SE) GHQ-28 score was 20.6 (0.84) in the intervention group and 19.9 (0.85) in the control group. There were no between-group differences in psychosocial well-being at 12 months post-stroke (mean difference: −0.74, 95% confidence interval (CI): −3.08, 1.60). The secondary outcomes showed no statistically significant between-group difference in health-related quality of life, sense of coherence, or depression at 12 months.

Conclusion:

The results of this trial did not demonstrate lower levels of emotional distress and anxiety or higher levels of health-related quality of life in the intervention group (dialogue-based intervention) as compared to the control group (usual care) at 12 months post-stroke.

Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis

BACKGROUND

Adherence to rehabilitation regimens is a major issue in the treatment of stroke. Despite the agreement on the importance of adherence, there is still no clear definition of this concept in rehabilitation. The aim of this study was the concept analysis of the concept of adherence to rehabilitation regimens in stroke patients.

MATERIALS AND METHODS

This qualitative concept analysis was performed using Walker and Avant's method. English and Persian articles were searched using keywords such as "adherence", "compliance", "rehabilitation", "stroke", and other related keywords among articles published from 1997 to 2018 in PubMed, Scopus, Web of Science, Google Scholar, Iranmedex, Magiran, and Scientific Information Database (SID). Related textbooks were also searched and all articles containing definitions, attributes, antecedents, and consequences of the concept were included in the study.

RESULTS

The attributes of the concept included complex, multidimensional, and dynamic behavior in the treatment process, personal experience, and adaptive behavior in patients, changeable, situational, voluntary, and collaborative behavior, and active communication between the patient and the healthcare provider. Common antecedents of the concept of adherence to the rehabilitation regimen were classified into patient-related and environmental-related categories and the consequences were classified into the three categories of patient-related, healthcare professional-related, and healthcare system-related.

CONCLUSIONS

This concept analysis can be useful in eliminating any ambiguity of the concept of adherence to rehabilitation regimens. It helps clarify the vague concepts used in nursing rehabilitation instead of adherence. The results of this study can be helpful for researchers for further studies in this context.

Clinical Validation of Nursing Diagnoses Related to Self-Care Deficits in Patients with Stroke

To clinically validate the defining characteristics of nursing diagnoses related to self-care deficits in feeding, bathing, toileting, and dressing in patients with stroke. A diagnostic accuracy study was conducted with a sample of 135 patients with stroke. Sensitivity and specificity were calculated based on the latent class analysis method using the random effects model. The prevalence of diagnoses was 23.5% for Bathing self-care deficit, 18.5% for Dressing self-care deficit, 13.3% for Toileting self-care deficit, and 7.5% for Feeding self-care deficit. Fourteen defining characteristics were sensitive, and 17 were specific. Hemorrhagic stroke and note 4 on the Rankin scale was associated with self-care deficits. Of the 37 defining characteristics of the four diagnoses studied, 19 were clinically validated according to the latent class analysis model. These most accurate clinical indicators contribute to the development of the care plan for patients with stroke.

Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed-methods study assessing the feasibility and acceptability of an educational intervention programme

AIM

To assess the feasibility of a nursing educational intervention for inpatient stroke rehabilitation and its acceptability from the nursing staff's perspective.

BACKGROUND

There is currently a lack of interventions that integrate the diversity of nurses' role and functions in stroke rehabilitation and explore their effect on patient outcomes.

DESIGN

We used a convergent, parallel, mixed-method design with data interviews and questionnaires.

METHODS

Data collection was undertaken between February - July 2016. Data from questionnaires (N = 31) were analysed using descriptive statistics. The interviews (N = 10) were analysed using deductive content analysis.

RESULTS

There was a high level of satisfaction with the educational programme in terms of its acceptability and feasibility. The qualitative findings disclosed the nursing staff's experiences with the educational programme. Mixed-methods analysis showed confirmatory results that were convergent and expanded. Only minor adjustments are required before an effect study can be conducted.

Strengthening the role and functions of nursing staff in inpatient stroke rehabilitation: developing a complex intervention using the Behaviour Change Wheel

Purpose: Over the past two decades, attempts have been made to describe the nurse’s role and functions in the inpatient stroke rehabilitation; however, the nursing contribution is neither clear nor well-defined. Previous studies have highlighted the need for research aimed at developing interventions in the neuro-nursing area. The objective of this paper was to describe the development of a nursing intervention aimed at optimising the inpatient rehabilitation of stroke patients by strengthening the role and functions of nursing staff.

Method: A systematic approach was used, consistent with the framework for developing and evaluating complex interventions by the UK’s Medical Research Council (MRC). Based on qualitative methods and using the Behaviour Change Wheel’s (BCW) stepwise approach, we sought behaviours related to nursing staffs’ roles and functions.

Results: We conducted a behavioural analysis to explain why nursing staff were or were not engaged in these behaviours. The nursing staff’s Capability, Opportunity and Motivation were analysed with regard to working systematically with a rehabilitative approach and working deliberately and systematically with the patient’s goals.

Conclusion: We developed the educational intervention Rehabilitation 24/7. Following the MRC and the BCW frameworks is resource-consuming, but offers a way of developing a practical, well-structured intervention that is theory- and evidence based.

Nursing staffs self-perceived outcome from a rehabilitation 24/7 educational programme - a mixed-methods study in stroke care

Background

During the past two decades, attempts have been made to describe nurses’ contributions to the rehabilitation of inpatients following stroke. There is currently a lack of interventions that integrate the diversity of nurses’ role and functions in stroke rehabilitation and explore their effect on patient outcomes. Using a systematic evidence- and theory-based design, we developed an educational programme, Rehabilitation 24/7, for nursing staff working in stroke rehabilitation aiming at two target behaviours; working systematically with a rehabilitative approach in all aspects of patient care and working deliberately and systematically with patients’ goals. The aim of this study was to assess nursing staff members’ self-perceived outcome related to their capability, opportunity and motivation to work with a rehabilitative approach after participating in the stroke Rehabilitation 24/7 educational programme.

Methods

A convergent mixed-method design was applied consisting of a survey and semi-structured interviews. Data collection was undertaken between February and June 2016. Data from the questionnaires (N = 33) distributed before and after the intervention were analysed using descriptive statistics and Wilcoxon sign rank test. The interviews (N = 10) were analysed using deductive content analysis. After analysing questionnaires and interviews separately, the results were merged in a side by side comparison presented in the discussion.

Results

The results from both the quantitative and qualitative analyses indicate that the educational programme shaped the target behaviours that we aimed to change by addressing the nursing staff’s capability, opportunity and motivation and hence could strengthen the nursing staff’s contribution to inpatient stroke rehabilitation. A number of behaviours changed significantly, and the qualitative results indicated that the staff experienced increased focus on their role and functions in rehabilitation practice.

Conclusion

Our study provides an understanding of the outcome of the Rehabilitation 24/7 educational programme on nursing staff’s behaviours. A mixed-methods approach provided extended knowledge of the changes in the nursing staff members’ self-percived behaviours after the intervention. These changes suggest that educating the nursing staff on rehabilitation using the Rehabilitation 24/7 programme strengthened their knowledge and beliefs about rehabilitation, goal-setting as well as their role and functions.

The physical environment and patients' activities and care: A comparative case study at three newly built stroke units

AIM

To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.

BACKGROUND

Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce.

DESIGN

This work is a comparative descriptive case study.

METHOD

Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015.

RESULTS

The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care.

CONCLUSIONS

Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.

Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial

Background

Stroke is a major public health threat globally. Psychosocial well-being may be affected following stroke. Depressive symptoms, anxiety, general psychological distress and social isolation are prevalent. Approximately one third report depressive symptoms and 20% report anxiety during the first months or years after the stroke. Psychosocial difficulties may impact significantly on long-term functioning and quality of life, reduce the effects of rehabilitation services and lead to higher mortality rates. The aim of the study is to evaluate the effect of a previously developed and feasibility tested dialogue-based psychosocial intervention aimed at promoting psychosocial well-being and coping following stroke among stroke survivors with and without aphasia.

Methods

The study will be conducted as a multicenter, randomized, single blind controlled trial with one intervention and one control arm. It will include a total of 330 stroke survivors randomly allocated into either an intervention group (dialogue-based intervention to promote psychosocial well-being) or a control group (usual care). Participants in the intervention group will receive eight individual sessions of supported dialogues in their homes during the first six months following an acute stroke. The primary outcome measure will be psychosocial well-being measured by the General Health Questionnaire (GHQ). Secondary outcome measures will be quality of life (SAQoL), sense of coherence (SOC), and depression (Yale). Process evaluation will be conducted in a longitudinal mixed methods study by individual qualitative interviews with 15–20 participants in the intervention and control groups, focus group interviews with the intervention personnel and data collectors, and a comprehensive analysis of implementation fidelity.

Discussion

The intervention described in this study protocol is based on thorough development and feasibility work, guided by the UK medical research council framework for developing and testing complex interventions. It combines classical effectiveness evaluation with a thorough process evaluation. The results from this study may inform the development of further trials aimed at promoting psychosocial well-being following stroke as well as inform the psychosocial follow up of stroke patients living at home.

Trial registration

NCT02338869; registered 10/04/2014 (On-going trial).

Nursing students contribution to rehabilitation for home-dwelling patients

Home-dwelling rehabilitation has expanded in the last years in Norway. The goal is to strengthen self-care for those who have suffered acute impairment or has due to chronic diseases. The purpose of this study was to explore whether nursing students in home-based nursing care (HBNC) can contribute to patients' rehabilitation and mastery work during clinical placement. The study considered 121 undergraduate nursing students' HBNC clinical placements where they, in collaboration with patients, have designed and applied a rehabilitation plan. The duration of the clinical placements were 8 weeks and took place in the municipality of Oslo. Prior to the clinic placement, the students have followed an introductory course rehabilitation plan development. During the initial phase of the placement, the students an eight-step model for mapping the patient's values: 1) home, 2) close relatives, 3) physical activities, 4) friends, 5) job, 6) leisure activities, 7) body and appearance, and 8) spiritual and philosophical values. The students scaled the intensity of each value on a scale from 1 to 10. Through their clinical training a teacher and clinical supervisors have coached the students. The clinical placements have been followed by a written exam. Based on patients' values and resources, the students coached patients in self-care activities that brought the patients closer to their targets, whether it was on an activation or a participation level. The principal finding of this study was that the students in HBNC were adequately prepared to plan and carry out rehabilitation activities with patients.

Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study

Background

Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation.

Methods

A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.

Results

Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care.

Conclusion

Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.

Electronic supplementary material

The online version of this article (10.1186/s12912-017-0262-y) contains supplementary material, which is available to authorized users.

The effect of involving significant others in chronic pain programs for adult patients with chronic non-malignant pain: a systematic review protocol

The objective of this review is to identify the effect of the involvement of significant others in chronic pain management programs for adult patients with chronic non-malignant pain on function, self-efficacy and pain.More specifically, the objectives are to identify the effect of involving significant others in chronic management programs for adults with chronic non-malignant pain in primary, secondary or tertiary health care. This is compared to those receiving usual care or other self-management interventions.

Perceptions of patients, significant others and health professionals of the role of significant others in programs for chronic non-malignant pain patients: a systematic review protocol

The objective of this review is to identify and synthesize the perceptions of patients, significant others and health professionals regarding the role of significant others in chronic pain programs or healthcare regimens that target patients with chronic non-malignant pain. More specifically, the objective is to identify the role of significant others in chronic pain programs and healthcare regimens for adult patients with chronic non-malignant pain in primary, secondary or tertiary healthcare settings.

Understanding nursing practice in stroke units: a Q-methodological study

PURPOSE

Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses' practice in stroke rehabilitation.

METHOD

Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members.

RESULTS

Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role.

CONCLUSIONS

The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills. Implications for Rehabilitation Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care. Views of stroke unit team members on nurses' involvement in rehabilitation have not been reported previously. Nurses can routinely incorporate rehabilitation principles in their care. Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

A Synthesis of Peer-Reviewed Literature on Team-Coordinated and Delivered Early Supported Discharge After Stroke

This review aimed to summarize data from peer-reviewed studies of team-coordinated and delivered early supported discharge (ESD) for postacute, poststroke rehabilitation. A systematic review was performed in Medline, Embase, and CINAHL for appropriate studies. Information on program details and patient cohorts was synthesized. All programs sought patients with mild-to-moderate functional impairment and minimal cognitive impairment (often based on Barthel Index and Mini-Mental State Examination scores, respectively). All also included at least one subjective admission criterion related to rehabilitation suitability or the suitability of the home environment. Based on the identified studies, ESD programs can assume that 15% of patients screened for ESD will be eligible and care should be provided for 4 to 5 weeks postdischarge. Although the benefits of team-coordinated and delivered ESD poststroke have been well-documented, this review may be helpful for clinicians, administrators, and policy makers looking to establish or refine an ESD program for stroke.

The Competency Model for Professional Rehabilitation Nursing

BACKGROUND

Rehabilitation nursing is practiced in various settings along the healthcare continuum. No framework is noted in the literature that defines the necessary competencies of the rehabilitation nurse.

PURPOSE

To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical and educational practice.

METHOD/DESIGN

A seven-member Association of Rehabilitation Nurses (ARN) task force was convened; conducted a literature review, reviewed current and historical ARN documents, including the Strategic Plan, and developed a Competency Model for Professional Rehabilitation Nursing practice.

FINDINGS

The Competency Model for Professional Rehabilitation Nursing delineates four domains of rehabilitation nursing practice and essential role competencies.

CONCLUSION

The Competency Model for Professional Rehabilitation Nursing addresses this diverse specialty practice in the current healthcare arena. This framework can be used to guide nurses practicing at different levels of proficiency in various settings.

CLINICAL RELEVANCE

The Competency Model can be used as a structure for staff orientation, evaluation tools, clinical ladder components, role descriptions and rehabilitation nursing courses.

Striving for a life worth living: stroke survivors' experiences of home rehabilitation

BACKGROUND

For mild-to-moderate stroke survivors, early supported discharge from hospital, followed by home rehabilitation is preferred over conventional care. How this mode of service contributes to recovery from stroke survivors' perspective needs further investigation.

AIM

The aim of this study was to explore mild-to-moderate stroke survivors' experiences with home rehabilitation after early supported discharge from hospital.

METHODS

A qualitative interpretive interview design was used in the context of a randomised controlled trial. A purposive sample of eight participants (45-80 years) was followed by an ambulant team, and a specific healthcare team provided home rehabilitation. Data were analysed using interpretive description, systematic text condensation and coping theory.

FINDINGS

A crucial determinant for the participants' hopes for a life worth living was the mutual confidence expressed in encounters with healthcare professionals and the participants' ability to make sense of their now-altered body. The professional caretakers' communication qualities and their ability to attend to individual needs were important. Help in processing the emotional reactions caused by a changed body and in socialising was requested by participants. Professional caretakers providing home rehabilitation should strive for a more flexible- and individually tailored service and should seek increased cooperation among stakeholders.

CONCLUSION

The focus on therapeutic communicative qualities, bodily changes, emotional processes, social concerns and long-term follow-up should be increased in order to achieve a more beneficial experience for stroke survivors.

Promoting psychosocial wellbeing following stroke using narratives and guided self-determination: a feasibility study

BACKGROUND

Extensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Psychosocial difficulties significantly affect long-term functioning and quality of life. Many studies have explored psychosocial interventions to prevent or treat psychosocial problems, but most have found modest effects. This study evaluated, from the perspective of adult stroke survivors, (1) the content, structure and process and (2) experienced usefulness of a dialogue-based psychosocial nursing intervention in primary care aimed at promoting psychosocial health and wellbeing.

METHODS

This was part of a feasibility study guided by the UK MRC complex interventions framework. It consisted of dialogue-based encounters with trained health professionals during approximately the first year poststroke. It was tested in two formats; individual or group encounters. Inclusion criteria were: Acute stroke, above 18 y.o., sufficient physical and cognitive functioning to participate. Data were collected immediately before, during and 14 days after the completion of the intervention. Pre- and post-data included medical and demographic data, quality of life, emotional wellbeing, life satisfaction, anxiety and depression. Qualitative interviews focusing on participant experiences were conducted two weeks following the intervention. Log notes taken by the health professionals conducting the intervention and work sheets filled in by participants also comprised data. Data analysis was case-oriented. The structured instruments were analysed regarding completeness of data and indication of changes in outcome variables. The qualitative interviews, log notes and work sheets were analysed using thematic content analysis.

RESULTS

Twenty-five stroke survivors (17 men, 8 women), median age 64 (range 33-89), participated. Physical limitations varied from mild to severe. Seven participants had moderate to severe expressive aphasia. The participants found the content and process of the intervention relevant. Both the individual and group formats were found useful. Patients with aphasia reported that there were too few encounters (eight encounters were originally planned). The participants underscored the benefits of being supported through a difficult time, having a chance to tell and (re)create their story and being supported in their attempts to cope with the situation.

CONCLUSIONS

This study provides initial support for the usefulness of the psychosocial intervention and highlights areas requiring further consideration and development.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT01912014.

Work-aged stroke survivors' psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study

Background

Studies point to the lack of psychosocial support and rehabilitation services that are adjusted to the work-aged stroke survivors’ specific needs in order to promote psychosocial well-being. The aim of the study was to illuminate the psychosocial challenges work-aged participants (i.e. aged 18–67 years) thematised during and after participating a dialogue-based psychosocial intervention during the first year following a stroke.

Methods

The study was a feasibility study guided by the UK Medical Research Council Framework for developing and evaluating complex interventions. Qualitative data from in-depth interviews with fourteen stroke-survivors aged 33–66 years, researcher field notes and log notes written during the intervention were analysed applying a hermeneutic-phenomenological approach.

Results

The stroke and its consequences had a substantial impact on family and work life. Their experiences were summarised in the two themes The threat of becoming marginalised in family life and The threat of becoming marginalised in work life.

Conclusion

Life as a work-aged stroke survivor was experienced as challenging and created a threat of becoming marginalised in family and work life. The study highlights the need to understand the specific psychosocial challenges and needs facing work-aged stroke survivors’ in order to promote their psychosocial well-being. More research is needed concerning specific life-span challenges amongst work-aged stroke survivors in order to further develop appropriate interventions that helps address this issue.

Nursing practice in stroke rehabilitation: systematic review and meta-ethnography

AIMS AND OBJECTIVES

To identify and synthesise the available research evidence in order to generate an explanatory framework for nursing practice in stroke rehabilitation.

BACKGROUND

Although nurses are the largest professional group working with stroke survivors, there is limited understanding of nursing practice in stroke units. In particular, there is currently very little evidence in respect of nurses' involvement in poststroke rehabilitation.

DESIGN

Meta-ethnography.

METHOD

A systematic review was undertaken. The review question was: 'What is the nature of nursing practice in the care and rehabilitation of inpatient stroke survivors?' Searches of 12 electronic databases identified 14,655 publications, and after screening, 778 remained; 137 papers were obtained and 54 retained for mapping. Sixteen qualitative studies were included in the meta-ethnography.

RESULTS

Nurses' involvement in poststroke rehabilitation was limited. Contextual factors impacted on nurses' perceptions and practice. Nurses' integration of rehabilitation skills was perceived to be contingent on adequate nurse staffing levels and management of demands on nurses' time. Team working practices and use of the built environment indicated separation of nursing and therapy work. Physical care and monitoring were prioritised. Stroke-specific education and training was evident, but not consistent in content or approach. Stroke survivors and families needed help to understand nurses' role in rehabilitation.

CONCLUSION

The review provides compelling evidence that there is an need to re-examine the role of nurses in contributing to poststroke rehabilitation, including clarifying when this process can safely begin and specifying the techniques that can be integrated in nurses' practice.

RELEVANCE TO CLINICAL PRACTICE

Integrating stroke-specific rehabilitation skills in nurses' practice could contribute substantially to improving outcomes for stroke survivors. The explanatory framework developed from the review findings identifies issues which will need to be addressed in order to maximise nurses' contribution to the rehabilitation of stroke survivors.

Sense of well-being 10 years after stroke

AIMS AND OBJECTIVES

To describe factors that promote subjective well-being in a long-time perspective of 10 years after stroke.

BACKGROUND

The research literature describes circumstances that are difficult to deal with after a stroke, but there is relatively little knowledge of factors that contribute to well-being in a longer-time perspective than two years after the incident. This study focuses on such conditions in a 10-year perspective.

DESIGN

Qualitative study

METHODS

Qualitative in-depth interviews were carried out with nine stroke survivors. The interviews addressed their description of factors accounting for adaptation and subjective well-being after the stroke. Kvale and Brinkmann's (2008, Interview. Sage Publications, Inc., København) guidelines for qualitative research informed the analysis.

RESULTS

Six major themes emerged from these analyses: (1) personal characteristics as the cause of positive adaptation to the new situation, (2) new meaningful activities, (3) new health habits, (4) social networks and family, (5) economical resources and (6) public help. Only a few of the survivors had received any home-based nursing care or health assistance, but they were nevertheless mainly satisfied with their rehabilitation outcome. Self-care, health literacy, stamina, a positive way of thinking and attention from family and friends seemed to be of immense importance for adaptation and well-being.

CONCLUSION

Personal characteristics and synergy with significant others seem to be the most important factors for having a good and long life after a stroke.

RELEVANCE TO CLINICAL PRACTICE

The results of this study will contribute to rehabilitation planning and to understanding, assisting and supporting stroke survivors in restoring a good life despite disabilities after the stroke.