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Bright FAS, Ibell-Roberts C, Featherstone K, Signal N, Wilson BJ, Collier A, Fu V. 'Physical well-being is our top priority': Healthcare professionals' challenges in supporting psychosocial well-being in stroke services. Health Expect 2024; 27:e14016. [PMID: 38469645 DOI: 10.1111/hex.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
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.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Claire Ibell-Roberts
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Katie Featherstone
- Geller Institute of Ageing and Memory, University of West London, London, UK
| | - Nada Signal
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
| | - Bobbie-Jo Wilson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Aileen Collier
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Vivian Fu
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Angel S, Steensgaard R, Kolbaek R, Frimann S. Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1267401. [PMID: 38149111 PMCID: PMC10749968 DOI: 10.3389/fresc.2023.1267401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
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.
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Affiliation(s)
- Sanne Angel
- Research Unit of Nursing and Healthcare, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Randi Steensgaard
- Specialized Hospital for Polio and Accident Victims, Aarhus, Denmark
| | - Raymond Kolbaek
- Research Unit of Nursing and Healthcare, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Søren Frimann
- Department of Culture and Learning, Aalborg University, Aalborg, Denmark
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de Lima JN, Lima LR, Cavalcante EGR, Quirino GDS, Pinheiro WR. Nursing theories in the care of stroke patients: a scoping review. Rev Bras Enferm 2023; 76:e20220791. [PMID: 37820129 PMCID: PMC10561425 DOI: 10.1590/0034-7167-2022-0791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/20/2023] [Indexed: 10/13/2023] Open
Abstract
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.
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Guitar NA, Connelly DM, Prentice K, Nguyen A, McIntyre A, Tanlaka EF, Snobelen N. The role of nurses in inpatient geriatric rehabilitation units: A scoping review. Nurs Open 2023; 10:6708-6723. [PMID: 37515319 PMCID: PMC10495722 DOI: 10.1002/nop2.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Kristin Prentice
- Health and Rehabilitation SciencesWestern UniversityLondonOntarioCanada
| | - Angela Nguyen
- School of Physical TherapyWestern UniversityLondonOntarioCanada
| | - Amanda McIntyre
- Arthur Labatt School of NursingWestern UniversityLondonOntarioCanada
| | | | - Nancy Snobelen
- Registered Practical Nurses Association of Ontario (WeRPN)MississaugaOntarioCanada
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Vaalburg AM, Wattel EM, Boersma P, Hertogh CMPM, Gobbens RJJ. The Role of Nursing Staff Regarding Goal Setting and Achieving in Geriatric Rehabilitation: A Focus Group Study. Rehabil Nurs 2023; 48:148-159. [PMID: 37669324 PMCID: PMC10487360 DOI: 10.1097/rnj.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
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.
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Affiliation(s)
- Anne Marie Vaalburg
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Elizabeth M. Wattel
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- University Network of Organizations for Care for the Elderly of VU University Medical Centre, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Ben Sajet Center for Long-Term Care, Amsterdam, the Netherlands
| | - Cees M. P. M. Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- University Network of Organizations for Care for the Elderly of VU University Medical Centre, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Osei SKJ, Adomako-Bempah E, Yeboah AA, Owiredu LA, Ohene LA. Nurse-led telerehabilitation intervention to improve stroke efficacy: Protocol for a pilot randomized feasibility trial. PLoS One 2023; 18:e0280973. [PMID: 37267261 DOI: 10.1371/journal.pone.0280973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
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.
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van Nimwegen D, Hjelle EG, Bragstad LK, Kirkevold M, Sveen U, Hafsteinsdóttir T, Schoonhoven L, Visser-Meily J, de Man-van Ginkel JM. Interventions for improving psychosocial well-being after stroke: A systematic review. Int J Nurs Stud 2023; 142:104492. [PMID: 37084476 DOI: 10.1016/j.ijnurstu.2023.104492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
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.
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Affiliation(s)
- Dagmar van Nimwegen
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Ellen Gabrielsen Hjelle
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Line Kildal Bragstad
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Marit Kirkevold
- Department of Public Health Science and CHARM Research Centre for Habilitation and Rehabilitation Models & Services, University of Oslo, Oslo, Norway; Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Thóra Hafsteinsdóttir
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, the Netherlands; Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Vaalburg AM, Boersma P, Wattel EM, Ket JCF, Hertogh CMPM, Gobbens RJJ. Supporting older patients in working on rehabilitation goals: A scoping review of nursing interventions. Int J Older People Nurs 2023:e12542. [PMID: 37082887 DOI: 10.1111/opn.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
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.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Elizabeth M Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
- University Network of Organizations for Care for Older People of Amsterdam University Medical Centers (UNO Amsterdam), Amsterdam, Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
- University Network of Organizations for Care for Older People of Amsterdam University Medical Centers (UNO Amsterdam), Amsterdam, Netherlands
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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Sepahvand E, Daryabor A, Hosseini RS, Neyseh F. Design and Development of Kardex and Nursing Reports in the Rehabilitation Hospital. SAGE Open Nurs 2023; 9:23779608231153472. [PMID: 36761365 PMCID: PMC9903012 DOI: 10.1177/23779608231153472] [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: 10/19/2022] [Revised: 11/29/2022] [Accepted: 01/08/2023] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- Elham Sepahvand
- Department of Nursing, School of Nursing and Midwifery, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran,Elham Sepahvand, Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Neyseh
- Department of Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Steensgaard R, Kolbaek R, Angel S. Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation. Health Expect 2022; 25:2525-2533. [PMID: 36004714 PMCID: PMC9615065 DOI: 10.1111/hex.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Randi Steensgaard
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Central Region Hospital, Viborg, Denmark.,Centre for Research in Clinical Nursing, Central Region Hospital, Viborg, Denmark
| | - Raymond Kolbaek
- Centre for Research in Clinical Nursing, Central Region Hospital, Viborg, Denmark.,Department of Nursing, Campus Viborg-VIA University College, Viborg, Denmark
| | - Sanne Angel
- Research Unit for Nursing and Healthcare, Institute of Public Health, Aarhus University, Aarhus, Denmark
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Anåker A, Morichetto H, Elf M. 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. Scand J Caring Sci 2022; 37:328-336. [PMID: 35938614 DOI: 10.1111/scs.13112] [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: 02/21/2022] [Revised: 07/01/2022] [Accepted: 07/17/2022] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Anna Anåker
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Marie Elf
- School of Health and Welfare, Dalarna University, Falun, Sweden
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12
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Health care providers’ effect on long-term mortality after the first-ever stroke: application of shared frailty survival models. Neurol Sci 2022; 43:4307-4313. [DOI: 10.1007/s10072-022-05983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
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Kok S, de Man-van Ginkel JM, Verstraten C, Resnick B, Metzelthin SF, Bleijenberg N, Schoonhoven L. Function focused care in hospital: A mixed-method feasibility study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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14
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Martinsen R, Kitzmüller G, Mangset M, Kvigne K, Evju AS, Bronken BA, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Nurses' and occupational therapists' experiences of conducting a home-based psychosocial intervention following stroke: a qualitative process evaluation. BMC Health Serv Res 2021; 21:791. [PMID: 34376188 PMCID: PMC8356405 DOI: 10.1186/s12913-021-06857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Randi Martinsen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway.
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Anne Svelstad Evju
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Line Kildal Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Geriatric Medicine and Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
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15
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Nordin S, Swall A, Anåker A, von Koch L, Elf M. Does the physical environment matter? - A qualitative study of healthcare professionals' experiences of newly built stroke units. Int J Qual Stud Health Well-being 2021; 16:1917880. [PMID: 34240677 PMCID: PMC8274537 DOI: 10.1080/17482631.2021.1917880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Susanna Nordin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anna Swall
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anna Anåker
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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16
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Vaalburg AM, Wattel E, Boersma P, Hertogh C, Gobbens R. Goal-setting in geriatric rehabilitation: Can the nursing profession meet patients' needs? A narrative review. Nurs Forum 2021; 56:648-659. [PMID: 33625738 PMCID: PMC8451803 DOI: 10.1111/nuf.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Elizabeth Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
| | - Cees Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
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17
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Cheng W, Tu J, Shen X. Registered nurses' role experiences of caring for older stroke patients: a qualitative study. BMC Nurs 2021; 20:96. [PMID: 34116661 PMCID: PMC8196525 DOI: 10.1186/s12912-021-00626-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Wei Cheng
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, 510282, Guangzhou, China
| | - Jiong Tu
- School of Sociology and Anthropology, Sun Yat-sen University, 510275, Guangzhou, China.
| | - Xiaoyan Shen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, 510282, Guangzhou, China
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18
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Mathisen TS, Eilertsen G, Ormstad H, Falkenberg HK. Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services. BMC Health Serv Res 2021; 21:497. [PMID: 34030691 PMCID: PMC8147019 DOI: 10.1186/s12913-021-06467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/29/2021] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway.
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway
- USN Research Group of Older Peoples' Health, University of South-Eastern Norway, Drammen, Norway
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19
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Burton LJ, Forster A, Johnson J, Crocker TF, Tyson SF, Wray F, Clarke DJ. Experiences and views of receiving and delivering information about recovery in acquired neurological conditions: a systematic review of qualitative literature. BMJ Open 2021; 11:e045297. [PMID: 33906841 PMCID: PMC8088240 DOI: 10.1136/bmjopen-2020-045297] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Judith Johnson
- School of Psychology, University of Leeds Faculty of Biological Sciences, Leeds, UK
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - David J Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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20
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Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis. J Adv Nurs 2021; 77:3255-3273. [PMID: 33675076 DOI: 10.1111/jan.14800] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/22/2020] [Accepted: 01/20/2021] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Bohan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Dan Li
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Yue Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Jiani Wang
- Fuwai Hospital, CAMS &PUMC, Beijing, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
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21
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Jarva E, Mikkonen K, Tuomikoski AM, Kääriäinen M, Meriläinen M, Karsikas E, Koivunen K, Jounila-Ilola P, Oikarinen A. Healthcare professionals' competence in stroke care pathways: A mixed-methods systematic review. J Clin Nurs 2021; 30:1206-1235. [PMID: 33350004 DOI: 10.1111/jocn.15612] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/30/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Erika Jarva
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Kristina Mikkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Oulu University of Applied Sciences, Oulu, Finland.,The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Meriläinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | | | | | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
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22
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Bragstad LK, Hjelle EG, Zucknick M, Sveen U, Thommessen B, Bronken BA, Martinsen R, Kitzmüller G, Mangset M, Kvigne KJ, Hilari K, Lightbody CE, Kirkevold M. The effects of a dialogue-based intervention to promote psychosocial well-being after stroke: a randomized controlled trial. Clin Rehabil 2020; 34:1056-1071. [PMID: 32517513 PMCID: PMC7372590 DOI: 10.1177/0269215520929737] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Line Kildal Bragstad
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Manuela Zucknick
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Randi Martinsen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Narvik, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Johanne Kvigne
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Katerina Hilari
- Centre for Language and Communication Sciences Research, School of Health Sciences, City, University of London, London, UK
| | | | - Marit Kirkevold
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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23
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Pishkhani MK, Dalvandi A, Ebadi A, Hosseini MA. Adherence to a Rehabilitation Regimen in Stroke Patients: A Concept Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:139-145. [PMID: 32195160 PMCID: PMC7055185 DOI: 10.4103/ijnmr.ijnmr_170_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/07/2019] [Accepted: 12/23/2019] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Maryam Khoshbakht Pishkhani
- Department of Nursing, School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- School of Rehabilitation, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- School of Nursing and Midwifery, Islamic Azad University of Tehran, Central Branch, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Hosseini
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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24
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Oliveira-Kumakura ARDS, Sousa CMFM, Biscaro JA, Silva KCRD, Silva JLG, Morais SCRV, Lopes MVDO. Clinical Validation of Nursing Diagnoses Related to Self-Care Deficits in Patients with Stroke. Clin Nurs Res 2019; 30:494-501. [PMID: 31640400 DOI: 10.1177/1054773819883352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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25
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Meng X, Chen X, Liu Z, Zhou L. Nursing practice in stroke rehabilitation: Perspectives from multi‐disciplinary healthcare professionals. Nurs Health Sci 2019; 22:28-37. [DOI: 10.1111/nhs.12641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/04/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Xianmei Meng
- School of Nursing, Second Military Medical University Shanghai China
- School of Health Sciences, Wuhan University Wuhan China
| | - Xuemei Chen
- School of Nursing, Second Military Medical University Shanghai China
| | - Zhihui Liu
- School of Nursing, Second Military Medical University Shanghai China
| | - Lanshu Zhou
- School of Nursing, Second Military Medical University Shanghai China
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26
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Loft MI, Poulsen I, Martinsen B, Mathiesen LL, Iversen HK, Esbensen BA. Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed-methods study assessing the feasibility and acceptability of an educational intervention programme. Nurs Open 2019; 6:162-174. [PMID: 30534406 PMCID: PMC6279726 DOI: 10.1002/nop2.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 04/24/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ingrid Poulsen
- Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC), Clinic of NeurorehabilitationTBI Unit RigshospitaletHvidovreDenmark
- Department of Nursing Science, Institute of Public HealthAarhus UniversityCopenhagenDenmark
| | - Bente Martinsen
- Department of Nursing Science, Institute of Public HealthAarhus UniversityCopenhagenDenmark
| | | | - Helle Klingenberg Iversen
- Department of NeurologyRigshospitaletGlostrupDenmark
- Clinical Research, Faculty of Health and Medical SciencesUniversity of CopenhagenGlostrupDenmark
| | - Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research (COPECARE)Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, RigshospitaletGlostrupDenmark
- Faculty of Health and Medical Sciences, Department of Clinical MedicineUniversity of CopenhagenGlostrupDenmark
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27
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Strengthening the role and functions of nursing staff in inpatient stroke rehabilitation: developing a complex intervention using the Behaviour Change Wheel. Int J Qual Stud Health Well-being 2018; 12:1392218. [PMID: 29088984 PMCID: PMC7011965 DOI: 10.1080/17482631.2017.1392218] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Mia Ingerslev Loft
- a Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark.,b Department of Public Health , Section of Nursing, Aarhus University , Aarhus , Denmark
| | - Bente Martinsen
- b Department of Public Health , Section of Nursing, Aarhus University , Aarhus , Denmark
| | - Bente Appel Esbensen
- c Copenhagen Centre for Arthritis Research (COPECARE) , Centre for Rheumatology and Spine Diseases, VRR Head and Orthopaedics Centre , Glostrup , Rigshospitalet , Denmark.,d Department of Clinical Medicine , Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Lone L Mathiesen
- a Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark
| | - Helle K Iversen
- a Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark.,d Department of Clinical Medicine , Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Ingrid Poulsen
- b Department of Public Health , Section of Nursing, Aarhus University , Aarhus , Denmark.,e Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC) , Clinic of Neurorehabilitaion , Hvidovre , TBI unit Rigshospitalet , Denmark
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28
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Loft MI, Esbensen BA, Kirk K, Pedersen L, Martinsen B, Iversen H, Mathiesen LL, Poulsen I. Nursing staffs self-perceived outcome from a rehabilitation 24/7 educational programme - a mixed-methods study in stroke care. BMC Nurs 2018; 17:17. [PMID: 29719491 PMCID: PMC5921301 DOI: 10.1186/s12912-018-0285-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/03/2018] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- M I Loft
- 1Department of Neurology, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark.,2Institute of Public Health, Department of Nursing Science, Aarhus University, Aarhus, Denmark
| | - B A Esbensen
- 3Copenhagen Centre for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark.,4Falcuty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K Kirk
- Partner PAR3(consulting firm), Copenhagen, Denmark
| | - L Pedersen
- Partner PAR3(consulting firm), Copenhagen, Denmark
| | - B Martinsen
- 2Institute of Public Health, Department of Nursing Science, Aarhus University, Aarhus, Denmark
| | - H Iversen
- 1Department of Neurology, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark.,4Falcuty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L L Mathiesen
- 1Department of Neurology, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - I Poulsen
- 2Institute of Public Health, Department of Nursing Science, Aarhus University, Aarhus, Denmark.,Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC), Clinic of Neurorehabilitaion, TBI unit Rigshospitalet, Glostrup, Denmark
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29
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Anåker A, von Koch L, Sjöstrand C, Heylighen A, Elf M. The physical environment and patients' activities and care: A comparative case study at three newly built stroke units. J Adv Nurs 2018; 74:1919-1931. [PMID: 29676493 DOI: 10.1111/jan.13690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Anna Anåker
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neurovascular Diseases, Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Sjöstrand
- Department of Neurovascular Diseases, Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ann Heylighen
- Department of Architecture, Research[x]Design, KU Leuven, Leuven, Belgium
| | - Marie Elf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Architecture and Civil Engineering, The School of Architecture, Chalmers University of Technology, Gothenburg, Sweden
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30
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Kirkevold M, Kildal Bragstad L, Bronken BA, Kvigne K, Martinsen R, Gabrielsen Hjelle E, Kitzmüller G, Mangset M, Angel S, Aadal L, Eriksen S, Wyller TB, Sveen U. Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial. BMC Psychol 2018; 6:12. [PMID: 29615136 PMCID: PMC5883408 DOI: 10.1186/s40359-018-0223-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/11/2018] [Indexed: 11/25/2022] Open
Abstract
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).
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Affiliation(s)
- Marit Kirkevold
- Institute of Health and Society and Research Center for habilitation and rehabilitation services and models (CHARM), University of Oslo, P.O.Box 1130, Blindern, 0318, Oslo, Norway.
| | - Line Kildal Bragstad
- Institute of Health and Society and Research Center for habilitation and rehabilitation services and models (CHARM), University of Oslo, P.O.Box 1130, Blindern, 0318, Oslo, Norway
| | - Berit A Bronken
- Inland Norway University of Applied Sciences, P.O.Box 400, 2418, Elverum, Norway
| | - Kari Kvigne
- Inland Norway University of Applied Sciences, P.O.Box 400, 2418, Elverum, Norway
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.O.Box 400, 2418, Elverum, Norway
| | - Ellen Gabrielsen Hjelle
- Institute of Health and Society and Research Center for habilitation and rehabilitation services and models (CHARM), University of Oslo, P.O.Box 1130, Blindern, 0318, Oslo, Norway
| | - Gabriele Kitzmüller
- Faculty of Health UIT, The Arctic University of Norway, Campus, Narvik, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, P.O box 4956, Nydalen, 0424, Oslo, Norway
| | - Sanne Angel
- Institute of Public Health, Aarhus University, Hoegh-Guldbergs Gade 6 A, 8000, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Voldbyvej 15 8450, Hammel, Denmark
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), P. O. Box 2136, 3103, Tønsberg, Norway
| | - Torgeir B Wyller
- Institute of Clinical Medicine, University of Oslo, and Department. of Geriatric Medicine, Oslo University Hospital, P.O box 4956 Nydalen, 0424, Oslo, Norway
| | - Unni Sveen
- Dept. of Geriatric Medicine, and Dept. of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O box 4956 Nydalen, 0424, Oslo, Norway
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31
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Pay BB, Sørbye LW. Nursing students contribution to rehabilitation for home-dwelling patients. Nurse Educ Pract 2018; 30:48-55. [PMID: 29550503 DOI: 10.1016/j.nepr.2018.03.003] [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: 09/06/2017] [Revised: 02/14/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Birgit Brunborg Pay
- Faculty of Health, Vid Spesialized University, Pb. 184 Vinderen, 0319 Oslo, Norway.
| | - Liv Wergeland Sørbye
- Faculty of Health, Vid Spesialized University, Pb. 184 Vinderen, 0319 Oslo, Norway.
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32
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Bjartmarz I, Jónsdóttir H, Hafsteinsdóttir TB. Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study. BMC Nurs 2017; 16:72. [PMID: 29213212 PMCID: PMC5709925 DOI: 10.1186/s12912-017-0262-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/10/2017] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Ingibjörg Bjartmarz
- Clinical Nurse Specialist, Department of Rehabilitation, Landspítali University Hospital, Reykjavík, Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Nursing Care for Chronically Ill Adults, Landspítali University Hospital, Reykjavík, Iceland
| | - Thóra B Hafsteinsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Julius Center for Health Sciences and Primary Care, Nursing Science Department, University Medical Center Utrecht, Utrecht, The Netherlands
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33
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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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34
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Worthington E, Hawkins L, Lincoln N, Drummond A. The day-to-day experiences of people with fatigue after stroke: Results from the Nottingham Fatigue After Stroke study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.10.449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Esme Worthington
- Research Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Louise Hawkins
- Stroke Association Postgraduate Fellow, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Nadina Lincoln
- Professor of Clinical Psychology, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Avril Drummond
- Professor of Healthcare Research, School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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35
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Loft MI, Poulsen I, Esbensen BA, Iversen HK, Mathiesen LL, Martinsen B. Nurses’ and nurse assistants’ beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit-A qualitative study. J Clin Nurs 2017; 26:4905-4914. [DOI: 10.1111/jocn.13972] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mia I Loft
- Department of Neurology; Rigshospitalet; Glostrup Denmark
- Department of Nursing Science; Institute of Public Health; Aarhus University; Aarhus C Denmark
| | - Ingrid Poulsen
- Department of Nursing Science; Institute of Public Health; Aarhus University; Aarhus C Denmark
- Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC); Clinic of Neurorehabilitation; TBI unit Rigshospitalet; Hvidovre Denmark
| | - Bente A Esbensen
- Copenhagen Centre for Arthritis Research (COPECARE); Centre for Rheumatology and Spine Diseases VRR; Head and Orthopaedics Centre; Rigshospitalet - Glostrup; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Helle K Iversen
- Department of Neurology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Bente Martinsen
- Department of Public Health; Section of Nursing; Faculty of Health; Aarhus University; Copenhagen NV Denmark
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Aadal L, Angel S, Langhorn L, Pedersen BB, Dreyer P. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement. Scand J Caring Sci 2017; 32:871-879. [DOI: 10.1111/scs.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/08/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Lena Aadal
- Hammel Neurorehabilitation and Reseach Centre; Denmark
| | - Sanne Angel
- Section for Nursing; Institute of Public Health; Aarhus University; Aarhus Denmark
- Department for Health and Social Care; Molde University College; Molde Norway
| | - Leanne Langhorn
- Department of Neurosurgery; Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | | | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Institute of Public Health; Section of Nursing; Aarhus University; Aarhus Denmark
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Christiansen B, Feiring M. Challenges in the nurse's role in rehabilitation contexts. J Clin Nurs 2017; 26:3239-3247. [DOI: 10.1111/jocn.13674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Bjørg Christiansen
- Department of Nursing and Health Promotion; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
| | - Marte Feiring
- Department of Physiotherapy; Faculty of Health Sciences; Oslo and Akershus University College of Applied Sciences; Oslo Norway
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Hansen CA, Larsen P. The effect of involving significant others in chronic pain programs for adult patients with chronic non-malignant pain: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:20-29. [PMID: 28085723 DOI: 10.11124/jbisrir-2016-003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Carrinna A Hansen
- 1Faculty of Health and Medical Sciences, Copenhagen, Denmark, Clinic of Neuroanesthesiology, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark 2Department of Public Health, Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Section of Nursing Science, Aarhus University, Aarhus, Denmark
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Hansen CA, Bjerrum MB. 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. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:43-49. [PMID: 27941509 DOI: 10.11124/jbisrir-2016-003192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Carrinna A Hansen
- 1Faculty of Health and Medical Sciences, Copenhagen, Denmark Clinic of Neuroanesthesiology, Rigshospitalet - Glostrup, University of Copenhagen, Copenhagen, Denmark 2Department of Public Health, Aarhus, Denmark Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Section of Nursing Science, Aarhus University, Aarhus, Denmark
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Rowat A, Pollock A, St George B, Cowey E, Booth J, Lawrence M. Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda. J Adv Nurs 2016; 72:2831-2843. [DOI: 10.1111/jan.13048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Anne Rowat
- School of Nursing, Midwifery and Social Care; Edinburgh Napier University; UK
| | - Alex Pollock
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit; Glasgow Caledonian University; UK
| | - Bridget St George
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit; Glasgow Caledonian University; UK
| | - Eileen Cowey
- Nursing and Health Care School; University of Glasgow; UK
| | - Joanne Booth
- Institute of Applied Health Research; School of Health and Life Sciences; Glasgow Caledonian University; UK
| | - Maggie Lawrence
- Institute of Applied Health Research; School of Health and Life Sciences; Glasgow Caledonian University; UK
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Abstract
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.
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Affiliation(s)
- David J Clarke
- a Academic Unit of Elderly Care and Rehabilitation, Leeds Institute for Health Sciences, University of Leeds , Bradford , UK and
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A Synthesis of Peer-Reviewed Literature on Team-Coordinated and Delivered Early Supported Discharge After Stroke. Can J Neurol Sci 2016; 43:353-9. [PMID: 26742718 DOI: 10.1017/cjn.2015.343] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Vaughn S, Mauk KL, Jacelon CS, Larsen PD, Rye J, Wintersgill W, Cave CE, Dufresne D. The Competency Model for Professional Rehabilitation Nursing. Rehabil Nurs 2015; 41:33-44. [PMID: 26395123 DOI: 10.1002/rnj.225] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Stephanie Vaughn
- School of Nursing, California State University Fullerton, Fullerton, CA, USA
| | | | | | | | - Jill Rye
- Nursing, Avera McKennan Hospital & University Health Center, Sioux Falls, SD, USA
| | | | - Christine E Cave
- Rehabilitation, El Camino Hospital Los Gatos, Los Gatos, CA, USA
| | - David Dufresne
- Professional Development, Association of Rehabilitation Nurses, Chicago, IL, USA
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Taule T, Strand LI, Skouen JS, Råheim M. Striving for a life worth living: stroke survivors' experiences of home rehabilitation. Scand J Caring Sci 2015; 29:651-61. [PMID: 25648326 DOI: 10.1111/scs.12193] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/10/2014] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital (HUH), Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physiotherapy, HUH, Bergen, Norway
| | - Jan Sture Skouen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, HUH, Bergen, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Kirkevold M, Martinsen R, Bronken BA, Kvigne K. Promoting psychosocial wellbeing following stroke using narratives and guided self-determination: a feasibility study. BMC Psychol 2014; 2:4. [PMID: 25566379 PMCID: PMC4270047 DOI: 10.1186/2050-7283-2-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/14/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Marit Kirkevold
- />Research Center for Habilitation and Rehabilitation Models and Services
(CHARM) and Department of Nursing Science, Institute of health and
Society, University of Oslo, P.O. Box 1153, N-0318 Blindern, Oslo, Norway
| | - Randi Martinsen
- />Department of Nursing and Mental Health, Hedmark University College, PO Box 400, 2418 Elverum, Norway
| | - Berit Arnesveen Bronken
- />Department of Nursing and Mental Health, Hedmark University College, PO Box 400, 2418 Elverum, Norway
| | - Kari Kvigne
- />Department of Nursing and Mental Health, Hedmark University College, PO Box 400, 2418 Elverum, Norway
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Martinsen R, Kirkevold M, Bronken BA, Kvigne K. Work-aged stroke survivors' psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study. BMC Nurs 2013; 12:22. [PMID: 24066840 PMCID: PMC3849869 DOI: 10.1186/1472-6955-12-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Randi Martinsen
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Oslo, Norway.
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Clarke DJ. Nursing practice in stroke rehabilitation: systematic review and meta-ethnography. J Clin Nurs 2013; 23:1201-26. [PMID: 24102924 DOI: 10.1111/jocn.12334] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institution for Health Research, Bradford and Lecturer, School of Healthcare, University of Leeds, Leeds, UK
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Brunborg B, Ytrehus S. Sense of well-being 10 years after stroke. J Clin Nurs 2013; 23:1055-63. [PMID: 24004444 DOI: 10.1111/jocn.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Birgit Brunborg
- Institute of Nursing and Health, Diakonhjemmet University College, Oslo, Norway
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Aadal L, Angel S, Dreyer P, Langhorn L, Pedersen BB. Nursing Roles and Functions in the Inpatient Neurorehabilitation of Stroke Patients. J Neurosci Nurs 2013; 45:158-70. [DOI: 10.1097/jnn.0b013e31828a3fda] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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