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Carlsson GE, Törnbom K, Nordin Å, Stibrant-Sunnerhagen K. Coming home in the context of very early supported discharge after stroke - An interview study of patients' experiences. J Stroke Cerebrovasc Dis 2024; 33:107869. [PMID: 39032718 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107869] [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: 12/07/2023] [Revised: 06/24/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVES To explore patients' experiences of coming home and managing everyday life within the context of very early supported discharge after stroke (VESD). STUDY DESIGN An explorative qualitative study using semi structured interviews. METHOD This study was nested within a randomised controlled trial,; Gothenburg Very Early Supported Discharge (GOTVED), comparing a home rehabilitation intervention given by a coordinated team (VESD) with conventional care. Eleven participants with a median age 70.0 years (range 63-95) of which nine scoring 0-4 on the NIHSS indicating no symptoms or minor stroke were interviewed on average 12 days after discharge. Data was analysed using thematic analysis. RESULTS The diversity of patients' experiences was reflected in the overarching main theme Very Early Supported Discharge after stroke - a multifaceted experience, built upon five themes: "Conditions surrounding the discharge", "Concerns about the condition", "Confronting a new everyday life", "Experiences of the intervention" and the "Role of next of kin". CONCLUSIONS The respondents were largely satisfied with the very early supported discharge which might be expected, given that it was well planned regarding timing, individualisation and content. The patients need to be aware of the purpose of the VESD intervention. Due to the unpredictability of the stroke and its consequences, interventions need to be flexible. Goal setting is important but must be comprehensible. The role and burden of next of kin should be addressed and negotiated, and the ending of the intervention must be planned, with seamless transition to further rehabilitation and social support including the issue of participation in everyday life.
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Affiliation(s)
- Gunnel E Carlsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden.
| | - Karin Törnbom
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden; Faculty of Social Sciences, Department of Social Work, University of Gothenburg, Sweden
| | - Åsa Nordin
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden; Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina Stibrant-Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience/Rehabilitation Medicine, Sahlgrenska Academy University of Gothenburg, Sweden; Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jackson K, Newbury-Birch D. Patient reported experiences of community rehabilitation and/or support services for people with long term neurological conditions: a narrative review of quantitative studies. Disabil Rehabil 2023:1-18. [PMID: 37905706 DOI: 10.1080/09638288.2023.2266369] [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: 12/13/2022] [Accepted: 09/24/2023] [Indexed: 11/02/2023]
Abstract
Objectives: 1. To identify validated quantitative Patient Reported Experience Measures (PREM's) being used in Community Rehabilitation and/or Support services for people with long term neurological conditions (PwLTNC). 2. To explore how data from quantitative PREM's adds to research on patient experiences of Community Rehabilitation and Support for PwLTNC.Method: Eight data bases were searched for peer reviewed studies (2005-2021) which met inclusion criteria. Data extraction and quality assessment for sixteen studies was performed by two reviewers. Narrative synthesis was conducted.Results: Eleven validated PREM's were identified which captured data for 15,831 PwLTNC. PREM scores indicated positive and negative experiences for people with Multiple Sclerosis (n = 13,123), Parkinson's Disease (n = 2215) and Acquired Brain Injury (n = 493). Negative experiences related to Picker Institute Principles: 1 (accessibility); 3 (coordination/continuity); 4 (involvement/support for family and carers); 5 (information provision), 6 (Involvement in decision making) and 7 (empathy and emotional support).Conclusion: Quantitative PREM's provide evidence of process quality and person-centred care within community rehabilitation and support services across large data sets of heterogeneous neurological conditions and geographical locations. Quality improvement initiatives for people with MS, PD and ABI should target processes relating to Picker Institute Principles 1,3,4,5,6, and 7.Implications for RehabilitationQuantitative validated Patient Reported Experience Measures can be used to evaluate process quality and person- centred care within community rehabilitation and support services for people with long term neurological conditions.Experiences of people with Multiple Sclerosis, Parkinson's Disease and Acquired Brain Injury indicate the need for quality improvement in community rehabilitation.Training in communication skills and person-centred care may enhance information provision and support for self-management for people with long term neurological conditions.
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Affiliation(s)
- Katherine Jackson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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3
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Hunt-O'Connor C, Moore Z, Patton D, Nugent L, Avsar P, O'Connor T. The effect of discharge planning on length of stay and readmission rates of older adults in acute hospitals: A systematic review and meta-analysis of systematic reviews. J Nurs Manag 2021; 29:2697-2706. [PMID: 34216502 DOI: 10.1111/jonm.13409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/30/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
AIM To examine the effectiveness of discharge planning on length of stay and readmission rates among older adults in acute hospitals. BACKGROUND Discharge planning takes place in all acute hospital settings in many forms. However, it is unclear how it contributes to reducing patient length of stay in hospital and readmission rates. METHODS Seven systematic reviews were identified and examined. All of the systematic reviews explored the impact of discharge planning on length of stay and readmission rates. RESULTS A limited meta-analysis of the results in relation to length of stay indicates positive finding for discharge planning as an intervention (MD = -0.71(95% CI -1.05,-0.37; p = .0001)). However, further analysis of the broader findings in relation to length of stay indicates inconclusive or mixed results. In relation to readmission rates both meta-analysis and narrative analysis point to a reduced risk for older people where discharge planning has taken place (RR = 0.78 (95% CI: 0.72, 0.84; p = .00001)). The ability to synthesize results however is severely hampered by the diversity of approaches to research in this area. IMPLICATIONS FOR NURSING MANAGEMENT It is unclear what impact discharge planning has on length of stay of older people. Indeed, while nurse mangers will be interested in gauging this impact on throughput and patient flow, it is questionable if length of stay is the correct outcome to measure when studying discharge planning as good discharge planning may increase length of stay. Readmission rates may be a more appropriate outcome measure but standardization of approach needs to be considered in this regard. This would assist nurse managers in assessing the impact of discharge planning processes.
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Affiliation(s)
- Caroline Hunt-O'Connor
- St James's Hospital, Dublin, Ireland.,RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland
| | - Zena Moore
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Faculty of Medicine and Health Sciences, UGent, Ghent University, Ghent, Belgium.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Declan Patton
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda Nugent
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia
| | - Pinar Avsar
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Tom O'Connor
- RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dulbin, Ireland.,Lida Institute, Shanghai, China.,Fakeeh College of Medical Science, Jeddah, Kingdom of Saudi Arabia.,Skin, Wounds and Trauma Research Centre (SWaT), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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4
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Weeks LE, Barber B, MacDougall ES, Macdonald M, Martin-Misener R, Warner G. An exploration of Canadian transitional care programs for older adults. Healthc Manage Forum 2020; 34:163-168. [PMID: 33272058 PMCID: PMC8079793 DOI: 10.1177/0840470420974040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transitional care programs are effective for improving patient outcomes upon discharge from acute care services and reducing the burden of healthcare costs; however, little is known about the types of transitional care programs for older adults across Canada. This exploratory study gathered an in-depth understanding of Canadian transitional care programs and described how each program functions to support older adults and family/friend caregivers. Nine key informants were interviewed about the development of transitional care programs within four Canadian provincial regions including Atlantic, Central, Prairie, and West Coast. Key facilitators and barriers influencing the development and long-term success of transitional care programs included program scope, program structure, continuity of care, funding, and health system infrastructure. Future research is required to identify how a broad range of transitional care programs operate and to disseminate knowledge with health leaders and decision-makers to ensure transitional care programs are embedded as essential health system services.
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Affiliation(s)
- Lori E Weeks
- School of Nursing, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brittany Barber
- School of Nursing, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Marilyn Macdonald
- School of Nursing, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Grace Warner
- School of Occupational Therapy, 3688Dalhousie University, Halifax, Nova Scotia, Canada
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5
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Hughes AK, Cummings CE. Grief and Loss Associated With Stroke Recovery: A Qualitative Study of Stroke Survivors and Their Spousal Caregivers. J Patient Exp 2020; 7:1219-1226. [PMID: 33457568 PMCID: PMC7786670 DOI: 10.1177/2374373520967796] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite a focus on physical and cognitive outcomes, stroke survivors are also impacted by emotional and mental health challenges. Additionally, their caregivers may experience decreased well-being due to increased burden and role adjustment. A small body of literature characterizes this experience as a form of grief and loss. This study seeks to explore experiences of grief and loss reported by stroke survivors and caregivers, using Holbrook's 4-stage bereavement model. This cross-sectional, qualitative study was conducted among adult stroke survivors (n = 9) and their spousal caregivers (n = 5). Focus groups on experiences of recent hospitalizations and transitions home were transcribed, coded, and thematic analysis was conducted, identifying a major theme of loss. Data were reanalyzed guided by Holbrook's model. Common themes were losses and changes experienced by patients/caregivers, disbelief, and lack of understanding. Subthemes of denial and confusion were present. Less prevalent themes were loss of existing support systems and silver lining. Stroke survivors and caregivers experienced a range of negative emotions, impacting behaviors, self-perception, roles, and social support. Awareness of these issues can improve practice with those affected by stroke.
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Affiliation(s)
- Anne K Hughes
- School of Social Work, Michigan State University, East Lansing, MI, USA
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6
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Rafsten L, Danielsson A, Nordin A, Björkdahl A, Lundgren-Nilsson A, Larsson MEH, Sunnerhagen KS. Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke. BMC Neurol 2019; 19:277. [PMID: 31706292 PMCID: PMC6878692 DOI: 10.1186/s12883-019-1503-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background and purpose Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).
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Affiliation(s)
- Lena Rafsten
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden. .,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Anna Danielsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Asa Nordin
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Ann Björkdahl
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Institute of Social Science, Campus Bräcke, Ersta Sköndal Bräcke University College, Gothenburg, Sweden
| | - Asa Lundgren-Nilsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Maria E H Larsson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Närhälsan, Research and Development Primary Health Care, Gothenburg, Region Västra Götaland, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.,Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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7
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Hall JF, Crocker TF, Clarke DJ, Forster A. Supporting carers of stroke survivors to reduce carer burden: development of the Preparing is Caring intervention using Intervention Mapping. BMC Public Health 2019; 19:1408. [PMID: 31664985 PMCID: PMC6819539 DOI: 10.1186/s12889-019-7615-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 09/12/2019] [Indexed: 01/19/2023] Open
Abstract
Background Burden is well documented among carers of stroke survivors, yet current evidence is insufficient to determine if any strategies reduce this negative outcome. Existing interventions for carers of stroke survivors typically involve supporting carers according to their individual needs through face-to-face interactions and provision of information including workbooks or educational guides. To date, no interventions have been developed using a method which systematically incorporates evidence, behaviour change theories, and stakeholder involvement to change the behaviours of carers and relevant individuals who support carers. This study aimed to develop a programme plan for a theory and evidence-based intervention to reduce burden in carers of stroke survivors. Methods Informed by evidence from two systematic reviews and 33 qualitative interviews, the first four stages of Intervention Mapping were used to guide the intervention development process: 1) needs assessment; 2) identifying outcomes and objectives; 3) selecting theoretical methods and practical applications; and 4) creating a programme plan. Structured and facilitated involvement from stakeholders, including carers, researchers, and professionals from health and community services was integral to the intervention development process. Stakeholders helped to prioritise the focus of the intervention, develop the goals, outcomes and objectives for the programme, and generate and refine intervention ideas. Results Stakeholders prioritised the need for carers to feel prepared before and during the transition from hospital to home as key to reducing burden. The proposed intervention ‘Preparing is Caring’ targets this need and involves providing and signposting carers to relevant information and support for practical and emotional needs. This is to be delivered before, during, and immediately after the stroke survivor’s transition from hospital to home by a person taking on a single point of contact role. It is comprised of multiple theory-based components including: training packages for information and support providers working with carers and wider staff teams, plus elements to support carers to feel prepared. Conclusions We have developed a comprehensive programme plan for a multiple-component, theory and evidence informed behaviour change intervention aimed at preparing carers before and during the transition from hospital to home. Future work is required to refine, implement and evaluate the Preparing is Caring intervention.
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Affiliation(s)
- Jessica F Hall
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK. .,Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Thomas F Crocker
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David J Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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8
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Oni OD, Olagunju AT, Okpataku CI, Erinfolami AR, Adeyemi JD. Predictors of caregiver burden after stroke in Nigeria: Effect on psychosocial well-being. Indian J Psychiatry 2019; 61:457-464. [PMID: 31579140 PMCID: PMC6767813 DOI: 10.4103/psychiatry.indianjpsychiatry_395_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Family caregivers (CGs) are critical to the care and recovery of stroke survivors (SSs), particularly in the community. However, little is known about their psychosocial well-being, especially in developing countries. In this study, we assessed CG burden, psychiatric morbidity, quality of life (QoL), and predictors of burden. MATERIALS AND METHODS We recruited 150 dyads of CGs/SSs from two outpatient clinics in Nigeria. Data were collected through sociodemographic/clinical questionnaire, the Zarit caregiver burden interview, the World Health Organization QoL-BREF, and the Mini-International Neuropsychiatric Interview. Disability in SSs was graded with the Modified Rankin Scale. RESULTS Compared to CGs who were mostly females (86.7%) with a mean age of 42.8 (±12.6) years, SSs were older with a mean age of 61.6 (±12.5) years and were mainly males (62.7%). The mean CG burden score was 31.6 (±10.5) and eight in 10 CGs, 124 (82.7%) reported moderate-to-severe burden scores. Mental disorders in the form of depression and/or anxiety disorders were diagnosed in 26 (17.3%) CGs. Significant predictors of high-burden scores (P < 0.05) were incontinence in SSs, psychological symptoms in SS, worse poststroke disability, and performance of more CG tasks (B = 8.3, 4.5, 3.9, and 3.5, respectively). CGs QoL scores correlated negatively with burden scores, with medium-to-large effect sizes (r = -0.4--0.6) across QoL spheres. CONCLUSION In this study, psychosocial burden in CGs was indexed by various determinants and impacted QoL negatively. Given the integral role of CGs to the care of SSs in the community, mental health services, psychosocial support programs, and stratification based on known vulnerability factors seems viable options for intervention, assessment, and planning.
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Affiliation(s)
| | | | | | | | - Joseph Dada Adeyemi
- Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
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9
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Schwertfeger JL, Thuente L, Hung P, Larson SL. Post-discharge interventions to enhance coping skills for survivors of stroke and their caregivers: a scoping review protocol. JBI Evid Synth 2019; 18:332-340. [DOI: 10.11124/jbisrir-d-18-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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10
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MacKenzie HM, Rice D, Teasell R, Macaluso S. Screening Adherence for Depression Post Stroke: Evaluation of Outpatients, a London Experience (SAD PEOPLE). Top Stroke Rehabil 2018; 26:6-17. [PMID: 30346909 DOI: 10.1080/10749357.2018.1536096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Post stroke depression (PSD) is common, and the transition home following discharge may be especially challenging for stroke survivors. OBJECTIVES This study aimed to determine how well specific Canadian Best Practice Recommendations for PSD screening were adopted within a stroke rehabilitation outpatient clinic before and after the utilization of a standardized clinical form. METHODS Practices were evaluated through retrospective chart review before and after the implementation of the standardized form which cued physicians to administer the Patient Health Questionnaire 9 (PHQ-9) at the first outpatient visit. Participants included those aged ≥18 years with a primary diagnosis of stroke. RESULTS One hundred thirty-five subjects' charts were reviewed. Form implementation was associated with increased rates of PSD screening (93.8% versus 0%) and charting regarding mood (55.4% versus 15.7%). CONCLUSION This study highlights the frequency of depressive symptoms in an outpatient cohort and demonstrates how screening rates can be improved by using a standardized form. Routine PHQ-9 completion at the first outpatient visit was associated with more physician-patient discussion and documentation regarding mood.
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11
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Moral-Fernández L, Frías-Osuna A, Moreno-Cámara S, Palomino-Moral PA, Del-Pino-Casado R. The start of caring for an elderly dependent family member: a qualitative metasynthesis. BMC Geriatr 2018; 18:228. [PMID: 30253750 PMCID: PMC6157059 DOI: 10.1186/s12877-018-0922-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/16/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers' lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. METHODS A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. RESULTS Three categories were developed to explain the process of becoming a caregiver 'taking on the role' (life changes, uncertainty and confusion, and acceptance or resistance); 'beginning to realise' (new needs, impact, and appraisal); and 'implementing strategies' (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). CONCLUSIONS The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.
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Affiliation(s)
- Lourdes Moral-Fernández
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Antonio Frías-Osuna
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Sara Moreno-Cámara
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Pedro A. Palomino-Moral
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Rafael Del-Pino-Casado
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
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12
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Weeks LE, Macdonald M, Martin-Misener R, Helwig M, Bishop A, Iduye DF, Moody E. The impact of transitional care programs on health services utilization in community-dwelling older adults. ACTA ACUST UNITED AC 2018; 16:345-384. [DOI: 10.11124/jbisrir-2017-003486] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Satink T, Cup EH, de Swart BJ, Nijhuis-van der Sanden MW. The perspectives of spouses of stroke survivors on self-management – a focus group study. Disabil Rehabil 2017; 40:176-184. [DOI: 10.1080/09638288.2016.1247920] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ton Satink
- Department of Occupational Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Edith H.C. Cup
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
| | - Bert J.M. de Swart
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
- Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W.G. Nijhuis-van der Sanden
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Health Care, Nijmegen, The Netherlands
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Weeks LE, Macdonald M, Helwig M, Bishop A, Martin-Misener R, Iduye D. The impact of transitional care programs on health services utilization among community-dwelling older adults and their caregivers: a systematic review protocol of quantitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:26-34. [PMID: 27532136 DOI: 10.11124/jbisrir-2016-2568] [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
What is the impact of transitional care programs on health services utilization among community-dwelling older adults and their caregivers?
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Affiliation(s)
- Lori E Weeks
- 1School of Nursing, Dalhousie University, Canada 2W.K. Kellogg Library, Dalhousie University, Canada
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Fisher RJ, Cobley CS, Potgieter I, Moody A, Nouri F, Gaynor C, Byrne A, Walker MF. Is Stroke Early Supported Discharge still effective in practice? A prospective comparative study. Clin Rehabil 2015; 30:268-76. [DOI: 10.1177/0269215515578697] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/28/2015] [Indexed: 11/16/2022]
Abstract
Objective: Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision. Design: We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: ‘ESD’ n=135 and ‘Non ESD’ n=158 and 84 caregivers. The ‘ESD’ group accessed either of two ESD services operating in Nottinghamshire, UK. The ‘Non ESD’ group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months. Results: The ESD group had a significantly shorter length of hospital stay ( P=0.029) and reported significantly higher levels of satisfaction with services received ( P<0.001). Following adjustment for age differences at baseline, participants in the ESD group ( n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores ( P<0.01). Conclusion: The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.
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Affiliation(s)
| | | | | | - Amy Moody
- School of Medicine, University of Nottingham, UK
| | - Fiona Nouri
- School of Health Sciences, University of Nottingham, UK
| | | | - Adrian Byrne
- School of Social Sciences, University of Manchester, UK
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Satink T, Cup EHC, de Swart BJM, Nijhuis-van der Sanden MWG. How is self-management perceived by community living people after a stroke? A focus group study. Disabil Rehabil 2014; 37:223-30. [DOI: 10.3109/09638288.2014.918187] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Taule T, Råheim M. Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke. Disabil Rehabil 2014; 36:2107-19. [PMID: 24670126 DOI: 10.3109/09638288.2014.904448] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore experiences of mild-stroke survivors in the context of early supported discharge. The meanings patients attributed to activities and participation in the home recovery process were our main interest. METHODS Eight participants (45-80 years) from a randomised controlled study were selected for this sub-study. This purposive sample had received rehabilitation in their homes in the post-stroke acute phase of recovery as part of the larger study. Extensive interview data were analysed using an interpretive strategy and systematic text condensation. Coping theory was included in later stages of analysis. FINDINGS The mild-stroke survivors' stories revealed that life had changed profoundly. Differences and similarities in experienced changes were related to: self-perceived health, the body, practical activities, taking part in society, and self-perception. The findings showed the ways in which life changed for mild-stroke survivors, experienced challenges, and survivors' thoughts about the future. CONCLUSIONS Mild-stroke rehabilitation should focus more strongly on basic concerns related to self-perceived health, self-perception, and body, since these dimensions seem to complicate daily activities and close relationships. Professionals should also be aware of patients who experience an uncertain situation and unresolved rehabilitation needs, which still can be present 6-8 months after the stroke. IMPLICATIONS FOR REHABILITATION When living with mild stroke, entrance to practical and social activities seemed founded on the patients' perception of the body and self as comprehensible or not. Comprehending their own changed body and sense of self seem to be a long-term process when living with mild stroke. It is suggested that long-term follow-up be incorporated in home rehabilitation service, also in the context of early supported discharge. This may contribute to help patient cope more optimally with activities and participation of importance to them.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital , Bergen , Norway and
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18
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Brusco NK, Taylor NF, Watts JJ, Shields N. Economic Evaluation of Adult Rehabilitation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials in a Variety of Settings. Arch Phys Med Rehabil 2014; 95:94-116.e4. [DOI: 10.1016/j.apmr.2013.03.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
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Pringle J, Drummond JS, McLafferty E. Revisioning, reconnecting and revisiting: the psychosocial transition of returning home from hospital following a stroke. Disabil Rehabil 2013; 35:1991-9. [PMID: 23614358 DOI: 10.3109/09638288.2013.770081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to investigate and improve understanding of the experiences of patients and their carers during the first month at home following discharge from hospital, thereby enhancing appropriate care from a more informed perspective. METHOD In-depth interviews and self-report diaries were used to capture data from 12 patient/carer dyads. Four survivors with marked communication problems were included in this number, two requiring the use of pictures and diagrams to express their views. Interpretative phenomenological analysis (IPA) was used to capture and interpret survivor and carer experiences. FINDINGS Three superordinate themes were derived from the data. Stroke survivors and their carers described the first month at home as a very dynamic time, recounting a process that involved revisioning (re-examining their identity and the reality of their new situation, including an awareness of their own mortality), reconnecting (with important relationships and previous activities) and revisiting (their past lives, and the stroke event and hospital experience). These three activities assisted in making and finding sense in their new situation; participants' vision of their lives was revised and revisited as they attempted to reconnect with as much of their past selves and past activities as possible. CONCLUSIONS This study contributes to understandings through in-depth individual accounts of the psychosocial transition of returning home. Details of how people make sense of their altered situation can make a valuable contribution to research, and the knowledge base for care provision. Implications for Rehabilitation Supporting people to revision their future can assist with psychosocial transition following a stroke. Assisting patients to reconnect and reintegrate in a way that is meaningful to them is an important part of the rehabilitation support that can be offered by professionals, and can be informed by awareness of their vision of what the future may now hold. Offering people the opportunity to reflect on what has occurred, either verbally or in the form of a diary, can assist adjustment and help people to make sense of their changed situation.
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Affiliation(s)
- Jan Pringle
- Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University , Glasgow , UK and
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20
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Cobley CS, Fisher RJ, Chouliara N, Kerr M, Walker MF. A qualitative study exploring patients' and carers' experiences of Early Supported Discharge services after stroke. Clin Rehabil 2013; 27:750-7. [PMID: 23455948 DOI: 10.1177/0269215512474030] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate patients' and carers' experiences of Early Supported Discharge services and inform future Early Supported Discharge service development and provision. DESIGN AND SUBJECTS Semi-structured interviews were completed with 27 stroke patients and 15 carers in the Nottinghamshire region who met evidence-based Early Supported Discharge service eligibility criteria. Participants were either receiving Early Supported Discharge or conventional services. SETTING Community stroke services in Nottinghamshire, UK. RESULTS A thematic analysis process was applied to identify similarities and differences across datasets. Themes specific to participants receiving Early Supported Discharge services were: the home-based form of rehabilitation; speed of response; intensity and duration of therapy; respite time for the carer; rehabilitation exercises and provision of technical equipment; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. Participants receiving Early Supported Discharge or conventional community services experienced difficulties related to: limited support in dealing with carer strain; lack of education and training of carers; inadequate provision and delivery of stroke-related information; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. CONCLUSIONS Accelerated hospital discharge and home-based rehabilitation was perceived positively by service users. The study findings highlight the need for Early Supported Discharge teams to address information and support needs of patients and carers and to monitor their impact on carers in addition to patients, using robust outcome measures.
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Affiliation(s)
- Christine S Cobley
- Faculty of Medicine and Health Sciences, Division of Rehabilitation and Ageing, Queens Medical Centre, Nottingham, UK.
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21
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Gallacher K, Morrison D, Jani B, Macdonald S, May CR, Montori VM, Erwin PJ, Batty GD, Eton DT, Langhorne P, Mair FS. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med 2013; 10:e1001473. [PMID: 23824703 PMCID: PMC3692487 DOI: 10.1371/journal.pmed.1001473] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. METHODS AND FINDINGS The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. CONCLUSIONS Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.
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Affiliation(s)
- Katie Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Bhautesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carl R. May
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Victor M. Montori
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Patricia J. Erwin
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom
| | - David T. Eton
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
- * E-mail:
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Affiliation(s)
- Marion F Walker
- Division of Rehabilitation and Ageing, Community Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham NG7 2HU, UK.
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23
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Plank A, Mazzoni V, Cavada L. Becoming a caregiver: new family carers’ experience during the transition from hospital to home. J Clin Nurs 2012; 21:2072-82. [DOI: 10.1111/j.1365-2702.2011.04025.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morris R, Jones J, Wilcox J, Cole S. Depression and anxiety screening after stroke: adherence to guidelines and future directions. Disabil Rehabil 2011; 34:733-9. [DOI: 10.3109/09638288.2011.619623] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yeung SM, Wong FKY, Mok E. Holistic concerns of Chinese stroke survivors during hospitalization and in transition to home. J Adv Nurs 2011; 67:2394-405. [DOI: 10.1111/j.1365-2648.2011.05673.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morris R. The psychology of stroke in young adults: the roles of service provision and return to work. Stroke Res Treat 2011; 2011:534812. [PMID: 21423559 PMCID: PMC3056452 DOI: 10.4061/2011/534812] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 12/23/2010] [Accepted: 01/09/2011] [Indexed: 01/23/2023] Open
Abstract
Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. "Hidden" cognitive impairments, a disrupted sense of self, and the incongruity of suffering an "older person's" disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.
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Affiliation(s)
- Reg Morris
- School of Psychology, Cardiff University, and Cardiff and Vale University Local Health Board, Archway House, 77 TY Glas Avenue, Llanishen, Cardiff CF14 5DX, UK
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Eilertsen G, Kirkevold M, Bjørk IT. Recovering from a stroke: a longitudinal, qualitative study of older Norwegian women. J Clin Nurs 2011; 19:2004-13. [PMID: 20920026 DOI: 10.1111/j.1365-2702.2009.03138.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To illuminate older women's experiences and the characteristics of the recovery process following a stroke. BACKGROUND Patients with stroke face serious challenges related to bodily changes, existential aspects and daily life after stroke. Few qualitative longitudinal studies have examined the recovery process from the perspective of the patient. Knowledge about older women's experiences in coping with life after a stroke is limited. DESIGN Prospective, longitudinal, case-study design. METHODS Six women aged 68-83 suffering from first-time stroke were recruited from two stroke units. Each participant was interviewed in-depth 12-14 times during the first two years post stroke. The interviews addressed how they experienced their body, their self-understanding, daily life and how this had changed over time. Most interviews took place in the participants' homes. Gadamer's philosophical hermeneutics informed the analyses. RESULTS Post stroke recovery was slow and complex and evolved through four distinct phases. In the first phase (0-2 months post stroke), the participants' main concerns were their bodily changes; in the second phase (2-6 months), activities of daily life; in the third phase (6-12 months), self-understanding and in the fourth phase (12-24 months), going on with life. The transition between phases was gradual. CONCLUSION Recovery from stroke evolves over time through four distinct phases, which differ depending on significant experiences and associated meanings. Psychological and social resources are equally critical in the women's process of recovery. RELEVANCE TO CLINICAL PRACTICE The four phases of rehabilitation suggest at what points various concerns require increased therapeutic attention. Psychological and social resources must be vitalised at an early phase similar to bodily resources. This knowledge may assist professionals in offering adequate help throughout the recovery process even beyond the established rehabilitation period.
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Bergström AL, Eriksson G, von Koch L, Tham K. Combined life satisfaction of persons with stroke and their caregivers: associations with caregiver burden and the impact of stroke. Health Qual Life Outcomes 2011; 9:1. [PMID: 21223594 PMCID: PMC3024212 DOI: 10.1186/1477-7525-9-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 01/11/2011] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the life satisfaction of the person with stroke combined with their caregiver, i.e. the dyad, despite the fact that life satisfaction is an important rehabilitation outcome. The aim of this study was to describe the dyads combined life satisfaction and to understand this in relationship to the perceived impact of stroke in everyday life and caregiver burden. Methods In this cross-sectional study, the life satisfaction of persons and their informal caregivers was measured in 81 dyads one year post stroke. Their global life satisfaction, measured with LiSat-11, was combined to a dyad score and the dyads were then categorized as satisfied, dissatisfied or discordant. The groups were compared and analyzed regarding levels of caregiver burden, measured with the Caregiver Burden scale, and the perceived impact of stroke in everyday life, measured with the Stroke Impact Scale (SIS). Results The satisfied dyads comprised 40%, dissatisfied 26% and those that were discordant 34%. The satisfied dyads reported a significantly lower impact of the stroke in everyday life compared with the dyads that were not satisfied. As expected, dyads that were not satisfied reported a significantly greater caregiver burden compared with the satisfied dyads. The discordant group was further broken down into a group of dissatisfied and satisfied caregivers. The caregivers that were not satisfied in the discordant group perceived a significantly greater level of caregiver burden compared with the satisfied group. Even caregivers who were satisfied with life but whose care recipients were not satisfied reported caregiver burden. Conclusions Measuring combined life satisfaction provides a unique focus and appears to be a feasible way of attaining the dyads' perspective. The findings suggest that those dyads with a discordant life satisfaction could be vulnerable because of the caregivers' reported caregiver burden. These findings support the importance of a dyadic perspective and add to the understanding of the reciprocal influences between the caregiver and recipient. This knowledge has clinical implications and contributes to the identification of possible vulnerable dyads in need of tailored support.
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Affiliation(s)
- Aileen L Bergström
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Measures of Psychological Stress and Physical Health in Family Caregivers of Stroke Survivors. J Neurosci Nurs 2010; 42:128-38. [DOI: 10.1097/jnn.0b013e3181d4a3ee] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Pringle J, Hendry C, McLafferty E, Drummond J. Stroke survivors with aphasia: personal experiences of coming home. Br J Community Nurs 2010; 15:241-247. [PMID: 20453826 DOI: 10.12968/bjcn.2010.15.5.47950] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although communication difficulties affect a significant number of stroke survivors, specialist stroke follow-up in the community may not always be available. It is therefore vital that community nurses have the skills and confidence not only to engage well with stroke patients with communication difficulties in their daily work, but also to encourage their inclusion in research and other projects. This article reports on the experiences of a small sample of stroke survivors and their carers during the first month at home following discharge from hospital. Their journey involved discovering and adapting to new situations and abilities. The article also details how participants with virtually no speech can be included in research studies.
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Affiliation(s)
- Jan Pringle
- School of Nursing and Midwifery, University of Dundee.
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Hedlund M, Zetterling M, Ronne-Engstrom E, Ekselius L, Carlsson M. Perceived recovery after aneurysmal subarachnoid haemorrhage in individuals with or without depression. J Clin Nurs 2010; 19:1578-87. [PMID: 20384663 DOI: 10.1111/j.1365-2702.2009.02940.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The aims of the study were to describe what patients with no or only minor neurological deficits after aneurysmal subarachnoid haemorrhage (SAH) perceived to be important for recovery, and perceived consequences of the illness. BACKGROUND Quantitative studies indicates unfavourable outcomes after aneurysmal SAH, concerning for example mental health and return to everyday life, among patients expected to recover completely. Thus, it is important to investigate the perceptions of patients and to give them the opportunity to communicate what they consider important for recovery. DESIGN Qualitative descriptive design. METHOD Semi-structured interviews with 20 aneurysmal subarachnoid haemorrhagic patients were conducted approximately 12 months after the onset. Analyses were carried out in two steps, beginning with a qualitative content analysis. Due to the findings in the initial content analysis, a structured clinical interview for psychiatric disorders was used as a second step to verify the presence or absence of depression in the participants. RESULTS Two patterns were identified. One pattern revealed that informants without depression experienced a 'confident perception of recovery', which included perceptions of meaningfulness. Another pattern revealed that depressed informants experienced a 'pessimistic perception of recovery', which included perceptions of hopelessness. Expectations regarding care after departure from the neurointensive care unit were not met. CONCLUSIONS Individuals suffering from depression after aneurysmal SAH have a pessimistic view of their recovery in contrast to those without depression. These findings highlight the importance of better recognition and treatment of depression in the aftermath of SAH. RELEVANCE TO CLINICAL PRACTICE These findings highlight the importance of better recognition and treatment of depression after aneurysmal SAH, where nurses play an active role. Nurses should seek to take actions to better meet patient's needs after departure from neurointensive care units.
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Affiliation(s)
- Mathilde Hedlund
- Department of Public Health and Caring Sciences and Department of Neuroscience Psychiatry, University Hospital, SE-751 85 Uppsala, Sweden.
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The role of nursing in the rehabilitation of stroke survivors: an extended theoretical account. ANS Adv Nurs Sci 2010; 33:E27-40. [PMID: 20154522 DOI: 10.1097/ans.0b013e3181cd837f] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article provides a critique and theoretical extension of a work that sought to describe the contribution of nurses to stroke rehabilitation. At the time, the role of nursing was considered important but therapeutically nonspecific. Stroke nursing research has increased significantly and so has research focusing on the patient experiences of the adjustment and rehabilitation processes following a stroke. These developments provide significant new insights that may refine and extend the original understanding of the role of nursing in stroke rehabilitation. This article proposes an extended theoretical framework of the role of nursing in stroke recovery and rehabilitation.
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