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Ye HMY, Xiao LD, Ullah S, Chang RHC. Hospital nurses perceived challenges and opportunities in the care of people with dementia: A mixed-methods systematic review. J Clin Nurs 2024; 33:2849-2884. [PMID: 38544319 DOI: 10.1111/jocn.17144] [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: 10/05/2023] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 07/09/2024]
Abstract
AIM To synthesise evidence from the literature on hospital nurses' perceived challenges and opportunities in the care of people with dementia. BACKGROUND People with dementia often have longer lengths of hospital stay and poorer health outcomes compared to those without dementia. Nurses play a pivotal role in the care of people with dementia. However, there is a scarcity of systematic reviews that synthesise the challenges and opportunities they perceive. METHODS A mixed-methods systematic review was conducted with a database search covering Ageline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Embase, Medline, PsycINFO, ProQuest, Scopus and Web of Science in April 2022. In total, 27 articles that met the selection criteria were critically reviewed and included in this systematic review. Data from the selected articles were extracted and synthesised using a convergent segregated approach. RESULTS Three main themes and eight subthemes were identified. Theme 1 described nurse-related factors consisting of the lack of capability in dementia care, experiencing multiple sources of stress and opportunities for nurses to improve dementia care. Theme 2 revealed people living with dementia-related factors including complex care needs and the need to engage family carers in care. Theme 3 explained organisation-related factors comprising the lack of organisational support for nurses and people with dementia and opportunities for quality dementia care. CONCLUSION Hospital nurses experience multidimensional challenges in the care of people with dementia. Opportunities to overcome those challenges include organisational support for nurses to develop dementia care capability, reduce their stress and partner with the family caregivers. RELEVANCE TO CLINICAL PRACTICE Hospitals will need to build an enabling environment for nurses to develop their capabilities in the care of people with dementia. Further research in empowering nurses and facilitating quality dementia care in acute care hospitals is needed. REPORTING METHOD The review followed the PRISMA 2020 checklist. PATIENT OR PUBLIC CONTRIBUTION No.
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Affiliation(s)
- Helen Mei-Yan Ye
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Rita Hui-Chen Chang
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
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Xu X, Chen H, Xu D, Tan F, Li X. A scoping review of hospital to home transitional care programmes for stroke survivors. J Clin Nurs 2024. [PMID: 38887147 DOI: 10.1111/jocn.17070] [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: 10/18/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 06/20/2024]
Abstract
AIM The study was aimed at exploring the current scope of hospital to home transitional care programmes for stroke survivors. BACKGROUND Stroke survivors face the dilemma of solving many complex problems that leave survivors at high risk for readmission as they discharge from hospital. The transitional care model has proved to be effective in reducing readmissions and mortality, thereby improving health outcomes and enhancing patient satisfaction for survivors with stroke. DESIGN A scoping review. METHODS Conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCES A comprehensive search was conducted in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, Medline, China Knowledge Net-work, Wanfang Database and China Biomedical Literature Database (SinoMed) from January 2014 to June 2023. RESULTS Title and abstract screening was performed on 10,171 articles resulting in 287 articles for full-text screening. Full-text screening yielded 49 articles that met inclusion criteria. CONCLUSION This study identified transitional care programmes for stroke survivors, as well as areas for future consideration to be explored in more depth to help improve transitional care for stroke survivors as they transition from hospital to home. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This study demonstrates that multidisciplinary collaboration becomes an integral part of the transitional care model for stroke survivors, which provides comprehensive and precise medical care to them. REPORTING METHOD PRISMA checklist for scoping reviews. PATIENT AND PUBLIC CONTRIBUTION No patient or public contribution was part of this study.
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Affiliation(s)
- Xuewei Xu
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Huijie Chen
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Dandan Xu
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Fengying Tan
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
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Ingram L, Pitt R, Shrubsole K. Health professionals' practices and perspectives of post-stroke coordinated discharge planning: a national survey. BRAIN IMPAIR 2024; 25:IB23092. [PMID: 38566295 DOI: 10.1071/ib23092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
Background It is best practice for stroke services to coordinate discharge care plans with primary/community care providers to ensure continuity of care. This study aimed to describe health professionals' practices in stroke discharge planning within Australia and the factors influencing whether discharge planning is coordinated between hospital and primary/community care providers. Methods A mixed-methods survey informed by the Theoretical Domains Framework was distributed nationally to stroke health professionals regarding post-stroke discharge planning practices and factors influencing coordinated discharge planning (CDP). Data were analysed using descriptive statistics and content analysis. Results Data from 42 participants working in hospital-based services were analysed. Participants reported that post-stroke CDP did not consistently occur across care providers. Three themes relating to perceived CDP needs were identified: (1) a need to improve coordination between care providers, (2) service-specific management of the discharge process, and (3) addressing the needs of the stroke survivor and family . The main perceived barriers were the socio-political context and health professionals' beliefs about capabilities . The main perceived facilitators were health professionals' social/professional role and identity, knowledge, and intentions . The organisation domain was perceived as both a barrier and facilitator to CDP. Conclusion Australian health professionals working in hospital-based services believe that CDP promotes optimal outcomes for stroke survivors, but experience implementation challenges. Efforts made by organisations to ensure workplace culture and resources support the CDP process through policies and procedures may improve practice. Tailored implementation strategies need to be designed and tested to address identified barriers.
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Affiliation(s)
- Lara Ingram
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rachelle Pitt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Office of the Chief Allied Health Officer, Queensland Health, Qld, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia; and Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia; and Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Vic., Australia
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Xian Yi H, Shuang L, Jie Y, Yan L, Yu L, Li C. Post-stroke fatigue, hope and discharge readiness: A cross-sectional survey. J Clin Nurs 2024. [PMID: 38356194 DOI: 10.1111/jocn.17039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIMS AND OBJECTIVES To explore the relationships among post-stroke fatigue, hope and discharge readiness in stroke patients, and to determine whether hope mediates the relationship between post-stroke fatigue and discharge readiness. BACKGROUND In stroke patients, inadequate discharge readiness has been found to correlate with higher readmission and mortality rates. Although previous qualitative studies have confirmed the impact of fatigue on discharge readiness, few studies explore the impact of post-stroke fatigue and hope on discharge readiness of stroke patients. Consequently, the current research on this relationship and its underlying mechanisms is still quite limited. DESIGN Cross-sectional study. METHODS Data were collected from 340 stroke patients. The research tools included demographic and disease characteristics, Discharge Readiness Assessment Scale for Stroke, Neurological Fatigue Index for Stroke and Herth Hope Index. The STROBE checklist was used to guide the presentation of this study. RESULTS Discharge readiness was negatively correlated with post-stroke fatigue and positively correlated with hope. Additionally, post-stroke fatigue was negatively correlated with hope. Post-stroke fatigue had a direct negative effect on discharge readiness, and it can also generate indirect effects through hope. Hope was the partial mediator between post-stroke fatigue and discharge readiness, explaining 55.8% of the total effect. CONCLUSION Discharge readiness of this population can be improved by reducing post-stroke fatigue and increasing hope. Therefore, effective management of post-stroke fatigue and hope will help improve discharge readiness. RELEVANCE TO CLINICAL PRACTICE It is recommended that nursing staff should monitor the occurrence and development of post-stroke fatigue in stroke patients, dynamically evaluate the patient's level of hope, and pay attention to the important role of positive psychological qualities in the outcome of discharge. If medical staff can formulate corresponding intervention measures based on the influence path of discharge readiness, then the discharge readiness of stroke patients can be improved.
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Affiliation(s)
- Huang- Xian Yi
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Liu Shuang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Jie
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Liu Yan
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Li Yu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Chen Li
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
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Bsharat B, Al-Duhoun A, Ghanouni P. The acceptance and attitudes towards using assistive technology for people with stroke in Jordan: caregivers' perspectives. Assist Technol 2024; 36:40-50. [PMID: 37083581 DOI: 10.1080/10400435.2023.2202723] [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] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
The aim of this study is to evaluate the acceptance and attitudes toward assistive technology (AT) for people with stroke from their caregivers' perspectives in Jordan. Also, this study further validates the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. This is a cross-sectional study that includes a three-sections survey: the first section contains demographic data, the second section includes the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, and the third section consists of two optional open-ended questions. Among 123 caregivers of people with stroke over 18 years of age who participated in this study, 23% were male. The findings indicate a moderate to high acceptance of using AT for stroke survivors, confirm the validity and reliability of the UTAUT questionnaire, and clarify novel issues regarding AT based on the caregivers' perspectives.
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Affiliation(s)
- Bara'ah Bsharat
- Clinical Rehabilitation Science, Occupational Therapy, Amman, Jordan
| | - Ahmad Al-Duhoun
- Princess Muna College of Nursing and Faculty of Nursing, Mutah university, Zarka, Jordan
| | - Parisa Ghanouni
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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Fox MT, Butler JI. Rural caregivers' preparedness for detecting and responding to the signs of worsening health conditions in recently hospitalised patients at risk for readmission: a qualitative descriptive study. BMJ Open 2023; 13:e076149. [PMID: 38154900 PMCID: PMC10759104 DOI: 10.1136/bmjopen-2023-076149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES This study aimed to explore informal rural caregivers' perceived preparedness to detect and respond to the signs of worsening health conditions in patients recently discharged from hospital and at risk for readmission. DESIGN A qualitative descriptive design and semistructured interviews were used. Data were thematically analysed. SETTING Data collection occurred in 2018 and 2019 in rural communities in Southwestern and Northeastern Ontario, Canada. PARTICIPANTS The study included sixteen informal caregivers who were all family members of a relative discharged from hospital at high risk for readmission following hospitalisation mostly for a medical illness (63%). Participants were mostly women (87.5%), living with their relative (62.5%) who was most often a parent (56.3%). RESULTS Three themes were identified: (1) warning signs and rural communities, (2) perceived preparedness, and (3) improving preparedness. The first theme elucidates informal caregivers' view that they needed to be prepared because they were taking over care previously provided by hospital healthcare professionals yet lacked accessible medical help in rural communities. The second theme captures informal caregivers' perceptions that they lacked knowledge of how to detect warning signs and how to respond to them appropriately. The last theme illuminates informal caregivers' suggestions for improving preparation related to warning signs. CONCLUSIONS Informal caregivers in rural communities were largely unprepared for detecting and responding to the signs of worsening health conditions for patients at high risk for hospital readmission. Healthcare professionals can anticipate that informal caregivers, particularly those whose relatives live far from medical help, need information on how to detect and respond to warning signs, and may prioritise their time to this aspect of postdischarge care for these caregivers.
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Affiliation(s)
- Mary T Fox
- School of Nursing, Centre for Aging Research and Education, York University, Toronto, Ontario, Canada
| | - Jeffrey I Butler
- School of Nursing, Centre for Aging Research and Education, York Univ, Toronto, Ontario, Canada
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Lynch EA, Bulto LN, West M, Cadilhac DA, Cooper F, Harvey G. Codesigning implementation strategies to improve evidence-based stroke rehabilitation: A feasibility study. Health Expect 2023; 27:e13904. [PMID: 37990469 PMCID: PMC10757151 DOI: 10.1111/hex.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/09/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION People with lived experience are rarely involved in implementation science research. This study was designed to assess the feasibility of codesigning and delivering implementation strategies with people with lived experience of stroke and health professionals to improve evidence-based stroke rehabilitation. METHODS We used Experience-Based CoDesign to design and deliver strategies to implement Stroke Clinical Guideline recommendations at one Australian inpatient stroke rehabilitation unit. Workgroups were formed with health professionals and people with 6-12 months experience of living with stroke (survivors and carers). Feasibility of the codesign approach (focusing on acceptability, implementation fidelity, signal of promise) was evaluated using mixed methods, using data from interviews, observations and inpatient self-reported outcomes. RESULTS Of 18 people with stroke invited, eight (44%) agreed to join the lived experience workgroup. All disciplines with ≥1 full-time staff members on the stroke unit were represented on the health professional workgroup. Median workgroup attendance over 6 months was n = 8 health professionals, n = 4 survivors of stroke and n = 1 carers. Workgroup members agreed to focus on two Guideline recommendations: information provision and amount of therapy. Workgroup members indicated that the codesign approach was enjoyable and facilitated effective partnerships between health professionals and lived experience workgroup members. Both cohorts reported contributing valuable input to all stages of the project, with responsibility shifting between groups at different project stages. The codesigned strategies signalled promise for improving aspects of information provision and creating additional opportunities for therapy. We could not compare patient-reported outcomes before and after the implementation period due to high variability between the preimplementation and postimplementation patient cohorts. CONCLUSION It is feasible to codesign implementation strategies in inpatient rehabilitation with people with lived experience of stroke and health professionals. More research is required to determine the effect of the codesigned strategies on patient and service outcomes. PATIENT OR PUBLIC CONTRIBUTION People with lived experience of stroke codesigned and evaluated implementation strategies. Author F. C. has lived experience of stroke and being an inpatient at the inpatient rehabilitation service, and has provided input into analysis of the findings and preparation of this manuscript.
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Affiliation(s)
- Elizabeth A. Lynch
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Lemma N. Bulto
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Maria West
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
- Occupational Therapy DepartmentCentral Adelaide Health ServiceAdelaideSouth AustraliaAustralia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Stroke Theme, The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | | | - Gillian Harvey
- College of Nursing and Health Sciences, Caring Futures InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
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Jiang N, Xv Y, Sun X, Feng L, Wang YB, Jiang XL. Study on self-management of real-time and individualized support in stroke patients based on resilience: a protocol for a randomized controlled trial. Trials 2023; 24:493. [PMID: 37537646 PMCID: PMC10401848 DOI: 10.1186/s13063-023-07475-x] [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: 04/23/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The transitional period from hospital to home is vital for stroke patients, but it poses serious challenges. Good self-management ability can optimize disease outcomes. However, stroke patients in China have a low level of self-management ability during the transitional period, and a lack of effective support may be the reason. With the rapid development of technology, using wearable monitors to achieve real-time and individualized support may be the key to solving this problem. This study uses a randomized controlled trial design to assess the efficacy of using wearable technology to realize real-time and individualized self-management support in stroke patients' self-management behavior during the transitional period following discharge from hospital. METHODS This parallel-group randomized controlled trial will be conducted in two hospitals and patients' homes. A total of 183 adult stroke patients will be enrolled in the study and randomly assigned to three groups in a 1:1:1 ratio. The smartwatch intervention group (n = 61) will receive Real-time and Individualized Self-management Support (RISS) program + routine care, the wristband group (n = 61) will wear a fitness tracker (self-monitoring) + routine care, and the control group (n = 61) will receive routine stroke care. The intervention will last for 6 months. The primary outcomes are neurological function status, self-management behavior, quality of life, biochemical indicators, recurrence rate, and unplanned readmission rate. Secondary outcomes are resilience, patient activation, psychological status, and caregiver assessments. The analysis is intention-to-treat. The intervention effect will be evaluated at baseline (T0), 2 months after discharge (T1), 3 months after discharge (T2), and 6 months after discharge (T3). DISCUSSION The cloud platform designed in this study not only has the function of real-time recording but also can push timely solutions when patients have abnormal conditions, as well as early warnings or alarms. This study could also potentially help patients develop good self-management habits through resilience theory, wearable devices, and individualized problem-solution library of self-management which can lay the foundation for long-term maintenance and continuous improvement of good self-management behavior in the future. TRIAL REGISTRATION The ethics approval has been granted by the Ethics Committee of West China Hospital, Sichuan University (2022-941). All patients will be informed of the study details and sign a written informed consent form before enrollment. The research results will be reported in conferences and peer-reviewed publications. The trial registration number is ChiCTR2300070384 . Registered on 11 April 2023.
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Affiliation(s)
- N Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Y Xv
- Department of Surgical Anesthesiology, Tai'an City Central Hospital, Tai'an, China
| | - X Sun
- Department of Neurology, Tianjin Third Central Hospital, Tianjin, China
| | - L Feng
- Department of Neurology/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Y B Wang
- Tai'an Tax Bureau, State Administration of Taxation, Tai'an, China
| | - X L Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Kokorelias KM, Singh H, Nelson MLA, Hitzig SL. "Why Do We Always Have to Focus on the Bad": A Strengths-Based Approach to Identify the Positive Aspects of Care From the Perspective of Older Adults Using a Secondary Qualitative Analysis. J Patient Exp 2023; 10:23743735231188841. [PMID: 37547702 PMCID: PMC10399251 DOI: 10.1177/23743735231188841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Hospitalization is often viewed as a burdensome and stressful period for older adults and their family caregivers; however, little attention has been given to the positive aspects of the care continuum journey. The purpose of this article is to highlight the positive aspects of healthcare from the perspective of Canadian older adults with complex needs and their family caregivers. This study utilized a strengths-based theoretical perspective to conduct a secondary qualitative analysis of interviews with 12 older adults and seven family caregivers. Four themes relating to positive aspects of care were identified, including: (1) looking beyond illness, (2) emotional support from healthcare providers, (3) timely discharge, and (4) upholding independence. Focusing on the positive aspects can help determine areas of care practice that currently work well. These insights will be valuable for current and future initiatives seeking to restructure and optimize healthcare services for older adults.
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Affiliation(s)
- Kristina M Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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10
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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11
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Mavragani A, Ancer Leal A, Montiel TC, Wynne KJ, Edquilang G, Vu KYT, Vahidy F, Savitz SI, Beauchamp JE, Sharrief A. An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study. JMIR Form Res 2023; 7:e31903. [PMID: 35972729 PMCID: PMC9850284 DOI: 10.2196/31903] [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: 12/28/2021] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy-an understanding of stroke symptoms, risk factors, and treatment-likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. OBJECTIVE We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. METHODS The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. RESULTS A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. CONCLUSIONS An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1371/journal.pone.0171952.
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Affiliation(s)
| | - Andrea Ancer Leal
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States
| | | | - Keona J Wynne
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | | | - Kim Yen Thi Vu
- Memorial Hermann - Texas Medical Center, Houston, TX, United States
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Population Health Sciences, Weill Cornell Medical School, New York, NY, United States.,Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
| | - Sean I Savitz
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Jennifer Es Beauchamp
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Anjail Sharrief
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
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12
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Saragih ID, Saragih IS, Tarihoran DETAU, Sharma S, Chou FH. A meta-analysis of studies of the effects of case management intervention for stroke survivors across three countries. J Nurs Scholarsh 2023; 55:345-355. [PMID: 36310396 DOI: 10.1111/jnu.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE A stroke survivor who is discharged to home care faces many challenges during the transition from the hospital to home, including managing their care at home and engaging in rehabilitation and recovery. Case management was developed to ease the transition from hospital to home and help people with stroke cope with their care management challenges. However, the effects of case management intervention remain inconclusive. Case management was designed to direct care and may represent a novel method for reducing the burden of care. This study was designed to evaluate the effects of case management interventions on mental health outcomes, activities of daily living capacity, physical function, and social function among stroke survivors. DESIGN Systematic review and meta-analysis. METHODS This study included studies examining the impacts of case management interventions for stroke survivors that were published in English and identified by searching eight databases, from database inception to February 20, 2022. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to pool effect sizes using a random-effects model (in Stata 16.0). The revised Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the methodological quality of each study. FINDINGS The inclusion criteria were satisfied by eight studies (including a total of 1119 stroke survivors). Case management had positive effects on mental health (SMD: 0.26; 95% CI: 0.07 to 0.45, p = 0.001) and activities of daily living (SMD: 0.68; 95% CI: 00.37 to 0.99, p < 0.001). However, no significant effects were observed for either physical function or social function. CONCLUSION Case management appears to enhance the mental health and activities of daily living among stroke survivors. CLINICAL RELEVANCE Case management interventions hold promise as efficient, cost-effective, and accessible strategies to positively influence care for stroke survivors. This intervention strategy could be applied to the hospital-to-home transition to guide care among this population.
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Affiliation(s)
| | | | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana Jakarta, Indonesia.,School of Nursing Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sapna Sharma
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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13
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See Toh WXS, Lim WHJ, Yobas P, Lim S. The experiences of spousal and adult child caregivers of stroke survivors in transitional care: A qualitative systematic review. J Adv Nurs 2022; 78:3897-3929. [PMID: 35986588 DOI: 10.1111/jan.15420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
AIM To synthesize and present the currently available literature on the experiences of spousal and adult child caregivers of stroke patients in transitional care. DESIGN This is a qualitative systematic review. DATA SOURCES Eight electronic databases (PubMed, CINAHL, Cochrane, Embase, Web of Science, PsychINFO, ProQuest and Scopus) were searched from September 2020 to April 2022 for relevant literature and grey literature. Qualitative studies exploring the experiences of sspousal or adult child caregivers of stroke survivors up till 1 year after discharge were included. REVIEW METHODS The selection of articles was done by two independent reviewers who screened the titles and the abstracts of studies, and the full texts of selected articles. Quality appraisal and data extraction of selected articles were undertaken by two independent reviewers using Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was conducted using a meta-aggregative approach recommended by JBI. RESULTS A total of 19 papers were included in this review. A total of three synthesized findings centred around caregivers' experience with healthcare professionals, changes in their life roles and needs, effects of caregiving and how they adapted to their changes were aggregated. CONCLUSION Spousal and adult child caregivers faced multiple barriers during transitional care, such as the lack of resources and an inability to cope with changes in their lives. Support and adequate preparation were key facilitators in easing stroke caregivers into their role. IMPACT The findings from this review can be used to guide future implementations of caregiver education programmes and comprehensive discharge planning for stroke survivors.
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Affiliation(s)
- Wen Xiu Samantha See Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiothoracic & Vascular Unit, National University Heart Centre, Singapore
| | - Wei Heong Joshua Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Acute Stroke Unit, Tan Tock Seng Hospital, Singapore
| | - Piyanee Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
| | - Siriwan Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
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14
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Lee YT, Tsai CF, Yen YC, Huang LK, Chao SP, Hu LY, Shen CC, Lee HC. Periodontitis is a potential risk factor for transient ischemic attack and minor ischemic stroke in young adults: A nationwide population-based cohort study. J Periodontol 2022; 93:1848-1856. [PMID: 35297043 DOI: 10.1002/jper.21-0528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aims to determine whether periodontitis is a risk factor for transient ischemic attack (TIA) in young adults. METHODS The National Health Insurance (NHI) Research Database in Taiwan was the source of the data used in this retrospective cohort study. Individuals aged 20 to 53 years with periodontitis in 2001 and 2002 (n = 792,426) and an age- and sex-matched control group (n = 792,426) were selected. All participants were followed up until TIA diagnosis, 55 years of age, removal from the NHI program, death, or December 31, 2016. The incidence density and hazard ratio (HR) of new-onset TIA were compared between individuals with periodontitis and controls. Periodontitis was defined by dentists according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 with concurrent antibiotic prescription or periodontal treatment excluding scaling performed by certified dentists. TIA was defined according to the ICD-9-CM code 435.x at hospital discharge. RESULTS After adjustment for confounding factors, the risk of developing TIA/minor ischemic stroke was calculated to be higher in participants with periodontitis (HR, 1.24; 95% confidence interval, 1.15-1.32; P <0.001) than in those without. The HR was slightly higher among people aged 20 to 40 years than among those aged 40 to 53 years. CONCLUSION Periodontitis is associated with an increased risk of developing TIA/minor ischemic stroke. Periodontitis might be a modifiable risk factor for stroke in young adults. Clinicians must devote greater attention to this potential association to develop new preventive and therapeutic strategies for stroke in young adults.
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Affiliation(s)
- Yao-Tung Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Neurological Institute, Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Li-Kai Huang
- Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shu-Ping Chao
- Center of Dementia, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Yu Hu
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, National Yang-Ming University, Taipei, Taiwan.,Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry & Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
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15
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O’Callaghan G, Fahy M, Murphy P, Langhorne P, Galvin R, Horgan F. Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis. BMC Health Serv Res 2022; 22:1095. [PMID: 36031608 PMCID: PMC9420257 DOI: 10.1186/s12913-022-08473-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective support interventions to manage the transition to home after stroke are still mostly unknown.
Aim
The purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home.
Methods
The Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021.
We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status.
Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD).
Results
We included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I2 = 77%). Results showed modest but significant functional gains in the medium to long-term (6–12 month follow up, MD 2.91 points, 95%CI:0.03 to 5.81; 1207 participants; six studies; I2 = 84%). Certainty of evidence was low.
Support interventions may enhance quality of life for up to 3-months (MD 1.3,95% CI:0.84 to 1.76), and reduce depression (SMD -0.1,95% CI:-0.29 to − 0.05) and anxiety (MD -1.18,95% CI:-1.84 to − 0.52) at 6–12 months. Effects on further secondary outcomes are still unclear.
Conclusions
Incorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home.
Trial registration
CRD42021237397 - https://www.crd.york.ac.uk/prospero
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16
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Influences of Magnetic Resonance Imaging Superresolution Algorithm-Based Transition Care on Prognosis of Children with Severe Viral Encephalitis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5909922. [PMID: 35756412 PMCID: PMC9232316 DOI: 10.1155/2022/5909922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
Objective Its goal was to see how convolutional neural network- (CNN-) based superresolution (SR) technology magnetic resonance imaging- (MRI-) assisted transition care (TC) affected the prognosis of children with severe viral encephalitis (SVE) and how effective it was. Methods 90 SVE children were selected as the research objects and divided into control group (39 cases receiving conventional nursing intervention) and observation group (51 cases performed with conventional nursing intervention and TC intervention) according to their nursing purpose. Based on SR-CNN-optimized MRI images, diagnosis was implemented. Life treatment and sequelae in two groups were compared. Results After the processing by CNN algorithm-based SR, peak signal to noise ratio (PSNR) (40.08 dB) and structural similarity (SSIM) (0.98) of MRI images were both higher than those of fully connected neural network (FNN) (38.01 dB, 0.93) and recurrent neural network (RNN) (37.21 dB, 0.93) algorithms. Diagnostic sensitivity (95.34%), specificity (75%), and accuracy (94.44%) of MRI images were obviously superior to those of conventional MRI (81.40%, 50%, and 80%). PedsQLTM 4.0 scores of the observation group 1 to 3 months after discharge were all higher than those of the control group (54.55 ± 5.76 vs. 52.32 ± 5.12 and 66.32 ± 8.89 vs. 55.02 ± 5.87). Sequela incidence in the observation group (13.73%) was apparently lower than that in the control group (43.59%) (P < 0.05). Conclusion (1) SR-CNN algorithm could increase the definition and diagnostic ability of MRI images. (2) TC could reduce sequelae incidence among SVE children and improve their quality of life (QOL).
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17
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Huang L, Peng S. Status Quo and Influencing Factors of Discharge Readiness of Patients with Bilateral Ureteral Stoma After Radical Cystectomy. Front Surg 2022; 9:860162. [PMID: 36034344 PMCID: PMC9407034 DOI: 10.3389/fsurg.2022.860162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Bladder cancer is a common malignancy of the urinary system, which occurs mostly in elderly men, and the incidence is increasing year by year. To analyze the status quo and related factors of discharge readiness of patients with bilateral ureteral stoma after radical cystectomy, a retrospective, noncomparative was performed. 544 patients with bilateral ureteral stoma after radical cystectomy in our hospital from December 2018 to December 2020 were selected. The self-designed questionnaire, discharge readiness scale (RHDS) and discharge guidance quality scale (QDTS) were used to investigate the general data, and multiple linear regression was used to analyze the related influencing factors. The total score of RHDS was (72.57 ± 18.56) and the total score of QDTS was (105.63 ± 24.18); the total score of RHDS was positively correlated with the total score of QDTS (r = 0.882, p = 0.000); the results of multiple linear regression showed that age, discharge direction and care mode were the main factors influencing the discharge readiness of patients (p < 0.05). In conclusions, the discharge readiness of patients with bilateral ureteral stoma after radical cystectomy is in the medium level, and there is a large space for improvement. Nurses should strengthen the guidance and nursing of patients’ discharge preparation to reduce the incidence of postoperative complications and readmission rate.
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18
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Lindblom S, Tistad M, Flink M, Laska AC, von Koch L, Ytterberg C. Referral-based transition to subsequent rehabilitation at home after stroke: one-year outcomes and use of healthcare services. BMC Health Serv Res 2022; 22:594. [PMID: 35505404 PMCID: PMC9066723 DOI: 10.1186/s12913-022-08000-7] [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: 01/08/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is a lack of knowledge about patients’ journeys across the stroke care continuum, especially regarding the transition from inpatient to outpatient care and rehabilitation. Therefore, the aim of the present study was to explore and describe patterns of healthcare use over a one-year period, health outcomes at 3 and 12 months for patients following a referral-based transition to subsequent rehabilitation in the home, and the caregiver burden on their significant others. A further aim was to explore factors associated with the use of rehabilitation and healthcare after the referral-based transition to continued rehabilitation in the home for people recovering from a stroke. Methods Data regarding healthcare use during the first 12 months post-stroke was collected from the Region Stockholm computerized register. Data on patient characteristics, disease-related data, and functioning were retrieved drawn from medical records and questionnaires. Descriptive statistics were used to present healthcare use, participants’ characteristics, disease-related data, and patient functioning. Multivariable regression models were created to explore associations between the total number of outpatient contacts, total visits with the neurorehabilitation team, and the independent variables. Results The mean age for the 190 participants was 73 years for men and 78 years for women. Twenty-one participants (11%) had an acute rehospitalization within 30 days after discharge, and 41 participants (21%) were re-hospitalized within 90 days. Twenty-two (12%) of the participants had no visits with the neurorehabilitation team, 73 (39%) participants had 1–3 visits, 57 (30%) had 4–16 visits, and 38 (20%) had ≥17 visits. Female sex and length of hospital stay were associated with a higher number of visits with the neurorehabilitation team. Living alone, higher self-rated recovery, and being able to walk independently were associated with a lower number of visits with the neurorehabilitation team. Female sex, having home help services before the stroke, longer length of hospital stay, and more comorbidities were associated with a higher number of outpatient contacts. Conclusions The findings indicate that there is no generic pattern of healthcare use during the first-year post-stroke in patients receiving referral-based transition to continued rehabilitation in the home. The different patterns of healthcare use seemed to mirror the participants’ level of functioning. However, there is a need to further investigate how follow-up and rehabilitation correspond to the needs of patients and their significant others in the short- and long-term perspective. Trial registration ClinicalTrials.gov, registration number: NCT02925871. Date of registration: October 6, 2016.
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Affiliation(s)
- Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. .,Karolinska University Hospital, Stockholm, Sweden.
| | - Malin Tistad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Dalarna University, School of Health and Social Studies, Falun, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Ann Charlotte Laska
- Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Karolinska University Hospital, Stockholm, Sweden
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19
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Chen L, Xiao LD, Chamberlain D. Exploring the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care: A hermeneutic study. J Adv Nurs 2022; 78:2983-2999. [PMID: 35474330 DOI: 10.1111/jan.15275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/18/2022] [Accepted: 04/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care. BACKGROUND People with stroke and caregivers show dyadic effects in dealing with post-discharge care challenges. However, few studies have explored their shared experiences and unique challenges for each dyadic member in preparedness to manage post-discharge care. This study addresses this research gap. DESIGN An interpretive approach underpinned by Gadamer's philosophical hermeneutics. METHODS Semi-structured interviews were conducted with people with stroke and caregivers in 5 days before hospital discharge (n = 26) or 2 weeks after discharge (n = 4) between July and December 2019. The study followed a five-step data analysis method aligning with Gadamerian hermeneutics. The study reporting followed the COREQ checklist. RESULTS Three themes and six subthemes were identified. First, both people with stroke and caregivers experienced psychological stress, although the sources differed. Second, stroke dyads demonstrated resilience built on positive thoughts, confidence, and support from family and health professionals. Third, stroke dyads exhibited different levels of certainty about post-discharge care. They desired to be equal partners in co-developing and co-implementing discharge plans. CONCLUSIONS Similarities and differences in perceived preparedness to manage post-discharge care existed between stroke dyadic members. A co-design approach to developing and implementing discharge plans would enhance planned post-discharge care. IMPACT Hospital-to-home transition is a challenging time for people with stroke and their caregivers. Understanding the shared experiences of stroke dyads in preparedness for post-discharge care enables nurses to take proactive actions to enhance managing post-discharge care. Early identification of those at risk of developing psychological stress will enable nurses to co-develop stress-coping strategies. These will have a positive influence on the dyad when facing setbacks due to stroke-related complications.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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20
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O'Callaghan G, Fahy M, Murphy P, Langhorne P, Galvin R, Horgan F. Effectiveness of interventions to support the transition home after acute stroke: a protocol for a systematic review. HRB Open Res 2022; 4:105. [PMID: 35224442 PMCID: PMC8844528 DOI: 10.12688/hrbopenres.13364.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background
Despite advances in the quality of acute stroke management, there are gaps in knowledge about effective support interventions to better manage the transition of care to home for patients with this complex condition. The goal of this systematic review is to explore the literature around support interventions available for patients as they navigate from acute hospital, rehabilitation or early supported discharge (ESD) services to independent living at home; and to establish if, in comparison with usual care or other comparative active interventions, support services offered to patients as they transition from acute hospital, inpatient rehabilitation/ESD to home, can achieve better patient and / or process outcomes.
Protocol
In June 2021, we will carry out, on electronic peer-reviewed databases, a comprehensive literature search based on a pre-defined search strategy, developed and conducted in collaboration with an Information Specialist. In an effort to identify all published trials we will perform citation tracking of included studies, check reference lists of relevant articles, review grey literature, and extend our search to google scholar. We will include randomised controlled trials (including cluster and quasi-randomisation) recruiting stroke patients transitioning to home, to receive either usual care or any support intervention designed to improve outcomes after stroke. The primary clinical outcome will be functional status. Two review authors will scrutinise trials, categorise them on their eligibility, and extract data. We will analyse the results for all trials and perform meta-analyses where possible. We will assess risk of bias for the included trials and use GRADE to assess the quality of the body of evidence. Patient and public involvement (PPI) engaged in the development of the research questions, and will participate in co-design of a strategy for dissemination of findings. Conclusions: The findings from this review will be used to identify knowledge gaps to direct future research.
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Affiliation(s)
- Geraldine O'Callaghan
- RCSI School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin 2, DO2 YN77, Ireland
| | - Martin Fahy
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G31 2ER, UK
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Frances Horgan
- RCSI School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin 2, DO2 YN77, Ireland
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21
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Yan F, Xiao LD, Zhou K, Li Z, Tang S. Perceptions and help-seeking behaviours among community-dwelling older people with urinary incontinence: A systematic integrative review. J Adv Nurs 2022; 78:1574-1587. [PMID: 35150161 DOI: 10.1111/jan.15183] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/05/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
AIM To synthesize research evidence on perceptions and help-seeking behaviours in community-dwelling older people with urinary incontinence based on the Capability-Opportunity-Motivation-Behaviours model. BACKGROUND Urinary incontinence is highly prevalent in community-dwelling older people, yet only a small proportion seek help from health professionals. Untreated urinary incontinence has a detrimental impact on older people's quality of life and distresses their caregivers. DESIGN Systematic integrative review. DATA SOURCES Ten databases were searched systematically between 9 November 2020 and 17 December 2020 including Medline (PubMed), CINAHL, Ageline, Web of Science, Scopus, ProQuest, Psyclnfo, CNKI, Wanfang and Vip. REVIEW METHODS Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aim were extracted from included articles for analysis. Convergent qualitative synthesis was used to synthesize findings. RESULTS Twenty articles were included and two main themes with six sub-themes were identified. Theme one described three common perceptions including urinary incontinence as a part of normal ageing, a stigma and a health problem. Each perception had a profound impact on older people's motivation to self-report the problem to health professionals. Theme two revealed three main help-seeking approaches comprising self-help, help from friends and help from health professionals. Of these, self-help was the dominant approach used to conceal urinary incontinence and contributed to social isolation. CONCLUSION Improving urinary incontinence management in community-dwelling older people requires the development of their capability and motivation, and increased opportunities to access and gain help from skilled health professionals. IMPACT Findings can facilitate resource development to improve health literacy for the general public pertinent to urinary incontinence and associated stigma. Moreover, findings can inform a user-friendly reporting and referral system for the problem. In addition, findings can inform education and skill training for health professionals, older people and their caregivers to effectively manage the problem.
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Affiliation(s)
- Fang Yan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lily D Xiao
- College of Nursing and Health Science, Adelaide, South Australia, Australia
| | - Keyi Zhou
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Zeen Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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22
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WANG C, LIN S, WANG Q, Xie S, Tu Q, ZHANG H, PENG M, ZHOU J, REDFERN J. The experience of stroke survivors and caregivers during hospital-to-home transitional care: A qualitative longitudinal study. Int J Nurs Stud 2022; 130:104213. [DOI: 10.1016/j.ijnurstu.2022.104213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
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Zafra-Tanaka JH, Portocarrero J, Abanto C, Zunt JR, Miranda JJ. Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru. J Stroke Cerebrovasc Dis 2021; 31:106275. [PMID: 35121533 PMCID: PMC8702405 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. METHODS A qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients' journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. RESULTS We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. CONCLUSION The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients' experiences and feelings by developing solutions in a participatory manner.
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Affiliation(s)
- Jessica Hanae Zafra-Tanaka
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru.
| | - Jill Portocarrero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Joseph R Zunt
- Departments of Neurology and Global Health, University of Washington, Seattle, United States
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Miraflores, Lima 15074, Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, Australia; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Kokorelias KM, Nelson MLA, Tang T, Steele Gray C, Ellen M, Plett D, Jarach CM, Xin Nie J, Thavorn K, Singh H. Who is Included in Digital Health Technologies to Support Hospital to Home Transitions for Older Adults?: Secondary analysis of a rapid review and equity-informed recommendations (Preprint). JMIR Aging 2021; 5:e35925. [PMID: 35475971 PMCID: PMC9096639 DOI: 10.2196/35925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kristina Marie Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Sinai Health System/University Health Network, Toronto, ON, Canada
| | - Michelle LA Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Moriah Ellen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Eilat, Israel
| | - Donna Plett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carlotta Micaela Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Hardeep Singh
- March of Dimes Canada, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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25
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Kakyo TA, Xiao LD, Chamberlain D. Benefits and challenges for hospital nurses engaged in formal mentoring programs: A systematic integrated review. Int Nurs Rev 2021; 69:229-238. [PMID: 34820833 DOI: 10.1111/inr.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/13/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
AIMS To explore the overall benefits and challenges for the mentee, the mentor, and the hospital (stakeholders) in hospital-sponsored mentoring programs. BACKGROUND Formal mentoring programs are widely used to assist nurses to adapt to clinical practice, facilitate their career development, and improve workforce retention. However, the overall benefits and challenges for stakeholders involved in formal mentoring programs remain largely unknown due to a lack of systematic reviews to synthesize relevant studies in this important area. DESIGN A systematic integrated review. DATA SOURCES A systematic search of six databases including CINAHL, Web of Science, MEDLINE, Scopus, Science Direct, and ProQuest was undertaken. REVIEW METHODS Studies that met the inclusion criteria were assessed for methodological quality using the Joanna Briggs Institute critical appraisal tools. Findings from qualitative, quantitative, and mixed-methods studies were extracted and synthesized thematically using a convergent synthesis method. RESULTS Twenty-two original studies were included in the review. Findings are presented under five themes: the benefits for mentees, the benefits for mentors, the benefits for the hospital, challenges perceived by mentees and mentors, and mismatched mentor-mentee pairs. CONCLUSION Mentoring programs that build on reciprocal relationships among mentees and mentors generate substantial benefits for all if mentees are able to navigate the challenges of the complex and dynamic nature of the clinical practice environment. Organizational support is important in overcoming these challenges.
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Affiliation(s)
- Tracy Alexis Kakyo
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Faculty of Health Science, Muni University, Arua, Uganda
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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26
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Tarihoran DETAU, Honey M, Slark J. Educational Strategies for Secondary Stroke Prevention: An Integrative Literature Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1973616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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O'Callaghan G, Fahy M, Murphy P, Langhorne P, Galvin R, Horgan F. Effectiveness of interventions to support the transition home after acute stroke: a protocol for a systematic review. HRB Open Res 2021; 4:105. [DOI: 10.12688/hrbopenres.13364.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Despite advances in the quality of acute stroke management, there are gaps in knowledge about effective support interventions to better manage the transition of care to home for patients with this complex condition. The goal of this systematic review is to explore the literature around support interventions available for patients as they navigate from acute hospital, rehabilitation or early supported discharge (ESD) services to independent living at home; and to establish if, in comparison with usual care or other comparative active interventions, support services offered to patients as they transition from acute hospital, inpatient rehabilitation/ESD to home, can achieve better patient and / or process outcomes. Protocol In September 2021, we will carry out, on electronic peer-reviewed databases, a comprehensive literature search based on a pre-defined search strategy, developed and conducted in collaboration with an Information Specialist. In an effort to identify all published trials we will perform citation tracking of included studies, check reference lists of relevant articles, review grey literature, and extend our search to google scholar. We will include randomised controlled trials (including cluster and quasi-randomisation) recruiting stroke patients transitioning to home, to receive either usual care or any support intervention designed to improve outcomes after stroke. The primary clinical outcome will be functional status. Two review authors will scrutinise trials, categorise them on their eligibility, and extract data. We will analyse the results for all trials and perform meta-analyses where possible. We will assess risk of bias for the included trials and use GRADE to assess the quality of the body of evidence. Patient and public involvement (PPI) engaged in the development of the research questions, and will participate in co-design of a strategy for dissemination of findings. Conclusions: The findings from this review will be used to identify knowledge gaps to direct future research.
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28
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Zimmerman WD, Grenier RE, Palka SV, Monacci KJ, Lantzy AK, Leutbecker JA, Geng X, Denny MC. Transitions of Care Coordination Intervention Identifies Barriers to Discharge in Hospitalized Stroke Patients. Front Neurol 2021; 12:573294. [PMID: 34079506 PMCID: PMC8165227 DOI: 10.3389/fneur.2021.573294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Prolonged hospital lengths of stay increase costs, delay rehabilitation, and expose acute ischemic stroke patients to hospital-acquired infections. We designed and implemented a nurse-driven transitions of care coordinator (TOCC) program to facilitate the transition of care from the acute care hospital setting to rehabilitation centers and home. Methods: This was a single-blinded, prospective, randomized pilot study of 40 participants to evaluate the feasibility of implementing a TOCC program led by a stroke nurse navigator in hospitalized acute ischemic stroke patients. The intervention consisted of a stroke nurse navigator completing eight specific tasks, including meeting with stroke patients and their families, facilitating communication between team members at multi-disciplinary rounds, assisting with referrals to rehabilitation facilities, providing stroke education, and arranging stroke clinic follow-up appointments, which were confirmed to be completed by independent study personnel. The primary outcome was to assess the feasibility of the program. The secondary outcomes included comparing hospital length of stay (LOS) and patient satisfaction between the TOCC and usual care groups. We also explored the association between patient-level variables and LOS. Results: The TOCC program was feasible with all pre-specified components completed in 84.2% (95% CI: 60.4–96.6%) and was not significantly different from the assumed completion rate of 75% (p = 0.438). There was no significant difference in median LOS between the two groups [TOCC 5.95 days (4.02, 9.57) vs. usual care 4.01 days (2.00, 10.45), false discovery rate (FDR)-adjusted p = 0.138]. There was a trend toward higher patient median satisfaction in the TOCC group [TOCC 35.00 (33.00, 35.00) vs. usual care 30 (26.00, 35.00), FDR-adjusted p = 0.1] as assessed by a questionnaire at 30 days after discharge. The TOCC study allowed us to identify patient variables (gender, insurance, stroke severity, and discharge disposition) that were significantly associated with longer hospital LOS. Conclusion: A TOCC program is feasible and can serve as a guide for future allocation of resources to facilitate transitions of care and avoid prolonged hospital stays.
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Affiliation(s)
| | - Rachel E Grenier
- Massachusetts General Hospital, Interventional Radiology, Boston, MA, United States
| | - Sydney V Palka
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Kelsey J Monacci
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Amanda K Lantzy
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Jacqueline A Leutbecker
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Xue Geng
- Department of Biostatistics, Bioinformatics and Biomathematics at Georgetown University Medical Center and Lombardi Comprehensive Cancer Center, Washington, DC, United States
| | - Mary Carter Denny
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, United States
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29
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Chen L, Xiao LD, Chamberlain D, Newman P. Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review. J Clin Nurs 2021; 30:2786-2807. [PMID: 33872424 DOI: 10.1111/jocn.15807] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. BACKGROUND Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. DESIGN A systematic review and meta-synthesis. METHODS A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. RESULTS The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. CONCLUSIONS Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. RELEVANCE TO CLINICAL PRACTICE Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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30
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Chong WFW, Ng LH, Ho RMH, Koh GCH, Hoenig H, Matchar DB, Yap P, Venketasubramanian N, Tan KB, Ning C, Menon E, Chang HM, De Silva DA, Lee KE, Tan BY, Young SHY, Ng YS, Tu TM, Ang YH, Yeo TT, Merchant RA, Kong KH, Singh R, Ng YL, Cheong A. Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis. J Am Med Dir Assoc 2021; 22:2350-2357.e2. [PMID: 33812841 DOI: 10.1016/j.jamda.2021.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and 12 months post-stroke after accounting for covariates. DESIGN Latent profile transition analysis of caregiver psychosocial health with stroke rehabilitation use at 12 month post-stroke as outcome. SETTING AND PARTICIPANTS A total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study. METHODS Cross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support. Changes in latent profile classification over 3 time points (baseline, 3 months, and 12 months post-stroke) were analyzed using latent transition analysis. A transition model with stroke rehabilitation use at 12 months post-stroke as the outcome was tested after accounting for covariates. RESULTS Two distinct caregiver psychosocial health latent profiles were found across time: nondistressed and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time. Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke. Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke. CONCLUSIONS AND IMPLICATIONS Whether caregiver adaptation explains the associations between the latent profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early psychosocial health assessment and sustained support should be made available to stroke caregivers to enhance their well-being and subsequent patient rehabilitation participation.
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Affiliation(s)
- Wayne F W Chong
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore; GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore.
| | - Leong Hwee Ng
- GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore
| | - Ringo M-H Ho
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore
| | - Gerald C H Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; Office of Healthcare Transformation, Ministry of Health, Singapore, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Science, Durham Veterans Administration Medical Center, Durham, NC, USA; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David B Matchar
- Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore, Singapore; Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | | | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore; InfoComm, Technology and Data Group, Ministry of Health, Singapore, Singapore, Singapore
| | - Chou Ning
- CHOU Neuroscience Clinic, Farrer Park Hospital, Singapore, Singapore, Singapore; Chou Neurosurgery Pte Ltd, Gleneagles Hospital, Singapore, Singapore, Singapore
| | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore, Singapore, Singapore
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Deidre A De Silva
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore, Singapore
| | | | - Sherry H Y Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University of Singapore, Singapore, Singapore, Singapore
| | - Reshma A Merchant
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore; Department of Medicine (Division of Geriatric Medicine), National University Hospital, Singapore, Singapore, Singapore
| | - Keng He Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore
| | - Yu Li Ng
- Manpower Planning and Strategy, Ministry of Health, Singapore, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore
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