The Impact of Doctor-Nurse Complementary Model Combined with Disease Tracking on Stroke Patients.

Objective: The incidence of stroke worldwide is increasing year by year. With the enhancement of public health awareness, people's demand for the quality of stroke rehabilitation is getting higher and higher, so better quality care measures are needed in the treatment of stroke. Based on this, this paper explores the impact of a new type of nursing care measure, the complementary health care model combined with condition tracking, on stroke patients. Methods: 238 stroke patients were randomly divided into a conventional group (n=119) and a combined group (n=119). 238 stroke patients were randomly divided into conventional group (n=119) and combined group (n=119). The conventional group received routine care, in which doctors and nursing carried out their own work without cooperation after the patients were admitted to the hospital; the combined group received a complementary health care model and condition tracking, in which doctors and nurses jointly checked the rooms, discussed cases, jointly formulated treatments and nursing care plans, and jointly formulated the patients' discharge and rehabilitation plans after the patients were admitted to the hospital. Before the intervention, at the time of discharge, and 6 months after discharge, the neurological function of the patients in both groups was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the Fugl-Meyer (FMA) scale, the cognitive function of the patients in both groups was assessed using the Montreal Cognitive Assessment (MoCA) scale and the Measured Mental State Examination (MMSE), and the cognitive function of the patients in both groups was assessed using the General Self-Efficacy Scale (GSS) and the Montreal Cognitive Assessment (MCA) scale. General Self-Efficacy Scale (GSES) to assess self-efficacy, Exercise Adherence Questionnaire (EAQ) to assess adherence to functional exercise and Specific Quality of Life Scale (SSQoL-12) to assess the quality of life of patients in both groups, and the self-developed satisfaction with nursing care to assess patients' satisfaction with the care model. Results: Before the intervention, there was no difference in the National Institutes of Health Stroke Scale (NIHSS), the Fugl-Meyer Assessment (FMA), the Montreal Cognitive Assessment (MoCA), the Mental State Examination (MMSE), the General Self-Efficacy Scale (GSES), the Exercise Adherence Questionnaire (EAQ) and the Stroke-Specific Quality of Life Scale-12 (SSQoL-12) scores between the two groups (P > .05). At discharge and six months later, NIHSS scores continued to decrease in both groups, with the joint group being lower than the conventional group (P < .05); scores for all other items continued to increase, with the joint being higher than the conventional group (P < .05). Satisfaction with care was higher in the combined group than in the conventional group (P < .05). Conclusion: The complementary healthcare model combined with condition tracking can effectively promote the prognosis of rehabilitation of stroke patients, and has a positive effect in promoting the recovery of neurological and cognitive functions, strengthening self-efficacy, and improving the quality of life, which can be promoted in the clinic.

Effect of traditional Chinese medicine emotional therapy on post-stroke depression: A protocol for systematic review and meta-analysis.

BACKGROUND: Post-stroke depression has seriously affected the rehabilitation and quality of life of patients, and there is no reliable treatment plan at present. Nursing plays an important role in the recovery of patients, some studies have pointed out that traditional Chinese medicine emotional therapy has advantages in improving post-stroke depression and promoting rehabilitation, but it is lack of evidence-based basis. The purpose of this study is to systematically evaluate the effect of traditional Chinese medicine emotional therapy on the improvement of post-stroke depression. METHOD: We will search CNKI, Wanfang, VIP and CBM, PubMed, Embase, Web of Science and the Cochrane Library database, and search the randomized controlled trial on traditional Chinese medicine emotional therapy in patients with post-stroke depression from the establishment of the database to February 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers. And meta-analysis is performed on the included literature using RevMan5.3 software. RESULT: In this study, the effect of traditional Chinese medicine emotional therapy on the improvement of post-stroke depression is evaluated by patient psychiatric scale score, compliance evaluation, quality of life evaluation and other indicators. CONCLUSION: This study will provide reliable evidence-based basis for establishing a reasonable and effective nursing scheme for patients with post-stroke depression. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/KA7G3.

Cuidado de si: representações sociais de cuidadores familiares de pacientes com AVC / Caring for oneself: social representations of stroke patients' family caregivers / Cuidado de sí mismos: representaciones sociales de los cuidadores de pacientes con familiares accidente cerebrovascular

Objetivo: Analisar as representações sociais de cuidadores familiares de pacientes acometidos por AVC, sobre o cuidado de si. Método: Estudo descritivo, no qual foi utilizado como aporte teórico as representações sociais. Foram investigados 20 cuidadores que frequentavam duas clinicas especializadas em Belém do Pará. Os dados foram coletados por meio de entrevistas semiestruturadas e organizados pela técnica de análise temática indutiva. Resultados:O cuidado de si foi representado pelos cuidadores como de difícil agregação às suas atividades de cuidar do adoecido pelo AVC devido à sobrecarga de trabalho, a qual gerou estresse e frustração. Alguns cuidadores conseguiram transformar esse estresse em uma representação pertencente a complexidade da sua vivência e da realidade do cuidado. Conclusão:Foi possível acessar o seu imaginário social e consequentemente a produção de significados atrelados as ações dos cuidadores, comportamentos e componentes cognitivos envolvidos na realidade do cuidar

Objective:The study's main goal has been to investigate the social representations of stroke patients' family caregivers by focusing on self-care. Methods: It is a descriptive study, which used the theoretical approach of social representations. There were investigated 20 caregivers who attended two specialized clinics in Belém city, Pará State, Brazil. Data were collected through semi-structured interviews and processed by the inductive thematic analysis technique. Results: Self-care was represented by caregivers as difficult to combine to their activities of caring for the person suffering from stroke due to work overload, which generated stress and frustration. Some caregivers were able to transform this stress into a representation belonging to a complexity of their experience and the care reality. Conclusion: It was possible to access their social imagery and, consequently, the production of linked meanings as caregivers' actions, behaviors and cognitive components involved in the care reality

Objetivo: Analizar las representaciones sociales de los cuidadores de pacientes con accidente cerebrovascular de la familia en el auto cuidado.Método: Estudio descriptivo, que se utilizó como las representaciones sociales teóricas. Investigaron 20 cuidadores que asisten a dos clínicas especializadas en Belem. Los datos fueron recolectados a través de entrevistas semi-estructuradas y organizadas por la técnica de análisis temático inductivo. Resultados: El cuidado de sí estuvo representada por los cuidadores como difíciles de agregar sus actividades para atender a los enfermos por accidente cerebrovascular debido a la sobrecarga de trabajo, lo que causó el estrés y la frustración. Algunos cuidadores fueron capaces de convertir ese estrés en una representación que pertenece a la complejidad de su experiencia y la realidad cuidado. Conclusión: Fue posible acceder a los imaginarios sociales y por lo tanto la producción de significados vinculado las acciones de los cuidadores, el comportamiento y los componentes cognitivos implicados en la realidad de la atención

Implementing Caregiver Support Programs in a Regional Stroke System.

Background and Purpose- Family caregivers play a central role in the recovery of people with stroke. They need support to optimize the care they provide and their own health and well-being. Despite support from the literature and best practice recommendations, healthcare systems are not formally adopting caregiver programs. This study aimed to describe system-level facilitators and barriers to caregiver support program implementation in a regional stroke system. Methods- Using a qualitative descriptive study design, focus groups were conducted with regional rehabilitation specialists, education coordinators, community and long-term care specialists, and regional/district program directors. Semi-structured interviews were conducted with regional medical directors, health professionals providing stroke care in acute care, rehabilitation and community settings, regional health executives, and primary care leaders. Data were analyzed using inductive thematic analysis. Results- Four focus groups (n=43) and 29 interviews were conducted. We identified 4 themes related to caregiver program implementation: (1) establishing the need for caregiver education and support in an integrated healthcare system; (2) incorporating caregiver programs into the system of care across the care continuum; (3) uncertainty regarding ownership and responsibility for implementation; and (4) addressing regional variations related to access, availability, and culture. Conclusions- This study provides a comprehensive understanding of organization and system-level considerations for implementing caregiver programs in a regional stroke system. Program implementation requires evidence to establish the need for caregiver programs, practical strategies, and establishing ownership to incorporate programs into existing healthcare systems, and consideration of regional variations across healthcare systems. Ultimately, adopting programs to support caregivers will improve recovery in people with stroke and caregiver well-being.

Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post-discharge from acute care hospital.

Neurological conditions represent leading causes of non-fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long-term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February-June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post-discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English-language studies published January 2000 to June 2016. Data were extracted using a purpose-designed protocol. Studies describing community neurological nursing care services post-discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self-management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post-discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology-generalist nurses to promote continuity of care for people with long-term or progressive, long-term neurological conditions post-discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.

Caring Interaction with stroke survivors' family members-Family members' and nurses' perspectives.

AIMS AND OBJECTIVES: To examine emotional support given by nurses to family members in the acute phase after a working-aged patient's stroke based on nurses' and family members' experiences. BACKGROUND: The number of patients with stroke is increasing globally. There is a lack of knowledge about the emotional support of family members during the acute phase of working-aged stroke victims. To be able to provide high-quality nursing care during this phase, we need information about emotional support from family members' and nurses' perspective. METHOD: Using a Glaserian grounded theory approach, the study was conducted using open interviews with family members and group interviews with nurses. Data were collected between 2012-2013. RESULTS: In this study, emotional support is identified as Caring Interaction. The changed life situation and diverse feelings aroused by the stroke are the starting point of providing emotional support to family members. It is important that the nurses notice family members' need for support at the right time, use their intuition and respond appropriately. CONCLUSIONS: The patient's family members are important when providing holistic nursing care for the whole family. As well as providing emotional support, high-quality nursing interventions enhance the care of family members. This study provides an explanation of the interaction process between family members and nurses. It helps family members and nurses to better understand each other. Although the data were collected 5 years ago, it is assumed that the interaction between family members and nurses has not changed during these years remarkably. RELEVANCE TO CLINICAL PRACTICE: According to the experiences of family members and nurses who participated in this research, emotional support manifests in Caring Interaction. Being aware of body language and behaviour of family members, nurses can better interact with them.

Effect of progressive muscle relaxation on the caregiver burden and level of depression among caregivers of older patients with a stroke: A randomized controlled trial.

AIM: This study aimed to investigate the effect of progressive muscle relaxation on the caregiver burden and level of depression among the caregivers of older patients with a stroke. METHODS: This randomized, controlled experimental study was conducted between December, 2015 and July, 2017 with the caregivers of older patients with a stroke who had been admitted to the home care unit of a state hospital. The caregivers were randomly assigned to intervention (n = 23) and control (n = 21) groups, based on the study's inclusion criteria. The caregivers in the intervention group practiced progressive muscle relaxation exercises at home 3 days per week for 8 weeks. The control group had no intervention. RESULTS: The mean age of the older patients with a stroke was 80.15 ± 9.86 years and the mean duration of the disease was 39.07 ± 44.69 months. The mean age of the caregivers was 50.29 ± 12.62 years, 84.1% of whom were female, 38.6% were elementary school graduates, and 86.4% were married. It was found that there was a statistically significant decrease in the mean Zarit Caregiver Burden Scale and Beck Depression Scale scores of the caregivers in the intervention group after practicing progressive muscle relaxation, but this decrease was not statistically significant when the intervention and control groups were compared. CONCLUSION: This study showed that there was a statistically significant decrease in the caregiver burden and level of depression among the caregivers in the intervention group after progressive muscle relaxation exercises, but that there was no statistically significant difference when the intervention and control groups were compared.

Palliative Care and Stroke: An Integrative Review of the Literature.

Stroke survivors often experience life-altering functional and cognitive changes and burdensome symptoms. Palliative care could provide additional support to improve outcomes of stroke patients and their families. The purpose of this review was to describe how palliative care is conceptualized and implemented within stroke care.An integrative review of the literature published between 1990 and 2016 using the terms "palliative care," "stroke," or "acute stroke" was conducted. Of the 363 articles identified, 44 were screened, 21 met inclusion criteria, and 2 additional articles were identified through reference list review, resulting in a final sample of 23 articles.Palliative care was predominantly understood as end-of-life care and was most commonly offered in acute stages when patients were expected to die. Patients, families, and providers reported challenges surrounding decision making, uncertainty regarding transitions to palliative care, and needs related to communication and physical and psychosocial support. The quality of the research was moderate to good but was limited by retrospective designs, reliability of data collection procedures and tools, recall bias, and generalizability.This review highlights gaps in access to palliative care throughout the illness trajectory and underscores the need for study of models that integrate palliative care into stroke care.

Multimodal rehabilitation in the late phase after stroke enhances the life situation of informal caregivers.

Purpose The burden of caregiving for stroke survivors is well known, but the effect of late stroke rehabilitation on the life situation of informal caregivers is unknown. Here, we assessed changes in the life situation of informal caregivers of stroke survivors enrolled in a multimodal intervention trial. Methods This controlled study was a questionnaire-based survey accompanying a three-armed randomized controlled trial of 123 stroke survivors. The care recipients of 106 caregivers who chose to participate were assigned to rhythm-and-music-based therapy (R-MT; n = 37), horse-riding therapy (H-RT; n = 37), or delayed intervention (control group, n = 32). Perceived changes in the life situation of the caregivers were evaluated with the Life Situation among Spouses after the Stroke Event (LISS) questionnaire before randomization, after the 12-week intervention, and 3 and 6 months later. Results After the intervention, the change in the median LISS score was significantly higher among intervention caregivers (1.5 [interquartile range (IQR) 8.8]) than controls (1.5 [IQR 8.8] vs. 0.0 [IQR 12.0], p = 0.036). The improvement was maintained at 3 months (1.5 [IQR 9.0] vs. 0.0 [IQR 10.5], p = 0.039) but not at 6 months (p = 0.284). Conclusion Engaging stroke survivors in multimodal interventions late after stroke appears to have potential to produce gains also in the general life situation of informal caregivers.

Feasibility and Efficacy of Nurse-Driven Acute Stroke Care.

BACKGROUND: Acute stroke care requires rapid assessment and intervention. Replacing traditional sequential algorithms in stroke care with parallel processing using telestroke consultation could be useful in the management of acute stroke patients. The purpose of this study was to assess the feasibility of a nurse-driven acute stroke protocol using a parallel processing model. METHODS: This is a prospective, nonrandomized, feasibility study of a quality improvement initiative. Stroke team members had a 1-month training phase, and then the protocol was implemented for 6 months and data were collected on a "run-sheet." The primary outcome of this study was to determine if a nurse-driven acute stroke protocol is feasible and assists in decreasing door to needle (intravenous tissue plasminogen activator [IV-tPA]) times. RESULTS: Of the 153 stroke patients seen during the protocol implementation phase, 57 were designated as "level 1" (symptom onset <4.5 hours) strokes requiring acute stroke management. Among these strokes, 78% were nurse-driven, and 75% of the telestroke encounters were also nurse-driven. The average door to computerized tomography time was significantly reduced in nurse-driven codes (38.9 minutes versus 24.4 minutes; P < .04). CONCLUSIONS: The use of a nurse-driven protocol is feasible and effective. When used in conjunction with a telestroke specialist, it may be of value in improving patient outcomes by decreasing the time for door to decision for IV-tPA.

Nursing interventions in stroke care delivery: An evidence-based clinical review.

INTRODUCTION: Generally, nursing interventions during the acute stages following a stroke aim at preventing secondary brain injury (intracranial hypertension), maintaining the airways (due to paralysis of the pharynx muscles), providing general body support (vital signs, fluid and electrolyte balance), and anticipating the occurrence of complications (atelectasis and pneumonia). AIM: This literature review is to prioritize nursing interventions for acute stroke and to update nursing roles and input considering recommended levels of evidence of care to date. METHOD AND MATERIALS: A systematic review was undertaken, and databases searched were Electronic Library Information Navigator (ELIN), Medline and the Cumulative Index to Nursing and Allied Health Literature from 1990 to 2015, using the OVID interface. RESULTS: The search originally yielded 400 articles of which 65 were selected for analysis and 12 of these included evidence synthesis (class I-IV, level A-Good Clinical Practice [GCP]). To facilitate early patient recovery, advanced nursing care should include the routine practice of a wide range of specific nursing interventions such as continence management, pressure area care, swallowing management, and early mobilization. Other important nursing interventions include the prevention of pulmonary thromboembolism and early antiplatelet therapy. CONCLUSIONS: For over 20 years, it has been established that specialized stroke care save lives, reduce disability, shorten length of stay, and generally have been associated with improved patient outcomes. Highly specialized nursing input is of paramount importance in achieving optimum patient outcomes and high quality of interdisciplinary care, providing a comprehensive, interactive, and holistic approach for both acute stroke and rehabilitation.

Effectiveness of non-pharmacological interventions to promote urinary continence in stroke survivors ­ a systematic literature review / Wirksamkeit von nichtmedikamentösen Interventionen zur Förderung der Urinkontinenz bei Menschen nach einem cerebro-vaskulären Insult - eine systematische Literaturübersicht

Background: Around half of the people who survive a cerebrovascular insult are suffering from urinary incontinence. This is a predictor for functional outcomes and affects the quality of life negatively. Until now, it is not clear, which the optimal method of treatment is. A systematic review of 2008 showed an insufficient data situation and couldn't make a recommendation. Research question: Which non-pharmacological interventions are effective to promote urinary continence in adult persons who have suffered a cerebrovascular insult? Method: To answer the question a systematic literature review was performed. The literature search was conducted in the databases PubMed, CINAHL, CENTRAL and PsycInfo. The period from March 2007 to May 2015 was taken into account. Results: There were a total of six studies included which examined 732 persons. The following interventions were explored for their effectiveness: transcutaneous electrical nerve stimulation, urodynamic assessment with recommendation of bladder emptying method and interventions that consist of several components (e. g. toilet training). All studies showed a positive effect in at least one outcome. Conclusions: There is limited evidence for interventions to promote urinary continence in people suffering a cerebrovascular insult. An intervention consisting of assessment and individual adapted measures currently appear to be the best treatment method.

Music as Medicine: The Therapeutic Potential of Music for Acute Stroke Patients.

Nurses caring for patients with acute stroke are likely to administer both music and medication with therapeutic intent. The administration of medication is based on accumulated scientific evidence and tailored to the needs of each patient. However, the therapeutic use of music is generally based on good intentions and anecdotal evidence. This review summarizes and examines the current literature regarding the effectiveness of music in the treatment of critically ill patients and the use of music in neurologically injured patients. The rationale for hypothesis-driven research to explore therapeutic music intervention in acute stroke is compelling.

Stroke among African-Caribbean women: lay beliefs of risks and causes.

AIMS AND OBJECTIVES: To investigate African Caribbean women's subjective accounts of stroke and how this impacted on their lives and identify beliefs attributed to the causes of stroke in this post stroke. BACKGROUND: In the UK, those from African or African Caribbean ethnicity are at an increased risk of stroke, and stroke risks are double that of the UK White population. This is because diabetes and hypertension are more common in those of African and African Caribbean ethnic groups. The main risk factors for stroke are high blood pressure, alongside obesity and overweight, poor diet and lack of physical activity. DESIGN: A qualitative study using interpretative phenomenological analysis. METHODS: Data were collected via semi-structured indepth interviews for six African Caribbean women. Interviews were audio recorded and transcribed verbatim. Interpretative Phenomenological Analysis was used to deconstruct the data and facilitate developing themes. RESULTS: Six semi-structured interviews were completed with women aged 47-85 years. Two themes emerged (1) the role of lifestyle and biological risk factors linked to the causes of stroke and (2) the role of spirituality, in identifying the lay beliefs and causes of stroke. CONCLUSION: Alternative explanations of the causes of stroke that include witchcraft, or wishing someone wrong suggests a lack of perceived control over stroke. This may suggest a focus on less visible risk factors such as hypertension, familial history or diabetes and will need inclusion in health promotion materials. Lay beliefs such as witchcraft can co-exist amicably alongside modern medicine, as long as they do not hinder access to medication, treatment or risk factor management of stroke. RELEVANCE TO CLINICAL PRACTICE: The results demonstrated that nursing care and health promotion materials should emphasise on obesity, overweight and management of these through diet and physical activity to prevent stroke occurring.

Issues post-stroke for Muslim people in maintaining the practice of salat (prayer): A qualitative study.

BACKGROUND: Muslims throughout the world perform salat (prayer) five times a day; salat involves a person reciting the Holy Qur'an while being in several positions. There are several steps that should be carried out before prayer, including wudhu (ablution) and covering one's awrah (body). OBJECTIVES: To identify educational needs for stroke patients and their caregivers in Malaysia. Another purpose is to report on the needs identified by stroke patients and their families related to salat. METHODS: Descriptive qualitative study. Phase 1 involved semi-structured interviews with stroke patients (n = 5), family caregivers (n = 5) and health professionals (n = 12) in Kelantan Malaysia. Phase 2 involved presenting the findings from Phase 1 to the health professionals with the aim of establishing priorities and processes to develop education strategies for stroke patients and their families. RESULTS: Preparing for and performing salat was challenging for both patient and family carers to do following a stroke. Themes identified were prayer and the meaning of the stroke events for participants, difficulties praying post-stroke, prayer as part of rehabilitation therapy. CONCLUSION: Providing culturally safe care should include how nurses assess and support patients and their caregivers post stroke to meet their prayer needs. Nurses have a role in discussing with stroke patients and their families how in addition to its spiritual and customary benefits, prayer and for Muslims reciting the Holy Qur'an can have cognitive and rehabilitation benefits, as well as being a source of psychological support for stroke patients.

Ward-based interventions for patients with hemispatial neglect in stroke rehabilitation: a systematic literature review.

OBJECTIVES: To identify rehabilitation interventions that can be integrated into ward-based nursing for patients with hemispatial neglect following stroke in the right brain hemisphere. DESIGN: A systematic review of interdisciplinary literature. DATA SOURCES: A preliminary literature search without time limits was conducted in the Cochrane Controlled Trials Register. We then searched the PubMed, CINAHL and PsychINFO databases for relevant articles published between January 2006 and June 2014. Selected journals were searched manually. Additional resources were explored by scrutinizing reference lists and tracking citations of the selected articles. REVIEW METHODS: Titles and abstracts were matched with the inclusion criteria. Articles were read in their entirety if the abstracts adhered to inclusion criteria or if there was any uncertainty. Two reviewers evaluated the risk of methodological bias independently by using quantitative appraisal forms from the Johanna Briggs Institute (JBI). Any disagreements were resolved by consensus. Authors of nine studies were contacted to acquire additional information. The JBI Reviewers' Manual was used to guide the overall procedure of the review. We used the PRISMA statement to ensure precise reporting of the results. The selected studies were graded according to the strength of their evidence (Levels 1-5); the proposed interventions were given recommendation grades (Grades A-D). RESULTS: Using 41 original studies, 11 interventions were identified. These comprise: (1) contralesional neck vibration (Grade C); (2) emotionally salient stimuli and reward (Grade D); (3) family participation and intensity of training (Grade C); (4) limb activation training (Grade C); (5) mental imagery training, (Grade D); (6) mirror therapy (Grade C); (7) music therapy (Grade D); (8) right half-field eye patching (Grade D); (9) smooth pursuit eye-movement training (Grade B); (10) virtual reality and computer-based training (Grade C); and (11) visual scanning training (Grade D). CONCLUSION: A total of 11 promising rehabilitation interventions were found. Encouraging results were, in particular, seen with smooth pursuit eye-movement training. It should be noted that the general low level of evidence and the diversity of interventions makes it difficult to endorse specific priorities and combinations for implementation. Instead, interventions should be applied after careful evaluation of each patient's unique capacities and problems. We include suggestions for operationalization into ward-based care in "Discussion" section. We also emphasize the need to integrate evidence-based interventions into nursing care to further stimulate rehabilitation outcomes and future research.

The impact of stroke aphasia on health and well-being and appropriate nursing interventions: an exploration using the Theory of Human Scale Development.

AIMS AND OBJECTIVES: This paper considers the impact of aphasia on health and well-being and provides suggestions for appropriate nursing interventions. Background. Effective communication is essential to holistic care and positive outcomes for individuals affected by aphasia. When verbal communication is absent, nurses fail to adequately use alternative strategies so that the standard of nurse/patient communication is frequently poor. DESIGN: This is a discursive paper which reviews relevant literature and uses the Theory of Human Scale Development as a framework for discussion. METHOD: The Theory of Human Scale Development is introduced. This theory emphasises that quality of life depends as much upon self-actualisation and relation building as on physical health. The theory is used within the discussion to highlight the significance of communication to quality of life and how its loss has profound psychological and social consequences. RESULTS: Aphasia results in 'loss of self'. The situation is exacerbated by inadequate healthcare communication strategies. Suggestions are offered regarding more appropriate strategies. Efficacy of family input is considered; nursing competence regarding language practice therapies is discussed, and the 'quest approach' is explored. Aphasia has a negative impact on relationships by denying access to support networks, which results in isolation. The individual's predicament is worsened by negative nursing responses. Positive nursing strategies, which alleviate effects of aphasia on individuals' social health, are investigated. Concept analysis and self-awareness exercises as methods of enhancing compassion skills are explored. The social model of disability is discussed to highlight the benefits to individuals of environmental adaptations. The social benefits of aphasia-group affiliation are discussed. CONCLUSION: The paper concludes by emphasising that fundamental human needs involve social and psychological as well as physical aspects. RELEVANCE TO CLINICAL PRACTICE: Nursing interventions must address all needs to provide holistic care in its fullest sense.

Sexuality and stroke: the effects and holistic management.

Since the days of the early pioneering work of authors such as Glover (1985) and Woods (1987), there has been a proliferation of research and practice guidelines related to the effects of ill health on individuals' and couples' sexuality and sexual health (Reis et al, 2010; Sadovsky et al, 2010; Royal College of Nursing, 2000). This article reviews the common difficulties experienced by individuals and couples affected by stroke regarding to their sexuality and sexual health. Furthermore, it presents and explores a possible model of care that can be used in practice to address these difficulties with people affected by stroke.

Transition of care for the elderly after cerebrovascular accidents--from hospital to the home.

OBJECTIVE: to examine the transition of care in families caring for elderly persons who suffered the first episode of a cerebrovascular accident. METHODOLOGY: an instrumental ethnographic case study was used. The sample comprised 20 subjects: 10 caregivers and 10 elderly persons aged 65 or over, of both sexes, with diagnoses of first episode of cerebrovascular accident, capable of communicating, and requiring care from a main carer in their family. The data was collected through interviews, observation, existing documentation and field notes. Qualitative analysis techniques were used to codify and classify the data and to formulate significant categories, which generated typologies of care. RESULTS AND DISCUSSION: The central idea was the Transition of Care and showed the context in three typologies: The care process for the dependent elderly person, Strategies for the care process and Impact and acceptance of the limitations. CONCLUSION: The data indicates that caring for an elderly person after a cerebrovascular accident is a challenge for the family. The data permitted it possible to elaborate a proposal for a model for the organization of the work, with a view to holistic care delivery in the health services, forming a care network, which constitutes an advance for the area of nursing.

Transition of care for the elderly after cerebrovascular accidents - from hospital to the home / Transição do cuidado com o idoso após acidente vascular cerebral do hospital para casa / Transición del cuidado del adulto mayor despues del accidente cerebral vascular del hospital para casa

OBJECTIVE: to examine the transition of care in families caring for elderly persons who suffered the first episode of a cerebrovascular accident. METHODOLOGY: an instrumental ethnographic case study was used. The sample comprised 20 subjects: 10 caregivers and 10 elderly persons aged 65 or over, of both sexes, with diagnoses of first episode of cerebrovascular accident, capable of communicating, and requiring care from a main carer in their family. The data was collected through interviews, observation, existing documentation and field notes. Qualitative analysis techniques were used to codify and classify the data and to formulate significant categories, which generated typologies of care. RESULTS AND DISCUSSION: The central idea was the Transition of Care and showed the context in three typologies: The care process for the dependent elderly person, Strategies for the care process and Impact and acceptance of the limitations. CONCLUSION: The data indicates that caring for an elderly person after a cerebrovascular accident is a challenge for the family. The data permitted it possible to elaborate a proposal for a model for the organization of the work, with a view to holistic care delivery in the health services, forming a care network, which constitutes an advance for the area of nursing.

OBJETIVO: examinar a transição do cuidado em famílias que cuidam de idosos que sofreram o primeiro episódio de acidente vascular cerebral. METODOLOGIA: foi utilizado o estudo de caso etnográfico instrumental. A amostra foi constituída por 20 sujeitos, sendo 10 cuidadores e 10 idosos, com 65 anos ou mais, de ambos os sexos, com diagnóstico de primeiro episódio de acidente vascular cerebral, capazes de se comunicarem, demandando cuidado de um cuidador principal na família. Os dados foram coletados por meio de entrevistas, observações, documentos existentes e notas de campo. Foram utilizadas técnicas de análises qualitativa para codificar, classificar os dados e formular categorias significativas, o que gerou tipologias de cuidado. RESULTADOS E DISCUSSÃO: a ideia central foi a transição do cuidado e mostrou o contexto em três tipologias: o processo de cuidar do idoso dependente, estratégias para o processo de cuidar e impacto e aceitação das limitações. CONCLUSÃO: os dados indicaram que o cuidado com o idoso, após o acidente vascular cerebral, é um desafio para a família. Os dados possibilitaram elaborar uma proposta de modelo para a organização do trabalho, visando a integralidade do cuidado nos serviços de saúde, formando uma rede de cuidado, o que constitui avanço para a área da enfermagem.

OBJETIVO: examinar la transición del cuidado en familias que cuidan de adultos mayores que sufrieron el primer episodio de accidente cerebral vascular. METODOLOGÍA: Fue utilizado el estudio de caso etnográfico instrumental. La muestra fue constituida de 20 sujetos, siendo 10 cuidadores y 10 adultos con 65 años y más, de ambos sexos, con diagnóstico de primer episodio de accidente cerebral vascular, capaces de comunicarse, demandando cuidado de un cuidador principal en la familia. Los datos fueron colectados por medio de entrevistas, observaciones, documentos existentes y notas de campo. Fueron utilizadas las técnicas de análisis cualitativo para codificar, clasificar los datos y formular categorías significativas, lo que generó tipologías de cuidado. RESULTADOS Y DISCUSIÓN: La idea central fue la transición del cuidado y mostró el contexto en tres tipologías: El proceso de cuidar del adulto mayor dependiente, Estrategias para el proceso de cuidar e Impacto y aceptación de las limitaciones. CONCLUSIÓN: Los datos nos indicaron que el cuidado para el adulto mayor, después del accidente cerebral vascular es un desafío para la familia. Los datos posibilitaron elaborar una propuesta de modelo para la organización del trabajo, visando la integralidad del cuidado en los servicios de salud, formando una red de cuidado, lo que representa un avance para el área de enfermería.