Outcomes Among Mexican American and Non-Hispanic White Informal Stroke Caregivers.

BACKGROUND: Informal home care is prevalent among Mexican American stroke survivors, but data on the impact on caregivers are not available. The aim was to assess ethnic differences in informal stroke caregiving and caregiver outcomes at 90 days poststroke. METHODS: Informal caregivers were recruited from the population-based Brain Attack Surveillance in Corpus Christi Project (2019-2023), conducted in a bi-ethnic community in Texas. Caregivers of community-dwelling stroke survivors who were not cognitively impaired and not employed by a formal caregiving agency were interviewed. Interviews included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (range 0-26, higher more positive), Positive Aspects of Caregiving scale (range, 5-45, higher more), Patient Health Questionnaire-8 (range, 0-30, higher worse), and PROMIS (Patient-Reported Outcomes Measurement Information System)-10 physical (range, 16.2-67.7, higher better) and mental health (range, 21.2-67.6, higher better) summary scores. Stroke survivor data was from interviews and medical records. Propensity score methods were used to balance caregiver and patient factors among Mexican American and Non-Hispanic White caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and functional disability. Propensity scores were included as a covariate in regression models, considering the association between ethnicity and outcomes. RESULTS: Mexican American caregivers were younger, more likely female, and more likely a child of the stroke survivor than Non-Hispanic White caregivers. Mexican American caregiver ethnicity was associated with less caregiver strain (ß, -1.87 [95% CI, -3.51 to -0.22]) and depressive symptoms (ß, -2.02 [95% CI, -3.41 to -0.64]) and more favorable mental health (ß, 4.90 [95% CI, 2.49-7.31]) and positive aspects of caregiving (ß, 3.29 [95% CI, 1.35-5.23]) but not associated with physical health. CONCLUSIONS: Understanding the mechanisms behind more favorable caregiver outcomes in Mexican American people may aid in the design of culturally sensitive interventions to improve both caregiver and stroke survivor outcomes, potentially across all race and ethnic groups.

Competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica / Competencias de enfermería en el cuidado de personas con accidente cerebrovascular elegibles para terapia trombolítica / Nursing competencies in the care of patients with stroke who are eligible for thrombolytic therapy

Resumo Introdução: O acidente vascular cerebral isquêmico tem como tratamento a terapia trombolítica, aplicada ainda na fase aguda, promovendo melhora importante nas sequelas acarretadas por este agravo. Considerando a complexidade da terapia trombolítica, torna-se necessário que os enfermeiros compreendam suas competências para auxiliar no cuidado. Objetivo: Identificar evidências científicas acerca das competências do enfermeiro no cuidado a pacientes com acidente vascular cerebral elegíveis à terapia trombolítica. Metodologia: Revisão integrativa composta por seis etapas em seis etapas (elaboração da questão, busca na literatura, coleta de dados, análise, discussão e apresentação da revisão), realizada nas bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase e CINAHL. A busca foi realizada entre agosto e setembro de 2022 adotando como critérios de inclusão estudos primários; gratuitos, disponíveis eletronicamente na íntegra; nos idiomas inglês, português e espanhol. Foram obtidos inicialmente 2.830 estudos, os quais passaram por uma seleção, onde foram incluídos aqueles que atendiam os critérios previamente estabelecidos. Resultados: Com base nos doze estudos incluídos nesta revisão identificaram-se competências voltadas à três atividades do cuidado: gestão do cuidado como trabalho em equipe, códigos, fluxos e protocolos, assistência ao paciente antes, durante e após a utilização da terapia trombolítica e educação em saúde para equipe, pacientes e familiares. Conclusão: Os achados desta revisão puderam evidenciar as competências do enfermeiro no cuidado aos pacientes elegíveis a terapia trombolítica, as quais perpassam diferentes áreas de atuação do enfermeiro. Para este estudo prevaleceram as competências assistências, seguida por competências gerenciais.

Resumen Introducción: El accidente cerebrovascular isquémico se trata con terapia trombolítica, aplicada incluso en la fase aguda, que promueve una mejoría significativa de las secuelas provocadas por este padecimiento. Considerando la complejidad de la terapia trombolítica, es necesario que las personas profesionales de enfermería comprendan sus competencias para ayudar en el cuidado. Objetivo: Identificar evidencias científicas sobre las competencias del personal de enfermería en el cuidado de pacientes con accidente cerebrovascular elegibles para terapia trombolítica. Metodología: Revisión integradora que consta de seis etapas (elaboración de la pregunta, búsqueda bibliográfica, recolección de datos, análisis, discusión y presentación de la revisión), realizada en las bases de dados MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase y CINAHL. La búsqueda se realizó entre agosto y septiembre de 2022. Los criterio de inclusión fueron: estudios primarios, gratuito, disponible electrónicamente en su totalidad, en inglés, portugués y español. Inicialmente se obtuvieron 2830 estudios, los cuales fueron sometidos a un proceso de selección, que incluyó aquellos que cumplían con los criterios previamente establecidos. Resultados: A partir de los doce estudios incluidos en esta revisión, se identificaron competencias centradas en tres actividades asistenciales: gestión del cuidado como trabajo en equipo, códigos, flujos y protocolos, atención a pacientes antes, durante y después del uso de la terapia trombolítica y educación en salud para personal, pacientes y familias. Conclusión: Los hallazgos de esta revisión pudieron resaltar las competencias de las personas profesionales en enfermería en el cuidado de personas elegibles para terapia trombolítica, que abarcan diferentes áreas de actuación del personal de enfermería. Para este estudio, prevalecieron las habilidades asistenciales, seguidas de las competencias gerenciales.

ABSTRACT Introduction: Ischemic stroke is treated with thrombolytic therapy, applied even in the acute phase, promoting a significant improvement in the after-effects caused by this condition. Considering the complexity of thrombolytic therapy, it is necessary for nurses to understand the skills required to assist in care. Objective: To identify scientific evidence about the competencies of nurses in the care of patients with stroke who are eligible for thrombolytic therapy. Methodology: An integrative review consisting of six stages (elaboration of the question, literature review, data collection, analysis, discussion, and presentation), conducted in MEDLINE, LILACS, BDENF, IBECS, PubMed, Scopus, Web of Science, Embase, and CINAHL databases. The search was carried out between August and September 2022 using primary studies as the inclusion criteria: free of charge, fully available electronically, published in English, Portuguese, or Spanish. Initially, 2.830 studies were obtained, which underwent a selection process that included only those studies that met the previously established criteria. Results: Based on the twelve studies included in this review, competencies focused on three care activities were identified: care management such as teamwork; codes; flows and protocols; patient care before, during, and after the use of thrombolytic therapy; and education health education for staff, patients, and families. Conclusion: The findings of this review highlighted the nurses' competencies in the care of patients eligible for thrombolytic therapy, which encompass different areas of the nurse's work. For this study, assistance competencies prevailed, followed by management competencies.

Home-based educational interventions for family caregivers of older adults after stroke: a scoping review.

OBJECTIVE: To map home-based educational interventions for family caregivers of older adults after stroke. METHOD: Scoping review based on the JBI methodology, carried out on May 23, 2023. The Rayyan application and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used. RESULTS: Of the 1,705 studies, nine published from 2006 to 2020 were included: 44% of interventions were theoretical-practical educational; 77.7% were randomized clinical trials; and the "in-person" intervention (56%) was the most common, carried out by nurses in 88.9% of cases. Three to 15 42-minute sessions were carried out. The educational contents were organized into ten categories, divided into education aimed at caring for older adults and self-care for caregivers. CONCLUSION: Identified educational interventions strengthen participants' knowledge and skills in areas such as education, care, communication, self-management, rehabilitation and nutrition as well as self-care to safely assist older adults in their activities of daily living.

Caracterização de pacientes com classificação de risco vermelha em uma unidade hospitalar filantrópica / Characterization of patients with red risk classification in a philanthropic hospital unit / Caracterización de pacientes con clasificación de riesgo roja en una unidad hospitalaria filantrópica

Objetivo: caracterizar o perfil epidemiológico e clínico dos pacientes com classificação de risco vermelha (prioridade zero) em um hospital filantrópico. Método: estudo documental, quantitativo, realizado em um hospital filantrópico com 109 prontuários de pacientes com classificação de risco vermelha que adentraram a emergência ao longo de oito meses. Realizou-se a análise estatística descritiva. Resultados: verificou-se que 33,9% da amostra tinha idade entre 61 e 80 anos; 67,7% eram mulheres; 61,4% não fumavam; 62,4% não eram etilistas; 42,2% eram hipertensos; 16,5% apresentou rebaixamento do sensório. Percebeu-se que 37,6% dos prontuários não tinham a hipótese diagnóstica registrada e que 56,9% tiveram alta hospitalar. Conclusão: constatou-se que a maioria dos pacientes com classificação de risco vermelha era idosa, hipertensa, tinha 2º grau completo, não fumava ou era etilista. A principal queixa referida foi rebaixamento do sensório. A principal hipótese diagnóstica foi acidente vascular encefálico. A maioria dos pacientes evoluiu para alta hospitalar

Objective: To characterize the epidemiological and clinical profile of patients with red risk classification (priority zero) in a philanthropic hospital. Method: A quantitative documentary study carried out in a philanthropic hospital with 109 charts of patients with red risk classification who entered the emergency room during eight months. The descriptive statistical analysis was performed. Results: It was verified that 33.9% of the sample was aged between 61 and 80 years; 67.7% were women; 61.4% did not smoke; 62.4% were non-alcoholic; 42.2% were hypertensive; 16.5% presented lowering of the sensorium. It was noticed that 37.6% of the medical records did not have the diagnostic hypothesis registered and that 56.9% were discharged from hospital. Conclusion: It was found that the majority of the DOI: 10.9789/2175-5361.rpcfo.v13.8072Caracterização de pacientes com classificação de risco vermelha...ISSN 2175-5361Pontes TO, Oliveira BSB, Joventino ES165R. pesq.: cuid. fundam. online 2021 jan/dez 13: 164-169patients with red risk classification were elderly, hypertensive, had a full second degree, did not smoke or were an alcoholic. The main complaint reported was lowering of the sensorium. The main diagnostic hypothesis was stroke. Most of the patients evolved to hospital discharge

Objetivo: Caracterizar el perfil epidemiológico y clínico de los pacientes con clasificación de riesgo rojo (prioridad cero) en un hospital filantrópico. Método: Estudio documental, cuantitativo, realizado en un hospital filantrópico con 109 prontuarios de pacientes con clasificación de riesgo roja que adentraron la emergencia a lo largo de ocho meses. Se realizó el análisis estadístico descriptivo. Resultados: Se verificó que el 33,9% de la muestra tenía edad entre 61 y 80 años; El 67,7% eran mujeres; 61,4% no fumaban; El 62,4% no eran etilistas; El 42,2% eran hipertensos; El 16,5% presentó descenso del sensorio. Se percibió que el 37,6% de los prontuarios no tenían la hipótesis diagnóstica registrada y que el 56,9% tuvo alta hospitalaria. Conclusión: Se constató que la mayoría de los pacientes con clasificación de riesgo rojo era anciana, hipertensa, tenía 2º grado completo, no fumaba o era etilista. La principal queja referida fue descenso del sensorio. La principal hipótesis diagnóstica fue accidente vascular encefálico. La mayoría de los pacientes evolucionaron a alta hospitalaria

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

Mobile Application as a Learning Aid for Nurses and Nursing Students to Identify and Care for Stroke Patients: Pretest and Posttest Results.

Cerebrovascular accident is a serious public health problem and requires the attention of professionals who can detect, diagnose, and provide care in a timely fashion. A quantitative quasi-experimental study was conducted using a mobile app called mSmartAVC for clinical evaluation of nursing care at the bedside. The study aimed at measuring the knowledge of nurses and nursing students in the detection and care of cerebrovascular accident. In this study, a total of 115 nurses from health services in the South of Brazil and 35 nursing students of a community university participated. The stages focused on development, modeling of clinical cases, problem-based learning, pretest (before) app use, and posttest (after) use of the app. The results of the pretest and posttest corrections showed a substantial statistical difference (P < .001), indicating a significant knowledge gain after the use of the app, particularly in terms of the detection scales and interpretation of the imaging tests. The mSmartAVC app used at the bedside supported decision-making for detection and nursing care. It was possible to confirm that the use of mobile apps plays an essential role as a learning tool for nurses and nursing students.

Fatores associados à ideação suicida em cuidadores de sobreviventes de acidente vascular encefálico / Factors associated with suicidal ideation in caregivers of stroke survivors

Objetivo: identificar os fatores associados à presença de ideação suicida em cuidadores de sobreviventes de acidente vascular encefálico. Métodos: pesquisa transversal, realizada com 151 cuidadores informais primários. Utilizaram-se da Escala de Depressão, Ansiedade e Estresse-21 (Depression Anxiety and Stress Scale) e de questionário para avaliação da presença de pensamentos de ideação suicida, cujos dados foram analisados por estatística descritiva e inferencial. Resultados: a maior parte dos cuidadores apresentou níveis normais de depressão (76,8%), ansiedade (76,2%) e estresse (79,5%), assim como a ausência de pensamentos de ideação suicida (70,9%). A correlação entre as escalas evidenciou que à medida que os níveis de ansiedade, depressão e estresse aumentam, os pensamentos de ideação suicida se elevam de maneira proporcional. Conclusão: observou-se que níveis elevados de depressão, ansiedade e estresse favoreceram o aumento da frequência de pensamentos de ideação suicida entre os cuidadores de sobreviventes de acidente vascular encefálico. (AU)

Factors associated with performing activities of daily living in women after suffering a stroke / Factores asociados con la realización de actividades de la vida diaria en mujeres tras accidente cerebrovascular / Fatores associados à realização de atividades da vida diária em mulheres após acidente vascular cerebral

Abstract Objective: To associate sociodemographic variables and risk factors for stroke to the degree of dependence for performing the activities of daily living of women of childbearing age after suffering a stroke. Method: A prospective and analytical longitudinal study conducted in three public hospitals in Fortaleza, CE, Brazil. The Modified Barthel Index was used at the time of attending the unit and 3 months after the stroke to assess the degree of disability in the performance of activities of daily living. The chi-squared and likelihood ratio tests were chosen to analyze the association between variables. Results: There were 109 women of childbearing age who participated in the study. There was an association between higher degrees of dependence in women from the interior/rural areas, with lower income and black people (p = 0.032, p = 0.043, p = 0.03, respectively). Regarding personal risk factors, there was a greater dependency in women with heart disease (p = 0.040), sedentary (p = 0.030) and alcoholics (p = 0.017). Conclusion: The results show the factors associated with higher degrees of dependence for performing activities of daily living by women of childbearing age after the occurrence of stroke.

Resumen Objetivo: Asociar las variables sociodemográficas y los factores de riesgo para Accidente Cerebrovascular con el grado de dependencia para la realización de las actividades de vida diaria de mujeres en la edad fértil con Accidente Cerebrovascular. Método: Investigación longitudinal prospectiva y analítica, llevada a cabo en tres hospitales públicos de Fortaleza, CE. A fin de evaluar el grado de discapacidad en el desempeño de las actividades de vida diaria, se utilizó el Índice de Barthel Modificado en el momento de la asistencia a la unidad y 3 meses después del Accidente Cerebrovascular. Para el análisis de asociación entre variables, se optó por las pruebas de Chi cuadrado y Razón de Verosimilitud. Resultados: Participaron en el estudio 109 mujeres en edad fértil. Se percibió asociación entre mayores grados de dependencia en las mujeres procedentes del interior, con menores ingresos y de raza negra (p=0,032, p=0,043, p=0,03, respectivamente). En cuanto a los factores de riesgo personales, se observó mayor dependencia en las mujeres con enfermedad cardiaca (p=0,040), sedentarias (p=0,030) y alcohólicas (p=0,017). Conclusión: Los resultados presentan los factores asociados con los mayores grados de dependencia para la realización de las actividades de vida diaria por las mujeres en edad fértil, tras la ocurrencia de Accidente Cerebrovascular.

Resumo Objetivo: Associar as variáveis sociodemográficas e os fatores de risco para Acidente Vascular Cerebral ao grau de dependência para realização das atividades de vida diária de mulheres na idade fértil com Acidente Vascular Cerebral. Método: Pesquisa longitudinal prospectiva e analítica, realizada em três hospitais públicos de Fortaleza, CE. Para avaliar o grau de incapacidade no desempenho das atividades de vida diária, foi utilizado o Índice de Barthel Modificado no momento do comparecimento à unidade e 3 meses após o Acidente Vascular Cerebral. Para a análise de associação entre variáveis, optaram-se pelos testes Qui-quadrado e Razão de Verossimilhança. Resultados: Participaram do estudo 109 mulheres em idade fértil. Percebeu-se associação entre maiores graus de dependência nas mulheres procedentes do interior, com menor renda e de raça negra (p=0,032, p=0,043, p=0,03, respectivamente). Quanto aos fatores de risco pessoais, observou-se maior dependência nas mulheres com doença cardíaca (p=0,040), sedentárias (p=0,030) e alcoolistas (p=0,017). Conclusão: Os resultados apresentam os fatores associados aos maiores graus de dependência para realização das atividades de vida diária pelas mulheres em idade fértil, após a ocorrência de Acidente Vascular Cerebral.

Resiliência, capacidade funcional e apoio social de pessoas com sequelas de acidente vascular encefálico / Resilience, functional capacity and social support of people with stroke sequelae

Objetivo: Investigar a relação entre a resiliência, a capacidade funcional e o apoio social de pessoas com sequelas de acidente vascular encefálico. Método: Estudo transversal, realizado com 108 indivíduos com sequelas de acidente vascular encefálico, cadastrados em Unidades de Saúde da Família, do município de João Pessoa, Paraíba, Brasil. Os instrumentos utilizados foram: Escala de Resiliência, Índice de Barthel e Escala de Apoio Social. Para análise, utilizou-se estatística descritiva e inferencial. Resultados: Houve maior frequência do sexo feminino (57,4%), 60 anos ou mais (59,2%), com companheiro (47,2%) e cuidador (76,6%). Os participantes apresentaram mais frequentemente o nível de resiliência moderada (64,8%), dependência funcional (93,6%) para realização das atividades diárias e médio apoio social (48,2%). Foi verificado que quanto maior a capacidade funcional e o apoio social, maior a resiliência. Conclusão: A capacidade funcional e o apoio social são preditores da resiliência de pessoas com sequelas de acidente vascular encefálico.

Objective: To investigate the relationship between resilience, functional capacity and social support of people with stroke sequelae. Method: Cross-sectional study, conducted with 108 individuals with sequelae of stroke, registered in Family Health Units, of the municipality of João Pessoa, Paraíba, Brazil. The instruments used were: Resilience Scale, Barthel Index and the Social Support Scale. For analysis, descriptive and inferential statistics were used. Results: There was a higher frequency of females (57.4%), 60 years old or more (59.2%), with partner (47.2%) and caregiver (76.6%). The participants presented more frequently the level of moderate resilience (64.8%), functional dependence (93.6%) for performing daily activities and medium social support (48.2%). It was verified that the greater the functional capacity and social support, the greater the resilience. Conclusion: Functional capacity and social support are predictors of resilience of people with sequelae of stroke.

Relationship between elderly stroke patient caregivers scale and nursing diagnoses.

OBJECTIVE: To describe relationships between the ECPICID-AVC scale factors and the NANDA-I domains, classes, and Nursing Diagnoses (NDs). METHOD: Cross-mapping study between the NANDA-I taxonomy and ECPICID-AVC scale was constructed based on the eight ECPICID-AVC scale factors and the 13 NANDA-I domains. A descriptive analysis was performed to present the mapped elements. RESULTS: Areas of similarity and intersection were found between the eight ECPICID-AVC factors and nine NANDA-I domains, 19 classes, and 72 NDs. All scale factors were mapped with the Domain 1/Health Promotion, Class 2/Health Management and the ND "Frail elderly syndrome". FINAL CONSIDERATIONS: The ECPICID-AVC scale factors were mapped with nine domains, their classes and diagnoses. This study demonstrates the importance of identifying nursing diagnoses and their relationship with factors that evaluate caregiving capacity. The ECPICID-AVC can help nurses generate nursing diagnoses regarding the caregiver's needs and their capacities related to care to focus such needs.

A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke.

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.

Quality of life perceptions of family caregivers of older adults stroke survivors: A longitudinal study.

BACKGROUND: There are few formal outreach and out-patient support services to help family caring for older adults who have had a stroke in developing countries. Family caregivers experience negative changes in their quality of life. AIM: To assess quality of life perceptions of spouse and non-spouse caregivers of older adult stroke survivors. METHODS: A longitudinal survey study. A convenience sample of forty-eight family caregivers was recruited from the Special Care Stroke Unit at a University Hospital in South Brazil. Quality of life was measured using the World Health Organization's Quality of Life BREF survey upon discharge from the hospital (Time 1) and two months after (Time 2). RESULTS: Non-spouse caregivers had the lowest Social Relationship scores at Time 1 (p < .001) and at Time 2 (p = .005), both in terms of personal relationship, the quality of their sex lives and support received from others. CONCLUSION: Unfortunately, formal community support programs for family caregivers in Brazil are lacking. Post-stroke caregiving is largely a family affair. Quality of Life assessments among family caregivers of older adult stroke survivors are crucial, particularly after discharge.

Psychometric Assessment of the Nursing Outcome Swallowing Status: Rasch Model Approach.

PURPOSE: To apply the Rasch model to test the psychometric assessment of the nursing outcome Swallowing status among poststroke patients. METHODS: Cross-sectional study was conducted with 227 poststroke patients, which were evaluated by a nurse. The Rasch model was used to examine psychometric properties. FINDINGS: Indicators fit the Rasch model and presented good reliability and good ability for separation index. The 5-point Likert scale did not present adequate discrimination and classification levels were compiled into three. CONCLUSIONS: Data evidenced the use of a robust method to perform a clinical validity of the Swallowing status, complementing previous validation studies. RELEVANCE TO CLINICAL PRACTICE: Using Rasch analysis serve as reference points to assess Swallowing status on a single scale. OBJETIVO: Aplicar o modelo Rasch para testar as medidas psicométricas do resultado de enfermagem Estado da deglutição em pacientes acometidos por acidente vascular cerebral. MÉTODOS: Estudo transversal, realizado com 227 pacientes após AVC avaliados por um único enfermeiro. O modelo Rasch foi usado para examinar propriedades psicométricas. RESULTADOS: Os indicadores se ajustaram ao modelo Rasch e apresentam boa confiabilidade e boa capacidade de separação. A escala Likert de 5 pontos não apresentou discriminação adequada e os níveis de classificação foram compilados em três pontos. CONCLUSÃO: Os dados evidenciaram o uso de um método robusto para a validade clínica do Estado da deglutição, complementando os estudos de validação anteriores. RELEVÂNCIA PARA A PRÁTICA CLÍNICA: O uso do modelo Rasch serve como ponto de referência para avaliar o Estado da deglutição em uma única escala.

Relationship between elderly stroke patient caregivers scale and nursing diagnoses / Relação entre escala ecpicid-avc e diagnósticos de enfermagem da NANDA-I / Relación entre escala ecpicid-avc y diagnósticos de enfermería de NANDA-I

ABSTRACT Objective: To describe relationships between the ECPICID-AVC scale factors and the NANDA-I domains, classes, and Nursing Diagnoses (NDs). Method: Cross-mapping study between the NANDA-I taxonomy and ECPICID-AVC scale was constructed based on the eight ECPICID-AVC scale factors and the 13 NANDA-I domains. A descriptive analysis was performed to present the mapped elements. Results: Areas of similarity and intersection were found between the eight ECPICID-AVC factors and nine NANDA-I domains, 19 classes, and 72 NDs. All scale factors were mapped with the Domain 1/Health Promotion, Class 2/Health Management and the ND "Frail elderly syndrome". Final considerations: The ECPICID-AVC scale factors were mapped with nine domains, their classes and diagnoses. This study demonstrates the importance of identifying nursing diagnoses and their relationship with factors that evaluate caregiving capacity. The ECPICID-AVC can help nurses generate nursing diagnoses regarding the caregiver's needs and their capacities related to care to focus such needs.

RESUMO Objetivo: Descrever como os fatores da escala ECPICID-AVC se relacionam com os domínios, as classes e os Diagnótiscos de Enfermagem (DE) da NANDA-I. Método: Estudo de mapeamento cruzado entre os oito fatores da escala ECPICID-AVC e os 13 domínios da taxonomia NANDA-I. Realizou-se análise descritiva para apresentar os elementos mapeados. Resultados: Identificadas áreas de similaridade e interseção entre os oito fatores da escala e os nove domínios da NANDA-I, bem como entre esses fatores e 19 classes e 72 DEs. Todos os fatores da escala foram mapeados com o Domínio 1/Promoção da Saúde, Classe 2/Controle da Saúde, e o DE "Síndrome do idoso frágil". Considerações finais: Os fatores da escala ECPICID-AVC foram mapeados de acordo com os nove domínios da NANDA-I, respectivas classes e diagnósticos. Este estudo demonstra ser importante que os enfermeiros compreendam como os DEs se relacionam com os fatores que avaliam a capacidade de cuidar de um idoso dependente por acidente vascular cerebral, pois isso permitirá o estabelecimento de diagnósticos mais adequados às necessidades do cuidador e condizentes com sua capacidade de oferecer este cuidado.

RESUMEN Objetivo: Describir cómo los factores de la escala ECPICID-AVC se relacionan con los dominios, las clases y los Diagnósticos de Enfermería (DE) de la NANDA-I. Método: Estudio de mapeo cruzado entre los ocho factores de la escala ECPICID-AVC y los 13 dominios de la taxonomía NANDA-I. Se llevó a cabo un análisis descriptivo para presentar los elementos mapeados. Resultados: Se identificaron las áreas de similitud e intersección entre los ocho factores de la escala y los nueve dominios de la NANDA-I, así como entre estos factores y 19 clases y 72 DEs. Todos los factores de la escala se mapearon con el Dominio 1/Promoción de la Salud, Clase 2/Controle de la Salud, y el DE "Síndrome del anciano frágil". Consideraciones finales: Se asignaron los factores de la escala ECPICID-AVC de acuerdo con los nueve dominios de la NANDA-I, sus clases y diagnósticos. Este estudio demuestra ser importante para que los enfermeros entiendan cómo los DEs se relacionan con los factores que evalúan la capacidad de cuidar de un anciano dependiente por accidente cerebrovascular, por lo que permitirá el establecimiento de diagnósticos más adecuados a las necesidades del cuidador y condizentes con su capacidad de ofrecer este cuidado.

A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.

Burden and Quality of Life of Family Caregivers of Stroke Patients.

The purpose of this study was to identify the level of burden and quality of life of family caregivers of stroke patients and to investigate the correlation between burden, quality of life (including physical, social, psychological, and environmental domains), age of caregivers, and the care period. A descriptive correlational cross-sectional study was performed, with a convenience sample of family caregivers (n = 30) of stroke patients in São Paulo, Brazil. Data were collected using a questionnaire on participants' characteristics, the Zarit Burden Interview Scale (ZBIS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument. A descriptive analysis was performed, and correlations between variables were analyzed using Pearson's product-moment correlation coefficient. The average burden score on the ZBIS was 29.6, representing a moderate burden, and the average overall quality of life score on the WHOQOL-BREF was 62.06%, which indicates moderate quality of life. A significant weak negative correlation was observed between burden and environmental domains (r = -0.470; p =.009), quality of life (r = -0.414; p =.023), and physical domains (r = -0.394; p =.031). No significant correlations were found between burden and quality of life, and variables in the psychological and social domains, age of caregivers, or care period. Caregivers for stroke patients presented with moderate levels of burden and reduction in quality of life. Levels of burden correlated negatively with environmental domains, quality of life levels, and physical domains; however, these correlations were weak, indicating the possible interference of other factors.

Effectiveness of two home ergonomic programs in reducing pain and enhancing quality of life in informal caregivers of post-stroke patients: A pilot randomized controlled clinical trial.

BACKGROUND: Informal caregivers of post-stroke patients usually undergo high levels of pain and stress and have a reduced quality of life. OBJECTIVE: To evaluate the effectiveness of two home ergonomic interventions aimed at reducing pain intensity and perceived stress and enhancing the quality of life in informal caregivers of chronic post-stroke patients. METHODS: A randomized single-blind controlled clinical trial was conducted, with a sample of 33 informal caregivers of patients with stroke. Three groups were included: one received postural hygiene training and kinesiotherapy, for 12 weeks, two days a week, one hour per session; another received adaptation of the home environment, and the third was a control group. Pain intensity, stress level and general quality of life were evaluated at three-time points: pre-intervention, post-intervention, and after a follow-up period of three months. RESULTS: Neck pain decreased in the two experimental groups, and increased in the control group. Pain in the shoulders and knees was alleviated in the group that received postural hygiene and kinesiotherapy. In addition, regarding quality of life, this group obtained an improvement in the physical health dimension, while the home adaptation group reported improved social relationships. CONCLUSIONS: These results suggest that 12 weeks of training in postural hygiene, combined with kinesiotherapy, and home adaptations can reduce pain and improve several aspects of the quality of life of this population. CLINICALTRIALS. GOV ID: NCT03284580.

Care path of person with stroke: from onset to rehabilitation.

OBJECTIVE:: to describe the care path of the person with stroke goes through and to identify the important events in this path. METHOD:: qualitative descriptive exploratory research, using the semi-structured interview technique based on Meleis's Middle-Range Theory. The sample was composed of 13 people who became dependent after a stroke and were admitted to two hospital units in the region of Vale do Ave, Portugal. Data were collected between January and October 2013. Content analysis was used to analyze the data. RESULTS:: The data revealed that the person's care path goes from recognition of the symptoms to preparation for hospital discharge. Adapting to the new situation of dependence brings the need for new competencies. FINAL CONSIDERATIONS:: The research aims to contribute to the improvement of nursing care regarding care for people with stroke including onset, recovery and rehabilitation, and home care. OBJETIVO:: Descrever o percurso da pessoa com Acidente Vascular Encefálico e identificar os acontecimentos significativos neste percurso. MÉTODO:: Abordagem qualitativa e natureza exploratória- descritiva, valeu-se da técnica de entrevista semiestruturada baseada na Teoria de Médio Alcance de Meleis. Participaram 13 pessoas que se tornaram dependentes devido à Acidente Vascular Encefálico e recorreram a duas Unidades da região do Vale do Ave, Portugal. A colheita de dados deu-se durante Janeiro a Outubro de 2013. Para análise dos dados foi utilizada a análise de conteúdo. RESULTADOS:: Os dados revelaram que o trajeto da pessoa vai desde o reconhecimento dos sintomas até à preparação da alta hospitalar. A dependência traz a necessidade de adquirir competências para se adaptar à nova situação. CONSIDERAÇÕES FINAIS:: Espera-se contribuir para a melhoria dos cuidados de enfermagem no atendimento das pessoas acometidas com Acidente Vascular Encefálico, desde o acometimento, recuperação e reabilitação, até aos cuidados domiciliares.

Care path of person with stroke: from onset to rehabilitation / Camino que recorre la persona con accidente vascular encefálico: desde el acontecimiento hasta la rehabilitación / Percurso da pessoa com acidente vascular encefálico: do evento à reabilitação

ABSTRACT Objective: to describe the care path of the person with stroke goes through and to identify the important events in this path. Method: qualitative descriptive exploratory research, using the semi-structured interview technique based on Meleis's Middle-Range Theory. The sample was composed of 13 people who became dependent after a stroke and were admitted to two hospital units in the region of Vale do Ave, Portugal. Data were collected between January and October 2013. Content analysis was used to analyze the data. Results: The data revealed that the person's care path goes from recognition of the symptoms to preparation for hospital discharge. Adapting to the new situation of dependence brings the need for new competencies. Final considerations: The research aims to contribute to the improvement of nursing care regarding care for people with stroke including onset, recovery and rehabilitation, and home care.

RESUMEN Objetivo: Describir el camino que recorre la persona con Accidente Vascular Encefálico e identificar los acontecimientos significativos de ese camino. Método: se trata de un abordaje cualitativo de naturaleza exploratoria- descriptiva, con técnica de entrevista mixta basada en la Teoría de Mediano Alcance de Meleis. Participaron 13 personas que se volvieron dependientes debido a un Accidente Vascular Encefálico y recurrieron a dos Unidades de la región del Valle del Ave, Portugal. La recolección de datos se realizó durante el período comprendido entre enero y octubre de 2013 mediante el análisis de contenido. Resultados: Los datos rebelaron que el trayecto de la persona comienza con el reconocimiento de los síntomas y se extiende hasta la preparación del alta hospitalaria. La dependencia hace surgir la necesidad de adquirir competencias para adaptarse a la nueva situación. Consideraciones finales: Se espera contribuir para la mejoría de los cuidados de enfermería en la atención de los pacientes con Accidente Vascular Encefálico, desde el acontecimiento, durante la recuperación y la rehabilitación, hasta los cuidados domiciliares.

RESUMO Objetivo: Descrever o percurso da pessoa com Acidente Vascular Encefálico e identificar os acontecimentos significativos neste percurso. Método: Abordagem qualitativa e natureza exploratória- descritiva, valeu-se da técnica de entrevista semiestruturada baseada na Teoria de Médio Alcance de Meleis. Participaram 13 pessoas que se tornaram dependentes devido à Acidente Vascular Encefálico e recorreram a duas Unidades da região do Vale do Ave, Portugal. A colheita de dados deu-se durante Janeiro a Outubro de 2013. Para análise dos dados foi utilizada a análise de conteúdo. Resultados: Os dados revelaram que o trajeto da pessoa vai desde o reconhecimento dos sintomas até à preparação da alta hospitalar. A dependência traz a necessidade de adquirir competências para se adaptar à nova situação. Considerações finais: Espera-se contribuir para a melhoria dos cuidados de enfermagem no atendimento das pessoas acometidas com Acidente Vascular Encefálico, desde o acometimento, recuperação e reabilitação, até aos cuidados domiciliares.