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1.
Hu Li Za Zhi ; 67(1): 81-88, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960399

RESUMO

BACKGROUND & PROBLEMS: Early rehabilitation after stroke is important for the recovery of bodily functions in stroke patients. However, the percentage of completion of early limb rehabilitation among stroke patients is only 16%. PURPOSE: Raise the early rehabilitation intervention rate to 88% for patients with stroke within 24 hours of hospitalization. RESOLUTION: We developed an education course on post-stroke rehabilitation and a related e-Learning course as well as organized an 'alliance for recovery' team. In addition, we established a standard for post-stroke relay rehabilitation and designed rehabilitation relay cards, Xbox rehabilitation games, and nine squares challenge for brain stroke care. RESULTS: The accuracy of the knowledge of nursing staff related to physical rehabilitation improved from 72.4% to 100%; the accuracy of their perceptions regarding early limb rehabilitation increased from 16% to 100%; and patient satisfaction increased from 68% to 98%. CONCLUSIONS: We deployed diverse and innovative strategies to assist limb rehabilitation in patients with stroke. Patients and caregivers should be encouraged to participate in early rehabilitation and related programs and should apply the skills and rehabilitation activities learned to daily life.


Assuntos
Extremidades/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/fisiopatologia , Difusão de Inovações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/psicologia , Satisfação do Paciente/estatística & dados numéricos , Desenvolvimento de Programas
2.
Pak J Pharm Sci ; 32(1(Special)): 413-419, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30852478

RESUMO

This paper aims to observe and analyze the safety and clinical efficacy of Fingolimod combined with alteplase intravenous thrombolysis in the treatment of acute ischemic stroke. 90 patients with acute ischemic stroke were randomly divided into two groups. 45 patients in the control group were given alteplase intravenous thrombolysis for injection. 45 cases in the trial group were treated with Fingolimod combined with alteplase. There was no significant difference in NIHSS score, mRS score and BI index between the two groups 14 days after treatment, but 90 days after treatment, NIHSS score and mRS score of the experimental group were significantly lower than that of the control group, and BI index was significantly higher (P<0.05). 24 hours after oral administration of Fingolimod (0.5 mg), the circulating blood CD4 + T, CD8 + T, CD19 + B and CD56 + natural killer cells of the patients in the combined treatment group decreased steadily to varying degrees. The results confirm the pharmacological effect of Fingolimod: it changes lymphocyte migration, promotes lymphocyte to enter lymphoid tissue, prevents lymphocyte from leaving lymphoid tissue to enter the peripheral circulation, and thus prevents these immune cells from infiltrating the central nervous system. The results showed that Fingolimod combined with alteplase intravenous thrombolysis is safe for patients with acute ischemic stroke. .


Assuntos
Fibrinolíticos/uso terapêutico , Cloridrato de Fingolimode/uso terapêutico , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Administração Oral , Esquema de Medicação , Quimioterapia Combinada , Feminino , Fibrinolíticos/administração & dosagem , Cloridrato de Fingolimode/administração & dosagem , Cloridrato de Fingolimode/efeitos adversos , Humanos , Infusões Intravenosas , Linfócitos/citologia , Linfócitos/imunologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/imunologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
3.
Home Healthc Now ; 37(1): 23-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30608464

RESUMO

STROKE is sudden and often traumatic with results that affect both the patient and family members who provide care. Approximately 40% of individuals caring for family members/friends are male. Transitioning from the noncaregiver role to caregiver can be unsettling. Guided by Friedemann's framework of systemic organization, this secondary data analysis examined problems reported by men caring for spouses in the first year after stroke. Using a mixed methods design, 73 caregivers (CGs) participated in bimonthly telephone interviews for 1 year. For this analysis, only the males caring for spouses (n = 12 married and n = 1 unmarried partner) were examined. These data were analyzed using Colaizzi's rigorous method of content analysis. Five problem themes emerged: 1) adjusting to multitasking in everyday living (Friedemann's system maintenance and individuation), 2) recognizing physical and mental disabilities (coherence), 3) dealing with outside forces and limited resources (individuation), 4) struggling to return to normal (system maintenance), and 5) feeling physically, mentally, and emotionally exhausted (system maintenance). These problem themes demonstrated incongruence as the men sought to maintain their prior lives.Theory-based themes of male stroke CGs' problems were uncovered that can be used to target interventions to help them achieve balance between incongruence and congruence in their lives.


Assuntos
Cuidadores/psicologia , Qualidade de Vida/psicologia , Cônjuges/psicologia , Reabilitação do Acidente Vascular Cerebral/enfermagem , Reabilitação do Acidente Vascular Cerebral/psicologia , Adaptação Psicológica , Adulto , Idoso , Empatia , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/psicologia
4.
J Clin Nurs ; 28(1-2): 47-55, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29987903

RESUMO

AIMS AND OBJECTIVES: To determine whether and how cognitive impairment interacts with therapy intensity to affect functional improvements in older stroke patients over an 8-week postdischarge intervention delivered in a community setting. BACKGROUND: Cognitive status is an important predictor of success of community-based rehabilitation, but little has been known as to how cognitive impairment may affect outcomes through its interaction with the rehabilitation process. DESIGN: A prospective follow-up evaluation was conducted in Hong Kong of older stroke patients (n = 384) who were admitted to an 8-week home-based rehabilitation intervention after discharge in Hong Kong between 2012-2014. METHODS: Cognitive screening was conducted among patients at the time of discharge from hospital. The intervention process was monitored, and individuals' therapy intensity was assessed and recorded by physical or occupational therapists independently in each therapy session. Outcomes were measured using the 10-item Barthel ADL index at discharge and after the intervention. RESULTS: Therapy intensity significantly moderated the relationship between cognitive impairment and functional recovery. Cognitively impaired stroke patients with moderate-intensity rehabilitation reported significantly higher increase in functional performance than that of patients with low- and high-intensity rehabilitation. In patients with no cognitive impairment, those who received high-intensity treatment showed significantly more functional gains than that of patients being treated with less intensive rehabilitation. CONCLUSION: Cognitive impairment affected functional outcomes through its interaction with different levels of therapy intensity among poststroke older patients. RELEVANCE TO CLINICAL PRACTICE: Increasing therapy intensity from moderate to high benefitted cognitively intact but not cognitively impaired patients. These results should inform decisions about community-based rehabilitation and be used to identify the most cost-effective service delivery model.


Assuntos
Disfunção Cognitiva/enfermagem , Pessoas com Deficiência/reabilitação , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/enfermagem , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos
5.
Rev. enferm. UFPE on line ; 12(5): 1430-1436, maio 2018. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-980887

RESUMO

Objetivo: apresentar o conhecimento produzido sobre as intervenções de Enfermagem direcionadas aos pacientes com acidente vascular cerebral em reabilitação. Método: revisão integrativa, com abordagem qualitativa, realizada no período de abril de 2015 a maio de 2016, a partir do acesso on-line na Medline, na Lilacs e na Cochrane, com os descritores controlados Cuidados de Enfermagem and Acidente Vascular Cerebral and Reabilitação. Os estudos foram analisados segundo checklist para a avaliação da qualidade metodológica e classificados de acordo com os níveis de evidência. As intervenções de Enfermagem foram apresentadas em três categorias temáticas ­ intervenções de Enfermagem assistenciais, educacionais e gerenciais. Resultados: foram selecionadas 29 publicações e a maioria dos estudos possui níveis de evidência II e VI. Dentre as intervenções de Enfermagem assistenciais, destacou-se a reabilitação motora e funcional. Nas intervenções educacionais, observou-se a educação do paciente sobre a doença. Dentre as intervenções gerenciais, sobressaíram as relacionadas à coordenação do cuidado. Foram encontradas intervenções de Enfermagem direcionadas aos cuidadores. Conclusão: identificou-se, nos estudos, um maior número de intervenções de Enfermagem assistenciais direcionadas ao paciente. Aos cuidadores, as intervenções de Enfermagem se concentram na esfera educativa.(AU)


Assuntos
Humanos , Masculino , Feminino , Educação em Saúde , Cuidadores , Acidente Vascular Cerebral , Reabilitação do Acidente Vascular Cerebral , Reabilitação do Acidente Vascular Cerebral/enfermagem , Enfermeiras e Enfermeiros , Conhecimentos, Atitudes e Prática em Saúde , MEDLINE
6.
Rehabil Nurs ; 43(2): 65-72, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29499003

RESUMO

PURPOSE: The purpose of this study was to describe the impact a stroke nurse navigation program has on concurrent chart reviews and patient compliance postdischarge. DESIGN: Phase I: Concurrent chart review of The Joint Commission Primary Stroke Center core measures for ischemic stroke patients. Phase II: Longitudinal study of 100 ischemic stroke patients discharged to home. METHODS: Telephone surveys were conducted at prescribed intervals posthospital discharge (Phase II). Surveys focused on medication compliance, follow-up medical appointment compliance, and neurovascular emergency department (ED) visits/readmissions. FINDINGS: Phase I trends included increased stroke performance measures compliance. Phase II favorable trends included increased medication compliance (>98%), increased follow-up appointments (100%), decreased rate of neurovascular ED visits/rehospitalizations (3%), and improvement in activities of daily living and quality of life measures through 12 months postdischarge. CONCLUSIONS: Stroke nurse navigation increased conformity of stroke performance measures and stroke patient discharge compliance through 12 months postdischarge.


Assuntos
Navegação de Pacientes/normas , Reabilitação do Acidente Vascular Cerebral/enfermagem , Cooperação e Adesão ao Tratamento/psicologia , Humanos , Cooperação do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Navegação de Pacientes/métodos , Satisfação do Paciente , Enfermagem em Reabilitação/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/normas , Recursos Humanos
7.
J Clin Nurs ; 27(9-10): 1913-1919, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29266493

RESUMO

AIMS AND OBJECTIVES: To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia. BACKGROUND: Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia. DESIGN: A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided. METHODS: All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined. RESULTS: Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p < .001). CONCLUSIONS: The clinical practice of providing oral hygiene care is less than ideal, and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Higiene , Higiene Bucal/enfermagem , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/enfermagem , Cuidados Críticos/métodos , Estudos Transversais , Feminino , Humanos , Malásia , Masculino , Acidente Vascular Cerebral/terapia , Inquéritos e Questionários
8.
Stroke ; 49(1): 236-239, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29222227

RESUMO

BACKGROUND AND PURPOSE: Stroke exacts an immense toll in sub-Saharan Africa where there are few resources, and stroke prevention research is limited. The aim of this study is to test the feasibility and preliminary efficacy of an m-Health technology-enabled, nurse-guided intervention in improving blood pressure (BP) control among Ghanaian stroke patients within 1 month of symptom onset. METHODS: We conducted a 2-arm cluster pilot randomized controlled trial involving 60 recent stroke survivors encountered within a single tertiary medical system in Ghana. Subjects in the intervention arm (n=30) received a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting BP measurements and medication intake for 3 months compared with standard of care (n=30). Primary outcome measure was systolic BP <140 mm Hg at month 3; secondary outcomes included medication adherence and autonomous self-regulation. Analysis accounting for clustering was made using generalized linear mixed model by intention to treat. RESULTS: Mean±SD age was 55±13 years, 65% male. Systolic BP <140 mm Hg at month 3 was found in 20/30 subjects (66.7%) in the intervention arm versus 14/30 subjects (46.7%) in the control arm (P=0.12). Medication possession ratio scores at month 3 were better in the intervention (0.88±0.40) versus control (0.64±0.45) arm (P=0.03). One subject in control arm died from a recurrent hemorrhagic stroke. CONCLUSIONS: It is feasible to conduct an m-Health-based, nurse-guided BP control intervention among recent stroke patients in sub-Saharan Africa. We observed a potential signal of efficacy with the intervention, which will need to be tested in a future large definitive study. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02568137.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Hemorragias Intracranianas , Smartphone , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Feminino , Gana , Humanos , Hemorragias Intracranianas/enfermagem , Hemorragias Intracranianas/fisiopatologia , Hemorragias Intracranianas/reabilitação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/fisiopatologia , Sobreviventes
9.
Scand J Caring Sci ; 32(2): 871-879, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28869654

RESUMO

RATIONALE: In the last decades, length of stay of in-hospital rehabilitation of patients with stroke has been significantly reduced. Health authorities expect relatives to be at disposal to convey the knowledge of everyday life and to provide emotional as well as practical support in relation to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity between the relatives' expectations and the actual contribution from nurses. AIM: This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. METHODOLOGICAL DESIGN: A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus group, interviews of 19 randomly selected nurses from three different hospital settings were interpreted in three levels. The study was conducted in accordance with the ethical guidelines for nursing research in the Nordic countries. FINDINGS: The nurses expressed that they address the patient and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. CONCLUSION: Nurses experience their roles and functions addressing relatives after stroke as crucial, challenging and multifaceted. They acknowledged care needs of the relatives in their own right by addressing the relatives' vulnerability during in-hospital rehabilitation characterised by an existential threat to the physical as well as the shared life. The focus on the needs of relatives considering their expected future role was experienced as conflicting with restricting time frames and a healthcare system focusing on the individual patient.


Assuntos
Família/psicologia , Pacientes Internados/psicologia , Papel do Profissional de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Enfermagem em Reabilitação/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Reabilitação do Acidente Vascular Cerebral/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Escandinavos e Nórdicos
10.
J Clin Nurs ; 26(23-24): 4905-4914, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28722777

RESUMO

AIMS AND OBJECTIVES: To explore nurses' and nurse assistants' beliefs, attitudes and actions related to their function in an inpatient stroke rehabilitation unit. BACKGROUND: Several attempts have been made to describe nurses' roles and functions in inpatient neurorehabilitation. However, current understandings of the contributions that nurses and nurse assistants make to neurorehabilitation remain sparse. DESIGN: Descriptive, interpretive qualitative study. METHODS: Participant observations were conducted during 1 month in a stroke rehabilitation unit at a university hospital in the Capital Region of Denmark. The observations were audiorecorded and field notes were taken on the spot. Semistructured interviews with nurses (N = 8) and nurse assistants (N = 6) were performed. The audiorecorded observations, field notes and interviews were transcribed for inductive and deductive content analysis. RESULTS: Three main categories with underlying subcategories were identified: (i) the importance of professionalism, (ii) striving for visibility, (iii) the importance of structure. CONCLUSION: This study contributes to present understandings of nurses' and nurse assistants' roles and functions in inpatient stroke rehabilitation. We obtained insights into nursing staff's beliefs and attitudes about rehabilitation-as well as their own role and function-and furthermore how the latter affects their actions in daily practice. RELEVANCE TO CLINICAL PRACTICE: The nursing role and function are still not clearly defined. Further education is needed to strengthen the contribution of nursing staff to patients' rehabilitation. Furthermore, focus on developing a professional language and a framework that supports continuity within daily care and rehabilitation is needed.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Papel do Profissional de Enfermagem/psicologia , Assistentes de Enfermagem/psicologia , Reabilitação do Acidente Vascular Cerebral/enfermagem , Adulto , Dinamarca , Humanos , Entrevistas como Assunto , Masculino , Enfermeiras e Enfermeiros , Pesquisa Qualitativa
11.
J Clin Nurs ; 26(7-8): 891-901, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27538382

RESUMO

AIMS AND OBJECTIVES: To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes and practices and the potential benefits of an integrated oral care programme. BACKGROUND: Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia. DESIGN: Scoping review. METHOD: A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed. RESULTS: The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing-driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes. CONCLUSION: Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia. RELEVANCE TO CLINICAL PRACTICE: Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia.


Assuntos
Papel do Profissional de Enfermagem , Saúde Bucal , Higiene Bucal/enfermagem , Enfermagem em Reabilitação/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/enfermagem , Pessoal Técnico de Saúde , Austrália , Humanos
12.
Invest Educ Enferm ; 35(3): 306-319, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29767911

RESUMO

OBJECTIVES: To identify and analyze the concept of the powerlessness in individuals with stroke, according to the NANDA-I Taxonomy. METHODS: Concept analysis from online access of four databases using the descriptors: impotence; helplessness, learned; Stroke, depression in languages: Portuguese, English and Spanish. RESULTS: The critical attributes of the feeling of powerlessness are: fragility, helplessness, lack of control, and power to achieve the proposed results for recovery and adaptation. Eleven new antecedents were found. It is recommended to reformulate three antecedents present in the taxonomy. Fourteen consequent were found. It is suggested to amend three consequential from the review. CONCLUSIONS: With the analysis, a more complete concept of the powerlessness was elaborated allowing clarifying the critical attributes that, in turn, will help the rehabilitating nurse to recognize the signs and symptoms and to strengthen mechanisms of tolerance and resistance to stress.


Assuntos
Acidente Vascular Cerebral/psicologia , Adaptação Psicológica , Bases de Dados Factuais , Depressão/etiologia , Desamparo Aprendido , Humanos , Diagnóstico de Enfermagem , Acidente Vascular Cerebral/enfermagem , Reabilitação do Acidente Vascular Cerebral/enfermagem , Reabilitação do Acidente Vascular Cerebral/psicologia
13.
J Clin Nurs ; 26(19-20): 3239-3247, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27878886

RESUMO

AIM AND OBJECTIVE: To shed light on how nurses perceive particular challenges that they experience in encounters with patients in rehabilitation wards. BACKGROUND: Rehabilitation is a tailor-made process that allows someone with impairment to live well. Many rehabilitation institutions embrace strong beliefs in patient participation as well as awareness of and listening to the needs and wishes of patients. To our knowledge, few studies have investigated the challenges encountered by nurses from patients in rehabilitation contexts and how these challenges might influence their roles as nurses. DESIGN AND METHODS: This study has a qualitative design that is based on three focus group interviews with nurses working in three rehabilitation wards. A convenience sample of 15 nurses, five from each ward, was recruited to participate in focus group interviews. The participants worked in wards for patients suffering mainly from stroke and head injuries. The analysis is inspired by hermeneutic principles to explore the participants' challenges in their role in rehabilitation contexts. RESULTS: Data analyses identified three main themes surrounding the challenges experienced by nurses: (1) Adjusting patients' and next of kin's expectations, (2) Tailoring support and information, (3) Recognising patients' knowledge. CONCLUSION: Our results from the three rehabilitation wards indicate that nurses display various educative strategies. There is, however, a need for further empirical work into how knowledgeable patients and next of kin create new challenges with implications for the nurse's role within rehabilitation contexts. RELEVANCE TO CLINICAL PRACTICE: The study highlights the educative aspects of the nurse's role in relation to patients and next of kin on rehabilitation wards as significant contributors to recovery processes.


Assuntos
Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Reabilitação do Acidente Vascular Cerebral/enfermagem , Adulto , Família/psicologia , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
14.
Trials ; 17(1): 436, 2016 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-27596244

RESUMO

BACKGROUND: Hypertension is the premier modifiable risk factor for recurrent stroke. In sub-Saharan Africa (SSA) where the stroke burden is escalating, little is known about the role of behavioral interventions in enhancing blood pressure (BP) control after stroke. Our objective is to test whether an m-Health technology-enabled, nurse-led, multilevel integrated approach is effective in improving BP control among Ghanaian stroke patients within 1 month of symptom onset compared with standard of care. METHODS: This two-arm cluster randomized controlled feasibility pilot trial will involve 60 recent-stroke survivors. Using a computer-generated sequence, patients will be randomly allocated into four clusters of 15 patients each per physician: two clusters in the intervention arm and two in the control arm. Patients in the intervention arm will receive a simple pillbox, a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting BP measurements and medication intake under nurse guidance for 3 months. Tailored motivational text messages will be delivered based upon levels of adherence to the medication intake. Both groups will be followed up for 6 months to compare BP control at months 3, 6 and 9 as primary outcome measure. Physicians assessing BP control will be blinded to arms into which patients are allocated. Secondary outcome measures will include medication adherence scores and Competence and Autonomous Self-regulation Scale scores. A qualitative study is planned after follow-up to explore the lived experiences of participants in the intervention arm. DISCUSSION: A feasible and preliminarily effective intervention would lead to a larger more definitive efficacy/effectiveness randomized controlled trial powered to look at clinical events, with the potential to reduce stroke-related morbidity and mortality in a low- to middle-income country. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02568137 , registered on 13 July 2015.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Papel do Profissional de Enfermagem , Smartphone , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/enfermagem , Telemedicina , Protocolos Clínicos , Estudos de Viabilidade , Feminino , Gana , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/psicologia , Masculino , Adesão à Medicação , Aplicativos Móveis , Motivação , Projetos Piloto , Projetos de Pesquisa , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Envio de Mensagens de Texto , Fatores de Tempo , Resultado do Tratamento
15.
BMC Health Serv Res ; 16(a): 387, 2016 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-27528049

RESUMO

BACKGROUND: Recovery after stroke is long-term and demanding. Optimising community-residing stroke survivors' capability to self-manage their health is integral. Recent systematic reviews have shown that stroke self-management programmes were associated with significant improvement in stroke survivors' health-related quality of life and self-efficacy. However some programmes were not designed with an underpinning theoretical framework. The aim of this study is to compare the effectiveness of a nurse-led stroke self-management programme with usual care on recovery of community-residing stroke survivors. METHODS/DESIGN: A single-blinded, two-arm, randomised controlled trial will be conducted. Patients with a history of first or recurrent ischaemic or haemorrhagic stroke who will be discharged to home settings will be recruited from acute stroke units of three acute public hospitals in Hong Kong. The estimated sample size is 160 (80 participants per group). Eligible participants will be randomised to receive either usual care or a 4-week nurse-led community-based self-management programme plus usual care after discharge. The programme, underpinned by Bandura's constructs of self-efficacy and outcome expectation, includes one individual home visit, two community-based group sessions, and three follow-up phone calls. Primary outcomes include stroke survivors' self-efficacy and outcome expectation of performing self-management behaviours. Secondary outcomes include health-related quality of life, satisfaction with performance of self-management behaviours, depressive symptoms, and community reintegration. Participants will be assessed at baseline and at 8 weeks after randomisation. Generalised estimating equations will be performed to evaluate the significance of changes in outcomes over time by treatment condition. Research ethics approvals were obtained. DISCUSSION: It is expected that stroke survivors receiving the stroke self-management programme will have improved self-efficacy, outcome expectation, and performance of stroke self-management behaviours. Enhanced quality of life and level of community reintegration, and decreased depressive symptoms are also expected. The study results will provide valuable evidence to inform future identification and evaluation of best approach to deliver stroke self-management programmes to enhance community-residing stroke survivors' recovery. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02112955 ; date of registration: 09/04/2014.


Assuntos
Autocuidado/psicologia , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/enfermagem , Acidente Vascular Cerebral/terapia , Sobreviventes , Idoso , Depressão , Feminino , Seguimentos , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Autoeficácia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia
16.
Occup Ther Int ; 23(2): 165-74, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26876527

RESUMO

The purpose of the present study was to investigate the effects of electromyogram-triggered neuromuscular stimulation (EMG-stim) combined with task-oriented training (TOT) on upper extremity function in chronic stroke patients. Twenty chronic stroke patients were randomly assigned to either the intervention (n = 10) or control (n = 10) group. The intervention group conducted TOT with EMG-stim on the wrist and finger extensor of the affected arm for 30 minutes per day, 5 days per week, for 4 weeks. The control group was provided EMG-stim for 20 minutes per day for the same duration. The intervention group exhibited significant improvement relative to the control group in muscle activation, motor recovery (Fugl-Meyer assessment) and dexterity (Box and Block Test) (p < 0.05). Significant differences in hand function between the groups were detected in the writing of short sentences and in stacking checkers (p < 0.05). It is concluded that EMG-stim in combination with TOT may be better than EMG-stim alone for the treatment of arm paresis in stroke patients. Further research with a larger sample is recommended to examine neurologic changes or cerebral cortex reorganization. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Braço/fisiopatologia , Eletromiografia/métodos , Terapia Ocupacional/métodos , Reabilitação do Acidente Vascular Cerebral/enfermagem , Idoso , Estimulação Elétrica , Terapia por Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
17.
Rehabil Nurs ; 41(4): 218-29, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25865578

RESUMO

PURPOSE: This mixed-methods pilot study examined the impact of a psychoeducational intervention (PEI) to expand coping skills and identify themes for focused nursing strategies to assist poststroke couples. DESIGN: Outcome variables, including dyadic coping, quality of life, depression, and self-care self-efficacy, were measured in experimental and control groups initially and after PEI was created with experimental couples in six home sessions. METHOD: Repeated measures analysis of variance compared control (n = 5 stroke survivors; n = 5 spouses) and experimental groups' (n = 5 stroke survivors; n = 5 spouses) on outcomes. FINDINGS: Significant increase occurred in experimental group stroke survivors in coping by oneself and quality of life; depressive symptoms decreased. Significant increase in positive dyadic coping occurred for experimental group spouses. PEI intervention generated a major theme. CONCLUSIONS: Nurse-initiated cognitive coping intervention was supported by experimental group's elements. CLINICAL RELEVANCE: Nurses may use psychoeducational techniques to motivate stroke couples.


Assuntos
Adaptação Psicológica , Enfermagem em Reabilitação/métodos , Cônjuges/psicologia , Estresse Psicológico/prevenção & controle , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Transtorno Depressivo/complicações , Transtorno Depressivo/prevenção & controle , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida/psicologia , Autocuidado/métodos , Autocuidado/psicologia , Apoio Social , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Reabilitação do Acidente Vascular Cerebral/enfermagem
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