A stroke affects both the stroke survivor and the spousal caregiver, so nurses and therapists should use multicomponent strategies to provide education, support, counseling and linkages to community resources to ease the transition from hospital to home. Stroke may have a negative impact on the dyad's relationship with each other and also on the availability of support people in their lives during the 12 months after hospital discharge. Comprehensive stroke programs should encourage dyads to attend support groups and to seek individual and group counseling, as needed. Establishing an ongoing relationship with stroke survivors and their spouses and providing relevant and engaging information by mail can reduce stress and depression over 12 months post-discharge at a minimal cost. Nurses and therapists should consider home visits post-discharge to reinforce education and skills taught in the hospital, increase self-reported health in stroke survivors and spousal CG, increase coping skills and to link the couple to community resources.

Aim To identify strategies that older adults use to adapt to live in long‐term care. Background The use of long‐term care services has risen and this trend is expected to continue as the population reaches old age. Moving into a long‐term care setting has been documented internationally as an overwhelming life change for many older adults. It has been observed that residents adjust differently over time, but the basis for these differences needs further exploration. Design A qualitative design using grounded theory method was employed. Methods A total of in‐depth interviews were conducted in October 2008–February 2009 with a sample of 21 participants. Participants ranged in age from 65–93 years, 81% women and 19% men; mainly Caucasian with one African American and one Hispanic. Length of stay ranged from 3 days to over 9 years living in long‐term care so that all stages of adjustment were included in the study. Ground theory method was used to analyse the data. Findings The results of this study yielded 21 facilitative strategies. The core category identified was personal resiliency, which served as the underpinning for the strategies used by the participants. Strategies were identified in making the decision to move into long‐term care and in day‐to‐day living. Conclusion Understanding the strategies that facilitate residents to make a successful transition to long‐term care life will assist nurses to intervene in ways that are supportive. The strategies identified in this study may be used to develop interventions for residents that are having difficulty living in long‐term care. Further exploration of how resiliency has an impact on strategies used by residents is clinically relevant, but further research is needed.

More than 50% of survivors of stroke (SSs) fall after discharge from the hospital, some of whom sustain significant injury. The purpose of this study was to explore SSs' and spousal caregivers' (CGs') lived experiences about falling and general mobility. Qualitative methods were used to perform a secondary analysis of interviews obtained from a larger study of 133 couples. Time, loss, and life changes emerged as themes in the qualitative analysis of expressers with "keep stepping no matter what," as the overarching theme. Number of SSs were examined for reports of falls and fall-related events. Of the 133 couples, 65 were in the original study's intervention group. Sixty-six percent of the intervention group reported at least one fall, and 12% of the intervention group and total study population sustained fall-related adverse events. Health care providers can learn from the experiences of SSs and CGs related to falling and mobility for enhanced discharge planning and fall prevention. Falling can cause injury in the SS or fear of falling of the SS, CG, or both.

Stroke survivors today are discharged home from the hospital more quickly than in the past because of shifting economic realities. Survivors continue to experience significant impairments after discharge and families may be poorly prepared for the full extent of caregiving responsibilities. This article describes 39 comprehensive educational guidelines that have been tested with 72 stroke survivors and families during 1,150 home visits throughout the first 6 months after discharge from inpatient rehabilitation. Two case studies illustrate use of the guidelines with stroke survivors and their families.Stroke is the third leading cause of death and the major cause of long-term disability among older adults in the United States. Approximately 5.7 million stroke survivors live in the United States (American Heart Association [AHA], 2007). The length of inpatient rehabilitation is decreasing, with a change of focus toward community-based rehabilitation (Lincoln, Walker, Dixon, & Knights, 2004), leaving a relatively short time for many stroke survivors and families to absorb all of the information they will need when they go home. Because many stroke survivors have comorbidities such as heart disease and diabetes, their educational needs may be extensive. They require information on risk-factor reduction to prevent future strokes, and also encouragement to live a healthy lifestyle through a wholesome diet, exercise, and stress management.This article describes a stroke educational program that was offered to 72 stroke survivors and their families as part of an interdisciplinary research study called CAReS (Committed to Assisting with Recovery after Stroke [NR005316]). CAReS was a 5-year randomized clinical intervention study funded by the National Institute for Nursing Research (NINR). As they were discharged home from inpatient rehabilitation, 159 stroke survivors and their spouses were Copyright © 2008 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript randomized into usual care or home visit groups. Physical and psychosocial data were collected on stroke survivors and spousal caregivers in both groups at discharge and 3, 6, 9, and 12 months after discharge to test for differences between the two groups. All couples received information by mail for 12 months. The group randomized into the home visit group also received home visits for 6 months from nurses and therapists, who used 39 flexible, evidencebased guidelines developed by this article's authors for use with stroke survivors following discharge from inpatient rehabilitation. The guidelines were tested for ease of use and acceptance by stroke survivors and their families during more than 1,150 visits from an interdisciplinary team comprising advanced practice nurses (APNs) and occupational and physical therapists. Case studies illustrate the use of these guidelines based on stroke survivor and family needs. Names of the family members in the case studies have been changed to protect identity. LiteratureStroke is a catastrophic...