Chinese elderly patients’ perceptions of their rehabilitation needs following a stroke

Abstract

Stroke is the third leading cause of death and disability among Chinese elderly patients in Hong Kong and yet the rehabilitation needs of these patients are rarely explored. The aim of this study was to identify the rehabilitation needs of Chinese elderly patients following a stroke. The study adopted an ethnographic approach, information being gathered by the researcher through interviews with 15 key informants selected by purposive sampling. The perceptions of patients as to their own needs were sought at three stages of recovery - in the acute and rehabilitation settings and at 1 month following discharge. Ethical approval was gained from the Chinese University Faculty of Medicine ethical committee and access agreed by the hospital authorities. Verbal approval was gained from the patients before each interview, following confirmation of the voluntary nature of participation and assurance of confidentiality and anonymity. The researcher's role was also clearly stated. Analysis of the interview data produced five categories of patient need at the three stages of recovery, namely informational, physical, psychological, social and spiritual. The most frequently stated, but largely unmet, need in all settings was the need for information, particularly information about the reasons for stroke and about the activities that promote recovery. In the acute and rehabilitation settings patients' responses indicated a need to be respected as individuals, to be addressed by name and to be provided with privacy. Although the Barthel Index administered during interviews charted recovery at different rates, nurses did not always make links between the level of functional ability and the help needed with physical tasks. They also failed to recognize the relationship between physical and psychological needs and the equal importance of both in recovery from stroke. As Chinese elderly patients tend to take a passive role in seeking help and information, nurses play a significant role in the identification of individual rehabilitation needs. Implications for nursing practice are discussed.

Perceptions of Hong Kong Chinese elders on adjustment to residential care

“…Indeed, previous local studies have identi ed Chinese elderly people's preferred sources of assistance when they were in need of help. In identifying the rehabilitation needs of elders after a stroke, Lui & Mackenzie (1999) found that Chinese elders were very reserved about seeking help from people whom they considered to be 'outside the family'. Moreover, residential home staff are seen as people who make up and administer the 'laws' of the home, they are the authority gures in the home.…”

Qualitative Studies of Stroke

“…These were reported as psychosocial, social, and spiritual as well as physical dimensions of need. 42 One study reported patients' accounts of the difficulties they face eating, and the fear and shame this and their changed physical and social appearance created for them. 43 Patients assessed as needing adaptive aids were found to be sometimes reluctant to use such devices because they reinforced the sense of loss associated with stroke impairment.…”

Physiotherapy Needs Assessment of People with Stroke Following Discharge from Hospital, Stratified by Acute Functional Independence Measure Score

“…Information related to the longitudinal needs of people with stroke could help hospital-and communitybased therapists to more effectively plan physiotherapy service beyond the initial period of returning home. Previous studies [3][4][5][6][7][8][9][10][11] have also tended to present patients with stroke as a relatively homogeneous group. It seems reasonable to expect, however, that the needs of people with mild stroke impairment will differ from those of people with more severe impairment and limited function.…”