Factors shaping the delivery of acute inpatient stroke therapy: A narrative synthesis

Taylor, Elizabeth; McKevitt, Christopher; Jones, Fiona

doi:10.2340/16501977-1918

Cited by 20 publications

(27 citation statements)

References 64 publications

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“…A narrative synthesis approach was selected as it produces a systematic, transparent approach, with guidance on enhancing trustworthiness [ 19 – 22 ]. The approach aims to produce a textual, narrative understanding of findings from included studies conducted in different settings and contexts [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff

Carter

Bick

Mackintosh

et al. 2017

BMC Pregnancy Childbirth

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BackgroundOne of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals’ responses to women and their families who ‘speak up’ about early warning signs and symptoms.MethodsA narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant.ResultsFollowing thematic analysis, three themes were identified; 1: Women’s understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families’; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from ‘normal’ pregnancy changes.ConclusionsWomen and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved.

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Section: Methodsmentioning

confidence: 99%

A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff

Carter

Bick

Mackintosh

et al. 2017

BMC Pregnancy Childbirth

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“…Therapists also operate under capacity constraints, for example lists of patients awaiting assessment and treatment [1], less visible demands such as discharge planning [53], and covering multiple sites [22]. However there is perhaps scope for therapists to go some way towards helping nurses, particularly when patients have 'nursing needs' within a therapy session that therapists have the skills to address [38], and such acts of mutuality have potential to benefit the therapist nurse relationships [54].…”

Section: Line Of Argumentmentioning

confidence: 99%

Communication between therapists and nurses working in inpatient interprofessional teams: systematic review and meta-ethnography

Barnard

Jones

Cruice

2018

Disability and Rehabilitation

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Communication between therapists and nurses working in inpatient interprofessional teams: Systematic review and meta-ethnography Purpose: The aim of the synthesis was to develop new understanding about the influences on communication in interprofessional teams from therapist and nurse perspectives. Methods: Six electronic databases were searched, combined with citation tracking and hand searching, yielding 3994 papers. Three researchers were involved in screening and quality appraisal, resulting in 18 papers for synthesis, using the process of meta-ethnography. Concepts were identified, compared and translated under five category headings. Two researchers mapped interpretative summaries and a line of argument was created. Results: The line of argument is that four interrelated contingences underpin effective communication between therapists and nurses. Effective communication depends on there being a genuine need to give and receive information for patient care, the capacity to attend to, hold, and use information, and opportunities to share space to enable communication to occur. The fourth contingency is good quality relationships and this is the glue that holds the contingencies together. Conclusion: This synthesis has provided an opportunity to illuminate how therapists and nurses accomplish interprofessional work through communication. The contingencies of need, capacity, opportunity and quality of relationships create a new structure for understanding what underpins communication between these two groups.

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“…[6][7][8] Currently, the focus in relation to activity levels is the provision of structured rehabilitation by therapists [physiotherapists (PTs), occupational therapists (OTs) and speech and language therapists], which is audited against a national guideline that recommends that every day each patient should receive at least 45 minutes of therapy, as appropriate. 9,10 However, audits and standards have not improved the experience of patients or increased activity opportunities outside these structured rehabilitation sessions with therapists. 11,12 This is critical as when patients are bored and inactive it can have an impact on aspects of their recovery and potentially foster a feeling that 'nothing is being done'.…”

Section: Introduction and Contextmentioning

confidence: 99%

Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study

Jones

Gombert-Waldron

Honey

et al. 2020

Health Serv Deliv Res

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Background Stroke is the most common neurological disability in the UK. Any activity contributes to recovery, but stroke patients can be inactive for > 60% of their waking hours. This problem remains, despite organisational changes and targeted interventions. A new approach to addressing post-stroke inactivity is needed. Experience-based co-design has successfully initiated improvements for patients and staff in other acute settings. Experience-based co-design uses observational fieldwork and filmed narratives with patients to trigger different conversations and interactions between patients and staff to improve health-care services. Objectives To complete a rapid evidence synthesis of the efficacy and effectiveness of co-production as an approach to quality improvement in acute health-care settings; to evaluate the feasibility and impact of patients, carers and staff co-producing and implementing interventions to increase supervised and independent therapeutic patient activity in acute stroke units; and to understand the experience of participating in experience-based co-design and whether or not interventions developed and implemented in two units could transfer to two additional units using an accelerated experience-based co-design cycle. Design A mixed-methods case comparison using interviews, observations, behavioural mapping and self-report surveys (patient-reported outcome measure/patient-reported experience measure) pre and post implementation of experience-based co-design cycles, and a process evaluation informed by normalisation process theory. Setting The setting was two stroke units (acute and rehabilitation) in London and two in Yorkshire. Participants In total, 130 staff, 76 stroke patients and 47 carers took part. Findings The rapid evidence synthesis showed a lack of rigorous evaluation of co-produced interventions in acute health care, and the need for a robust critique of co-production approaches. Interviews and observations (365 hours) identified that it was feasible to co-produce and implement interventions to increase activity in priority areas including ‘space’ (environment), ‘activity’ and, to a lesser extent, ‘communication’. Patients and families reported benefits from participating in co-design and perceived that they were equal and valued members. Staff perceived that experience-based co-design provided a positive experience, was a valuable improvement approach and led to increased activity opportunities. Observations and interviews confirmed the use of new social spaces and increased activity opportunities. However, staff interactions remained largely task focused, with limited focus on enabling patient activity. Behavioural mapping indicated a mixed pattern of activity pre and post implementation of co-designed changes. Patient-reported outcome measure/patient-reported experience measure response rates were low, at 12–38%; pre- and post-experience-based co-design cohorts reported dependency, emotional and social limitations consistent with national statistics. Post-experience-based co-design patient-reported experience measure data indicated that more respondents reported that they had ‘enough things to do in their free time’. The use of experience-based co-design – full and accelerated – legitimised and supported co-production activity. Staff, patients and families played a pivotal role in intervention co-design. All participants recognised that increased activity should be embedded in everyday routines and in work on stroke units. Limitations Communication by staff that enabled patient activity was challenging to initiate and sustain. Conclusions It was feasible to implement experience-based co-design in stroke units. This resulted in some positive changes in unit environments and increased activity opportunities for patients. There was no discernible difference in experiences or outcomes between full and accelerated experience-based co-design. Future work should consider multiple ways to embed increased patient activity into everyday routines in stroke units. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 35. See the NIHR Journals Library website for further project information.

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Factors shaping the delivery of acute inpatient stroke therapy: A narrative synthesis

Abstract: Conceptual, individual and professional factors impact on the delivery of rehabilitation. Further research is needed to examine how therapists negotiate the sometimes conflicting factors shaping delivery of therapy.

Cited by 20 publications

References 64 publications

A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff

A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff

Communication between therapists and nurses working in inpatient interprofessional teams: systematic review and meta-ethnography

Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study

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