Some determinants of care of patients with stroke who were nursed in their own homes

Abstract

This article considers some of the components of a model of care which was constructed to help with the analysis of care given to a small number of patients with stroke in the course of a recent research project. The components which are put forward for consideration in this paper are the knowledge district nurses had of stroke care and the value they attached to such care. It is demonstrated how these are based mainly on knowledge and values transferred from their training in general hospitals catering for acutely ill patients. In addition the importance of'managing' and 'fairness' are considered and these are shown to form a link between the nurses and the administrators. The special problems inherent in the administration of a district nursing service are also outlined.

A conceptual framework for home nursing

“…Completion ofthe course takes 2 years. It was felt that this in-service programme was significant in the differences found between Kratz's (1976) and the present study.…”

“…This home nursing service was chosen because it is the largest home nursing organization in the state of New South Wales and more closely resembles the nursing situation described by Kratz (1976 It was found that the home service utilizes a problem-solving record which provides for a patient/family/others approach to care and that a section dealt specifically with the needs of the carer. Because registered nurses in Australia have usually been educated in hospital programmes and few hold post-basic qualifications from tertiary institutions, the service provides an in-service education programme to assist nurses to make the transition from disease-orientated patient care to community-health-and familycentred long-term care.…”

“…She found that nurses in general valued looking after patients who showed some signs of fairly rapid improvement, who required special technical skills for their care not possessed by the general public, who had an easy manner and who expressed gratitude for what was being done for them. Kratz (1976Kratz ( , 1978 found that district nurses in the United Kingdom held similar values. They liked patients who had improved and who were grateful.…”

“…However many also 'confessed' a fondness for their 'old chronics'. Kratz (1976) presumed this was because the 'old chronics' had an easy manner and showed gratitude for what was being done for them. The fact that these older patients, because of their extended and long-term needs, represented primary nursing in its most essential form, was not considered.…”

“…Home nursing was observed to be far more complex and challenging than generally acknowledged. Whilst the development ofa conceptual framework was the primary aim ofthe research, the author has compared the home nursing studied in Australia to the observations of Kratz (1976Kratz ( , 1978 upon district nursing in England. It was found that the home nurse plays a central role in the patient's response to chronic illness.…”