Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Word count: 6758Key Words: Q-methodology, qualitative research, rehabilitation nursing, stroke, stroke units. 2Title: Understanding nursing practice in stroke units: a Q-methodological study. Abstract:Purpose: Nurses represent the largest professional group working with stroke-survivors but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team oke rehabilitation.Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semistructured interviews with 27 stroke unit team members.Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions:The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency based multidisciplinary training in rehabilitation skills.3 Introduction:

A Process of Multidisciplinary Team Communication to Individualize Stroke Rehabilitation of an 84-Year-Old Stroke Patient

“…The KATR process achieved similar benefits of effective MDT work as those reported by Clarke and Holt (2015), including more patient-centered decision making (Petrarca et al, 2011), a reduction in the fragmentation of care (Atwal & Caldwell, 2005;Kilbride et al, 2005), and increased staff satisfaction (Clarke, 2010;Kilbride et al, 2011), as well as more efficient and effective use of resources (Schmitt, 2001). In addition, the KATR process was also consistent with the findings of Kilbride et al (2005), demonstrating that change emerges over time and that the road toward being part of a newly formed team presents several challenges, including building a team (as a prerequisite for team work), developing practice-based knowledge and skills in stroke care, valuing the central role of the nurse in stroke care, and creating an organizational climate for supporting change.…”

“…Together, these results suggest that, over time, the variations in knowledge dictated the modification in the KATR process such that individualization could evolve along with the patient needs. Given the complexity of the response to and recovery from neurological injury following a stroke, it is self-evident that health professionals with specialist skills should work together to bring their collective knowledge and skills for the benefit of patients (Clarke, 2010, Clarke et al, 2012Clarke & Holt, 2015). The present report provided specific suggestions on how to improve the flow of the care process and examples on how to develop a language surrounding our MDT care model.…”

“…Several researchers (Clarke, 2010, Clarke & Holt, 2015Kilbride et al, 2011) Yasuo Suzuki, is an assistant director at Kurashiki Kinen Hospital, and director of rehabilitation center.…”

Nurses’ and nurse assistants’ beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit—A qualitative study

“…Although some attempts have been made over past two decades to describe nurses' contributions to stroke rehabilitation (Clarke, 2014;Clarke & Holt, 2015;Kirkevold, 2010;Langhorne, 2006;Long et al, 2002), only little research has been devoted to when, why and how nurses partake in stroke rehabilitation. Hence, in a systematic review and meta-ethnographic study, Clarke (2014) concludes that there is a need to re-examine the nursing role in inpatient stroke rehabilitation.…”

Nursing roles and functions addressing relatives during in‐hospital rehabilitation following stroke. Care needs and involvement

“…However, for the relative to be able to do that, they also need help to acknowledge their own needs . This conflicts with the viewpoint that the task of teaching relatives in how to support and care for patients is not routinely undertaken by nurses . This may indicate ambiguity how nurses experience their roles in relation to the relatives.…”