Living in a group dwelling: how do residents spend their time in a psychiatric group dwelling?

The aim of the study was to investigate how residents at psychiatric group dwellings spend their time. The study consisted of two parts: questionnaires and an observation survey. It included all the staff at two municipal psychiatric group dwellings where the residents were primarily diagnosed as having long-term schizophrenia. This study indicated that, even if the dwellings had a creative climate, there was a negative process in terms of nurses' well-being with a high level of depersonalisation. The residents who displayed a predominant picture of negative symptoms were left alone for 84% of the day, and 29.5% of this could be explained by their illness. The remainder of the residents' time alone remains unexplained.     

Developing a faculty fitness training program for community college nurse educators: “A pilot project”

This pilot project examined a faculty fitness training program executed over a spring and summer session. It was supported by a $5,000.00 grant from the City University of New York, Office of Academic Affairs (2010–11). The program was offered to a small number of nursing faculty on a volunteer basis. The goal was to introduce and demonstrate the science behind exercise and cardiovascular fitness testing, while providing a comprehensive cardiovascular health assessment. Second, all participants underwent exercise training to demonstrate physiologic improvements in their fitness. The assessment included a maximal exercise tolerance test (ETT) with a follow-up post-ETT allowing faculty to witness progress of their cardiovascular fitness first hand. As a result, participants will be better able to relay this information and employ firsthand experiences regarding the use of exercise for health promotion and disease prevention to future students by incorporating pertinent content into their coursework.     

Therapists’ perspectives on adapting the Stepping On falls prevention programme for community-dwelling stroke survivors in Singapore

Abstract

Purpose: This study investigates the perspectives of rehabilitation therapists on the implementation of fall prevention programmes with community-dwelling stroke survivors in the Singapore context, and elicits recommendations to adapt the Stepping On programme with stroke survivors.

Method: Qualitative data were elicited during 4 focus groups with 23 rehabilitation therapists (15 occupational therapists [OTs]; 8 physiotherapists [PTs]) who had received training to deliver the original Stepping On programme, and had experienced delivery of fall-prevention intervention programmes locally. Collected data were analysed using thematic analysis method.

Results: Three themes emerged from the focus groups describing: (a) limitations of existing falls prevention intervention for stroke clients; (b) the need to adapt the Stepping On programme to use with stroke clients; and (c) challenges in implementing fall prevention programmes in the stroke context. A series of new components were suggested to be included as part of the Stepping On after stroke (SOAS) programme, including involvement of family members and caregivers, and tailored community reintegration sessions (such as taking public transport and shopping).

Conclusions: Rehabilitation therapists describe challenges in addressing fall prevention within a stroke context, and findings highlight the need for a structured, stroke-specific fall prevention programme rather than a more general approach to education and training. Contextual components identified provide valuable inputs towards the development of a culturally relevant fall prevention programme for stroke survivors in Singapore.

• Implications for Rehabilitation

• Stroke survivors living in the community are at a high risk of falls.

• A structured and culturally relevant fall prevention programme for community-living stroke survivors is needed.

• Falls prevention for community-living stroke survivors should be multi-dimensional and targeting the modifiable risk factors for falls in this group.

• Both stroke survivors and caregivers should be involved in any fall prevention after stroke programmes.

     

Stroke survivors’ and family members’ perspectives of multimodal lifestyle interventions for secondary prevention of stroke and transient ischemic attack: a qualitative review and meta-aggregation

Purpose: The incidence of stroke is of global concern, and the rates of recurrence are high. Many risk factors are related to lifestyle behaviours and, as such, are amenable to change. Implementation of effective secondary prevention interventions is essential; however, little is known about influences on participation and adherence. This review and meta-aggregation aimed to improve understanding of stroke survivor and family member perspectives of secondary prevention interventions. Methods: We searched 11 databases, e.g. Medline and PsycINFO. We included qualitative studies that focused on adult stroke survivors and family members who had participated in a multimodal stroke secondary prevention intervention. Critical appraisal and data extraction were performed independently by two reviewers. A meta-aggregation of qualitative findings was conducted. Results: Five papers were included. One hundred and three findings were extracted and grouped into 14 categories from which three synthesised findings emerged: feeling supported, acquiring knowledge and gaining confidence. Conclusions: The findings highlight the perceived benefits of participation in secondary prevention group interventions from the perspective of stroke survivors and family members, i.e. feeling supported, by others with shared understanding and by knowledgeable health professionals, acquiring new knowledge and gaining confidence. These findings may be used to inform development of patient-centred interventions and thereby assist in improving health outcomes.

• Implications for Rehabilitation

• Health professionals should consider implementing group-based secondary prevention interventions.

• The content of group-based secondary prevention interventions should be person-centred, i.e. meaningful and relevant to the individual.

• Stroke survivors and family members are more likely to comply with advice and information provided by expert and experienced health professionals.

     

Using a cultural dance program to increase sustainable physical activity for breast cancer survivors—A pilot study

BackgroundStudies have shown that physical activity can reduce the risk of mortality for female breast cancer patients and improve quality of life, reduce weight, and alter circulating biomarker levels. We conducted a pilot trial to determine the feasibility of increasing physical activity through a cultural dance intervention to achieve similar benefits.MethodsConducted a pilot trial implementing a cultural dance intervention to increase and sustain physical activity for breast cancer survivors, which consisted of a six-month group-based intervention of Hula Dance. Anthropometric measures, fasting blood draws, and self-reported questionnaires to assess physical activity, mood, and quality of life, were completed at baseline, at the end of the 6-month intervention (time point month-6), and at two additional post-intervention time points (month-12 and month-24) to assess sustainability.ResultsA total of 11 women with a median age of 63 years were enrolled in the intervention trial. Eight of the 11 (73%) completed the trial to month-12 and demonstrated an overall significant increase in weekly moderate exercise. There were no significant changes in intra-individual body mass index (BMI). However, there was a sustained post-intervention reduction in waist circumference and significant changes in circulating biomarker levels. For the self-reported measures, there was a significant increase in vigor/activity (p < 0.001; Profile of Mood States-Short Form).ConclusionOur intervention pilot trial demonstrated that a cultural dance program could achieve a sustainable increase in physical activity for breast cancer survivors, with potential to improve quality of life, increase vigor, and decrease levels of circulating cytokines associated with obesity and inflammation.     

The perspectives of spouses of stroke survivors on self-management – a focus group study

Purpose: This qualitative study explored how stroke survivors’ spouses described their own self-management, their partner’s self-management post-stroke and how they had been supported in developing self-management.

Method: Focus group interviews were conducted with 33 spouses of stroke survivors 34–79 years of age. A constant comparative framework was used for the analysis.

Result: Stroke also affected the spouses, gave changes in their relationships and challenged in being a caregiver beside being partner. They felt burdened, lonely, sad, and guilty. To manage themselves, many participants created time for themselves. For most spouses, self-management was connoted with co-management because they perceived their partners were not able to manage themselves completely post-stroke. They often felt lost after their partners came home and reported that they learned how to coach their partners post-stroke by trial and error, without much professional support. Moreover, many spouses experienced informal peer support as helpful.

Conclusion: Spouses of stroke survivors should be involved as soon as possible in stroke-rehabilitation and continue at home post-discharge. In addition to enhancing the spouses’ skills in caregiving and supporting self-management, stroke survivors’ spouses also need support in their own emotional and role management. Moreover, peers can play a role in rehabilitation post-stroke.

• Implications for Rehabilitation

• Spouses of stroke survivors should be considered as full participants of stroke-self-management programs to enhance their skills in caregiving and supporting self-management.

• Stroke survivors’ spouses need support in their own emotional and role management.

• Peer support can play a role in rehabilitation post-stroke for stroke survivors as well as their spouses.

     

‘Factors contributing to upper limb recovery after stroke: A survey of stroke survivors in Queensland Australia’

Purpose. To identify factors which contribute to upper limb recovery, from the perspective of stroke survivors.

Method. A retrospective cross-sectional survey was administered by post to 220 stroke survivors with upper limb impairment who were more than 3 months post-stroke. The content and language for the questionnaire were drawn from a series of focus groups and in-depth interviews with stroke survivors (n = 29). Where possible items or composite scales were replicated or adapted from existing surveys.

Results. Many factors regarding the stroke survivors' commitment to recovery, the type and amount of exercise undertaken and their knowledge of how to progress were associated with self-reported upper limb recovery. The single most important factor was ‘use of the arm in everyday tasks’, which was independently responsible for more than 12% of the variance in recovery. ‘Not enough movement to work with’ was the second most important factor, representing the greatest barrier to recovery.

Conclusions. The findings of this survey highlight many practical day to day factors that may contribute to a stroke survivor's ability to advance the recovery of their upper limb. Stroke recovery services can use this information to tailor their services to ensure these practical concerns are addressed.     

Is the mineralocorticoid receptor a potential target for stroke prevention?

In recent years, it has become increasingly clear that the extra-renal effects of aldosterone play an important role in the pathogenesis of cardiovascular disease. Stroke is one of the leading causes of death in the Western world, and MR (mineralocorticoid receptor) antagonism is a potential preventative therapy for patients at risk of both ischaemic and haemorrhagic strokes. This protective effect of MR antagonism appears to occur at the level of the cerebral vasculature and may be related to the expression and activation of the EGFR (epidermal growth factor receptor) and the degree of vessel wall collagen deposition.     

Patient-directed therapy during in-patient stroke rehabilitation: stroke survivors’ views of feasibility and acceptability

Abstract

Purpose: Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients’ receive without increasing staff demands. Here, we report patients’ views of patient-led mirror therapy and lower limb exercises. Method: 94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions. Results: Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it “worked” and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties included arranging the equipment and their position, particularly for more severe strokes, loss of motivation and concerns about working unsupervised. Conclusions: Patient-led mirror therapy and lower limb exercises during in-patient rehabilitation is generally feasible and acceptable to patients but “light touch” supervision to deal with any problems, and strategies to maintain focus and motivation are needed.

• Implications for Rehabilitation

• Most stroke patients receive insufficient therapy to maximize recovery during rehabilitation. As increases in staffing are unlikely there is an imperative to find ways for patients to increase the amount of exercise and practice of functional tasks they undertake without increasing demands on staff.

• Patient-led therapy (also known as patient-directed therapy or independent practice), in which patients undertake exercises or functional tasks practice prescribed by a professional outside formal therapy sessions is one way of achieving this. It is widely used in community-based rehabilitation but is uncommon in hospital-based stroke care.

• We explored the feasibility and acceptability of two types of patient-led therapy during hospital-based stroke care; mirror therapy for the upper limb and exercises (without a mirror) for the lower limb. Here, we report patients’ experiences of undertaking patient-led therapy.

• Patient-led mirror therapy and lower limb exercises during in-patient stroke rehabilitation is generally feasible and acceptable to patients but “light touch” supervision to deal with any problems, and strategies to maintain focus and motivation are needed.

     

Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex ‘ward for a day’ education program

Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience.With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena.Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment.     

Work-aged stroke survivors’ psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study

Background

Studies point to the lack of psychosocial support and rehabilitation services that are adjusted to the work-aged stroke survivors’ specific needs in order to promote psychosocial well-being. The aim of the study was to illuminate the psychosocial challenges work-aged participants (i.e. aged 18–67 years) thematised during and after participating a dialogue-based psychosocial intervention during the first year following a stroke.

Methods

The study was a feasibility study guided by the UK Medical Research Council Framework for developing and evaluating complex interventions. Qualitative data from in-depth interviews with fourteen stroke-survivors aged 33–66 years, researcher field notes and log notes written during the intervention were analysed applying a hermeneutic-phenomenological approach.

Results

The stroke and its consequences had a substantial impact on family and work life. Their experiences were summarised in the two themes The threat of becoming marginalised in family life and The threat of becoming marginalised in work life.

Conclusion

Life as a work-aged stroke survivor was experienced as challenging and created a threat of becoming marginalised in family and work life. The study highlights the need to understand the specific psychosocial challenges and needs facing work-aged stroke survivors’ in order to promote their psychosocial well-being. More research is needed concerning specific life-span challenges amongst work-aged stroke survivors in order to further develop appropriate interventions that helps address this issue.

     

Religious views of the ‘medical’ rehabilitation model: a pilot qualitative study

Purpose:?To explore the religious beliefs that patients may bring to the rehabilitation process, and the hypothesis that these beliefs may diverge from the medical model of rehabilitation.

Methods:?Qualitative semi-structured interviews with representatives of six major religions—Islam, Buddhism, Christianity, Judaism, Sikhism, and Hinduism. Representatives were either health care professionals or religious leaders, all with an interest in how their religion approached health issues.

Results:?There were three recurrent themes in the interviews: religious explanations for injury and illness; beliefs about recovery; religious duties of care towards family members. The Buddhist, Sikh, and Hindu interviewees described beliefs about karma—unfortunate events happening due to a person's former deeds. Fatalistic ideas, involving God having control over an individual's recovery, were expressed by the Muslim, Jewish, and Christian interviewees. All interviewees expressed the fundamental importance of a family's religious duty of care towards ill or injured relatives, and all expressed some views that were compatible with the medical model of rehabilitation.

Conclusions:?Religious beliefs may both diverge from and resonate with the medical rehabilitation model. Understanding these beliefs may be valuable in facilitating the rehabilitation of diverse religious groups.     

“All Stars” for at-risk middle school students in an afterschool setting: a pilot program

Abstract

Introduction: The evidenced-based program, All Stars, usually conducted in the in-school setting and taught by classroom teachers; was implemented in an afterschool setting for at-risk middle school students by local university student volunteers. The classroom-based program was moved to the after-school setting in this study in order to target the most at-risk students, and university student volunteers served as instructors to decrease program costs.

Methods: Middle school students enrolled in an afterschool program for the most academically and socially at-risk participated in an evidence-based substance abuse prevention program and study as a part of their overall afterschool curriculum. The Pre-Post Post All Stars Student Survey was used as the data collection instrument and included 45 demographic, behavior, and core mediator Likert-scale questions. A series of paired samples t-tests were used to assess pre-post differences in the following: Commitment to Avoid Risky Behaviors, Normative Beliefs, and Lifestyle Incongruence.

Results: At the conclusion of the program, participants’ lifestyle incongruence about substance abuse improved significantly, their commitment to avoid risky behaviors improved, but their normative beliefs decreased.

Discussion/conclusion: For those youth at high-risk, providing the program in the afterschool setting and using non-classroom teachers as instructors does seem to have potential for successful program delivery.     

Nurse’s perceptions of their group goal attainment capability and professional autonomy: a pilot study

Aim A pilot study to examine staff nurses’ perceptions of, and relationships between, group goal attainment capability and professional autonomy. Background A nursing group’s capability to employ appropriate nursing interventions leads to improvement in patient outcomes. Nurses’ goal attainment capability plays a role in achieving high-quality patient outcomes and may be related to professional autonomy. Method Staff nurses (N = 90) in one community hospital completed the Sieloff–King Assessment of Group Goal Attainment Capability within Organizations and the Nursing Activity Scale instrument. Results Staff nurses reported high goal attainment capability and high professional autonomy, and a positive significant but weak correlation (r = 0.24, P < 0.05) was found between nurses’ perceptions of group goal attainment capability and perceptions of professional autonomy. Three of the eight group goal attainment subscales were positively correlated with professional autonomy including: group leaders’ goal attainment capability competency, goals/outcomes competency and goal attainment capability perspective. Conclusion While three subscales of goal attainment capability were significant, the correlations were weak between professional autonomy and group leader’s goal attainment competency, goals/outcome competency and goal attainment perspective. Implications for Nursing Management Nurse managers can play a key role in nurses’ group goal attainment capability and perceived professional autonomy.     

Exploring the experience of facilitating self-management with minority ethnic stroke survivors: a qualitative study of therapists’ perceptions

Abstract

Purpose: The utility of self-management with people from minority ethnic backgrounds has been questioned, resulting in the development of culturally specific tools. Yet, the use of stroke specific self-management programmes is underexplored in these high risk groups. This article presents the experience of stroke therapists in using a stroke specific self-management programme with stroke survivors from minority ethnic backgrounds. Methods: 26 stroke therapists with experience of using the self-management programme with stroke survivors from minority ethnic backgrounds participated in semi-structured interviews. These were audio recorded, transcribed verbatim and analysed thematically. Results: Three themes were identified. One questioned perceived differences in stroke survivors interaction with self-management based on ethnicity. The other themes contrasted with this view demonstrating two areas in which ethnic and cultural attributes were deemed to influence the self-management process both positively and negatively. Aspects of knowledge of health, illness and recovery, religion, family and the professionals themselves are highlighted. Conclusions: This study indicates that ethnicity should not be considered a limitation to the use of an individualized stroke specific self-management programme. However, it highlights potential facilitators and barriers, many of which relate to the capacity of the professional to effectively navigate cultural and ethnic differences.

• Implications for Rehabilitation

• Stroke therapists suggest that ethnicity should not be considered a barrier to successful engagement with a stroke specific self-management programme.

• Health, illness and recovery beliefs along with religion and the specific role of the family do however need to be considered to maximize the effectiveness of the programme.

• A number of the facilitators and barriers identified are not unique to stroke survivors from ethnic minority communities, nor shared by all.

• The therapists skills at negotiating identified barriers to self-management are highlighted as an area for further development.