Evaluation of discharge documentation after hospitalization for stroke patients discharged home in Australia: A cross‐sectional,pilot study

In this cross‐sectional study, we evaluated the quality of discharge documentation for stroke patients discharged home. Participants were stroke patients discharged from a regional tertiary acute and rehabilitation hospital in Australia from 2014 to 2015. Compliance with expected discharge documentation and its relationship with readmission was measured using an audit instrument for stroke patients (n = 54), and a post‐discharge survey of carers was conducted. There were deficits in the documentation of the mechanism of stroke (70%), functional assessments (58%), pending test results (39%), types of support services required after discharge (35%), and patient/carer meetings with the multi‐disciplinary stroke team (20%). Readmission was associated with lower compliance scores for information provided to patients or their carer. The survey results suggested that carer burden was high for carers of stroke patients discharged home. Documentation of carer/family meetings with the stroke team, functional assessments, medications, and adequate support services needs to be improved. General practitioners and carers need this information, so that they can address the post‐discharge needs of these vulnerable patients.     

外科大手术后患者延续性护理服务影响因素的质性研究

目的了解外科大手术后患者延续性护理服务的影响因素。方法采用现象学研究方法,对11名护士进行半结构式访谈,运用Colaizzi资料分析原则对资料进行整理分析,提炼主题。结果经分析提炼的主题是:护士知识缺乏、护士人力不足、医院社区衔接不畅、患者在执行医嘱时依从性差。结论可从提高护士延续性护理知识水平、加强护理人力资源配置、促进医院社区有效衔接及提高患者执行医嘱依从性等方面采取有效措施,不断提高延续护理服务的实施效果。     

Person-centred care in individuals with stroke: a qualitative study using in-depth interviews

BackgroundPerson-centred care (PCC) has considerable effects on the clinical practice of health professionals. The purpose of this study was to describe the perspectives and perceived barriers and enablers of individuals with stroke regarding the PCC model in stroke rehabilitation.MethodsA qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited using non-probabilistic purposeful sampling and a snowball-technique strategy. The inclusion criteria consisted of: (a) individuals > 18 years, (b) diagnosed with moderate or severe stroke according to the National Institutes of Health Stroke Scale and (c) in the post-acute or chronic stage of the disease. In total, 31 individuals with stroke were included. In-depth interviews and researchers’ field notes were used to collect the data. A thematic analysis was performed. Also, credibility, transferability, dependability and confirmability techniques were followed to establish trustworthiness of the data.ResultsThirty-one individuals with stroke (11 women) were included. Three main themes were identified: (a) The person behind the “patient” label, recognizing the person beyond their illness and valuing their identity and individual characteristics, (b) The person at the centre of care, considering themselves as an active agent in their own care and respecting their preferences and expectations for their care process and (c) Training for PCC, providing health professionals with tools to achieve professional skills for the implementation and development of the PCC model.Conclusions and significanceThis paper describes relevant aspects that health professionals should consider when providing PCC in the context of the rehabilitation of individuals with stroke.

Key messages

• The individuals’ perspective regarding person-centred care (PCC) has considerable effects on the clinical practice of health professionals.
• Individuals with stroke describe how there is a person behind the "patient" label, with identity, needs and desire to participate in decision making.
• Training in the PCC model helps healthcare professionals identify the needs of individuals with stroke during rehabilitation.

     

Quality of life in the care home: a qualitative study of the perspectives of residents with multiple sclerosis

Purpose: Care home residents with multiple sclerosis (MS) are more physically dependent than the average residents. However, little is known about their quality of life (QoL). We investigated the experiences of residents with MS using qualitative research methods and developed a conceptual model of QoL. Methods: Twenty-one people with MS (age range 43–80 years) residing in a range of care homes were interviewed. The interviews were transcribed verbatim and analyzed using the constant comparative method. Results: Four core model domains identified were as follows: (i) What the care home means to the residents, (ii) Self, (iii) Environmentand (iv) Relationships. Some residents reported that care homes can relieve the burden on family, address specific environmental issues regarding safety and act as a form of social support. However, some reported isolation and difficulties adjusting to life in the care home. Having access to rehabilitation strengthened the feelings of independence within the care home. Conclusions: QoL is a broad, multidimensional construct for residents with MS. QoL measures for residents with MS should incorporate broad domains, including environmental factors. The conceptual model highlighted several areas for improving QoL of residents with MS, including more involvement of family members, encouraging independence by providing access to rehabilitation and providing support in the transition process.

Implications for Rehabilitation

• Quality of life for people with multiple sclerosis in care homes is a multidimensional construct.

• Participants in this qualitative study differed in whether they were able to have access to rehabilitation in the care home.

• For those that did have access, this appeared to enhance their feelings of maintaining some degree of independence in the care home.

• This study demonstrated that rehabilitation, such as physiotherapy, is greatly valued by care home residents with disabilities and has an impact on their quality of life.

     

脑卒中病人出院后对延续性护理意愿和需求的质性研究

[目的]评估脑卒中病人出院后对延续性护理的意愿和需求,为此类病人家庭护理支持提供依据及建议,从而提高病人的运动功能及生活质量。[方法]对10例脑卒中病人进行半结构式访谈,通过质性研究现象学分析法对资料进行整理和分析,并提炼主题。[结果]对脑卒中病人出院后延续护理意愿和需求的真实体验提炼出5个主题,包括健康知识相关方面的需求、对经济方面的需求、居家康复的需求、社会方面的支持及负性情绪增加。[结论]延续性护理在脑卒中病人人群中需求度高,今后应加强社区康复的建设,使社区康复和医院康复相结合,制定出针对脑卒中病人的延续性护理方案。