Ella McLafferty

A review of the early discharge experiences of stroke survivors and their carers

AIMS AND OBJECTIVES Understanding the experiences of stroke patients and their carers during the early days following discharge from hospital is an important aspect of providing appropriate care during this crucial time. BACKGROUND Due to the diverse changes that can result from a stroke, adjustment to returning home may raise many issues for those involved. A review of research was undertaken with the aim of identifying what is already known about experiences at this time. DESIGN Systematic review. METHOD Search of electronic databases. RESULTS The review revealed that recognition of the impact of stroke on patients and carers is improving, with many studies focussing on the longer-term aspects of stroke recovery. Research into the early discharge experiences of stroke patients and/or their carers is often limited to retrospective, longitudinal studies. With the continuing shift towards care in the community, patients and carers can increasingly expect more recovery to be taking place at home at an even earlier stage. Earlier discharge may have important implications for those involved. The review also highlighted that patients with aphasia have frequently been excluded from stroke research and that social roles are important aspects in stroke recovery. CONCLUSIONS To prepare patients and carers better for the impact of returning home, further research is needed into their experiences at this significant time, particularly in the UK. There is also a need to facilitate the inclusion of those with aphasia in stroke research. RELEVANCE TO CLINICAL PRACTICE An improved understanding of the issues facing stroke patients and carers during their early days at home should facilitate the preparation for discharge in the hospital setting and allow more focussed follow-up services in the community.

Revisioning, reconnecting and revisiting: the psychosocial transition of returning home from hospital following a stroke.

Abstract Purpose: This study aimed to investigate and improve understanding of the experiences of patients and their carers during the first month at home following discharge from hospital, thereby enhancing appropriate care from a more informed perspective. Method: In-depth interviews and self-report diaries were used to capture data from 12 patient/carer dyads. Four survivors with marked communication problems were included in this number, two requiring the use of pictures and diagrams to express their views. Interpretative phenomenological analysis (IPA) was used to capture and interpret survivor and carer experiences. Findings: Three superordinate themes were derived from the data. Stroke survivors and their carers described the first month at home as a very dynamic time, recounting a process that involved revisioning (re-examining their identity and the reality of their new situation, including an awareness of their own mortality), reconnecting (with important relationships and previous activities) and revisiting (their past lives, and the stroke event and hospital experience). These three activities assisted in making and finding sense in their new situation; participants’ vision of their lives was revised and revisited as they attempted to reconnect with as much of their past selves and past activities as possible. Conclusions: This study contributes to understandings through in-depth individual accounts of the psychosocial transition of returning home. Details of how people make sense of their altered situation can make a valuable contribution to research, and the knowledge base for care provision. Implications for Rehabilitation Supporting people to revision their future can assist with psychosocial transition following a stroke. Assisting patients to reconnect and reintegrate in a way that is meaningful to them is an important part of the rehabilitation support that can be offered by professionals, and can be informed by awareness of their vision of what the future may now hold. Offering people the opportunity to reflect on what has occurred, either verbally or in the form of a diary, can assist adjustment and help people to make sense of their changed situation.

Fluid and electrolyte balance.

Assessment and careful maintenance of fluid and electrolyte balance in patients is an essential part of the nurses role. This article explores fluid and electrolyte balance with reference to the normal physiology of body fluids and regulation of fluids and electrolytes. It also considers some common conditions associated with fluid imbalance.

Endocrine system: part 1.

This article, which forms part of the life sciences series and is the first of two articles on the endocrine system, examines the structure and function of the organs of the endocrine system. It is important that nurses understand how the endocrine system works and its role in maintaining health. The role of the endocrine system and the types, actions and control of hormones are explored. The gross structure of the pituitary and thyroid glands are described along with relevant physiology. Several disorders of the thyroid gland are outlined. The second article examines growth hormone, the pancreas and adrenal glands.

The digestive system: part 1.

This article, which forms part of the life sciences series and is the first of two articles on the digestive system, explores the structure and function of the digestive system. It is important that nurses understand how the digestive system works and its role in maintaining health. The article describes the gross structure of the gastrointestinal tract along with relevant physiology. It also outlines several disorders of the gastrointestinal tract and their treatment and nursing management. The second article will explain the liver, pancreas and gall bladder and their digestive functions, and provides a brief overview of the disorders of chronic liver disease, pancreatitis and gallstones.

Nervous system: part 2

This article, which forms part of the life sciences series and is the first of three articles on the nervous system, explores the major divisions of the nervous system and their functions. The basic structure of a nerve cell is described, and generation and conduction of nerve impulses is discussed. Blood supply to the brain is also covered. The second article will examine the central nervous system (CNS) in greater detail, including protection of the CNS, and the structure and function of the cerebral cortex and cerebellum. The third article will examine the peripheral nervous system and the autonomic nervous system, and provides an overview of some of the disorders of the nervous system.

Male and female reproductive systems and associated conditions.

Sexual reproduction is the process in which a male sperm unites with a female ovum to permit fertilisation. Each fertilised cell contains a set of chromosomes from each parent, therefore both the male and female gametes contribute equally to the process of reproduction. This article provides an overview of the normal anatomy and physiology of the male and female reproductive systems. Common disorders of these systems are also discussed.

In previously continent adults, aged 70 or older, use of urinary catheters or diapers while in hospital increases the risk of new urinary incontinence

Commentary on: ZisbergAGarySGur-YaishN. In-hospital use of continence aids and new-onset urinary incontinence in adults aged 70 and older. J Am Geriatr Soc 2011;59:1099–104.