Lena Aadal

Nursing roles and functions in the inpatient neurorehabilitation of stroke patients: a literature review.

ABSTRACTStroke is a major cause of morbidity and mortality in the world. In the United States, it was estimated that approximately 750,000 patients had a stroke annually. Denmark, with a population of 5.5 million, had about 12,500 cases of hospitalizations from stroke in 2009. Despite the patient’s obvious need for complex nursing care and a common recognition of the nurse’s central role in rehabilitation after a stroke, a description of their specific contributions appeared sparse. Therefore, a literature review was conducted using the matrix method. The purpose was to explore the nursing roles and functions identified in empirical research and to discern any possible evolution in the nursing roles and functions during a span of years. The rehabilitation literature related to inpatient rehabilitation after stroke during the period from 1997 to 2010 was reviewed. The total number of identified citations was 1,529. After screening for relevancy, 134 eligible articles remained. Of these, 30 articles were extracted into a table and formed the basis for the conclusion. We found that four nursing roles and functions described in 1997 still accommodated central aspects of the current nursing practice but also emerging changes reflecting a development in the nurses’ responsibilities and contributions in conducting rehabilitation after a stroke. These changes seemed mainly to be shaped instigated by changes in the (1) patient role, (2) increasing interdisciplinary teamwork, and (3) focus on rehabilitation efforts conducted in the patient’s environment.

Neurorehabilitation analysed through ‘situated learning’ theory

This paper proposes a perspective of learning in the context of neurorehabilitation. Central concepts from Lave and Wengers theory of situated learning are presented as a promising theoretical perspective to grasp the problems typically encountered by professionals and a strategy to analyse the effectiveness of rehabilitation strategies aimed at everyday activities. Empirical data from field studies and focus group interviews describing rehabilitating efforts were analysed and discussed using central concepts from the ‘theory of situated learning’. We found that professionals are challenged when including patients with severe brain injury as ‘participants’ in the ‘rehabilitation practice community’. Systematic use of the proposed learning concepts may support rehabilitation professionals to facilitate and challenge patient participation and learning during rehabilitation. Two interrelated levels of pedagogical challenges exist: (1) supporting the gain of the patient or compensation for changed learning a...

Weight reduction after severe brain injury: a challenge during the rehabilitation course.

Abstract Background: There is a paucity of studies, which have described malnutrition in patients with acquired brain injury (ABI) across etiology. This study describes weight change, malnutrition, and potential associations in patients with ABI at a subacute inpatient rehabilitation hospital. Method: This is a descriptive cohort study. Ninety-eight patients were admitted in a 3-month period, of whom n = 76 met inclusion criteria. The Malnutrition Universal Screening Tool was used for categorizing patients according to risk of malnutrition. Results: Patients had experienced weight loss of 5.59% ± 5.89% (p < .001) at admission at the rehabilitation hospital, and patients with traumatic brain injury had experienced a greater weight loss than patients with stroke (p < .01). Thirty percent of patients were at high risk for malnutrition, and 52% of these patients received enteral or parenteral nutrition at admission at the rehabilitation hospital. No association was found between risk of malnutrition and severity of injury, complications, functional outcome, or length of stay. Conclusion: Results underline the importance that nurses, especially in acute care, adhere to clinical guidelines to minimize weight loss. Special attention should be on patients with traumatic brain injury. Weight gain in the following course of rehabilitation may facilitate positive rehabilitation outcomes.

Nursing Roles and Functions in the Acute and Subacute Rehabilitation of Patients With Stroke: Going All In for the Patient.

ABSTRACT Background: The description of nursing roles and functions in rehabilitation of patients with stroke remains sparse. Aim: The aim of this study was to describe the experienced roles and functions of nurses during in-hospital rehabilitation of patients with stroke. Methods: Within a phenomenological hermeneutic approach, 19 nurses working with in-hospital rehabilitation of patients with stroke participated in three focus group interviews during 2013. Findings: The nurses’ experiences were described in two themes: (a) the nurse’s role and function in relation to the patient’s needs 24/7 and (b) the nurse’s role and function in the interdisciplinary team. Getting to know the patient as a person was essential to the nurses to care for the patient’s basic needs; these must come first working with rehabilitation and always include the relatives. Recognition of the team members’ individual skills with focus on the patient’s needs must be the center of attention. Conclusion: An interdisciplinary rehabilitation program actively needs to include the patient by integrating the patient’s perspective in the goals as well as in daily rehabilitation. In the team, nurses had the role of coordinator and the patient’s voice.

Monitoring agitated behavior after acquired brain injury: onset, duration, intensity, and nursing shift variation

Purpose To describe the onset, duration, intensity, and nursing shift variation of agitated behavior in patients with acquired brain injury (ABI) at a rehabilitation hospital. Design Prospective descriptive study. Methods A total of 11 patients with agitated behavior were included. Agitated behavior was registered with the Agitated Behavior Scale (ABS). The nurse or therapist allocated the individual patient assessed ABS during each shift. Intensity of agitated behavior was tested using exact test. A within‐subject shift effect was analyzed with repeated‐measure ANOVA. Findings The onset of agitated behavior was at a median of 14 (1–28) days from admission. Seven patients remained agitated beyond 3 weeks from onset. Severe intensity of agitation was observed in 86 of 453 nursing shifts. Differences in agitated behavior between day, evening, and night shifts were found, F(2.20) = 7.90, p = .008, with tendencies of increased agitated behavior in day and evening shifts compared to night shifts. Conclusion Agitated behavior had a late onset, was severe, and long‐lasting in the present sample of patients. Clinical Relevance The study increases awareness on the potential challenge of agitated behavior in patients with ABI.

Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial

BackgroundStroke is a major public health threat globally. Psychosocial well-being may be affected following stroke. Depressive symptoms, anxiety, general psychological distress and social isolation are prevalent. Approximately one third report depressive symptoms and 20% report anxiety during the first months or years after the stroke. Psychosocial difficulties may impact significantly on long-term functioning and quality of life, reduce the effects of rehabilitation services and lead to higher mortality rates. The aim of the study is to evaluate the effect of a previously developed and feasibility tested dialogue-based psychosocial intervention aimed at promoting psychosocial well-being and coping following stroke among stroke survivors with and without aphasia.MethodsThe study will be conducted as a multicenter, randomized, single blind controlled trial with one intervention and one control arm. It will include a total of 330 stroke survivors randomly allocated into either an intervention group (dialogue-based intervention to promote psychosocial well-being) or a control group (usual care). Participants in the intervention group will receive eight individual sessions of supported dialogues in their homes during the first six months following an acute stroke. The primary outcome measure will be psychosocial well-being measured by the General Health Questionnaire (GHQ). Secondary outcome measures will be quality of life (SAQoL), sense of coherence (SOC), and depression (Yale). Process evaluation will be conducted in a longitudinal mixed methods study by individual qualitative interviews with 15–20 participants in the intervention and control groups, focus group interviews with the intervention personnel and data collectors, and a comprehensive analysis of implementation fidelity.DiscussionThe intervention described in this study protocol is based on thorough development and feasibility work, guided by the UK medical research council framework for developing and testing complex interventions. It combines classical effectiveness evaluation with a thorough process evaluation. The results from this study may inform the development of further trials aimed at promoting psychosocial well-being following stroke as well as inform the psychosocial follow up of stroke patients living at home.Trial registrationNCT02338869; registered 10/04/2014 (On-going trial).