Abstract
BackgroundNurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation.MethodsA sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.ResultsImproved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care.ConclusionNursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.
Highlights
Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing
The study was conducted in three phases: In phase one (February 2012 to February 2013) pre-test retrospective patient record data were collected from: a) patients’ electronic nursing documentation system (ENDS-system) on screening and application of key interventions in stroke care which included items focusing on: activities of daily living, falls, pain, depression, patient education and discharge planning, and b) registered nurses and auxiliary nurses answers on the Barriers and Facilitators Assessment Instrument (BFAI) [46] and the Quality Indicators Tool (QIT) reflecting the Stroke Nursing Guideline (SNG)
Nursing staff view of the implementation process Facilitating characteristics for change were significantly less for two of the four subscales, namely Innovation (p = 0.019) and Context (p = 0.001) on the BFAI, whereas no change was found for Professional and Patient subscales (Table 6)
Summary
Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. In the long term 25–74% of patients have to rely on assistance of family for the help in basic Activities of Daily Living (ADL’s) like feeding, self-care, and mobility due to the physical impairments, like paralysis of one side of the body, decrease in abilities such as reaching and handling objects [2]. Rehabilitation is provided by an interdisciplinary team of health care professionals, including nurses, physical therapists, occupational therapists and other professionals, who support the patient to regain abilities that were lost. For the patient this is a time-intensive, effortful and often exasperating process [5, 7]. The literature emphasizes that patients with stroke need more rehabilitation training [8, 9]
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