Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed-methods study assessing the feasibility and acceptability of an educational intervention programme

The impact of education/training on nurses caring for patients with stroke: a scoping review

BACKGROUND

Stroke survivors have complex needs that necessitate the expertise and skill of well-trained healthcare professionals to provide effective rehabilitation and long-term support. Limited knowledge exists regarding the availability of specialized education and training programs specifically designed for nurses caring for stroke patients.

AIM

This review aims to assess the content and methods of training for nurses caring for stroke patients, examine its impact on both nurses and patients, and identify key facilitators and barriers to its implementation.

METHODS

We conducted a comprehensive scoping review by reviewing multiple databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, Google Scholar, and Cochrane databases. Data extraction and narrative synthesis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

RESULTS

Seventeen articles were included in this review. We found that education/training not only enhanced patients' self-care abilities, nursing outcomes, and satisfaction, but also had a positive impact on the knowledge, skills, and practices of nurses. The obstacles to education/training included feasibility and cost-effectiveness, while the driving factors were management support and participation, professional education/training, and controlled environment creation.

CONCLUSIONS

This review highlights the crucial role of education/training in enhancing stroke care provided by nurses. Effective education/training integrates various educational methods and management support to overcome implementation barriers and optimize clinical practice benefits. These findings indicate the necessity of universal and consistent stroke education/training for nurses to further improve patient outcomes in stroke care.

Assessing the feasibility, fidelity and acceptability of a behaviour change intervention to improve tractor safety on farms: protocol for the BeSafe tractor safety feasibility study

BACKGROUND

In Ireland, the agriculture sector reports the highest number of fatalities even though farmers constitute only 6% of the working population. Tractor-related behaviours are implicated in 55% of all vehicle work-related fatalities and 25% of reported injuries, and many of these occur in farmyards. There is limited research on the feasibility and acceptability of behaviour change interventions to improve tractor safety. Target behaviours that promote safe operation in farmyards, determining and addressing blind spots of tractors, were identified, and an intervention was developed following the Behaviour Change Wheel Approach. The objective of the study is to examine the feasibility, fidelity and acceptability of a behaviour change intervention to enhance the safe operation of tractors in farmyards with a particular focus on tractor blind spots.

METHOD

A single group feasibility study will be undertaken. Approximately 16 farmers from four major farm types will be recruited for the study between August and September 2022. The intervention involves an in-person demo session, facilitated discussion and personalised safety training procedure with safety goals. The study will collect data from participants at three time points: baseline (3-10 days prior to the intervention), during the intervention and at the follow-up session (7-30 days post-intervention). Quantitative data will be collected through a pre-intervention interview and feedback surveys. A pre- and post-intervention qualitative interview will also be conducted with the participants and will be supplemented with qualitative data from recruitment logs, observational memos and logs and feedback from recruiters. Evaluation of the feasibility, acceptability and fidelity of the intervention will be guided by a pre-determined feasibility checklist, fidelity framework and theoretical framework of acceptability, respectively. Interviews will be analysed using the content analysis.

DISCUSSION

The current study can determine the feasibility and fidelity of delivering a systematic, theoretically driven, tailored behaviour change intervention. It will also assess whether the intervention, its ingredients and delivery are acceptable to the farming population. This study will also inform the development of a future larger trial to test the effectiveness of the intervention.

TRIAL REGISTRATION

ISRCTN Identifier: ISRCTN22219089. Date applied 29 July 2022.

The Effect of Self-Care Nurturance Using the Theory of Modeling and Role-Modeling on Self-Efficacy in Stroke Patients: A Randomized Controlled Trial

The disability after a stroke results in reduced self-care capacity and lower levels of self-efficacy in survivors. Exploiting a holistic self-care plan to strengthen internal resources in clients can be thus deemed as an effective solution. This study aimed to determine the effect of self-care nurturance using the Theory of Modeling/Role-Modeling (TMRM) on self-efficacy in stroke clients. A randomized controlled trial was conducted at Qaem Hospital, Mashhad, Iran, in 2020. For this purpose, 70 clients were randomly assigned to 2 groups. Then, the experimental group received self-care nurturance based on the TMRM, all through 4 to 6 individual sessions of 30 to 45 minutes in the hospital, and subsequently 2 sessions of telephone counseling up to 8 weeks after the discharge. With reference to patient evaluation in terms of self-care resources, knowledge, and actions, the researcher also tried to strengthen such factors based on the individual needs of each client. The control group received routine care. The data were collected through completing a demographic/disease information form at the onset and the Stroke Self-Efficacy Questionnaire (SSEQ) before the intervention, 4 and 8 weeks after it. The results revealed that the self-efficacy mean scores of the experimental group, in the course of 3 measurement stages, had significantly improved, compared with that in the control group (P = .018). It was concluded that applying the TMRM could strengthen internal and external resources and self-care knowledge in stroke patients, develop their self-care actions, and improve their levels of self-efficacy.

Clinical Promotion of Comfort Nursing Combined with Comprehensive Nursing in the Treatment of Severe Stroke Patients with Diabetes in ICU

Objective

To investigate the application value of comprehensive nursing combined with comfort nursing for severe stroke patients with diabetes in the intensive care unit (ICU), as well as its effect on the incidence of pressure ulcers and aspiration.

Methods

Between March 2019 and March 2021, 123 severe stroke patients with diabetes who were treated at our hospital were randomly assigned to one of two groups: the control group (n = 61) or the study group (n = 62). The control group received normal care, but the research group received comprehensive nursing as well as comfort nursing. The two patient groups were compared in terms of the effects of the clinical application.

Results

The two groups did not differ significantly in general data (P > 0.05). The shorter ICU monitoring and extubation times, the lower incidence of pressure ulcers, aspiration, and nosocomial infections, and higher self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores and a lower MOS 36-item short-form health survey (SF-36) score were all observed in the research group when compared to the control group (P < 0.05).

Conclusion

For severe stroke patients with diabetes in the ICU, comprehensive nursing combined with comfort nursing has a promising effect, significantly, lowering the risk of pressure ulcers, aspiration, and nosocomial infections, accelerating physical recovery, enhancing mental state, and ensuring a better prognosis, deserving general clinical promotion.

Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation

Introduction

Persons with spinal cord injury have experienced a life‐changing event, and they need to engage in the rehabilitation process to adjust to their current situation and future living conditions. Due to the highly contextual and varying psychological and physical ability to participate from patient to patient during rehabilitation, this is difficult for the injured person and for health professionals to support. Therefore, the aim of the study was to develop and facilitate patient participation by engaging nursing staff and from this engagement in the process, disclose methods to support participation.

Methods

The processes conducted were based on an action research approach, from problem identification to the development, test and evaluation of four new nursing initiatives. The initiatives were developed by eight nursing staff members who participated actively as co‐researchers in a 2‐year study conducted at a Spinal Cord Injury Centre in Denmark from 2016 to 2018. Data evolved from workshops, transcriptions of meetings and written evaluations and was further analysed using Ricoeur's phenomenological‐hermeneutic approach.

Results

Action research processes facilitated the development of four communicative initiatives and a shift in the nursing staff's support of the patient. In a collaborative process, the nursing staff acted as participants in the patient's rehabilitation. Awareness of the patient's perspective facilitated a caring, attentive and engaged approach from the nursing staff, which promoted rehabilitation tailored to the individual.

Conclusion

Patient participation was enhanced when nursing staff actively participated in the development of initiatives and a culture supporting a person‐to‐person approach involving the patient and themselves as equal participants in the collaborative rehabilitation process.

Patient or Public Contribution

Eight nursing staff members from the rehabilitation centre participated throughout the study as co‐researchers. Patients participated in observations and as informants in interviews during the first phase to identify challenges to patient participation. Patients also participated in testing the nursing initiatives during the action phase (Phase 3). Furthermore, a former patient was a member of the advisory board.

Factors Facilitating and Hindering the Use of Newly Acquired Positioning Skills in Clinical Practice: A Longitudinal Survey

Background

After learning new skills, healthcare professionals do not always apply them in practice, despite being motivated. This may be referred to as an intention-behavior gap. One example is the positioning of immobilized and disabled patients in hospitals, nursing homes, or neurorehabilitation clinics. Positioning is crucial to prevent complications such as pressure sores, pneumonia, and deep vein thrombosis. However, it is often not carried out optimally even when professionals have completed education programs. The LiN-method is a positioning procedure involving a special focus on aligning and stabilizing body parts, which has been shown to have advantages over conventional positioning. We assess which factors may facilitate or hinder the use of LiN in clinical practice after participants complete training.

Methods

A longitudinal survey with 101 LiN-course participants was conducted in Germany. Each participant completed a questionnaire directly after the course and 12 weeks later, including a report of the frequency of use in practice. They also completed a questionnaire which surveyed 23 aspects that might facilitate or hinder use of the new skills, covering the workplace, socio-collegial factors, motivation, self-confidence, and mindset.

Results

Most assessed aspects were associated with LiN-use, with the highest correlations found for confidence with the method, perceived ease of application, sufficient time, assessing one's skills as sufficient, remembering the relevant steps, and a work environment open to advanced therapeutic concepts. To reduce data complexity, the questionnaire was subjected to a factor analysis, revealing six factors. A regression analysis showed that four factors predicted use 12 weeks after course completion, in the following order of importance: (1) subjective aspects/confidence, (2) access to materials, (3) work context, and (4) competent support in the workplace.

Conclusion

Numerous aspects are associated with the use of recently acquired clinical or nursing skills, such as LiN. Many of these can be improved by appropriately setting up the workplace. The aspects most associated with use, however, are confidence with the method and self-perceived competence of healthcare professionals. While causality still needs to be demonstrated, this suggests that education programs should support participants in developing confidence and foster a mindset of continuous learning.

The Prevalence of Nonprescription Cannabinoid-Based Medicines in British Children's Hospices: Results of a National Survey

Background: Almost 50,000 children and young people are affected by life-limiting conditions in the United Kingdom, around a third of which use children's hospices. Anecdotal evidence suggests that cannabinoid-based medicines (CBMs), specifically cannabis oil (CO), are being used by families with increasing frequency to manage distressing symptoms. The use of most nonprescription CBMs in the United Kingdom remains illegal. Objective: The objective of the study was to identify the prevalence of CO use by families who use children's hospices in the United Kingdom, and the approaches taken by those services to manage it. Design: An electronic survey was sent to each of the 54 children's hospices in the United Kingdom between May and July 2018, comprising 10 questions. Results: Forty children's hospices from across the four countries of the United Kingdom responded to the survey, representing 74% of British children's hospices. About 87.5% of hospices knew of children who use CO therapeutically. Sixty-nine percent of those hospices have received requests to administer CO during an episode of care. Approaches by organizations around CO management varied across the sectors, including arrangements for storage, administration, and recording of its use. Hospices highlighted how the lack of available guidance made decision making more challenging. Only a third of responding organizations routinely questioned families about the use of cannabis when prescribing medicines. Conclusion: CO is used extensively by children who use children's hospices. Despite recognizing the use of CO, many hospices are unable to support it. There is a need for clear guidelines on how hospices should approach the care needs of children, allowing hospices to meet the needs of children who use CO, and families in a safe, consistent, and relevant way, safeguarding all children, families, and professionals within the organization.