Perceived challenges in delivering comprehensive care for patients following stroke: a qualitative study of stroke care providers in Guangdong Province, China

Clinical staff's perceptions of transitional care from hospital to home for stroke patients: a qualitative study

BACKGROUND

The transition from hospital to home is a critical period for stroke survivors and their caregivers. This study explores the clinical staff's attitudes and perspectives on transitional care (from hospital to home) for stroke patients in the neurology department.

METHODS

This qualitative descriptive phenomenological study involved semi-structured interviews with 15 clinical staff members in the neurology department of a tertiary hospital, conducted either face-to-face or via telephone. Colaizzi's method was used to analyze the data.

RESULTS

Five major themes emerged: (1) Clinical staff recognize the importance of transitional care for patients' recovery post-stroke and the value of building strong relationships with stroke patients; (2) There are diverse understandings of the definition of transitional care, doctors generally have a more accurate understanding, while nurses' understanding of transitional care needs improvement; (3) Staff perceive challenges in implementing transitional care, including a lack of self-directed learning, time constraints, and limited opportunities for continuous learning; (4) There is a consistent need for education, both doctors and nurses expressed a desire for training, but nurses require fair opportunities for ongoing learning; (5) The establishment of advanced (nursing) specialists is recommended, including specific work positions or specialized professionals.

CONCLUSIONS

Clinical staff in the neurology department could recognize the significance of transitional care for stroke patients. However, heavy workloads, inadequate competence, and limited learning opportunities reported by nurses hinder their participation in transitional care. To ensure quality transitional care, nurses, in particular, need equitable access to training in areas such as stroke pathophysiology, rehabilitation, symptom monitoring and evaluation, communication, and educational skills. Guidance from clinical specialists is strongly recommended to enhance the implementation and quality of transitional care.

Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low- and middle-income countries: a scoping review

PURPOSE

Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs).

MATERIALS AND METHODS

We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework.

RESULTS

Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited.

CONCLUSION

The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.

Healthcare provider perceptions of support provision for people with stroke: a qualitative study

PURPOSE

This study aimed to explore healthcare providers' perceptions of support provision for people who have experienced stroke.

MATERIALS AND METHODS

A qualitative descriptive study was conducted. Snowball sampling was used to recruit Australian healthcare workers providing care to people with stroke. Semi-structured one-on-one interviews were audiotaped and transcribed. An inductive thematic analysis of all transcripts was undertaken by two authors.

RESULTS

Fourteen participants who worked across the care continuum in three Australian states were interviewed. Responses fit into three overarching themes: (1) attitudes to supports; (2) availability and accessibility of supports; and (3) awareness of supports. These themes encompassed perceptions of the support options available for people with stroke and the factors affecting support provision decision making among healthcare providers.

CONCLUSIONS

The healthcare providers in this study thought people with stroke would benefit from a greater range of available supports. Supports should take into account the diverse experiences and acute and long-term needs of people with stroke, as well as be accessible to people from all cultural, linguistic, and socioeconomic backgrounds. Healthcare providers and people who have experienced stroke may benefit from a roadmap for post-stroke support that clearly outlines where responsibility lies for support provision.

Post-Stroke Experiences and Rehabilitation Needs of Community-Dwelling Chinese Stroke Survivors: A Qualitative Study

Stroke survivors encounter significant limitations in daily life activities and face increased risk of health complications such as stroke recurrence. Considering the escalating demand for personalised community rehabilitation services, this qualitative study was conducted to understand the current recovery experiences, needs, and expectations of community-dwelling stroke survivors. Fifty stroke survivors were recruited from two tertiary teaching hospitals and community centres in two provinces in mainland China. Semi-structured interviews were carried out, and participants were asked to describe their experiences of stroke, current lifestyles, exercise habits, and rehabilitation needs and expectations. Resulting data were thematically analysed. The majority of participants were first-time stroke survivors (80%) and lived with their family or caregivers (92%). Four main themes and twelve sub-themes emerged from the data: (1) shifts in social life, (2) shaken sense of self and perceived helplessness, (3) complex rehabilitation needs, and (4) perceptions and patterns of physical activity. Findings suggest that though survivors recognised their need for further rehabilitation, their demands remained unmet due to a combination of personal and external factors such as limited mobility and the absence of supportive companions and accessible facilities. The enhancement and diversification of home rehabilitation strategies are therefore necessary to make community rehabilitation more accessible and equitable.