First time stroke survivors' perceptions of their health status and their goals for recovery

Stroke is an intensely individual, complex and life changing experience. Stroke recovery has many dimensions, and perceptions of health status are thought to affect recovery. The purpose of this qualitative study was to describe patients' perceptions of their health status and their goals for recovery from early post stroke. Following ethical approval, semi structured interviews were conducted with patients (n=10) diagnosed with a first incident of stroke. Time following stroke onset ranged from 4 to 7 days. Gender difference was equal, and mean age of participants was 77 years. Participants considered themselves to be active and in excellent health prior to the stroke onset. All participants perceived that their health had declined since the stroke onset, but they were hopeful for the future. Two distinct themes emerged; "sudden fear and helplessness" and "regaining control in life". Participants reported wanting to quickly return to doing everyday things and identified individual goals for recovery. The patients' experience should be considered early post stroke to provide a complete picture of their role in recovery. Participants believed that the greatest challenge would be testing themselves at home. This study reinforces the importance of engaging with patients early post stroke so that recovery goals are identified that help restore meaning through the re-establishment of previous activities. Patient goals for recovery need to be discussed and devised in conjunction with health care professionals

Staff awareness of suicide and self-harm risk in healthcare settings: A mixed-methods systematic review

Background: Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings. Methods: Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed. Results: Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so. Limitations: The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies. Conclusions: Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups

The impact of the mySupport advance care planning intervention on family caregivers’ perceptions of decision-making and care for nursing home residents with dementia : pretest-posttest study in six countries

Background the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative’s future care. Objectives to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers’ uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents’ hospitalisations and documented advance decisions. Design a pretest–posttest design. Setting in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. Participants in total, 88 family caregivers completed baseline, intervention and follow-up assessments. Methods family caregivers’ scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents’ hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. Results family caregivers reported less decision-making uncertainty (−9.6, 95% confidence interval: −13.3, −6.0, P  Conclusions the mySupport intervention may be impactful in countries beyond the original setting

Suicide and self-harm risk assessment: A systematic review of prospective research

Objective: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. Method: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. Results: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. Conclusions: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide

Clinical and economic systematic literature review to support the development of an integrated care programme for chronic disease prevention and management for the Irish health system

Report prepared for the Clinical Strategy and Programmes Division (CSPD) of the Health Service Executive to support the work of integrated clinical care programmes.Based on a clinical and economic systematic review of the international literature, this report presents the evidence on integrated care programmes and generic models of care designed for chronic disease prevention and management. This evidence will support the work of integrated clinical care programmes in Ireland through the Clinical Strategy and Programmes Division of the HSE

Physical function, psychosocial adaptation, and hardiness post stroke

Introduction: Stroke is a chronic condition that significantly impacts on morbidity and mortality (Balanda et al. 2010). Globally, the complexity of stroke is well documented and more recently, in Ireland, as part of the National Survey of Stroke Survivors (Horgan et al. 2014). There are a number of factors that are known to influence adaptation post stroke. However, there is a lack of research to explain the variability in how survivors adapt post stroke. Hardiness is a broad personality trait that leads to better outcome. This study investigated the influence of hardiness and physical function on psychosocial adaptation post stroke. Methods: A quantitative cross-sectional, correlational, exploratory study was conducted between April and November 2013. The sample consisted of stroke survivors (n=100) who were recruited from three hospital outpatient departments and completed a questionnaire package. Results: The mean age of participants was 76 years (range 70-80), over half (56%) of the participants achieved the maximum score of 20 on the Barthel Index indicating independence in activities of daily living. The median number of days since stroke onset was 91 days (range 74-128). The total mean score and standard deviation for hardiness was 1.89 (0.4) as measured by the Dispositional Resilience Scale, indicating medium hardiness (possible range 0-3). Psychosocial adaptation was measured using the Psychosocial Adjustment to Illness Scale, the total weighted mean and standard deviation was 0.54 (0.3) indicating a satisfactory level of psychosocial adaptation (possible range 0-3). A hierarchical multiple linear regression was performed which contained 6 independent variables (hardiness, living arrangement, and length of hospital stay, number of days since stroke onset, physical function and self-rated recovery). Findings demonstrated that physical function (p<0.001) and hardiness (p=0.008) were significantly related to psychosocial adaptation. Altogether, 65% of the variation in psychosocial adaptation can be explained by the combined effect of the independent variables. Physical functioning had the highest unique contribution (11%) to explain the variance in psychosocial adaptation while self-rated recovery, hardiness, and living arrangements contributed 3% each. Conclusion: This research provides important information regarding factors that influence psychosocial adaptation post stroke at 3 months. Physical function significantly contributed to psychosocial adaptation post stroke. The personality trait of hardiness provides insight into how behaviour influenced adaptation post stroke. While hardiness also had a strong relationship with psychosocial adaptation, further research is necessary to fully comprehend this process

First time stroke survivors\u27 perceptions of their health status and their goals for recovery

Stroke is an intensely individual, complex and life changing experience. Stroke recovery has many dimensions, and perceptions of health status are thought to affect recovery. The purpose of this qualitative study was to describe patients\u27 perceptions of their health status and their goals for recovery from early post stroke. Following ethical approval, semi structured interviews were conducted with patients (n=10) diagnosed with a first incident of stroke. Time following stroke onset ranged from 4 to 7 days. Gender difference was equal, and mean age of participants was 77 years. Participants considered themselves to be active and in excellent health prior to the stroke onset. All participants perceived that their health had declined since the stroke onset, but they were hopeful for the future. Two distinct themes emerged; "sudden fear and helplessness" and "regaining control in life". Participants reported wanting to quickly return to doing everyday things and identified individual goals for recovery. The patients\u27 experience should be considered early post stroke to provide a complete picture of their role in recovery. Participants believed that the greatest challenge would be testing themselves at home. This study reinforces the importance of engaging with patients early post stroke so that recovery goals are identified that help restore meaning through the re-establishment of previous activities. Patient goals for recovery need to be discussed and devised in conjunction with health care professionals

Guidance for family about comfort care in dementia: a comparison of an educational booklet adopted in six jurisdictions over a 15 year timespan

Contains fulltext : 250244.pdf (Publisher’s version ) (Open Access

Implementation of an advance care planning intervention in nursing homes: an international multiple case study

Background and Objectives: The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention. Research Design and Methods: A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom. Results: Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery. Discussion and Implications: There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time