Do stroke units need nursing?:Therapeutic and non-therapeutic activities and the relation to functional outcome and cognition in frail stroke patients who rehabilitate in Dutch nursing homes

Scherder, E.J.A. [Promotor]Rademaker, A.C.H.J. [Copromotor

The effects of increased therapy time on cognition and mood in frail patients with a stroke who rehabilitate on rehabilitation units of nursing homes in the Netherlands: a protocol of a comparative study

BACKGROUND: Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients. METHODS: A comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients’ cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home. DISCUSSION: The present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes. TRIAL REGISTRATION: TNR Our study has been documented in the Dutch Trial Registration, TC = 3871

The aesthetic and cultural pursuits of patients with stroke

peer-reviewedTables to accompany this article on second fileGOAL: There has been an increasing interest in the arts in healthcare, with a suggestion that the arts and aesthetics can augment patient outcomes in stroke and other illnesses. Designing such programmes requires better knowledge of the artistic, aesthetic and cultural pursuits of people affected by stroke. The aim of this study was to obtain the insights of this group about the profile of arts and aesthetics activities in their lives as well as the influence of stroke on these aspects. MATERIALS AND METHODS: Patients attending a stroke service were administered questions adapted from the Irish Arts Council’s 2006 questionnaire on participation in aesthetics and cultural pursuits, Information was also collected on stroke type and present functional and cognitive status. Thirty-eight patients were interviewed. Of these, twenty were inpatients in hospital at the time of the interview and eighteen were interviewed in an outpatient setting. FINDINGS: Popular activities included mainstream cinema, listening to music, dancing, attending plays or musicals and being outdoors. Many patients ceased these activities after their stroke, mostly due to health issues and inaccessibility. The majority of patients valued the importance of the arts in the healthcare setting. CONCLUSION: This study gives a perspective for the first time on the aesthetic and cultural pursuits of stroke patients prior to their stroke. It portrays a wide variety of cultural and leisure activities, and the cessation of these post-stroke. It revealed the restrictions patients felt on gaining access to leisure pursuits both while in hospital and following discharge.Acceptedpeer-reviewe

Does feedback on daily activity level from a Smart watch during in-patient stroke rehabilitation increase physical activity levels? Study protocol for a randomized controlled trial

Background. Practicing activities improves recovery after stroke, but many people in hospital do little activity. Feedback on activity using an accelerometer is a potential method to increase activities in hospital inpatients. This study’s goal is to investigate the effect of feedback, enabled by a Smart watch, on daily physical activity levels during inpatient stroke rehabilitation and the short-term effects on simple functional activities, primarily mobility. Methods/design. A randomized controlled trial will be undertaken within the stroke rehabilitation wards of the 2nd affiliated hospital of Anhui University of Traditional Chinese Medicine, Hefei, China. The study participants will be stroke survivors who meet inclusion criteria for the study, primarily: able to participate, no more than four months after stroke, and walking independently before stroke. Participants will all receive standard local rehabilitation and will be randomly assigned either to receive regular feedback about activity levels, relative to a daily goal tailored by the smart watch over five time periods throughout a working day, or to no feedback, but still wearing the Smart watch. The intervention will last up to three weeks, ending sooner if discharged. The data to be collected in all participants includes measures of: daily activity (Smart watch measure); mobility (Rivermead Mobility Index and ten metre walking time); independence in personal care (the Barthel ADL index); overall activities (the WHO Disability Assessment Scale, 12-item version); and quality of life (the Euro-Qol 5L5D). Data will be collected by masked assessors at baseline, three weeks or at discharge (whichever is the sooner); and a reduced data set at 12 weeks by telephone interview. The primary outcome will be change in daily accelerometer activity scores. Secondary outcomes are compliance and adherence to wearing the watch, and changes in mobility, independence in personal care activities, and health-related quality of life. Discussion. This project is being implemented in a large city hospital with limited resources and limited research experience. There has been a pilot feasibility study using the Smart Watch, which highlighted some areas needing change and these are incorporated in this protocol

Can practice undertaken by patients be increased simply through implementing agreed national guidelines?' An observational study

Objective: To increase autonomous practice time of patients on the stroke unit of a nursing home. Intervention: Nurses stimulated and coached patients with the help of four interventions (muscle strengthening, sitting balance and reach, getting up from a chair, walking) from the evidence-based Clinical Nursing Rehabilitation Stroke Guidelines. Design: An observational study. Practice time of elderly stroke patients in this study was compared with the time observed in our previous study in the same setting. Setting: Rehabilitation units of a nursing home in the Netherlands. Subjects: Seventeen frail stroke patients, including 8 men, 9 women, with a mean age of 75.8 (SD ± 9) and 17 subjects with the same characteristics who participated in a previous observational study. Main measures: Time spent on therapeutic activities was measured using the Behavioral Mapping method. Results: The time spent on therapeutic activities increased significantly from 103.5 minutes measured in our previous study to 156.5 minutes in this study (Z = 2.86; P < 0.005; d' = 1.09) The mean Barthel Index score was 8.8 (SD ± 4.1). The patients with more possibilities were more active, resulting in a significant positive Barthel Indextherapy time relationship (r = 0.73, P ≤ 0.001). Conclusions: The autonomous practice time of older fragile comorbid stroke patients increased during the weekdays. Patients, stimulated and challenged by nurses, exercise harder and more according to their possibilities. Since this guideline was developed especially for nurses, nurses can stimulate stroke patients to contribute more to autonomous practice and therefore help their recovery. © The Author(s) 2012

Evalueren van zorg is niet zo eenvoudig.

Achtergrond: Om inzicht te krijgen in de ervaringen met betrekking tot de verslaglegging met het Omaha System is bij een wijkzorgorganisatie een kwalitatief, praktijkgericht onderzoek uitgevoerd. Bevindingen: Een groot deel van de verpleegkundigen en verzorgenden die hebben meegedaan aan het onderzoek geeft aan een kennistekort te ervaren en daardoor moeite te hebben met de verslaglegging van de evaluatie. Een belangrijk voordeel dat enkele geïnterviewden ervaren is dat zij door gebruik van het Omaha System een vollediger beeld hebben van de cliënten. Als nadeel wordt genoemd dat geïnterviewden nieuwe informatie die volgt uit een evaluatiegesprek zelf niet bij het assessmentdeel kunnen vastleggen. Hierdoor wordt het cyclische aspect van het verpleegkundig proces verstoord

De hbo-verpleegkundige in 2030 Een explorerend onderzoek naar de toekomstige hbo-verpleegkundige in een veranderend zorglandschap

INLEIDING: In dit onderzoek wordt geëxploreerd welke opvattingen de respondenten met bestuurlijke en beleidsfuncties binnen de zorgsector hebben omtrent de toekomstige zorg en de inzet van de hbo-verpleegkundige in 2030. METHODE: Een kwalitatieve onderzoeksmethode is toegepast waarbij elf een-op-een semigestructureerde interviews werden uitgevoerd. De verwachtingen over de hbo-verpleegkundige in 2030 zijn in kaart gebracht aan de hand van vier vragen. RESULTATEN: De cliënt verandert en beheert de regie over het zorgproces. De behoefte richt zich op het ontvangen van hoogwaardige zorg en begeleiding in het verduidelijken van de zorgvraag. De hbo-verpleegkundige kenmerkt zich door sociale vaardigheden, vakkennis, multidisciplinaire samenwerking, zorg op maat, een holistische visie en de attitude om de regie bij de cliënt te laten. CONCLUSIE: De hbo-verpleegkundige communiceert met de cliënt vanuit een holistische en positieve gezondheidsbenadering. Shared decision making staat tijdens zorg en welzijn in 2030 centraal. De hbo-verpleegkundige werkt intensief samen en krijgt een overkoepelende taak tijdens de zorgverlening om de continuïteit te optimaliseren en te waarborgen. Tegelijkertijd levert de verschuiving van zorg naar de wijk vragen op over de bereikbaarheid van zorg, de hbo-verpleegkundige en het informele netwerk. Het personeelstekort wordt beschouwd als een complexe uitdaging voor de toekomst

Cognition in relation to independency in older, comorbid stroke patients in a stroke unit

Objective: The objective of this study was to ascertain if cognition helps to predict functional outcome in older comorbid stroke patients with severe loss of independence. Design: This is a cross-sectional study. Subjects: The subjects of this study are patients who have suffered a stroke and who rehabilitated in the nursing homes' rehabilitation units and patients (n = 160) (mean age: 77; SD: 9.5) with a mean Barthel Index of 11.02. Method: Demographic, illness-related, functional and cognitive data were selected at baseline. Main Assessment Measures: Functional abilities were tested using the Barthel Index. Cognitive functions were assessed using a wide variety of neuropsychological tests. Results: Patients faced cognitive impairments especially in executive functioning and memory. Stepwise linear regression analysis shows that executive functioning (p = 0.050) and memory (p = 0.000; confidence interval −1.255, −0.403) are significantly associated with functional outcome. Conclusion: From a clinical point of view, we suggest combining physical and cognitive training from the very early phase of recovery