Dissertations / Theses on the topic 'Patient experience and stroke rehabilitation'

Thesis (MPhil (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--University of Stellenbosch, 2007.
Current emphasis for rehabilitation in South Africa remains on individual intervention within the move towards primary health care. Primary health care is the strategy that has been adopted by the South African department of health to bring access and equity in health care services. Even so, the burden of providing effective rehabilitative services with limited resources requires innovative strategies, such as the use of therapeutic groups, to address certain aspects of rehabilitation. These strategies must be proven effective. There is a paucity of literature detailing the uses of group therapy in physical rehabilitation, and particularly the use of interdisciplinary group work in stroke rehabilitation. Furthermore, evidence shows that stroke survivors feel ill equipped to return to their communities despite rehabilitation. Stroke is a major cause of death and disability in South Africa, and is a condition shown to benefit from rehabilitation. These factors led to the selection of the Bishop Lavis Rehabilitation Centre stroke group as the setting for this study, which aims to describe the range of experiences relating to attendance or non-attendance of those referred to this programme. This descriptive study, employing quantitative means (to describe the demographic details of the participants) and qualitative means (to describe the experiences of participants), was conducted with twenty participants. Data was collected by means of an administered questionnaire. Following that, a focus group discussion involving six participants was used to gather in-depth information. Quantitative data was analysed with the assistance of a statistician, utilising the computer program, Statistica. The Chi-Squared, Kruskal-Wallis and ANOVA tests were used, with p>0.05 showing statistical significance. Qualitative data was thematically analysed, whereby data was categorised by means of an inductive approach. The study population consisted of 20 participants, with an average age of 59 years, of whom 15 were female and five male. The stroke group provided meaning to participants on two levels. On a psychosocial level, the phenomena of universality (identifying with others in a similar position), development of socialising techniques, imparting information and cohesiveness emerged strongly. On the level of meaning related to stroke recovery, improvement in ability to execute activities of daily living, mobility and strength were most frequently mentioned. Transportation issues were most commonly mentioned as factors negatively influencing attendance. Staff attitude and activities of the programme were most often cited as positive factors. Given the positive response of study participants, and the programme’s ability to sustain intervention with limited resources, it was concluded that this programme has a valid place within stroke rehabilitation in Bishop Lavis. Recommendations in terms of the group programme included investigating methods of providing transportation, providing childcare facilities and expanding the content of educational sessions. Further recommendations were to maintain the positive attitude of staff and the current activities of the programme. Frequency of group outings should also be increased and compensatory strategies for inclement weather must be explored.

Bakgrund: Stroke är en av Sveriges folksjukdomar och den främsta anledningen till att vuxna personer drabbas av funktionsnedsättningar. Sjukdomen innebär en stor omställning för patienten då den medför en förändrad vardag. Det är en av många faktorer som påverkar patientens livskvalitet. Rehabilitering och stöd från interdisciplinärt team och närstående är viktiga delar för snabbare återhämtning. Syfte: Syftet var att beskriva patienters upplevelser av vardagslivet efter stroke. Metod: Metoden var en litteraturöversikt baserad på kvalitativa artiklar som analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier; förändrad tillvaro, förändrad identitet och behov av hjälp framåt. Patienterna upplevde en förändrad vardag på grund av de omständigheter stroke gav. Hemmet och anhöriga var två viktiga faktorer för att patienterna skulle känna trygghet. Fysiska och psykiska förändringar till följd av stroke gjorde att patienterna upplevde sin kropp som främmande. De fick lära sig att tolka sin nya kropp vilket upplevdes påfrestande. De behövde verktyg för att kunna hantera sin nya vardag och den förändrade kroppen vilket de erhöll från det interdisciplinära teamet. Konklusion: Patienternas upplevda livskvalitet påverkades negativt på grund av livsomställningarna efter stroke. Vad som gav mening och sammanhang blev tydligare för patienterna och att återgå till sitt ”gamla jag” var något som patienterna prioriterade högt. Viktigt för återhämtningen var det sociala och professionella stödet. De bildade tillsammans ett säkerhetsnät för patienten och möjliggjorde en meningsfull framtid.
Background: Stroke is one of the most common diseases in Sweden and the primary reason why adults get disabilities. Stroke means a great conversion for the patient which leads to a changed everyday life. There are many factors that affects the patients’ quality of life. Rehabilitation and support from the interdisciplinary team and family are important for efficiency of the recovery. Aim: The aim of this study was to describe patients’ experiences of everyday life after stroke. Method: The method was a literature review based on qualitative studies and were analyzed with qualitative content analysis. Results: The analyses resulted in three main catagories; changed living, changed identity and needs of help forward. Patients experienced a changed living because of the circumstances their stroke gave them. Their home and closest family were two main factors for the patients to feel safe. Because of the stroke patients received a new body that meant both physical and psychological changes. The patients got to learn their new body which was experienced as demanding. Patients needed tools to be able to handle their new everyday life and changed body, which they received from the interdisciplinary team. Conclusion: Patients experienced that their quality of life was affected negativly because of the life adjusment after the stroke. What gave the patients meaning and connection became more clear after the stroke, to revert the ”old me” were highly priotitized. The social and profesional support was important for the rehabilitation. Together they created a saftey net for the patient and enabled a meaningful future.

Bakgrund: Stroke är en folksjukdom som drabbar cirka 20 000-25 000 personer i Sverige varje år och leder till syrebrist i hjärnan. De symtom som uppkommer vid en stroke varierar beroende på vilken del av hjärnan som skadas Tiden från första symtom tills att behandling sätts in har en stor inverkan på hur allvarliga skador det blir. De vanligaste symtomen är domning eller förlamning och en lång rehabilitering väntar oftast. Syfte: Syftet med denna litteraturstudie var att beskriva personers upplevelser efter att ha drabbats av en stroke samt att beskriva undersökningsgrupperna i de valda artiklarna. Metod: En beskrivande litteraturstudie som baseras på tolv kvalitativa vetenskapliga artiklar. Databaserna Cinahl och Medline via PubMed användes för att söka artiklarna, via högskolan i Gävle. Huvudresultat: I resultatet presenteras personers upplevelser efter en stroke utifrån deras fysiska och psykiska hälsa, samt det sociala livet. Funktionsnedsättningar var den vanligaste fysiska förändringen i livet som fick dessa personer att uppleva en psykisk påfrestning, bland annat depression, rädsla och förändrad självbild. Det sociala nätverket påverkas genom isolering på grund av den fysiska funktionsnedsättningen och den psykiska påfrestningen. Totala antalet deltagare i studien var 184 personer vars erfarenheter och upplevelser studerades, 53,3% var män och 46,7% var kvinnor. Slutsats: Alla personer som drabbats av en stroke upplevde någon form av förändring i det dagliga livet. Därför krävs det att vårdpersonalen har kunskap om hur olika individer hanterar denna livsförändring. Det kunde vara allt från fysiska, psykiska och sociala förändringar. Stödhjälp ansågs varit en viktig del under rehabiliteringsprocessen för dessa personer.
Background: Stroke is a widespread disease in Sweden and it affects approximately 20 000-25 000 persons every year and it leads to oxygen deprivation in the brain. The symptoms that are caused by a stroke very depending on which part of the brain that is damaged. The time between the first symptoms of a Stroke and the first treatment of the disease is another major reason of how serious the damage becomes. The most common symptoms are numbness or paralysis and a long time of rehabilitation waits for the person that suffers from a stroke. Aim: To describe people´s experience after having suffered a stroke and to describe the included articles study-group.. Method: A descriptive literature study based on twelve qualitative scientific articles. The databases Cihnal and PubMed was used to search the articles, through the University of Gävle. Results: People's experiences after a stroke based on their physical and mental health, their social life are being presented in the results. Movement disabilities was the most common physical change in people’s life and also the reason why people experienced psychological distress such as depression, fear and a different view of themselves. Their social network is affected because of their physical movement disabilities and psychological distress. The total amount of people participating in the study was 184 persons whose experiences were studied, 53, 3% were men and 46, 7 % were women. Conclusion: Every person who suffered from a stroke experienced some kind of change in their daily life. Therefore, it requires that health professionals have the knowledge of how individuals manage this life-changing. It could be anything from physical, psychological to social changes in their lives. Supportive help for the affected people has been an important part of the rehabilitation process.

Magister Scientiae (Physiotherapy) - MSc(Physio)
Stroke is the second leading cause of disability worldwide. Up to 60% of the survivors remain severely disabled. These people experience various challenges in such areas as self-care, mobility, accessing medical and rehabilitation services, transportation and finance. These affect them psychologically, physically and socially predisposing them to complications. Hospital based stroke records report on critical cases, which are not a true reflection of after effects of stroke in a community setting. The impact of stroke on patients and spouses cannot be underestimated considering that it is often sudden, giving no chance to patients or spouse to adjust to the predicament. The aim of this study was, therefore, to explore the challenges stroke patients and their spouses experienced during the rehabilitation process, from diagnosis through to treatment and discharge. The study was based on a qualitative approach, utilising an exploratory design. Data was collected using semi-structured in-depth interviews and focus group discussions. All interviews were tape recorded and transcribed verbatim. A thematic content analysis was used to analyse data. Ethical approval was sought from the University of the Western Cape and the College of Medicine Research Ethics Committee, University of Malawi. Permission was obtained from the General Manager of Malawi Against Physical Disabilities. The results indicates a range of challenges including dependence on spouse for basic self-care activities and activities of daily living, stress due to fear of dependence on their spouses, loss of opportunity for regular interaction with friends and family, limited facilities and accessibility to rehabilitation. Spouses are also burdened by of caregiving responsibilities. In conclusion, this study highlights that the consequences of stroke affect both patients and spouses in the areas of health, finance and social. There is need for rehabilitation professionals to give equal attention to the challenges experienced by spouses when managing stroke patients. The study recommends that accessibility to rehabilitation should be improved by increasing patients’ space at the centre, construction of more centres and expand CBR services to cover all districts in the country.

Bakgrund: Stroke är den tredje största dödsorsaken i Sverige och drabbar ca 30 000 människor årligen. Att återvända hem efter en sjukhusvistelse är ofta mycket efterlängtad av strokeöverlevare. Men förhoppningen att återgå till sina normala liv är inte alltid kopplat till verkligheten. Forskning visar att många strokeöverlevare är oförberedda på vad de nya begränsningar och förlorade förmågor innebär för dem i hemmet. Syfte: Att undersöka vilka medgångar och motgångar som strokepatienter mött efter utskrivning från sjukhus till hemmet, för att undersöka hur sjuksköterskan kan hjälpa patienter som drabbats av en stroke att förbereda sig för att klara sig i den dagliga hemmiljön. Metod: Litteraturöversikt baserat på 10 vetenskapliga kvalitativa originalartiklar publicerade i PubMed och Cinahl från 2000. Artiklarna granskades utifrån SBUs kvalitetsgranskningsmall. Resultat: Resultatet visade att flera av de svårigheter som uppkommer i hemmet kunde minskas med insatser att skapa realistiska förväntningar genom praktiska övningar samt att coacha strokeöverlevare inför återkomst till hemmet. Ur de motgångar som framkom skapades kategorierna; rädslan att vara en börda, familjen som ett hinder, livet saktade ner, sjukhus vs hemmet, existentiella och sociala konsekvenser. Interaktionen med sjuksköterskorna var viktigt både innan utskrivning och i hemsjukvården då bemötandet kunde försämra och förbättra deltagarnas förväntningar på rehabilitering. Information, meningsfulla relationer samt att finna mening i det lilla kunde hjälpte deltagarna att hantera vardagen bättre. Slutsats: Hur förberedda strokeöverlevare är inför utskrivning påverkar hur de hanterar de motgångar de möter i sin hemmiljö. Resultaten visar vikten av att de strokedrabbade får stöd att skapa realistiska förväntningar för sin vardag.

Background: Stroke is a common disease in Sweden and between 25 000–30 000 people fall ill every year. A stroke causes oxygen deficiency and can lead to lifelong disabilities for the patient. Multidisciplinary teams work together where the nurse plays an important role for the care and the process of recovery. Aim: Highlight nurses' experiences of caring for patients who have had a stroke. Method: The design of the study is a literature study with a qualitative approach. The study is based on ten articles and was analyzed using Friberg’s five-step analysis. Results: Two themes and six subthemes emerged. Nurses felt that their care was important for the patient's recovery but wanted further specialized training. Multidisciplinary collaboration was perceived as important both for the development of knowledge and the patient's care. Nurses highlighted relatives' participation in patient care. However, there were daily challenges of, among other things, time pressure and understaffing. Conclusion: The study showed that nurses wish to provide good care for their patients and that their care was important. However, they experience daily challenges. Through organizational changes such as increased staff density and continuing education, the role of the nurse can be strengthened and lead to improved patient care.

Bakgrund Varje år insjuknar 25 000-30 000 personer i Sverige med stroke. Stroke är ett samlingsbegrepp för hjärninfarkt och hjärnblödning som leder till syrebrist eller direkt skada i hjärnan. Hjärnskadorna kan leda till bestående eller övergående funktionsnedsättningar i varierande grad. Patienterna tas om hand av multidisciplinära team där sjuksköterskan ingår i alla leden i vårdkedjan. Sjuksköterskan utför omvårdnad för att stödja patienterna i deras återhämtning, vilket kan bidra till att förbättra prognosen för dessa patienter. Syfte Syftet med litteraturöversikten var att belysa sjuksköterskans upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke. Metod Studiedesignen var en icke-systematisk litteraturöversikt. Studien baserades på 15 artiklar av både kvalitativ och kvantitativ design. Artikelsökningarna genomfördes i databaserna PubMed och CINAHL. Vidare gjordes en kvalitetsgranskning av de 15 vetenskapliga artiklarnas kvalitet och trovärdighet. Slutligen användes en integrerad översiktsmetod som dataanalysmetod för att färdigställa resultatet. Resultat Litteraturöversikten sammanfattade sjuksköterskans upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke. Betydelsefulla aspekter och förhållningssätt som identifierades var att känna ett yrkesansvar, arbeta i multidisciplinära team, arbeta utifrån personcentrerad vård och sjuksköterskans relation med patientens närstående. Förbättringsområden inom strokevård var enligt sjuksköterskorna mer strokeutbildning, bättre samarbete i det multidisciplinära stroketeamet och med patientens närstående. Återkommande problem var tidsbrist och underbemanning. Slutsats Genom att studera och sammanfatta sjuksköterskors upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke kan betydelsefulla aspekter, förhållningssätt och förbättringsområden inom strokevården förstås.
Background Every year 25,000-30,000 people in Sweden take ill with stroke. Stroke is a collective term for cerebral infarction and cerebral hemorrhage that leads to a lack of oxygen or direct damage in the brain. Brain damage can lead to permanent or transient disabilities of varying degrees. Patients are cared for by multidisciplinary teams where the nurse is part of all stages of the care. The nurse performs nursing care to support patients in their recovery and can help improve prognosis for these patients. Aim The purpose of the literature review was to describe the nurse's experiences in caring for patients taken ill with stroke. Method The design of the study was a non-systematic literature review. The study was based on 15 articles of both qualitative and quantitative design. The article searches were made in the databases PubMed and CINAHL. Furthermore, a quality review was made of the quality and credibility of the 15 articles. Finally, an integrated overview was used as a data analysis method to complete the result. Results The literature review summarized the nurse's experiences of caring for stroke patients. Identified significant aspects and attitudes were as follows, to feel a professional responsibility, to work in multidisciplinary teams, to practice person-centered care, and the nurses' relationship with the patient's relatives. According to the nurses, areas for improvement in stroke care were more stroke training, and better collaboration in multidisciplinary stroke teams and with the patient's relatives. Recurring problems were lack of time and understaffing. Conclusions By studying and summarizing the nurse's experiences in caring for patients taken ill with stroke significant aspects, attitudes and areas for improvement in stroke care can be understood.

Magister Scientiae (Physiotherapy) - MSc(Physio)
Background and aim: Despite the high number of strokes globally, and among people of African origin in particular, there are few available data on stroke in most countries of sub-Saharan African (SSA), including Tanzania. In addition, the profile and challenges affecting stroke patients in these countries has not been adequately explored. The aim of this study was to determine the profile and explore the challenges experienced by stroke patients admitted at Haydom Lutheran Hospital in Tanzania. The objectives of the study were to determine the documented risk factors among the patients admitted to Haydom Lutheran Hospital, to identify the stroke on-set admission interval and length of hospital stay, to identify the process of physiotherapy for the stroke patients, and to explore the challenges experienced by stroke patients discharged from Haydom Lutheran Hospital, Tanzania. Methods: Qualitative and quantitative research designs were used to collect the data. The quantitative design used a retrospective descriptive study, in which medical records of stroke patients were reviewed. The qualitative approach included in-depth interviews to collect information regarding the challenges experienced by stroke patients residing in Haydom, Tanzania. Existing medical records were perused to obtain information related to demographic profile, medical characteristics and rehabilitation data among stroke patients admitted at Haydom Lutheran Hospital. Relevant data was captured on a data information sheet. The SPSS (14.0 version) and Microsoft Excel (2007) were used to analyse quantitative data. Descriptive Statistics were used to determine ranges, percentages, frequencies, means and standard deviations calculate. The qualitative interviews were transcribed verbatim and also translated from Kiswahili to English. Stated concepts were coded, grouped into categories, and reduced into sub-themes and main themes. Prior to conducting this study, final permission was obtained from the Senate Research Grant and Study Leave Committee at the University of the Western Cape as well as the relevant authorities of the Tanzania Ministry of Health, Tanzanian National Institute of Medical Research, and the Administration of Haydom Lutheran Hospital. Written informed consent were obtained from the participants prior to interviews. Results: A total number of 145 stroke patients were admitted to Haydom Hospital between 1st January 2004 and 31st December 2010. However, only 128 of the potential sample participants met the inclusion criteria for the sample. The mean age of the participants was 57.7years, (SD=18.673). Of these, 104 (81.2%) had haemorrhagic stroke and 24(18.7%) had ischemic strokes. HIV infection (78.1%), previous stroke (74.2%), smoking (58.5%) and hypertension (55.4%) were the most common risk factors for stroke. Among the participants, the documented impairments included emotional impairments 42(32.8%), speech impairment 47(36.7%), cognitive impairment 39(30.4%), muscle impairment 36(28.1%), and occurrence of coma 33(25.8%) respectively. The mean time from onset of stroke to admission was 1.2 days with (SD=0.42 days). The mean length of hospital stay was 12.16 days (SD=4.1 days), the majority (61.7%), started physiotherapy within 3 days after admission, mean duration of physiotherapy was 14.1 days (SD=5.79), and the mean number sessions of physiotherapy 3.7days (SD=18.8 days). The challenges that emerged during the qualitative interviews with participants were limitation in walking activities, inability to return to work and to participate in leisure activities as before the onset of stroke, and environmental factors such as physical barriers and attitude of family. Conclusion: The findings of the research reveal that stroke in Tanzanian patients occurs at a relatively young age, and that frequency of intra-cerebral haemorrhage is higher than that reported in developed countries. The clinical presentations and risk factors are similar to those in other studies. The qualitative findings revealed that the stroke patients had problems with limitation of activity, participation restrictions, and environmental challenges. They also expressed uncertainties as a result of a lack of knowledge about stroke and its effects, and discharge challenges relating to rehabilitation. These challenges should be addressed in the process of management of patients with stroke in the research setting.

Aims: Life satisfaction and self-efficacy are psychosocial experiences that appear to profoundly influence the rehabilitation of a stroke patient. However, relevant studies have been mostly carried out on Western stroke survivors, with limited reports on stroke experience in the Middle East. Reviewed literature suggests a positive correlation between religious faith and health outcome, however studies investigating relationships among religious faith, self-efficacy and other psychosocial variables in stroke patients are limited. The aims of this study were therefore to (1) explore stroke experience and factors associated with life satisfaction post-stroke in Kuwait, (2) to investigate the relationships between self-efficacy, life satisfaction and religious faith in female stroke patients living in Kuwait, and (3) to identify cultural influences on stroke survivors in Kuwait from the health professionals‘ point of view. Method: The study was carried out in these four phases. 1) Phase 1:- Exploring stroke experience in patients in Kuwait with semi-structured interviews 2) Phase 2:- Client-Centred Adaptation of a Self-Efficacy measure for stroke patients living in Kuwait 3) Phase 3:- Assessing quantitative relationships between the three variables (self-efficacy, life satisfaction and religious faith) with questionnaires 4) Phase 4:- Exploring perceptions of health professionals regarding the world of the stroke patient and effects of culture on recovery and rehabilitation with semi-structured interviews Qualitative data were analysed with thematic analysis. Results: Significant correlations were found between general self-efficacy, and psychosocial adaptation self-efficacy. Self-efficacy (both general and psychosocial adaptation) showed significant correlations with life satisfaction post-stroke. Religious faith was not related to either life satisfaction or self-efficacy. Health professionals‘ interviews identified cultural characteristics specific to stroke patients living in Kuwait. These included family involvement, prevailing attitude towards stroke, dependency and access to maids, religious beliefs, and social stigma. Conclusion: Psychosocial self-efficacy was identified as having the strongest relationship to life satisfaction compared with the other variables tested. This study failed to show any significant relationship between religious faith and self-efficacy or life satisfaction in female stroke patients living in Kuwait. However, results from patient and health professional interviews identified religious beliefs as playing an important role in recovery, behaviour during rehabilitation and in interaction with the health professions. The qualitative aspects of this study, in particular, highlight the importance of taking into consideration religious and cultural influences during the rehabilitation of stroke patients in Kuwait.

Stroke is the world&rsquo
s third highest cause of death and a major cause of disability. In order to define optimal management for stroke, reliable data are needed. Although Ruhengeri Hospital in Rwanda receives many stroke patients, no in-depth study has been carried out on stroke patients admitted at the hospital. This study, therefore, identified the profile of stroke patients admitted at Ruhengeri Hospital in Rwanda and explored the challenges that they experienced. A concurrent mixed model design was used to collect data. With a data gathering instrument which was developed by the researcher, a quantitative retrospective approach was used to review existing patients&rsquo
records to collect information related to demographic characteristics, documented clinical features and risk factors for stroke, stroke onset-admission interval, length of hospital stay and the process of hysiotherapy for stroke patients. In-depth face-toface interviews were also used to collect data regarding the challenges experienced by stroke patients. The sample for the quantitative phase consisted of medical records of stroke patients admitted at Ruhengeri Hospital from January 1st, 2005 up to December 31st, 2008. In the qualitative phase, a purposive sample of 10 participants was selected.

The present research used van Manen's application of hermeneutic phenomenology as philosophy and method to explore stroke rehabilitation experience across two different settings, i.e. (i) a conventional setting (National Health Service or NHS stroke unit) and (ii) an unconventional setting (Conductive Education or CE). Interviews, observations and reflective diaries were used to collect data on 24 volunteering stroke patients' experiences. High levels of dis empowerment and negative images of self as well as the nature of motivation were indicated to be thematic of stroke rehabilitation experience in the stroke unit. In the CE setting stroke rehabilitation experience was characterised by increased selfconfidence, unconditional positive regard from conductors, challenging activities and body-half integration. A juxtaposition of stroke rehabilitation experience in the CE setting with stroke rehabilitation experience in the NHS stroke unit brought to light an important difference between the physical body-split caused by stroke, and a much wider and deeper disintegration of being. The juxtaposition further indicated that (i) the approach used in the NHS stroke unit is biomedical in spite of the presence of a multi-disciplinary team, and (ii) that the one adopted by CE is a person-centred approach characterised by holistic principles, with an overall focus on mobility. A reflective evaluation of this hermeneutic phenomenological study ensues, including a discussion on the difference between person-centredness and holism. The better understanding gained regarding stroke rehabilitation experience across the two settings was then used to make recommendations regarding what could constitute a holistic approach to stroke rehabilitation. Finally, the researcher's experience of 'being-immersed' in others' lived experiences was discussed in order to illustrate the holistic effect the research process had on the researcher's well-being, and the development of a tool which addresses researcher emotions holistically is also presented.

Problemställning: Stroke är en världsomspännande, allvarlig och kostnadskrävande sjukdom. Sjuksköterskans omvårdnadsinsatser av patienter med stroke bör anpassas individuellt och syfta till att främja återhämtning och förhindra komplikationer. Det är därför av vikt för sjuksköterskan att ha kunskap om hur strokedrabbade patienter upplever sin sjukdom. Syftet var att belysa patienters upplevelse av att drabbas av och leva med stroke. Metod: En litteraturstudie där 11 kvalitativa och 1 kvantitativ artikel som svarade mot studiens syfte ingick. Resultat och konklusion: Att drabbas av stroke påverkar personens hela liv med förlorad kontroll över både kropp och personlighet. Oro för att drabbas av en ny stroke leder till ett liv i osäkerhet men också till förändrade levnadsvanor. Stroken påverkar den drabbades roll i familjen och förhållandet, ilska och frustration över situationen går ut över de närmaste. Den sociala relationen med familj och vänner försämras, eftersom kvarstående fysiska eller kognitiva funktionsnedsättningar gör det svårt att delta i sociala sammanhang på samma sätt som innan sjukdomen. Överdrivna känslomässiga yttranden och extrem trötthet försvårar ytterligare social samvaro. Implikation: Det är viktigt att sjuksköterskan får ökad medvetenhet om strokepatienternas upplevelser för att kunna ge en individuellt utformad omvårdnad. Det finns behov av vidare forskning kring copingstrategier samt strokepatienternas upplevelser av sjuksköterskans omvårdnad.

Problem: Stroke is a worldwide, serious and costly disease. Nursing interventions of patients with stroke should be individualized and adapted to promote recovery and prevent complications. It is therefore important for nurses to have knowledge of how the stroke affected patients experience their illness. The purpose was to illustrate patients’ experience of suffering from and living with a stroke. Method: A literature study, where 11 qualitative and one quantitative article that met the study’s purpose, were used. Results and conclusion: To suffer a stroke, affects the patient’s whole life with loss of control over both body and personality. Worries concerning the possibility to suffer a new stroke often results in a life of uncertainty but also in changing of lifestyles. The stroke affects the patient’s role in the family and in the relationship with the spouse; anger and frustration over the situation affect the immediate family negatively. The social relationships with family and friends deteriorate, because the residual physical or cognitive disabilities make it difficult to participate in social contexts in the same way as before the illness. Exaggerated emotional expressions and extreme fatigue makes social interaction even more difficult. Implication: It is important that nurses are more aware of stroke patients' experiences in order to provide individualized care. There is a need for further research on coping strategies and the stroke patients' experiences of nursing.

Background: Guidelines suggest that rehabilitation for people with stroke should adopt patient-centred goal-setting (PCGS). Methods: A literature review and two qualitative studies were done in an acute stroke-unit. Study one aimed to explore influence of PCGS within stroke rehabilitation. Patients with stroke, with ability to participate and staff caring for them were included. Data collection involved interviews, observations, document analysis and focus-groups. Analysis involved sequential and intra-case analysis methods. Study two aimed to build a resource to improve PCGS and evaluate its feasibility and appropriateness. Based on Study one and review, a resource (T-PEGS) was developed and applied in this setting. Patients with same criteria as Study one and staff who agreed to act as keyworkers were recruited. Data collection and analysis methods were similar to Study one. Findings: Study one, with thirteen patients and twelve professionals, revealed limited application of PCGS due to participants’ health beliefs, limitations in knowledge and resources. Study two involved five patients and five staff who applied T-PEGS; recording of psychosocial goals, information sharing and rapport between patients and professionals had improved. Conclusion: T-PEGS seemed to improve PCGS locally. Small study-size and single site limit generalisability. Future work should explore mechanisms and effectiveness of T-PEGS.

Philosophiae Doctor - PhD
Stroke is a known health challenge for the public as it is both incapacitating and fatal to many people world over. Malawi, one of the developing countries has stroke as the fourth leading cause of death, and is fast becoming even more significant due, primarily, to lifestyle changes and nature of healthcare practices. For these reasons, and particularly, the negative impact on quality of life, the management of people with stroke is a critical area of interest. While research activity throughout the world has advanced acute stroke-care interventions, patients in Low to Middle Income Countries (LMICs) benefit less from evidence-based stroke care practices due to less conventional applicability to the setting and continuing medical care and rehabilitation challenges. This doctoral project applied the results of a Diagnostic and Solution Phases to the development of a contextual model for in-patient stroke care and rehabilitation (MoC) in Malawi.

Stroke is the third most common cause of death in the United Kingdom and the single greatest cause of severe disability. The effects of stroke are complex but the impact on emotional wellbeing is arguably one of the most problematic aspects of stroke rehabilitation to address. Nurses play a key role in stroke rehabilitation and the ways in which they interact with and respond to the emotional experience of stroke, may be crucial to the well-being of the patient and their relatives. Informed by an interactionist theory of emotion, the aims of this interpretive ethnographic study were to explore the emotional experiences of persons affected by a stroke (patients and relatives), nurses’ interpretations of these experiences and how they used them to inform and influence person-to-person interactions during the period of hospital-based rehabilitation. Taking a case study approach, a purposive sample of 10 cases was selected, with each ‘case’ comprising a patient, their closest relative and the nurses who provide their care. Data were constructed through participant observation, interviews and documentary review. Data analysis revealed that through a complex interplay of core beliefs, personal and professional attributes and interpersonal skills, nurses enabled patients and relatives to access and utilise their own personal attributes in order to recover from stroke. An emergent relationship model explains how the relationships built and sustained between nurses, patients and relatives during their encounters with each other on a stroke rehabilitation unit are central to creating a positive culture of caring which promotes emotional wellbeing and aids recovery. The findings have implications for policy, clinical practice, health care education and research.

Thesis (MPhil)--Stellenbosch University, 2009.
A research assignment submitted in partial fulfilment of the requirements of the degree Master of Philosophy (MPhil) in rehabilitation at Stellenbosch University
ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector.
AFRIKAANSE OPSOMMING: Beroerte is reeds die grootste enkele oorsaak van gestremdheid in Suid Afrika en steeds aan die toeneem in insidensie. Navorsing het bewys dat rehabilitasie geskoei op wetenskaplik bewese metodes die uitkomste van beroerte lyers beduidend kan verbeter. Daarom was dit die doel van die studie om vas te stel tot watter mate dokters, werksaam in die privaat sektor in die Wes Kaapse Metropool, bewese rehabilitasie metodes implimenteer tydens behandeling van akute beroerte pasiënte. Spesifieke areas waaraan aandag geskenk is, was die gebruik van beroerte protokolle, die volg van die interdissiplinêre spanwerk benadering, kommunikasie metodes tussen spanlede en die deurgee van inligting met betrekking tot die diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning aan pasiënte na `n eerste beroerte. Die studie was retrospektief en beskrywend van aard. Daar was primêr kwantitatiewe data ingesamel met behulp van twee self ontwerpde vraelyste. ‘n Klein hoeveelheid kwalitatiewe data is aanvullend ingesamel om kwantitatiewe bevindings toe te lig. 35 dokters en 48 pasiënte het aan die studie deelgeneem. ‘n STATISTICA sagteware pakket is gebruik vir die analise van kwalitatiewe data. ‘n P waarde van minder as 0.05 is as statisties beduidend beskou. Nie een van die dokters wat aan die studie deelgeneem het, het nagraadse opleiding in rehabilitasie gehad nie. 46% van dokters het beroerte protokolle gebruik in hulle praktyke, terwyl 89% gevoel het dat die gebruik van protokolle voordele inhou. Waar spanwerk gebruik was (57% van dokters), is die multidissiplinêre benadering gevolg. Kommunikasie tussen spanlede het meesal op `n informele basis geskied. Geen dokter het spanvergaderings gehou nie. 11% van dokters het saalrondtes gehou waartydens met spanlede gekommunikeer is. 6% van dokters het die pasiënt en familie ingesluit in die rehabilitasie span. Volgens dokters was daar beduidend meer inligting sessies met pasiënte gehou as volgens pasiënte (p = 0.00039). Die verskil in mening tussen die twee groepe is ook waargeneem met betrekking tot die hoeveelheid inligting wat verskaf is oor diagnose, prognose, risiko faktore, post akute rehabilitasie en onslag beplanning (P waardes het gewissel van 0.00013 tot 0.0041). 25% van pasiënte het deelgeneem aan die besluitnemings proses oor opvolg rehabilitasie. Die finale besluit hieroor was in die meerderheid van gevalle deur die dokter en die mediese versekeringsskema geneem. Dit het uit die kwalitatiewe data geblyk dat van die pasiënte ongelukkig was met die opvolg rehabilitasie wat hulle ontvang het. Voorts het pasiënte gevoel dat algemene praktisyns beter ingelig behoort te wees oor die vroeë waarskuwingstekens van beroerte sowel as die noodbehandling van die tekens. Die navorser het tot die gevolgtrekking gekom dat dokters oortuig moet word van die belang van verdere navorsing, spesialisasie in rehabilitasie en die implementasie van bewese beroerte rehabilitasie metodes. Sy beveel aan dat administrateurs van beide die privaat en staatssektor sowel as verteenwoordigers van nie regerings organisasies betrokke raak om bogenoemde te bewerkstellig. Daar moet vasgestel word waarom dokters huiwerig is om bestaande kennis te implemteer. Beroerte rehabilitasie opleiding moet beskikbaar gestel word aan dokters en dokters moet aangemoedig word om bewese kennis soos die gebruik van protokolle, interdissiplinêre spanwerk en verskaffing van inligting oor diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning toe te pas in die praktyk. Die doen van meer navorsing in die privaat sektor word ook aangemoedig.

Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue. Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake. Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity. Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.

Bakgrund: Patienter som har insjuknat i stroke och deras anhöriga upplever att utförd vård av sjuksköterskorna är bristfällig på grund av faktorer som avsaknad av kunskap och tidsbrist. Patienter och anhöriga upplever att de behöver mer stöd gällande återhämtning och rehabilitering. Problem: Patienters vård och anhörigas stöd kan påverkas negativt på grund av sjuksköterskornas bristande kunskap och tid. Syfte: Syftet är att beskriva sjuksköterskors upplevelser av att vårda patienter som har insjuknat i stroke. Metod: Tio kvalitativa och vårdvetenskapliga artiklar analyserades enligt en systematisk litteraturstudie utifrån Evans kvalitativa metod med beskrivande syntes. Resultat: Temat ”Utmaningar i förhållande till strokevård” beskriver hur olika faktorer påverkade sjuksköterskorna att uppleva strokevård som utmanande. Temat består av subteman; Känslor av frustration, Känslor av otillräcklighet och Brist på tid. Temat ”Vikten av kunskap” beskriver sjuksköterskornas upplevelser angående att självständigt kunna ta beslut men att samtidigt samarbeta med patienter och deras anhöriga. Temat består av subteman; Att kunna samarbeta och Att finna trygghet. Slutsats: Sjuksköterskorna beskrev att vården av patienter som har insjuknat i stroke kan upplevas både negativt och positivt. De negativa upplevelserna grundades i faktorer som tidsbrist, utmaningar och bristande kunskap. De positiva upplevelserna grundades i faktorer som gott samarbete och trygghet gällande utförande av strokevård och ansvarstagande.
Background: Patients with stroke and their relatives experience that offered nursing care is insufficient due to factors such as lack of knowledge and time. Patients and relatives feel that they need more support regarding recovery and rehabilitation. Problem: The care of patients and the support of relatives may be adversely affected due to the lack of nurses’ knowledge and time. Aim: The aim is to describe nurses’ experiences of caring for patients with stroke. Method: Ten qualitative and care scientific articles were analyzed according to a systematic literature study based on Evans qualitative method with descriptive synthesis. Results: The theme ”Challenges in relation to stroke care” describes how different factors affected nurses to experience stroke care as challenging. The theme consists of subthemes; Feelings of frustration, Feelings of inadequacy and Lack of time. The theme ”Importance of knowledge” describes the nurses’ experiences regarding the importance of being able to make decisions independently and to cooperate with patients and their relatives. The theme consists of subthemes; To be able to cooperate and To find safety. Conclusion: The nurses described that the care of stroke patients can be experienced both negatively and positively. The negative experiences were based on factors such as challenges and lack of both time and knowledge. The positive experiences were based on factors such as good cooperation and safety regarding the achieved stroke care and accountability.

Bakgrund: Stroke är ett sjukdomstillstånd som skadar hjärnvävnaden. Tillståndet innebär stora konsekvenser för de drabbade. De patienter som drabbats av stroke känner oftast skam och förtvivlan med en förlorad livsglädje som resultat. Idag upptar sjukdomsgruppen flest antal vårdplatser på sjukhusen runtom i Sverige. Med ökad kunskap i omhändertagande i kombination med stöttning för patienten efter insjuknandet, kan känslan av förlorad livskvalitet minskas markant. Syftet: Syfte med denna studie var att belysa patienters erfarenheter av att drabbas av stroke. Metod: En litteraturbaserad studie där 12 kvalitativa artiklar har analyserats. Resultat: Ur analysen av datamaterialet framträdde tre kategorier: Tappat kontrollen över sin kropp, Hamnar i beroendeställning och Återfå ett liv som självständig med åtta underkategorier. Slutsats: Studien bidrar med kunskap om patienters erfarenheter efter att ha drabbats av en stroke. Det kan vara omtumlande känslor att bearbeta för dessa patienter. Behovet av stöd är nödvändigt för att patienterna ska finna livskvalité. Motivation, hopp och uppmuntran stärker patientens självförtroende och leder till ett ökat välbefinnande. Genom en ökad förståelse för patientens upplevelser efter insjuknandet kan sjuksköterskan främja patientens hälsa och välbefinnande.

Stroke är en av våra stora folksjukdomar som drabbar cirka 30 000 människor varje år.Strokedrabbade patienter kommer i kontakt med hälso- och sjukvården och sjuksköterskanhar en central roll i omvårdnaden. Därför är det viktigt att sjuksköterskan har kunskap ompatienters upplevelse av att drabbas av stroke. Syftet med denna studie är att beskrivapatienters upplevelse av stroke. Metoden som använts är en litteraturstudie där trettonkvalitativa artiklar analyserats. Tre olika huvudteman framkom ur analysen: upplevelse avförändringar efter stroke, Strategier för att hantera den nya situationen och upplevelse avmötet med sjukvården. Temat upplevelse av förändringar efter stroke har delats in i treolika underteman. Dessa är upplevelse av fysiska och kognitiva förändringar ochupplevelse av sociala förändringar samt upplevelse av emotionella förändringar. Resultatetvisar att patienterna är i behov av stöd och uppmuntran för att hantera de förändringar somuppstår efter stroke. Därför är det viktigt att sjuksköterskan erbjuder patienterna ett adekvatstöd.

Stroke is one of our biggest national diseases which affects about 30 000 people everyyear. People victim of stroke gets in contact with the health and hospital care and at thispoint the nurse has a very central role regarding the nursing care. It is therefore importantthat the nurse has knowledge of patients’ experience of suffering stroke. The aim is todescribe patients’ experience of stroke. The method used is a literature review in whichthirteen qualitative articles analyzed. Three major themes emerged from the analysis: theexperience of changes after stroke, strategies to handle the new situation and theexperience of meeting with the health care. The theme of the experience changes afterstroke has been divided into three different sub-themes. These are experiences of physicalchanges and experience of social changes and the experience of emotional changes. Theresult shows that the patients are in need of encouragement and assistance to be able tomanage the changes that occur after stroke. It is therefore important that the nurse offerspatients an adequate support.

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists. Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. Next, semi-structured interviews were conducted with 13 stroke survivors and 12 caregivers from rural Appalachian Kentucky, a region with high incidence of stroke and lower levels of educational attainment. Lastly, 13 physical therapists, representing inpatient rehabilitation, outpatient, and home health, were recruited and participated in pre-interview reflection activities and interviews. Data analysis involved predetermined and emerging coding and a constant comparative method was employed. Verification strategies included self-reflective memos, analytic memos, peer debriefing, and triangulation. The theory generated from this dissertation is: physical therapists continually assess the educational needs of stroke survivors and caregivers, to participate in dynamic educational interactions that involve the provision of comprehensive content, at a point in time, delivered through diverse teaching methods and skilled communication. This phenomenon is influenced by characteristics of the physical therapist and receiver (stroke survivor/caregiver) and occurs within the context of the physical therapist’s professional responsibility, the multidisciplinary team, a complex healthcare system, and the environmental/socio-cultural context. The RECAP theoretical model depicts the relationships between the core and encompassing constructs of the theory. The RECAP theory and model presents a significant advancement in the study of patient and caregiver education in physical therapy in stroke rehabilitation. This research provides a springboard to inform future research, guide RECAP in stroke physical therapy practice, design optimal educational interventions, develop training tools for entry-level curriculum and practicing clinicians, and to potentially translate to the practice of patient and caregiver education for other rehabilitation professionals and patient populations.

Bakgrund: Stroke är en folksjukdom som drabbar ungefär 30 000 personer i Sverige varje år och beräknas kosta samhället runt 18 miljarder kronor. Rehabiliteringen efter stroke är ofta intensiv, mångfacetterad och långvarig. Syfte: Syftet var att beskriva patienters upplevelser i samband med rehabiliteringen efter stroke samt att beskriva undersökningsgruppen i de ingående artiklarna. Metod: En beskrivande litteraturstudie som grundar sig på 12 kvalitativa artiklars resultat. Resultat: Stroke upplevdes som en omvälvande livshändelse och huvudmålet med all rehabilitering var att få återgå till det liv som patienterna levt innan stroken. Hoppet om att återfå förlorade funktioner upplevdes som viktigt och varje tecken på förbättring gav motivation till fortsatt rehabilitering. Det var stor kontrast mellan de patienter som upplevde delaktighet i rehabiliteringsprocessen och de som önskade att de hade haft ett större inflytande. Kvinnor upplevde sig mindre delaktiga än män. Det framkom att patienter upplevde att de hade skrivits ut för tidigt från strokeenheten och inte förberetts tillräckligt inför hemkomsten. Den nedsatta funktionsnivån blev mycket tydligare när de kom tillbaka till sin vardag hemma och de saknade den nära kontakten och erfarenhetsutbytet som de hade haft med andra patienter på sjukhuset. Slutsats: Det framkom att patienter med stroke har skilda upplevelser beträffande mål, stöd, information och delaktighet i rehabiliteringen. Ett individanpassat förhållningsätt till patienters målsättningar är betydelsefullt och adekvat information viktigt. Ändamålsenligt stöd från vårdpersonal bidrar till ökad delaktighet samt ökar patientens förmåga att utföra och klara av aktiviteter i rehabiliteringen.
Background: Stroke is a disease that affects approximately 30,000 people in Sweden each year, and is estimated to cost society around SEK 18 billion. Rehabilitation after stroke is often intense, multi-faceted and long lasting. Aim: The aim of the present study was to describe patients' experiences of rehabilitation after stroke and to describe the study group in the included articles. Methods: A descriptive literature review based on 12 qualitative studies. Results: Stroke was perceived as a disruptive life events and the main goal of all rehabilitation was to return to the life that patients lived before the stroke.The hope of regaining lost functions were perceived as important and any signs of improvement gave motivation to continue rehabilitation.The contrast was considerable between those patients who experienced participation in the rehabilitation process, and those who wished they had a bigger influence.Women felt less involved than men. It was revealed that the patients felt that they had been discharged prematurely from the stroke unit and were not prepared for the homecoming. Their reduced abilities became much clearer when they returned to their everyday lives at home and they lacked the close contact and the exchange of experiences they had had with other patients in the hospital. Conclusion: It was found that patients with stroke have different experiences regarding goals, support, information and participation in rehabilitation. An individualized approach to patient goals is significant and adequate information is important. Effective support from health professionals contribute to increased participation and increase the patient's ability to perform and manage activities in the rehabilitation.

Cognitive difficulties can persist for months and years after stroke and adversely impact confidence, mood and functional recovery. Stroke survivors, carers and healthcare professionals collectively agree that improving cognition is the number one research priority for life after stroke. Future research should include measurements of outcome that service users deem important. Patient reported outcome measures (PROMs) are a means of gaining patient perspectives that can be standardised for use in a trial. PROMs should be developed with service users to incorporate their priorities but people with cognitive difficulties are often systematically excluded from the development and use of PROMs. Study 1 used qualitative interviews (N=16) to explore stroke survivor perspectives on the important and measureable impacts of persisting cognitive problems. The results of this study generated requirements for a PROM that related to conceptual underpinning and face validity of a measurement tool. Study 2 was a systematic review of existing PROMs related to cognition. 20 Identified PROMs were critically appraised against the requirements generated in the qualitative study. No existing PROMs were identified that met all of the qualitative study review criteria. The next stage described in chapter 3, was to develop a new PROM that: utilised the strengths of existing tools; met qualitative study requirements; and was refined through consultation with different stakeholders, prioritising feedback of stroke survivors with cognitive difficulties. The result of this work was the Patient Reported Evaluation of Cognitive State (PRECiS) scale. Study 3 was a psychometric study with stroke survivors (N=164) to test PRECiS in a large sample. Quantitative and qualitative data were collected on acceptability, feasibility and other psychometric properties of validity and reliability. PRECiS demonstrated good acceptability to stroke survivors and performed well psychometrically. Future validation work required for PRECiS is described in discussion chapter 4. Subject to further validation work, PRECiS may be particularly useful for pragmatic trials of cognitive rehabilitation after stroke.

Stroke är den näst vanligaste orsaken till funktionsnedsättning och död i världen. Vid en stroke kan livet förändras plötsligt och medför ofta en stor omställning för individen. Syftet med litteraturstudien var att undersöka patienters upplevelse av att ha drabbats av en stroke, upplevelse av tiden på sjukhus i direkt anslutning till stroke. Litteraturstudien genererade elva vetenskapliga artiklar och vars resultat resulterade i fyra teman: Den oförutsägbara kroppen, Förlusten av identitet, I vårdarens händer och Viljan och hoppet om livet. Patienters upplevelser visar att god omvårdnad är anpassad utefter varje individ. Att drabbas av en stroke upplevdes som att mista sin självständighet, genom förlust av förmågor som medförde att patienter blev beroende av andra. Att bli beroende upplevdes som en svår situation och det skapade en känsla av att förlora sin kropp och identitet, då förmågor som tagits för givet var förlorade. Upplevelserna och behoven var individuella och bör utgå från varje enskild person. Genom att ta reda på hur patienter upplever att drabbas av en stroke kan det bidra till en ökad förståelse för enskilde individen och dess behov, vilket resulterar i en bättre omvårdnadskvalitet.
Stroke is worldwide the second common cause to disabilities and death. At a stroke life can sudden change and is often a great conversion for the individual. The purpose with this literature review was to investigate patients experiences of suffering a stroke, in directly connection to hospitalization. The literature review generated in eleven scientific articles that resulted in four themes: The unpredictable body, Loss of identity, In the hands of the caregiver and The will and hope of life. Patients´ experiences show that they consider the care as good when the care is custom along each individual. Suffering a stroke was experienced as a loss of independency, thru loss of abilities that resulted in that patients became dependent of others. To become dependent of others was experienced as difficult and it created a feeling of losing its body and identity, when abilities that were taken for granted was lost. The experiences and the needs from individuals should arise from each person. By investigating how patients experience the suffering of a stroke it could contribute to an increased understanding for the individual and its needs, which results in a better quality of nursing.

Bakgrund: Stroke är ett samlingsnamn som innefattar hjärninfarkt och hjärnblödning. Sjukdomen innebär ett akut insjuknande som kräver omedelbar vård. Dessa personer får mer eller mindre kroppsliga förluster som medför ett beroende. Därför är tidig mobilisering central redan i det akuta skedet eftersom symtomen kan förbättras med tiden. Sjuksköterskan är omvårdnadsansvarig på strokeavdelningen. Omvårdnaden ska vara individuell och utgå från ett gott bemötande. Syfte: Syftet var att belysa hur personer drabbade av stroke upplevde sjuksköterskans omvårdnad under vårdtiden på sjukhus. Metod: Studien är litteraturstudie som baserades på tio kvalitativa vetenskapliga artiklar samt en artikel med både kvalitativa och kvantitativa data. Resultat: Fem kategorier sammanställdes, vilka var: information, tillgänglighet, beteende & förhållningssätt, tillit & relation samt värdighet & mänsklighet. Dessa kategorier var alla faktorer som ingick i sjuksköterskans omvårdnad. Slutsats: Stroke är en sjukdom som kan orska allvarliga men för livet. Under vårdtiden på sjukhus är dessa patienter beroende av omvårdnad och rehabilitering. Sjuksköterskan måste i omvårdnaden se hela människan och främja dennes autonomi och värdighet. Patienterna upplevde tidsbrist hos sjuksköterskorna, vilket de tyckte var negativt i omvårdnaden.

Bakgrund: En av de vanligaste folksjukdomarna i Sverige är stroke. Cirka 25 500 personer drabbas årligen och sjukdomen ökar. Stroke är en livshotande sjukdom som omfattar hjärninfarkt och hjärnblödning. Detta påverkar både människors psykiska och fysiska hälsa negativt. Syfte: Syftet med studien är att beskriva äldre patienters upplevelse av livet efterstroke. Metod: Studien är baserad på en litteraturöversikt som innehålleranalyserade kvalitativa och kvantitativa vetenskapliga studier. Resultat: Resultatet visar hur vanligt det är med olika förändringar, till exempel livs- och relationsförändringar efter en stroke och att patienterna är i behov av stöd. Rehabiliteringen har till uppgift att hjälpa och det är viktigt att patienterna kommer igång med detta efter en stroke. Det är också viktigt att man som patient medverkar och utför egenvård för att rehabiliteringen ska ge resultat. En bedömning ska göras av patienten för att se om hen behöver hjälp med att utföra sin egenvård. Det är viktigt med delaktighet och personcentrerad vård under återhämtningen efter en stroke. En av sjuksköterskans viktigaste uppgifter är att främja patienternas hälsa och att lindra deras lidande. Slutsats: Av litteraturstudien framkommer att det är viktigt att öka det egna deltagandet i hälsoprocessen för patienter med stroke. Patienternas fysiska och psykiska kapacitet är begränsad efter en stroke vilket det kan vara svårt för dem att acceptera. De måste dessutom bearbeta sina känslor kring sjukdomstillståndet. Fokus, planering och motivation är viktigt hos strokepatienter. Det är viktigt att sjuksköterskan erbjuder stöd till patientens anhöriga när en familjemedlem drabbas av stroke.
Background: One of the most common public diseases in Sweden is stroke. Approximately 25,500 people suffer a stroke each year. Stroke is a life-threatening disease that includes cerebral infarction and cerebral hemorrhage. The disease is increasing. This affects both people's mental and physical health negatively. Aim: The aim of the study is to describe older patients' experience of life after stroke. Method: The study is based on a literature review that contains analyzed qualitative and quantitative scientific articles. Results: The results show how common it is with various changes, such as life and relationship changes after a stroke and that patients need support. Rehabilitation has the task of helping and it is important that patients get started with this after stroke. It is also important that patient participates and performs self-care for the rehabilitation to give results. An assessment must be made by the patient to see if he needs help with performing his own care. Participation and person-centered care during recovering after a stroke are important. One of the most important tasks of the nurse is to promote patients´ health and alleviate their suffering. Conclusion: The results of the literature study show that it is important to increase participation in the health process for patients with stroke. Patients experience physical and mental limitations after a stroke, and it can be difficult for them to accept and process their feelings. Focus, planning, and motivation are important för stroke patients. It is important that the nurse offers support to the patient's relatives when a of the family member suffers a stroke.

Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

: Stroke är ett samlingsnamn för kärlsjukdomar i hjärnan som ger upphov till akuta symtom. Vid stroke drabbas hjärnans vävnad av bristande blodtillförsel (ischemi). Orsaker till ischemi kan var blödning eller tilltäppning från en central artär . Patienterna som överlever stroke har ofta någon typ av fysisk funktionsnedsättning kvar. Detta kan medföra känslomässiga och kognitiva komplikationer, vilket i sin tur kan leda till isolering. Däremot finns det patienter som har hopp och acceptans trots tillståndet. Syfte : Syftet med denna litteraturstudie var att beskriva patienters erfarenheter efter en stroke. Vidare var syftet med studien att beskriva de inkluderade artiklarnas undersökningsgrupp. Metod : Vår metod var en litteraturstudie av deskriptiv design som grundar sig i tolv vetenskapliga artiklar. Artiklarna valdes från databaserna PubMed och Cinahl. Huvudresultat : Resultatet i studien visar på att patienter efter stroke ofta lider av någon grad av funktionsnedsättning, kognitiva eller känslomässig som leder till isolering. Dock får vissa patienter acceptansen av det nya tillståndet och bestämmer sig för att hantera sin vardag genom att lära sig nya sätt som är anpassade till nya aktiviteter. Slutsats : Samtliga deltagare har fått ett annorlunda liv med olika grad och form av funktionshinder som påverkar deras liv. Det dagliga livet blev svårare att hantera vilket ofta ledde till psykisk påfrestning. För de, med låg KASAM, som inte kunde acceptera sin förändrade livssituation kunde påfrestningarna medför isolering från omvärlden. Att var beroende av närstående kunde vara krävande men av stor betydelse under hela återhämtningsprocessen. Nyckelord :

Context/issue: Stroke is the major cause of disability in both Scotland and Portugal. It is estimated that each year stroke affects 15,000 people in Scotland and approximately 21,000 in Portugal, and possibly one-third of these individuals require rehabilitation. Research (Ekberg et al., 2002; Wright et al., 2005) has identified that the quality of the mealtime experience for patients affected by stroke in rehabilitation is poor, which may be demotivating and a factor in influencing recovery. Questions and previous studies: Is there an opportunity for design methods and approaches to help understand and improve the patient mealtime experience and if so, how? In previous studies, Cottam and Leadbeater (2004), Murray et al. (2006) and Boyle and Harris (2009) suggest that the integration of multi-stakeholders’ participation into the design process can be valuable. Bate and Robert (2007) suggest directly taking account of patients’ and healthcare professionals’ experiences – “the real virtuosos of the experience” (Sanders, 2001) – as the basis for designing service improvements and, consequently, better experiences. So, can design approaches help elicit patients’ and healthcare professionals’ “voices” and can these voices be used to help enhance the quality of the mealtime experience for patients undergoing stroke rehabilitation and if so, how? Methodology: This thesis adopts a participatory design (PD) approach to play a role in engaging and structuring the direct participation of patients and healthcare professionals in research. This method encompasses socialised and materialised situations in time and space with a focus on understanding the reasons behind current experiences while also exploring desirable futures. The analysis is based on translating and interpreting those patients’ and healthcare professionals’ voices, using the principles of framework analysis. Subjects, methods and activities: This pilot study included 11 participants comprising 6 healthcare professionals: a nurse, speech therapist, occupational therapist and dietician; and 5 patients who had a clinical diagnosis of stroke and eating difficulties. This research employed the following data collection techniques within a participatory design (PD) framework: i) integrating 4 interviews with observations, ii) 5 interviews combining a tool (storyboard) and a technique (nurse verbalising), and iii) 2 workshops acting as games. This chosen study design facilitated the aligning of different design situations where patients and healthcare professionals were temporarily engaged in discussing the present experiences, and, subsequently, in two different groups, suggesting ideas for future experiences. In this research study, PD methods were adapted to permit patients to participate, so that tools and techniques become connected, flexible and adapted to better accommodate their individual needs. Findings: This study found that socio-cultural differences highlight different perspectives: what patients imagined as desirable experiences differed from the views of the healthcare professionals. The study found that the current mealtime experience largely reflects a pre-occupation within functional rehabilitation issues, such as swallowing, but both patients and healthcare professionals highlight issues of subjective well-being which were not well-catered for. However, both patients and healthcare professionals emphasised complementary concerns about the mealtime, such as: experiencing positive socialisation; sensorial stimulation in ways that evoke well-being; and environmental factors designed to accommodate individual needs. The “What if” situations allowed patients and healthcare professionals to imagine a desirable design of the mealtime experience. These findings highlight the reconsidering the idea of the mealtime as one which offers a desirable and temporary break from the clinical “mechanistic” routine to create an opportunity to celebrate life and influence the patients’ emotional state in positive ways. Discussion In this study, eliciting multi-voicedness through a process of inquiry by engaging patients and healthcare professionals has brought forth new insights and issues. The method enabled the building of scenarios, not only to translate both the patients’ and healthcare professionals’ voices into visual narratives of both what happens presently and their desirable future experiences. This process made information-sharing between different individuals and the two groups possible. Originality of contribution, implications of findings and future work This is the first study to consider the voices of the patients and healthcare professionals in the mealtime experience for people affected by stroke. Here, some of the participants involved were at the extreme end of their ability to participate due to being fatigued by their condition. The work has shown how methods derived from PD can still be applied in these conditions but they must be adapted and evaluated in ways that do not cause tiredness for patients. The combination of methods has opened up new possibilities for patients, those affected by stroke, and their therapists, to actively engage and participate with their own experiences and ideas. By eliciting these voices, this research study has made a contribution to knowledge by obtaining an understanding of the patient experience at the mealtime. While PD methods have helped to evaluate the way the International Classification of Functioning (ICF) model is currently being applied in this context and have helped to show what issues are not being addressed, this study has further developed and tested new PD approaches and methods in this setting and has provided insights on the modifications required and their implications for participants. The adoption of a PD approach revealed a novel and valuable way to highlight the pre-occupation with functional restoration in rehabilitation and revealed the absence of certain aspects of the ICF model from practice that are important to patients, such as attention to subjective well-being. In this way, this study has revealed how employing a PD approach can potentially improve the delivery of the ICF model. The approach and techniques used here may be appropriate to be employed in other healthcare settings. This study will therefore be of interest across healthcare communities looking for new and useful ways of improving the patient experience.

Aim: The aim was to describe adult patients quality of life after cardiac arrest and resuscitation with CPR. Method: A literature overview based on eight scientific articles and one master thesis. Results: The result is presented in three categories, physical, psychological and social quality of life. Sleeping disorders, fatigue and low energy level affected the physical quality of life in a negative way. The psychological quality of life was often impaired the first time after the cardiac arrest, to be improved over time. Number of patients described a will to change their life, to put priorities straight and live for the moment. The social quality of life was affected by several factors such as social isolation, work disability and impaired social network. Several patients had to move to sheltered accommodation and many more patients was relaying on others to manage their activity of daily living (ADL). Other patients described no change regarding their social quality of life. Conclusion: The results showed that very few people survived a cardiac arrest, but once survival was achieved, a fairly good quality of life could be expected. Several of the studies also showed that patients can have a good quality of life despite physical, psychological and social dysfunction.

Bakgrund: Stroke är en av det vanligaste folksjukdomar i Sverige. De som överlever      strokeanfall drabbas av varierande grad av aktivitet och funktionsnedsättningar, som i sin tur kräver rehabilitering. Syfte: Syftet med litteraturstudien var att beskriva patienters upplevelse av rehabilitering efter stroke. Metod: Litteraturstudien genomfördes genom att söka ett antal artiklar i databaserna Cinahl Complete och PubMed.  Resultat: Strokedrabbade hade oftast en önskan om att återgå till sitt gamla liv före insjuknandet. De som drabbas av en omfattande stroke kan påverkas både fysiskt och psykiskt. Tillståndet sänker livskvalitén, självständighet och självkänslan. Entusiasm och positiv attityd från rehabiliteringspersonal beskrevs som grundläggande för en lyckad rehabiliteringsprocess. Med rätt stöd från rehabiliteringspersonal förbättrades patienternas kognitiva och instrumentella funktioner samt att självkänslan stärktes. Rehabilitering behöver startas så snarast som möjligt för att förhindra en långdragen funktionsnedsättning. Den bör anpassas efter individens förutsättningar. Slutsats: Patienter hade delade upplevelser gällande stöd, information, delaktighet och effekten av rehabilitering. Det är betydelsefullt att sjuksköterskan har ett individanpassat förhållningssätt utifrån patientens förutsättningar. Rätt stöd och lyhördhet från vårdpersonalen bidrar till ökad delaktighet samt att den ökar patientens förutsättningar att utföra aktiviteter under rehabiliteringsprocessen. Rehabilitering behövs oavsett boendemiljö och ska vara av hög kvalité för ett positivt resultat.
Background: Stroke is one of the most common diseases in Sweden. Those who survive strokes suffer from varying degrees of activity and disabilities., which in turn require rehabilitation. Aim: The purpose of this literature study was to describe patients' experiences of rehabilitation after stroke. Method: The literature study was carried out by searching for a number of articles in Cinahl Complete and PubMed. Results: Stroke sufferers usually had a desire to return to their old life before falling ill. Those who suffer from an extensive stroke can be affected both physically and mentally. The condition lowers the quality of life, independence, and self-esteem. Enthusiasm and positive attitude from rehabilitation staff was described as fundamental to a successful rehabilitation process. With the right support from rehabilitation staff, the patients' cognitive and instrumental functions were improved, and self-esteem was strengthened. Rehabilitation needs to be started as soon as possible to prevent a long-term disability. It should be adapted to the individual's conditions. Conclusion: Patients had shared experiences regarding support, information, participation, and the effect of rehabilitation. It is important that the nurse has an individualized approach based on the patient's conditions. The right support and sensitivity from the care staff contributes to increased participation and that it increases the patient's ability to perform activities during the rehabilitation process. Rehabilitation is needed regardless of living environment and must be of high quality for a positive result.

Background: Various follow-up studies show that there are deficiencies in the care of patients affected by stroke. In order to provide good care according to the National Board of health and welfare and national guidelines for stroke care systematic quality audits need to be carried out. Purpose: To investigate if the local guidelines for stroke care in Örebro County are followed and to explore how people with stroke experience care and rehabilitation in hospital, primary care and community. Method: Primary health care records were reviewed using quality indicators in the local stroke guidelines. Samples of patients were obtained from the County´s three hospitals. Differences between men and women, younger and older, were analysed with chi-squared test. Eleven people were interviewed about their experiences of care, rehabilitation, support and participation. The interviews were analysed with qualitative content analysis. Result: 123 records were reviewed and for 69% referrals had been sent to the primary health care. Of the referred patients 78% were followed up within 6 months. Men were treated in significantly higher extent with lipid-lowering medicines compared with women, and people below 75 years in significantly higher extent than those over 75 years. Diagnosis was significantly more frequent registered in records for younger people. The interviewed people were at large satisfied with the hospital care. Those who lived in municipal residents enjoyed company of the staff and the other people living there but could also feel restricted by the ward routines and partially lose their autonomy. Some experienced the primary health care as a security while others experienced a lack of follow-up despite the fact that it happened.  Several felt not involved in the health care planning, but instead relied on staff´s judgement. Conclusion: Quality indicators were met in large in the primary health care but there were differences between gender and between older and younger. People were generally satisfied with care but they did not feel involved in the health care planning. People living in municipal  residents experienced some shortcomings and described loss of autonomy.

Purpose: The purpose of this study was to explore the efficacy of an interdisciplinary intervention on interdisciplinary teamwork and patient functional outcomes in an acute inpatient rehabilitation unit at a mid-sized regional hospital. Design: Pilot mixed-methods pre-post intervention study. Methods: Interdisciplinary teamwork and patient functional outcomes were measured before and after a teamwork intervention. Interdisciplinary teamwork was measured with the Healthcare Team Vitality Instrument (HTVI) and a qualitative staff questionnaire developed by a content expert. Patient functional outcomes were measured by aggregated Functional Independence Measure (FIM®) scores. Findings: Post-intervention FIM® gain scores increased significantly (p = .008). Staff questionnaire revealed improvement in interdisciplinary teamwork, with the major themes of teamwork and appreciation/respect. Post-intervention HTVI showed no significant change (p=.528). Conclusions: Initial results of this intervention are promising; additional research is needed to study the effectiveness of this intervention in a variety of acute rehabilitation settings. Clinical Relevance: Rehabilitation leaders can implement low-cost teamwork interventions to improve interdisciplinary teamwork and patient outcomes.

Background: Alcohol Related Brain Damage (ARBD) is an umbrella term used to describe the range of effects that long-term consumption of alcohol can have on the structure and function of the brain. Despite the increasing prevalence of ARBD, there is a lack of research in this area, and as a result, there are no current guidelines and few services available for the treatment of this condition. There is therefore a need to increase the evidence base in this area, which will assist in the understanding, and ultimately treatment, of ARBD. Aims: This thesis consists of two parts. The first is a systematic review journal article which asks the question: “What is the impact of alcohol-abuse on memory function within the first three weeks of alcohol withdrawal?” The second part is a qualitative research project which aims to develop a grounded theory regarding the patient experience of ARBD, identifying and highlighting themes and concepts that are central to the experience. Methods: For the systematic review, four databases were searched. Studies that were included in the review had to have participants with alcohol-dependence; abstinence of less than or equal to three weeks; and to have undergone some form of neuropsychological assessment of memory function. Data from 15 articles were extracted and assessed for quality. For the qualitative study, participants (n=10) were interviewed regarding their experiences of ARBD and the data was then analysed using grounded theory methodology. Results: The results of the systematic review were somewhat ambiguous with some studies reporting impairments in verbal and visual memory, while other studies found no impairments. Episodic memory deficits were present in all studies reviewed. The results of the qualitative study propose a tentative model which describes “transformation through adaptation”. This model hypothesises that successful negotiation of the journey through ARBD hinges on the adaptations that need to be made in order to progress towards transformation. The model is understood in the framework of a number of phases, “Being diagnosed with ARBD, “Focusing on abstinence”, “Taking ownership of life with ARBD” and “Creating a valuable life”, all of which exist within a framework of being supported by specialist services. Conclusions and implications: The systematic review demonstrated some support for deficits in visual and episodic memory within the first three weeks of abstinence, while it appeared that verbal memory was relatively preserved. The heterogeneity of the studies, coupled with the methodological variability, meant that all conclusions need to be considered as tentative, and be interpreted with caution. The main difficulties with interpretation were to do with the confounding factors often found within this client group. The results reinforce the concept of tailored treatment programmes for individuals due to the large variability of the effect of alcohol (and other factors). The qualitative study proposes a model that shows how adaptation appears to play a key role in the successful negotiation of a diagnosis of ARBD. The study describes a series of categories that can be used as a framework to identify and support the changes that are necessary for recovery and reintegration. The value in this study is that the results are directly attributable to individuals who have been diagnosed, and are now successfully living, with ARBD.

Bakgrund: Att insjukna i stroke innebär en förändrad livssituation både för den som drabbats av stroke men också dess anhöriga. Fysiskt, psykiskt, socialt och existentiellt välbefinnande är faktorer som påverkar situationen och sjuksköterskan har en väsentlig roll i att stötta patienten under rehabiliteringen. Syfte: Syftet med studien var att beskriva hur patienter upplevde hälsa och välbefinnande efter stroke. Metod: En litteraturstudie med kvalitativ design där 12 olika kvalitativa artiklar har analyserats. Resultat: Fyra olika kategorier presenterades utifrån begreppet hälsa: fysiskt, psykiskt, socialt och existentiellt välbefinnande vilka var faktorer som påverkades efter att en patient insjuknat i stroke. Faktorer som påverkade patientens hälsa och välbefinnande negativt var nedsatt mobilitet, ätsvårigheter, fatigue, isolering, minskade sociala relationer och oförmåga att kunna arbeta medan faktorer som påverkade patienten positivt var stöd från familjen, betydelsefulla aktiviteter och förbättrade hälsovanor. Slutsats: Litteraturöversikten bidrar med kunskap om patienters upplevelser efter att ha insjuknat i stroke, vilket ger vårdpersonal och andra människor i patienternas omgivning förutsättningar för att de lättare ska kunna bemöta patienter som insjuknat i stroke.

Jönsson, J & Persson, TAfasi. En litteraturstudie om kommunikation vid afasi orsakad av stroke.Examensarbete i omvårdnad 10 poäng. Malmö högskola: Hälsa och samhälle, utbildningsområde omvårdnad, 2007.Afasi är ett samlingsnamn för språkliga skador och kan drabba människor i alla åldrar. Cirka 12 000 personer drabbas årligen i Sverige av afasi vilket är en vanlig åkomma efter stroke. Individen med afasi och dennes anhöriga känner en frustration då de inte kan kommunicera med varandra, sjuksköterskan går här in och stöttar både patient och anhöriga. Syftet med denna litteraturstudie var att belysa kommunikationen mellan sjuksköterska och patient med afasi. Frågeställningarna var: vilka metoder använder sjuksköterskan för att kommunicera med patienten? Hur upplever sjuksköterskan kommunikationen med patienter med afasi? Hur upplever patienten sin situation vid kommunikationssvårigheter? Litteraturstudien omfattar både kvalitativa och kvantitativa studier. Resultatet visade att sjuksköterskans kommunikations -metoder består av att skapa en relation med patienten, visa empati, använda fysisk beröring, kroppsspråk samt humor. Sjuksköterskan känner empati för patienten och hon upplever patientens situation som tragisk och stöttar honom genom att visa uppmärksamhet och uppmuntran. Patienten kan känna sig frustrerad och deprimerad av att inte kunna uttrycka sig verbalt. Resultatet diskuteras utifrån Virginia Hendersons omvårdnadsteori. En konversation behöver inte innehålla ord, utan en förståelse kan även nås genom att använda kroppsspråk och fysisk beröring. Nyckelord: afasi, kommunikation, patient, relation, sjuksköterska, stroke, upplevelser.
Jönsson, J & Persson, TAphasia. A literature review about communication at aphasia caused by a cerebrovascular accident.Degree Projekt, 10 Credit Points. Nursing Programme, Malmö University: Health and society, Department of Nursing, 2007. Aphasia is a common name for several speech disabilities and this can affect people in all ages. Approximately 12 000 people develop aphasia every year in Sweden and it is a common sequel after a cerebrovascular event. The patients and their relatives feel a frustration when they can not communicate with each other, and the nurse needs to support both parties. The aim of this review-study was to illuminate the communication between the nurse and the patient with aphasia. The questions at issue were: which methods does the nurse use when communicating with the patient? How does the nurse experience the communication with patients who have aphasia? How does the patient experience the situation when having difficulties to communicate? This literature study is based on qualitative and quantitative studies. The results show; that methods used by the nurse to communicate include the ability to create a relationship with the patient, show empathy, use physical touch, body language and humour. The nurse experience sympathy for the patient and find the situation most tragic. She or he supports the patient by showing attention and encourage. The patient can be frustrated and depressed by not being able to verbally express himself/herself. The results are discussed on the basis of Virginia Henderson’s theory. A conversation does not necessarily need words, comprehension might also be achieved by using body language and physical touch. Keywords: aphasia, cerebrovascular accident, communication, experience, nurse, patient, relation.

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Aims and objectives; We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs' views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored. Design A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice. Results Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home-based atmosphere. The formal, or 'hard', process of rehabilitation was not well understood by patients. They were primarily concerned with 'soft' or process issues ¿ where and how care was delivered. Conclusions We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.

The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the 
functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the 
outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered 
questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating 
to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised 
outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human 
subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package 
2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using 
chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93 
with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke 
was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All 
patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients 
(80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle 
weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following 
domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p<
0.0001) and stroke (p<
0.0001) 
between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on 
admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple 
redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p<
0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity 
limitations and participation restrictions still experienced at the time of discharge. The latter finding 
questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation 
programme and referral process .

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia
Resumo: Introdução: A reabilitação em pacientes após sequelas de AVE é importante para minimizar as incapacidades funcionais. Assim, vários estudos têm utilizados o programa de ensino de autogestão sobre pacientes com sequelas de AVE. Objetivo: Avaliar os efeitos de um programa de ensino de autogestão em pacientes com sequelas de AVE. Metodologia: Foi realizada uma pesquisa computorizada com palavras-chaves nas bases de dados PubMed e PEDro e no motor de busca B-on de modo a encontrar artigos publicados na última década, randomizados controlados, publicados em inglês, e que abordassem o tema da autogestão na recuperação dos paciente com AVE. Foram excluídos estudos sem texto integral disponível e artigos duplicados. Resultados: Foram selecionados cinco artigos randomizados controlados com qualidade de metodologia de 6,8 na escala de PEDro. Conclusão: Os resultados análisados mostram que parece existir benefícios na reabilitação com um programa de ensino de autogestão em pacientes com sequelas de AVE, pelo que poderá ser um ferramenta terapêutica a aplicar em programa de fisioterapia.
Introduction: Rehabilitation in patients following stroke sequelae is important to minimize functional disabilities. Thus, several studies have used the Self-Management Program on patients with stroke sequelae. Aim: To evaluate the effects of a Self-Management Program in patients with stroke sequelae. Methodology: A computerized search with keywords in databases of PubMed, PEDro and B-on, in order to find articles published in the last decade, randomized controlled trials, published in English and that addressed of the Self-Management Program in the recovery of stroke. Results: Five randomized controlled articles with a methodology quality of 6.8 were selected on the PEDro scale. Conclusion: The analyse results show that there are benefits in the rehabilitation with Self-Management Program in patients with stroke sequelae.
N/A

Stroke är en stor orsak till funktionsnedsättningar. Dödligheten från stroke har minskat de senaste åren och därmed har antalet överlevanden med funktionsnedsättningar ökat. Svårigheten av en funktionsnedsättning kommer sig av vad den leder till för den enskilde individen. Målet vid omvårdnaden vid stroke ska individualiseras och arbeta för att uppnå största möjliga hälsa. Meleis transitionsteori beskriver en individs övergång från ett stabilt tillstånd till ett nytt och processen däremellan. Syfte: Syftet med denna litteraturstudie var att beskriva patienternas upplevelser av funktionsnedsättningar efter stroke. Metod: Litteraturstudie baserad på tio vetenskapliga artiklar. Resultat: De strokedrabbade upplevde emotionella reaktioner av de funktionsnedsättningar som de drabbats av. De upplevde också förändringar i sina dagliga aktiviteter och hur de genomförde dessa. De upplevde en förlust av sin identitet och de förlorade sin autonomi i och med att de inte längre kunde klara sig själva. Slutsats: Denna litteraturstudie visar att patienter upplever funktionsnedsättningar efter stroke som en livsförändrande händelse som påverkar hela deras liv. De som drabbas är inte förberedda på i hur stor utsträckning de kommer att påverkas, både socialt och emotionellt, av funktionsnedsättningarna. De tvingas att omstrukturera vardagen, vilket ofta upplevs frustrerande och är tidskrävande
Stroke is a major cause of disability. Mortality from stroke has decreased in recent years and therefore the number of survivors with disabilities has increased. The difficulty of a disability is defined from what impact the disability has on the individuals’ life. The goal of nursing in stroke should be individualized and aim to achieve maximum health. Meleis transition theory describes an individual's transition from one stable state to a new one and the process in between. Purpose: The purpose of this study is to describe patients' experiences of disability after stroke. Method: Literature study based on ten scientific articles. Results: The stroke victims experienced emotional reactions from the disabilities that they had suffered. They also experienced changes in their daily activities and how they carried them through. They experienced a loss of their identity and they lost their autonomy in that they no longer could care for themselves Conclusion: This literature review shows that patients experience impairments after stroke as a life-changing event that affects their entire lives. Those affected are not prepared for how much they will be affected, both socially and emotionally, by their impairment. They are forced to restructure everyday life which is often frustrating and time-consuming

Att drabbas av en hjärtinfarkt innebär psykisk och fysisk påfrestning för patienten, och efterföljande hjärtrehabilitering ställer krav på livsstilsförändringar. Stödet från vårdpersonal och socialt nätverk har betydelse för patientens förmåga att hantera sjukdomen och dess konsekvenser. Syftet med föreliggande litteraturstudie var att beskriva patienters behov av stöd i samband med rehabilitering efter en hjärtinfarkt. Studiens resultat baseras på 13 vetenskapliga artiklar. Resultatet visar att patienterna är i behov av professionellt stöd, stöd i det dagliga livet samt stöd genom delade upplevelser. Stödet från familjen är betydelsefullt för genomförandet av livsstilsförändringar, och rehabiliteringen kan påverkas negativt om anhöriga ställer för höga krav eller agerar överbeskyddande. Patienterna fann stöd i gemenskapen i rehabiliterings- eller stödgrupper och lyckades i större utsträckning med företagna livsstilsförändringar. Dock ansågs grupperna vara svåra att anpassa efter deltagarnas individuella behov. Individanpassad information och hjälp med strategier att hantera stress i det dagliga livet efterfrågas av patienterna. För att erbjuda optimala rehabiliteringsmöjligheter krävs att sjukvården tar hänsyn till varje enskild patient och individanpassar rehabiliteringsprocessen inom ramen för befintliga riktlinjer och möjligheter. Vidare forskning inom stöd och rehabilitering efter hjärtinfarkt är önskvärd för att utreda hur rehabiliterings- respektive stödgrupper optimalt kan anpassas efter deltagarnas olika behov.

To be stricken with a myocardial infarction implies psychological and physical strain for the patient, and the following cardiac rehabilitation make demands on lifestyle changes. Support from nursing staff and social network are of importance for the patient's ability to deal with the disease and its consequences. The aim of this study was to describe patients need for social support in rehabilitation following a myocardial infarction. The results are based on 13 research articles. The results indicate that the patients are in need of professional support, support in the daily life and support through shared experiences. The social support from the family is significant for the accomplishment of lifestyle changes, and the rehabilitation is negatively affected if the family makes too high demands or act overprotective. The patients found social support in the fellowship of rehabilitation- or support groups and succeed to a greater extent in achieving lifestyle changes. However there are difficulties in adjusting these groups to the participants’ individual needs. Individually adjusted information and assistance with strategies to handle stress in the daily life are demanded by the patients. To be able to offer optimum rehabilitation, the healthcare needs to take into consideration every patient and individualize the rehabilitation process within available guidelines and possibilities. Further research in support and rehabilitation after a myocardial infarction is desirable to investigate how rehabilitation- and support groups can be adjusted based on the different needs of the participants.