Discuss About The Generating Assessing Evidence For Nursing.
Rehabilitation of the patients after the stroke is very crucial and overall affects the wellbeing of the patient throughout the life. In has been found that most of the patients have their needs unaddressed. It is the amount and the type of the rehabilitation that has been found to be important for the recovery of these stroke patients (Cameron et al., 2013). There were studies that have shown that the informal caregivers play an important role in the rehabilitation of the patients and that they should be more involved in the rehabilitation process. And hence their perception regarding the rehabilitation process is important. Thus perception is also important because in many cases the informal care givers are elderly and hence suffer from both physical as well as psychological burden(Cameron et al., 2013). Hence any future interventions should be set as per the psychosocial needs of both the patients and the care givers. This paper appraises a paper regarding the patient and the caregiver’s perception regarding stroke rehabilitation.
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with
stroke and their carers regarding rehabilitation needs 1
year after stroke:
A mixed methods study. British Medical Journal, 5(2), 1?7. Retrieved from: https://bmjopen.bmj.com/content/5/2/e006784
Lisa Ekstam, having affiliations from the division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden and Department of Occupational Therapy, Karolinska University Hospital, Stockholm, Sweden
Ulla Johansson, affiliated byDivision of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden and Department of Clinical Research, Uppsala University/County Council of Gävle, Gävle, Sweden.
Susanne Guidetti, affiliated by the Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
Charlotte Ytterberg, affiliated byDivision of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden, Department of Clinical Neuroscience, Division of Neurology, Karolinska University Hospital, Huddinge, Sweden and Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
How may a caregiver effectively support a (67 year old female) family member with her activities of daily living following a stroke?
The aim of this study is to understand the association between the dyad’s (person having stroke and informal caregiver) viewpoint of the individual with the requirements for the rehabilitation of stroke and the severity of the stroke.
The study has used a mixed method combining both the qualitative and the quantitative data analysis. This study has been conducted on the basis on the secondary analysis of a data of an observational study of the progression of rehabilitation after the stroke. Both qualitative and quantitative analysis have disadvantages (Greenhalgh et al.,2016). Combination of the methodologies helps in the reduction of the biases. Furthermore it combines both the inductive and the deductive thinking, where the researcher can communicate both with words as well as number to deal with audiences (Greenhalgh et al.,2016).
86 persons with stroke (38 % women with mean age 73 years) and their caregivers (40 % women with mean age 65 years were taken for the interview.
The sample size has been described in much details but the sample size was low, which reduced the precision and the interpretation of the results (Greenhalgh et al.,2016).
The candidates for the observational study were taken from the three stroke units of the Karolinska University Hospital between 15 May 2006 and 14 May 2007 and 349 candidates were included in the study “life after stroke phase I”.
Data regarding the age, sex, and severity of the stroke were collected at the baseline level by the conduction of structured as well as semi structure interviews i.e questionnaires and open ended questions (Ekstam et al., 2015).
The patient was asked to choose a personal care giver for the interview, which could be their children or friend or partner. The participants chosen for this study had been the participant of LAS-I. The questionnaire was based on the taxonomy prepared by Ware and generally covered all the extent of patient satisfaction (Greenhalgh et al.,2016). Among the different questions asked, a particular statement addressed the level of satisfaction regarding the requirements of rehabilitation and hence was considered as the dependent variable for the study. The five graded Likert scale was used to score the statements. This scale is useful in measuring the levels of agreement or disagreement for measuring the attitudes of the patients (Greenhalgh et al.,2016).
A similar questionnaire was also prepared for the informal care givers, at 3 months after the stroke. The rating given by the caregivers on the basis of Likert scale with “agree and do not agree” as the end options. The sense of coherence was used by the SOC scale.
The burden of the caregiver was been assessed by the Care giver’s burden scale. Open ended questions were asked regarding the modifications that had come in the daily life of the patients or any activity where the patient has asked for their assistance (Myers et al., 2013).Open ended questions allow the respondents to include attitudes, feelings and their perceptions of the subject as they do not limit the answers.All the outcome measure were valid and reliable (Myers et al., 2013).This study has been conducted on the basis of self-reported data and may cause biases.
Anofficial written consent has been taken from the participants. The ethical approval was taken from the Regional Ethical Review Board in Stockholm, Sweden.
Tools used for the data analysis
The Kruskal Wallis ANOVA test was used to find out any statistical difference between the three groups of joint perception such as the SOC, age and the use of the inpatients (Grove et al., 2016). The χ2 test was used for detecting the distinction between the combined perception groups with context to age, stroke severity and informal care. The Mann Whitney U test was used to measure the comparison between the combined ideas of the rehabilitation needs. Content analysis was used for analysis the question and answers. This approach has been used correctly for examining the data by adhering to the naturalistic paradigm (Grove et al., 2012). Mixed model analysis was made to analyze the qualitative and the quantitative findings(Greenhalgh et al.,2016).
52 % of the dyads have professed that rehabilitation was achieved 12 months after the stroke. Rehabilitation was found to be met more in less severe strokes. And hence it can be said that the research question was answered as the paper has been successful in proving the role of the caregiver’s perception in rehabilitation of the patient. It is both the psychosocial wellbeing of the patient and the caregivers that the matters in stroke rehabilitation.
The strengths of this study is that it is a mixed method that applies makes the use of both the qualitative as well as the quantitative analysis that helps to provide a more comprehensive scenario of the rehabilitation after the stroke. The dyadic viewpoint of this paper helps to provide knowledge about the use of the systemic approaches used in the rehabilitation and the importance of the social environment (Cumming et al., 2013).
Some of the limitations of the study is that the open ended question used are not sufficient to compare between the partners present in the dyads. The responds taken from the persons with strokes are not rich for making the comparison between the individuals of the dyads. The response taken from the persons with strokes and he caregivers were analyzed distinctly and compared between the caregivers and the person affected from stroke in a group level (Polit&Beck, 2018). Another limitation was the smaller sample size and the SOC scale was not used for the caregivers.
The clinical implication of this study is that the addition of the caregivers and other people in the rehabilitation of the stroke patients would be useful (Tistad et al., 2013). From the findings that moderate to severe stroke requires more rehabilitation; the extent of the interventions required could be easily decided in the future.
The most important barrier for the use of the research findings from the nurse’s perspective is the lack of time, organizational factors such as guided protocols for the nurses, lack of organizational and financial support, low ability of understanding of the medical reports and improper system for the adequate development of the nurses.
Conclusion
In conclusion it can be said the extent of the rehabilitation and its fruitfulness can be dependent upon the psychological and the physical support provided by the caregivers. Further it has also been found that the rehabilitation interventions for the person suffering from stroke has to focus more on the psychological wellbeing of both the patient as well as the personal caregiver (Cumming et al., 2013). Using the perception of the caregivers would definitely help in the making of suitable interventions for the rehabilitation of the stroke patients. The studies have also been successful in showing the home driven care has been found to be more useful than the hospital stay. However it has also been observed that the psychological wellbeing of the patient also depends upon the burden on the caregivers.
Normally the care givers are not involved in the planning of the stroke survivor’s rehabilitation regimen. Form these papers it can be understood that involving the caregivers in the decision making process can provide the patient centered viewpoints and further help in the appropriateness of the prescribed rehabilitation interventions.
References
Cameron, J. I., Naglie, G., Silver, F. L., &Gignac, M. A. (2013). Stroke family caregivers’ support needs change across the care continuum: a qualitative study using the timing it right framework. Disability and rehabilitation, 35(4), 315-324. https://doi.org/10.1111/hex.12095
Cumming, T. B., Marshall, R. S., & Lazar, R. M. (2013). Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. International Journal of Stroke, 8(1), 38-45.Retrieved from: https://journals.sagepub.com/doi/abs/10.1111/j.1747-4949.2012.00972.x?journalCode=wsoa
Greenhalgh, T., Bidewell, J., Crisp, E., Lambros, A., &Warland, J. (2016). Understanding Research Methods for Evidence-Based Practice in Health.
Grove, S. K., Burns, N., & Gray, J. (2012). The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=r32jPNVYIacC&oi=fnd&pg=PA4&dq=Grove,+S.+K.,+Burns,+N.,+%26+Gray,+J.+(2012).+The+practice+of+nursing+research:+Appraisal,+synthesis,+and+generation+of+evidence.+Elsevier+Health+Sciences.&ots=viq6T0j26J&sig%20of%20nursing%20research%3A%20Appraisal%2C%20synthesis%2C%20and%20generation%20of%20evidence.%20Elsevier%20Health%20Sciences.&f=false
Myers, J. L., Well, A. D., &LorchJr, R. F. (2013). Research design and statistical analysis. Routledge. https://www.taylorfrancis.com/books/9781135811563
Polit, D. F., & Beck, C. T. (2018). Nursing research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins. https://books.google.co.in/books?hl=en&lr=&id=Ej3wstotgkQC&oi=fnd&pg=PA1&dq=Polit,+D.+F.,+%26+Beck,+C.+T.+(2018).+Nursing+research:+Generating+and+assessing+evidence+for+nursing+practice.+Lippincott+Williams+%26+Wilkins.&ots=wgKCCMcxyq&sig=YTcaWHLRYTyGrwWVdzzZGi5zIvI#v=onepage&q&f=false
Tistad, M., Koch, L., Sjöstrand, C., Tham, K., &Ytterberg, C. (2013). What aspects of rehabilitation provision contribute to self?reported met needs for rehabilitation one year after stroke–amount, place, operator or timing?.Health Expectations, 16(3). https://doi.org/10.1111/hex.12095
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