A Framework for Care During the Stroke Experience

Abstract

This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms "stroke," "stress," "coping," "chronic illness," and "transitions and growth" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences.

Uncovering Treatment Burden as a Key Concept for Stroke Care: A Systematic Review of Qualitative Research

“…Treatment burden has not been well examined in relation to stroke. Previous syntheses of qualitative studies in stroke have focussed either on the patient experience of illness rather than treatments [26],[27],[28] or on the experience of informal carers [29],[30]. A few syntheses have explored the patient experience of stroke treatments, but these have concentrated either on one specific aspect of the management process [31]–[38] or specifically on the interaction between patient and health care providers [39]–[41].…”

A review of the early discharge experiences of stroke survivors and their carers

“…2000, p. 511). Indeed, it has been suggested that stroke has a far greater impact on an individual than other diseases because brain function is at the very essence of what we regard as ‘humanness’ (Brauer et al. 2001, p. 90).…”

Long-term outcomes of stroke rehabilitation: patients and informal caregivers

“…But, stroke patients' experience of life after the event is characterized by existential aspects of suffering and loss (Pilkington, 1999;Secrest & Thomas, 1999). Stroke is considered to be a lifetransforming event by those it affects (Brauer, Schmidt, & Pearson, 2001). Much has been reported on patients' post-discharge limitations in physical (de Wit et al, 2007), cognitive (Wagle et al, 2011), and emotional functioning (Bergersen, Frey Froslie, Stibrant Sunnerhagen, & Schanke, 2010;Herrmann, Black, Lawrence, Szekely, & Szalai, 1998).…”

“…Notwithstanding the fact that patients may have regained a certain level of functioning, most patients cannot return home without informal care and the support of a social network (Meijer et al, 2004). The immediate post-discharge period is described as difficult, demanding and stressful , and greatly marked by uncertainty (Brauer, et al, 2001;Carlsson, Möller, & Blomstrand, 2009). It is probably only at home that patients and their families will fully understand the consequences imposed by stroke (Olofsson, Andersson, & Carlberg, 2005).…”