Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care

Queralt-Tomas Mª Ll.; Gil-Guillen V. F.; Clua-Espuny J. L.; Forcadell-Arenas T.; González-Henares M. A.; Panisello-Tafalla A.; Ripolles-Vicente R.; López-Pablo C.; Lucas-Noll J.

doi:doi:10.11648/j.ajns.20150404.14

Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care

Queralt-Tomas Mª Ll., Gil-Guillen V. F., Clua-Espuny J. L., Forcadell-Arenas T., González-Henares M. A., Panisello-Tafalla A., Ripolles-Vicente R., López-Pablo C., Lucas-Noll J.

Published in American Journal of Nursing Science (Volume 4, Issue 4)

Received: 20 May 2015 Accepted: 6 June 2015 Published: 29 June 2015

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Abstract

Background. Stroke is characterized by its complexity as a result of residual deficits, dependence in basic activities of daily living, and new needs for caregivers. The purpose of this study was to propose nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers beyond the patient’s length of stay. Methods. This is a longitudinal prospective study of a population-based cohort of all cases recorded in inpatient care of a first episode of stroke that occurred between 1 April 2006 and 31 December 2014. Results. There were 1,494 cases (54.1% male) and the mean age was 77.4±12.9 years. Only 27.9% were evaluated by their disability after hospital discharge. Ischemic stroke treated with thrombolysis had the best results in mortality (6.3%) and Barthel score (85.5). Mild dependence for thrombolysis was OR=2.5 with RRR=46%, ARR=9.4%, and NNT=10 to get a Barthel score >60 at discharge. After the episode the percentage of individuals with moderate or greater dependence increased up to 22.5%, with a loss (p=0.023) higher in women, halving the number of individuals with early independence. Of the stroke survivors 43.4% went directly home after acute care and needed a home caregiver. Age (p<0.001) and NIHSS <12 (p=0.045) were identified as the only prognostic factors associated with mild dependence (Barthel>60).Conclusions. This study recommends consideration of special interests, both standardization of a discharge report as organizing an individualized primary care plan and the unification of processes for assessment of the situation of dependency among all public administrations to facilitate the necessary support planning for the stroke patient and their family in primary care.

Published in	American Journal of Nursing Science (Volume 4, Issue 4)
DOI	10.11648/j.ajns.20150404.14
Page(s)	166-173
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Stroke, Disability, Dependence, Basic Daily Activities, Caregiver, Primary Care

References

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Queralt-Tomas Mª Ll., Gil-Guillen V. F., Clua-Espuny J. L., Forcadell-Arenas T., González-Henares M. A., et al. (2015). Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care. American Journal of Nursing Science, 4(4), 166-173. https://doi.org/10.11648/j.ajns.20150404.14

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ACS Style

Queralt-Tomas Mª Ll.; Gil-Guillen V. F.; Clua-Espuny J. L.; Forcadell-Arenas T.; González-Henares M. A., et al. Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care. Am. J. Nurs. Sci. 2015, 4(4), 166-173. doi: 10.11648/j.ajns.20150404.14

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AMA Style

Queralt-Tomas Mª Ll., Gil-Guillen V. F., Clua-Espuny J. L., Forcadell-Arenas T., González-Henares M. A., et al. Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care. Am J Nurs Sci. 2015;4(4):166-173. doi: 10.11648/j.ajns.20150404.14

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@article{10.11648/j.ajns.20150404.14,
  author = {Queralt-Tomas Mª Ll. and Gil-Guillen V. F. and Clua-Espuny J. L. and Forcadell-Arenas T. and González-Henares M. A. and Panisello-Tafalla A. and Ripolles-Vicente R. and López-Pablo C. and Lucas-Noll J.},
  title = {Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care},
  journal = {American Journal of Nursing Science},
  volume = {4},
  number = {4},
  pages = {166-173},
  doi = {10.11648/j.ajns.20150404.14},
  url = {https://doi.org/10.11648/j.ajns.20150404.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20150404.14},
  abstract = {Background. Stroke is characterized by its complexity as a result of residual deficits, dependence in basic activities of daily living, and new needs for caregivers. The purpose of this study was to propose nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers beyond the patient’s length of stay. Methods. This is a longitudinal prospective study of a population-based cohort of all cases recorded in inpatient care of a first episode of stroke that occurred between 1 April 2006 and 31 December 2014. Results. There were 1,494 cases (54.1% male) and the mean age was 77.4±12.9 years. Only 27.9% were evaluated by their disability after hospital discharge. Ischemic stroke treated with thrombolysis had the best results in mortality (6.3%) and Barthel score (85.5). Mild dependence for thrombolysis was OR=2.5 with RRR=46%, ARR=9.4%, and NNT=10 to get a Barthel score >60 at discharge. After the episode the percentage of individuals with moderate or greater dependence increased up to 22.5%, with a loss (p=0.023) higher in women, halving the number of individuals with early independence. Of the stroke survivors 43.4% went directly home after acute care and needed a home caregiver. Age (p60).Conclusions. This study recommends consideration of special interests, both standardization of a discharge report as organizing an individualized primary care plan and the unification of processes for assessment of the situation of dependency among all public administrations to facilitate the necessary support planning for the stroke patient and their family in primary care.},
 year = {2015}
}

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TY - JOUR
T1 - Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care
AU - Queralt-Tomas Mª Ll.
AU - Gil-Guillen V. F.
AU - Clua-Espuny J. L.
AU - Forcadell-Arenas T.
AU - González-Henares M. A.
AU - Panisello-Tafalla A.
AU - Ripolles-Vicente R.
AU - López-Pablo C.
AU - Lucas-Noll J.
Y1 - 2015/06/29
PY - 2015
N1 - https://doi.org/10.11648/j.ajns.20150404.14
DO - 10.11648/j.ajns.20150404.14
T2 - American Journal of Nursing Science
JF - American Journal of Nursing Science
JO - American Journal of Nursing Science
SP - 166
EP - 173
PB - Science Publishing Group
SN - 2328-5753
UR - https://doi.org/10.11648/j.ajns.20150404.14
AB - Background. Stroke is characterized by its complexity as a result of residual deficits, dependence in basic activities of daily living, and new needs for caregivers. The purpose of this study was to propose nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers beyond the patient’s length of stay. Methods. This is a longitudinal prospective study of a population-based cohort of all cases recorded in inpatient care of a first episode of stroke that occurred between 1 April 2006 and 31 December 2014. Results. There were 1,494 cases (54.1% male) and the mean age was 77.4±12.9 years. Only 27.9% were evaluated by their disability after hospital discharge. Ischemic stroke treated with thrombolysis had the best results in mortality (6.3%) and Barthel score (85.5). Mild dependence for thrombolysis was OR=2.5 with RRR=46%, ARR=9.4%, and NNT=10 to get a Barthel score >60 at discharge. After the episode the percentage of individuals with moderate or greater dependence increased up to 22.5%, with a loss (p=0.023) higher in women, halving the number of individuals with early independence. Of the stroke survivors 43.4% went directly home after acute care and needed a home caregiver. Age (p60).Conclusions. This study recommends consideration of special interests, both standardization of a discharge report as organizing an individualized primary care plan and the unification of processes for assessment of the situation of dependency among all public administrations to facilitate the necessary support planning for the stroke patient and their family in primary care.
VL - 4
IS - 4
ER -

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Author Information

Queralt-Tomas Mª Ll.
Gil-Guillen V. F.

Miguel Hernández University, Family and Community Speciality, Elche, Spain
Clua-Espuny J. L.

Primary Care Services, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain
Forcadell-Arenas T.

Primary Care Services, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain
González-Henares M. A.

Primary Care Services, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain
Panisello-Tafalla A.

Primary Care Services, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain
Ripolles-Vicente R.

Primary Care Services, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain
López-Pablo C.

Department of Primary Care Research Institute (IDIAP) Jordi Gol, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain
Lucas-Noll J.

Primary Care Services, Health Department “Terres de l’Ebre”, Catalonian Health Institute, Tortosa, Spain

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Queralt-Tomas Mª Ll., Gil-Guillen V. F., Clua-Espuny J. L., Forcadell-Arenas T., González-Henares M. A., et al. (2015). Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care. American Journal of Nursing Science, 4(4), 166-173. https://doi.org/10.11648/j.ajns.20150404.14

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Queralt-Tomas Mª Ll.; Gil-Guillen V. F.; Clua-Espuny J. L.; Forcadell-Arenas T.; González-Henares M. A., et al. Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care. Am. J. Nurs. Sci. 2015, 4(4), 166-173. doi: 10.11648/j.ajns.20150404.14

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AMA Style

Queralt-Tomas Mª Ll., Gil-Guillen V. F., Clua-Espuny J. L., Forcadell-Arenas T., González-Henares M. A., et al. Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care. Am J Nurs Sci. 2015;4(4):166-173. doi: 10.11648/j.ajns.20150404.14

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@article{10.11648/j.ajns.20150404.14,
  author = {Queralt-Tomas Mª Ll. and Gil-Guillen V. F. and Clua-Espuny J. L. and Forcadell-Arenas T. and González-Henares M. A. and Panisello-Tafalla A. and Ripolles-Vicente R. and López-Pablo C. and Lucas-Noll J.},
  title = {Coordination Strategies of Care Across Stroke Recovery: Proposals for Nursing Interventions in Primary Care},
  journal = {American Journal of Nursing Science},
  volume = {4},
  number = {4},
  pages = {166-173},
  doi = {10.11648/j.ajns.20150404.14},
  url = {https://doi.org/10.11648/j.ajns.20150404.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajns.20150404.14},
  abstract = {Background. Stroke is characterized by its complexity as a result of residual deficits, dependence in basic activities of daily living, and new needs for caregivers. The purpose of this study was to propose nursing interventions in accordance with general practice to provide continuity of care of stroke patients across the stroke-recovery trajectory and support for caregivers beyond the patient’s length of stay. Methods. This is a longitudinal prospective study of a population-based cohort of all cases recorded in inpatient care of a first episode of stroke that occurred between 1 April 2006 and 31 December 2014. Results. There were 1,494 cases (54.1% male) and the mean age was 77.4±12.9 years. Only 27.9% were evaluated by their disability after hospital discharge. Ischemic stroke treated with thrombolysis had the best results in mortality (6.3%) and Barthel score (85.5). Mild dependence for thrombolysis was OR=2.5 with RRR=46%, ARR=9.4%, and NNT=10 to get a Barthel score >60 at discharge. After the episode the percentage of individuals with moderate or greater dependence increased up to 22.5%, with a loss (p=0.023) higher in women, halving the number of individuals with early independence. Of the stroke survivors 43.4% went directly home after acute care and needed a home caregiver. Age (p60).Conclusions. This study recommends consideration of special interests, both standardization of a discharge report as organizing an individualized primary care plan and the unification of processes for assessment of the situation of dependency among all public administrations to facilitate the necessary support planning for the stroke patient and their family in primary care.},
 year = {2015}
}

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