Journal of Neuroscience Nursing:
Nursing Roles and Functions in the Inpatient Neurorehabilitation of Stroke Patients: A Literature Review
Aadal, Lena; Angel, Sanne; Dreyer, Pia; Langhorn, Leanne; Pedersen, Birgitte Blicher
Sanne Angel, PhD RN, is an Associate Professor, Department of Nursing Science, Institute of Public Health, The Faculty of Health, University of Aarhus, Aarhus, Denmark.
Pia Dreyer, RN MScN PhD, is a Clinical Nurse Specialist at the Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark, and an Assistant Professor at the Institute of Public Health, Department of Nursing Science, University of Aarhus, Aarhus, Denmark.
Leanne Langhorn, RN CCRN MScN PhD, is a Clinical Nurse Specialist at the Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
Birgitte Blicher Pedersen, RN MSPH, is a Clinical Nurse Specialist at the Department of Neurology, Aarhus University Hospital, Aarhus, Denmark, and a PhD student at the Department of Nursing Science, Institute of Public Health, University of Aarhus, Aarhus, Denmark.
Questions or comments about this article may be directed to Lena Aadal, RN MScN PhD, at firstname.lastname@example.org. She is Head of Clinical Nursing Research at the Hammel Neurorehabilitation and Research Center, Hammel, Denmark.
The authors declare no conflicts of interest.
ABSTRACT: Stroke is a major cause of morbidity and mortality in the world. In the United States, it was estimated that approximately 750,000 patients had a stroke annually. Denmark, with a population of 5.5 million, had about 12,500 cases of hospitalizations from stroke in 2009. Despite the patient’s obvious need for complex nursing care and a common recognition of the nurse’s central role in rehabilitation after a stroke, a description of their specific contributions appeared sparse. Therefore, a literature review was conducted using the matrix method. The purpose was to explore the nursing roles and functions identified in empirical research and to discern any possible evolution in the nursing roles and functions during a span of years. The rehabilitation literature related to inpatient rehabilitation after stroke during the period from 1997 to 2010 was reviewed. The total number of identified citations was 1,529. After screening for relevancy, 134 eligible articles remained. Of these, 30 articles were extracted into a table and formed the basis for the conclusion. We found that four nursing roles and functions described in 1997 still accommodated central aspects of the current nursing practice but also emerging changes reflecting a development in the nurses’ responsibilities and contributions in conducting rehabilitation after a stroke. These changes seemed mainly to be shaped instigated by changes in the (1) patient role, (2) increasing interdisciplinary teamwork, and (3) focus on rehabilitation efforts conducted in the patient’s environment.
For decades, the nursing profession has been characterized by the care of individuals, families, and communities so that they may attain, maintain, or recover optimal health and quality of life. However, the specific roles and functions of rehabilitation nursing often appear unclear. In this article, we present a literature review to describe the therapeutic nursing contributions to hospital-based rehabilitation after stroke.
Stroke is a major cause of morbidity and mortality in the world. In the United States, it was estimated that approximately 700,000 people experience a new or recurrent stroke annually. About 500,000 of these are first attacks, and 200,000 are recurrent attacks (Goff et al., 2007). Denmark, with a population of 5.5 million, had about 12,500 cases of hospitalizations from stroke in 2009 (Sundhedsstyrelsen Sundhedsdokumentation, 2011a). Despite the patient’s obvious need for complex nursing care and a common recognition of the nurse’s central role in rehabilitation after a stroke, a description of their specific contribution appears sparse (Kirkevold, 1997, 2010; Thorn, 2000). Such an account could reflect the complementary nursing roles to promote recovery from both the functional and adaptive perspectives after stroke (Burton & Gibbon, 2005). Further descriptions of the nursing contributions are however needed to improve rehabilitation efforts.
During the last decade, the focus on inpatient rehabilitation has changed toward the increasing involvement of the patient as a subject with individual values and needs (Sundhedsstyrelsen Sundhedsdokumentation, 2011b). Thus, neurorehabilitation promotes body function but also more activity and participation. The change toward patient involvement has also been explicated in the newest definition by World Health Organization (WHO): “Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need.” (http://www.who.int/topics/rehabilitation/en/). This definition applies keywords such as functioning, independence, and self-determination, which illustrate a broad perspective and involvement of the patient/relatives as crucial. Therefore, the collaboration between patient, relatives, and rehabilitation professionals may form the basis of the conducted rehabilitation efforts. To conduct rehabilitation concordant to this definition, interdisciplinary teams have evolved over the last decade (Turner-Stokes, Disler, Nair, & Wade, 2005). The team organizing has been recommended to individualize and improve the effect of rehabilitation efforts (Langum Bredland, Linge, & Vik, 2002; Wæhrens, Winkel, & Gyring, 2006). The interdisciplinary teams are characterized by a closely coordinated collaboration between the staff from the different professions in activity-based objectives that are determined jointly with the patient and the relatives (Hjortbak & Rehabiliteringsforum Danmark, 2011; Wæhrens et al., 2006). According to a European competence profile, the core areas of the neuroscience nurses, besides physical and instrumental care, are the psychological aspects, such as the communication of information, teaching, and supervision to support the patient to handle his everyday life with the consequences of an injury (Leonardo da Vinci Fund of the European Commission, 2006). This indicates that the nurse’s role and function during inpatient rehabilitation may be changing in accordance with the increased focus on individuality and patient-centered rehabilitation.
Historically, various studies have attempted to identify the specific role and functions of nurses in rehabilitation efforts. Unfortunately, it appears to be very difficult to outline (Kirkevold, 1997; Long, Kneafsey, Ryan, & Berry, 2002; O’Connor, 1993). In 1997, Kirkevold identified four therapeutic roles of nurses in addition to management and coordination during rehabilitation of stroke patients. The therapeutic nursing roles accommodated interpretive, consoling, conserving, and integrative functions (Kirkevold, 1997). However, a review of the current neuro-nursing literature revealed a need for further studies to identify nursing roles and functions (Thorn, 2000). After decades of discussions and contributions based on adjustments in treatment, ideology, or culture, the original four therapeutic nursing roles were reconsidered, and the theory was extended to describe the actual nursing contribution (Kirkevold, 2010). The conclusion was that the originally proposed therapeutic nursing roles and functions were still adequate, but future nursing roles need to be developed to foster coping and well- being in the postdischarge period. Furthermore, a tendency toward describing bedside nursing initiatives was emphasized (Kirkevold, 2010). It is, however, noteworthy that this important work was based on a number of research projects that referred to the original study from 1997 and supplemented by research on patient experiences of living through the realization and rehabilitation process after a stroke. Thus, the reconsideration did not draw on the full range of research studies by completing a systematic review of articles published in the intervening period. During this decade, the actual rehabilitation initiatives after stroke have changed to increasingly focus on patient involvement, interdisciplinary organization, and rehabilitation efforts conducted during short-period hospitalization followed by outpatient initiatives (Danmark Sundhedsstyrelsen, 1997). We acknowledge that rehabilitation after stroke may require highly professional nurses after discharge. An unclear nursing role may constitute a barrier to discuss and develop contributions conducted by nurses. Therefore, we find it crucial to explore how clinical research describes the nurse’s role and functions in modern hospital rehabilitation practice. Therefore, this review was conducted to identify previous evolution and future tendencies in nursing roles and efforts during inpatient rehabilitation after stroke.
The objectives of this study were to derive whether the four nursing roles and functions—interpretive, consoling, conserving, and integrative—identified in 1997 still epitomize the nursing contribution to inpatient rehabilitation after stroke and to discern any possible evolution in the nursing roles and functions during the span of years from 1997.
A literature review was conducted using the matrix method developed by Garrard (2007). This is a systematic method to identify, describe, and interpret research irrespective of the methods used. To avoid the exclusion of important sources, we chose an integrative approach that accommodates the inclusion of studies with different methodologies. The rehabilitation literature related to inpatient rehabilitation after stroke during the period from 1997 to 2010 was reviewed. This period was chosen because we wanted to explore the nursing roles and functions we could identify in empirical research. We looked at inpatients, as then the results could be compared with the findings of Kirkevold (1997), which are illustrated in Table 1.
The search strategy involved a computerized and manual search overlooking the period 1997–2010. The computerized search was conducted in cooperation with an information scientist in the following databases: PubMed, Cinahl, PsychLit, Web of Science, Science Citation Index, and Scopus. We used the search terms rehabilitation, stroke, inpatient, and nursing. The search was conducted using these MeSH words or major subject headings one by one and then combining the results.
Qualitative or quantitative, original, empirical studies of inpatient rehabilitation after stroke that mentioned nursing roles and functions and studies dealing with adult patients older than 18 years old and published in Scandinavian languages or English in the time span from January 1997 until 2010 were included.
The total number of identified citations was 1,529, which was subsequently reduced to 975 by excluding obviously irrelevant articles (titles, language, date). The articles were then distributed between all five authors who then performed a detailed screening for relevancy. Studies that, according to the title or abstract, contained data relating to the specific nursing roles and/or functions were examined closely. After screening for relevancy, 134 eligible articles remained (Figure 1). These articles were read in full text and analyzed according to a standardized theoretical frame of Kirkevold’s four nursing roles supplemented by the category “beyond the four roles.” Furthermore, the study design and conclusions were assessed followed by our comments. If there was doubt about including the article, it was discussed and the decision of inclusion was made by consensus with one of other four authors. The assessment was based on information gained from the articles alone. Relevant data from the remaining (30) articles were extracted into a table and formed the basis for the conclusion.
We analyzed original empirical studies according to a theoretical frame of the four nursing roles and added a category “beyond the four roles” to identify any possible evolution in the nursing contribution. The review of the literature and the critical analysis were summarized in a table to join the disparate parts together into a logical coherent whole (Table 2). The synthesis was based on studies focusing and covering, for example, nursing roles and functions related to rehabilitation as it has developed across the studies and over the years, including similarities and discrepancies in content, methodology, and findings (Garrard, 2007).
In the following discussion, we will describe the evolution of nursing practice in the four nursing roles and functions—interpretive, consoling, conserving, and integrative, as outlined in the literature. We will furthermore describe the role and function going beyond the four roles (see Table 2).
Interpretive Role and Function
Only 5 of the 30 articles reflected an interpretive nursing role. In 1998, Macduff emphasized assessing the patient’s developmental needs, perceptions of self-care ability as therapeutic goals concerning mobility, and ADL activities as the crux in conducting rehabilitation nursing. However, the patient as a subject soon appeared (Macduff, 1998). In 1999, Lui and Mackenzie calls attention to the patient’s psychological needs such as individuality and dignity (Lui & Mackenzie, 1999). Awareness of the patients’ conditions and abilities to participate and cooperate became central by assessing the patient’s physiological, psychological, and social challenges that could hinder rehabilitation (Long et al., 2002). The nursing role was to support and respect the diversity of needs during interaction with the patient (Kvigne, Kirkevold, & Gjengedal, 2005). In 2009, Engmann described emotional support, guidance, and education as central in facilitating the patient’s recognition and ability to perform self-care activities. The interpretive role seems to evolve toward conducting increasing individuality, close collaboration, and joint responsibility during the process where the patient regains self-care skills.
The Consoling Role and Function
Consoling was an issue in 7 of the 30 articles. They focused on the importance of the nurse’s relationship with both patients and relatives to provide emotional support. This implied listening to their anxieties, providing the necessary information, and giving encouragement. In the span of years from 1997 until 2008, this function did not seem to have changed. Nurses ascribed meaning to patients’ behavior by providing time, overcoming language difficulties by using nonverbal language, and helping the patients to “fit into” the rehabilitation context (Jones, Partridge, & Reid, 2008). Lui & Mackenzie (1999) pointed out the need for information, particularly about the reasons for stroke and activities that promoted recovery, which covered all data concerning the illness and its treatment and recovery. Long et al. (2002) wrote that nurses fulfill a key role in providing emotional support and helping the patients to cope, including just being there, reassuring, explaining and encouraging, recognizing fears and worries, and giving referrals for psychiatric treatment. This implied being aware of the patients’ conditions and abilities to participate and cooperate, entailing the assessment of physiological, psychological, and social challenges that could hinder rehabilitation (Long et al., 2002). Secrest (2002) reported that the consoling function of the nurse was expected by both the patients and relatives and helped them to gain insight into their perceptions and promote quality of life. In 2005, Kvigne et al. (2005) repeated the importance of motivating the patients by giving praise and encouragement and pointing out functional improvements to the patient. However, they found that only a few nurses were talking to the patient about their experiences, grief and crises (Kvigne et al., 2005). Hedlund et al. (2008) found that this consoling function was considered as a part of nursing that distinguished it from therapy. Barreca and Wilkins (2008) supported this by saying, “The relationships that nurses form with patients, families and other team members are fundamental to the work of nursing.” Thus, there was agreement about the content and importance of this function, although some of the statement implied that this function could be a challenge to perform.
The Conserving Role and Function
Conserving was described as an issue in 10 of the 30 articles. In 1998, Macduff described the conserving role as typically a role of assistance, helping the patient with personal care, washing, dressing, and mobility functions. Around the millennium, several studies added a new dimension to the conserving role of helping. This was described as physical care; carrying out daily activities such as maintaining hygiene, nutrition, sleep, and rest (Gross, Goodrich, Kain, & Faulkner, 2001; Lui & Mackenzie, 1999). Then in 2002, Long et al. (2002) argued that the nurses’ role also included both technical and physical care: preventing deterioration in pressure areas, falls, constipation, urination, wounds, aspiration pneumonia or chest infections, and unwanted drug interactions; providing nutritional support, medication administration, wound dressing, and infection screening; and helping clients meet personal hygiene needs and maintaining their comfort. Kvigne and colleagues in 2005 not only outline the helping and carrying role but argue the need for life-preserving care to secure vital bodily functions, particularly in respect to respiration, blood pressure, temperature, fluid balance, and urine flow (Kvigne et al., 2005) as well as the prevention of complications related to bed rest, such as lung infections contractures and pressure sores. In line with the life-preserving care, Hedlund et al. in 2008 emphasized both the early detection of secondary insults and the improvement of well-being. The process was described as ranging from highly advanced technological care to “softer,” more emotional care (Lightbody et al., 2007). Within a 10-year period, the conserving role increased to include helping, carrying, and preserving, and then in 2008, the training and teaching element was introduced to the conserving role (Barreca & Wilkins, 2008)—training and teaching programs, where individuals benefit from repetitive training to relearn how to dress, bathe, and toilet themselves and transfer safely and independently. In a context of continence and bladder rehabilitation, Booth et al. (2009) argue the need for nurses to focus on containment and social conservation. In summary, the conserving role of the nurses has developed from a helping role to a carrying, life-preserving, and training role enabling the patients to perform self-care (Pryor & O’Connell, 2009).
The Integrative Role and Function
The integrative function is an issue in 9 of the 30 articles. This function was directed toward the patients benefitting from the rehabilitation during communication and practice in relation to both patients and relatives. Johnson, Pearson, and McDivitt (1997) found that rehabilitation nurses had a key role in encouraging stroke survivors to continue their rehabilitation efforts beyond discharge from the rehabilitation setting. They pointed at a need for community-based education and nurses being experts in that field (Johnson et al., 1997). In 2002, Long et al. found a need to integrate therapy into the activities of daily living. This implied feedback to the staff about the patient’s progress as well as how the patient was responding to enable the staff to adjust their care plans (Long et al., 2002). In 2003, Burton introduced a need for interventions after discharge to ensure the provision of information and advice in response to individual patient needs by visiting the patients at home. This included goal setting, problem solving, and advice on specific issues. The spouses’ need for support groups was mentioned as having an integrative effect in 2005 (Visser-Meily et al., 2005). The integrative function progressed, and according to Hedlund et al. (2008), the process of the integration moved from monitoring physical functions to psychological strategies. Educating the patient was introduced in 2009 as a part of the practical management, education like information on general care, feeding, hygiene, and mobilization with a verbal aspect (Torres-Arreola et al., 2009). In addition, the education of the nurse was an issue (Edwards, 2006; Hafsteinsdóttir & Grypdonck, 2004). Kvigne et al. (2005) discussed the education of the professionals, in that they then would be able to offer training focused on how to manage life at home, including coping with activities like preparing food and setting the table. This should enable them to help the stroke survivor re-enter social life (Kvigne et al., 2005). Thus, the benefits of educating both patients and nurses have been an issue in the integration of the rehabilitation beyond discharge.
Beyond the Four Roles and Functions
To elucidate and understand the developments in the nursing role, we constructed a category that went beyond the four roles. Conceivable role changes over time enhanced the necessity of narrowing down nursing activities and roles deviating from the nursing roles described by Kirkevold (1997). Hence, the “ beyond the four roles” category was a capacious analytical category framing these nursing activities that were inconsistent with Kirkevold’s descriptions. Consequently, the “beyond the four roles” category appears pivotal to identify arising changes of the nursing role in rehabilitating patients hospitalized after a stroke. In the following discussion, these development tendencies are construed and contextualized.
Around the millennium, the role of nurses in rehabilitation after stroke was described as having a coordinating role in comparison with multidisciplinary care during rehabilitation after stroke (Burton, 1999). Furthermore, Burton emphasized the potential of developing new partnerships with stroke patients and their families as significant in the literature. This development highlighted the therapeutic aspects of the nursing role, the nurse as the traditional care provider and the nurse as the manager of care and multidisciplinary provisions. Nonetheless, it is noteworthy that the patient as the subject in the rehabilitation process appears alongside the nurse as the facilitator of personal recovery. Implicit to this, it was pertinent to equip primary caregivers and patients with skills and the knowledge to cope every day in changing social contexts other than the clinical rehabilitation environment (Burton, 2000; Jacobsson, Axelsson, Osterlind, & Norberg, 2000; King, Hartke, & Denby, 2007).
The multidisciplinary team organization and structure seems to blur the description of an autonomous nursing role in the literature. Circumstantial and intrinsic overlaps were identified, indicating that nurses undertook substituting roles when a member of the appropriate profession was absent or when the care or procedures were part of the normal role of other professions (Booth, Davidson, Winstanley, & Waters, 2001). Unfortunately, a later study strengthened the impression of a vague nursing role. Here, the prevailing norm was not to cooperate with or involve the patient but “do for” the patient, and at a closer look, the role of nursing appeared diffuse and lacking clarity or focus (Booth, Hillier, Waters, & Davidson, 2005). In spite of this, the nursing role implied a twofold responsibility encompassing an overall responsibility but also patient-focused care and interaction. By having the overall responsibility for 24-hour rehabilitation, the nurses took over an extended coordinating role in the multiprofessional rehabilitation. Only a minority were however aware of the potential of nurses as coordinators or of fulfilling their role as coordinators (Pryor, 2008). Hence, this role of multidisciplinary coordination might be confused by the fact that nurses were expected to have not only an overview over the treatment and care but also an insight into all the efforts performed by the interdisciplinary team members.
The patient as the focal point of rehabilitation also affected the rehabilitation efforts conducted by the nurses. Nursing was described as the helping and educating of patients to promote self-care, independence, and coping with their situation. This perspective embraced the education of patients about the nature of rehabilitation and how to optimize their rehabilitation. To promote their participation and cooperation, it was necessary to explain the roles of patients and nurses to help them to understand the central role that they themselves played in their recovery (Pryor & O’Connell, 2009). Interestingly, the discussion of the active role of the patient seems to persist in a nursing perspective. The aim of involving the patient as collaborator entailed a new professional responsibility. Cognitive changes after a stroke might challenge the patient’s motivation and ability to enter into relationships as well as problem solving. From this perspective, facilitating patient participation seems to be a newly arisen responsibility. In 2009, a study emphasized the need to explore the therapeutic approach in “doing for” or “working with” in facilitating high-quality care (Burton, Fisher, & Green, 2009). This could suggest continuing confusion about the role of therapeutic nursing, but nurses’ facilitation of the patient’s recognition of their ability to perform self-care activities through education, guidance, and emotional support was continuously underlined (Engman & Lundgren, 2009). Furthermore, the nurses generated strategies for the enhancement of the rehabilitation service. This may be because the nurses then could exploit their privileged position of being able to manage the neurological patient’s holistic needs and deal with nonphysical aspects of care (Portillo & Cowley, 2011).
Perspectives on Nurses’ Roles and Functions in Neurorehabilitation
The aim of this literature review was to identify the nurses’ actual contribution to inpatient rehabilitation after stroke. The review covers empirical research from 1997 to 2010. The four nursing roles identified by Kirkevold characterize the physical, psychological, and social nursing interventions at an abstract level. However, the patient’s realization of the changes after a stroke needs to be taken into account when performing concrete therapeutic nursing in rehabilitation. This could imply changes over time. Hence, nursing contributions in addition to the four nursing roles were identified when we analyzed whether the four nursing roles and functions described in 1997 still accommodated all aspects of the current nursing practice. Remarkably, the four therapeutic nursing roles were retrieved, but a good deal of distinct nursing functions fell beside these roles. Hence, changes in nursing roles and activities were identified in the research literature. These emerging changes were categorized in the “beyond the four roles” aspects, reflecting a development in the nurses’ responsibilities and contributions in conducting rehabilitation after a stroke. The “beyond the four roles” category seems mainly to be shaped and instigated by changes in the (1) patient role, (2) increasing interdisciplinary teamwork, and (3) focus on rehabilitation efforts conducted in the patient’s environment.
Emerging aspects of the patient role included more focus on individuality, patient centralization, patient participation, the involvement of relatives, interdisciplinary cooperation, and rehabilitation efforts conducted during a short period of hospitalization followed by outpatient initiatives. This inclination toward cooperation between nurse and patient could be expected. Rehabilitation is defined as “a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimal physical, psychological and social function” (Section of Physical and Rehabilitation Medicine Union Europeenne des Medecins Specialistes, European Board of Physical and Rehabilitation Medicine, Academie Europeenne de Medecine de Readaptation, & European Society for Physical and Rehabilitation Medicine, 2006). From this perspective, the patient’s participation is central, both as a goal in itself and as a way to facilitate motivation and learning (Carlson et al., 2006; Standal & Jespersen, 2008). The patient is encouraged to assume an active position in everyday life and be involved in the development of rehabilitation plans and strategies. These major changes obviously influence the required nursing care to create a meaningful individual cross-sectional rehabilitation trajectory. To take joint responsibility, the patient and relatives need professional support and education to identify the cognitive, physical, or social consequences after the stroke and to recognize future opportunities. At the same time, the substance and course of the rehabilitation efforts need to be systematically and individually elaborated to ensure the integration of the rehabilitation beyond discharge.
Increasing Interdisciplinary Teamwork
In 1997, the role of nursing in stroke rehabilitation was most clearly associated with that of providing a safe, comfortable environment conducive for rehabilitation. The major focus of these context functions was to prepare and support the therapeutic interventions of other healthcare professionals. However, it is now evident that close interaction, patient education, and confidence with cross-sectional initiatives are fundamental to ensure high quality in stroke rehabilitation (Abreu, Zhang, Seale, Primeau, & Jones, 2002; Schonberger, Humle, & Teasdale, 2006). A general point in our review is the fact that nurses are close to the patient 24 hours a day, and therefore, they are in a good position to establish a good relationship with the patient and relatives. This enables the nurse to adopt a key position in this distinct supportive and coordinating role, being present throughout the entire recovery and rehabilitation phase. Interestingly, the stroke-coordinator role was already described by Burton in 1999.
Environmental Changes in Rehabilitation Efforts
Various sectors of the healthcare system are involved in the inpatient and outpatient rehabilitation process. These primary contacts need to be identified, and the necessary measures need to be consequently selected in response to the individuals’ values and changes after the stroke. If the rehabilitation efforts are to correspond to the intentions of individuality and quality of life explicated by WHO, then the planning process becomes crucial. This requires that the coordinator supports or compensates the patient with various cognitive and physical disabilities to achieve cooperation and the preferred way of life as recommended in a recent medical technology assessment and a national whitebook (Hjortbak & Rehabiliteringsforum Danmark, 2011). These recommendations are consistent with earlier findings and, furthermore, with the recent theoretical framework for therapeutic stroke nursing developed by Kirkevold, where the focus of stroke nursing is extended beyond the acute and initial rehabilitation phase (Kirkevold, 2010). Hence, the nurse facilitates the position of the patient and family as the center of the efforts surrounded by the interdisciplinary team, where each professional member contributes in approaching the patient as an individual with individual values and needs.
The Challenges Ahead
High-quality therapeutic nursing in rehabilitation after stroke include support in carrying through the process of recovery, the facilitation of the patients’ ability to learn, promotion of patients and families’ participation, interdisciplinary cooperation, and cross-sectional coordination. Stroke rehabilitation is the temporary process by which a stroke survivor works with an interdisciplinary team of healthcare providers with the aim of regaining as much as possible of the function lost after a stroke (http://www.who.int/topics/rehabilitation/en/). Rehabilitation efforts are designed to facilitate the lengthy process of recovery by emphasizing and supporting each individual’s potential. Recovery is seen as a personal journey, which may involve developing hope, a secure base and sense of self, supportive relationships, handling every day life, social inclusion, and meaning. Further debate about the extent of effort is needed to develop the nurse coordinator role. This discussion is further actualized by the continuing reduction in the duration of inpatient rehabilitation courses followed by outpatient or rehabilitation efforts at home. Unfortunately, our knowledge of the patients’ ability to and expectations of participating despite cognitive changes are still sparse. Furthermore, the cognitive changes affect the patients’ ability to learn, and teaching strategies need to be elaborated to promote patient participation. Finally, organizational changes are required to identify and overcome barriers between hospital and home care interventions. Therefore, further elaboration on the abovementioned topics is needed to provide high-quality rehabilitation nursing after stroke. Our study indicates that significant changes in the nursing role during rehabilitation after stroke have occurred, changes that will be interesting to follow.
Abreu B. C., Zhang L., Seale G., Primeau L., Jones J. S. (2002). Interdisciplinary meetings: Investigating the collaboration between persons with brain injury and treatment teams. Brain Injury, 16 (8), 691–704.
Barreca S., Wilkins S. (2008). Experiences of nurses working in a stroke rehabilitation unit. Journal of Advanced Nursing, 63 (1), 36–44.
Booth J., Davidson I., Winstanley J., Waters K. (2001). Observing washing and dressing of stroke patients: Nursing intervention compared with occupational therapists. What is the difference? Journal of Advanced Nursing, 33 (1), 98–105.
Booth J., Hillier V. F., Waters K. R., Davidson I. (2005). Effects of a stroke rehabilitation education programme for nurses. Journal of Advanced Nursing, 49 (5), 465–473.
Booth J., Kumlien S., Zang Y.,, Gustafsson B., Tolson D. (2009). Rehabilitation nurses practices in relation to urinary incontinence following stroke: A cross-cultural comparison. Journal of Clinical Nursing, 18 (7), 1049–1058.
Burton C., Gibbon B. (2005). Expanding the role of the stroke nurse: A pragmatic clinical trial. Journal of Advanced Nursing, 52 (6), 640–650.
Burton C. R. (1999). An exploration of the stroke co-ordinator role. Journal of Clinical Nursing, 8 (5), 535–541.
Burton C. R. (2000). Re-thinking stroke rehabilitation: The Corbin and Strauss chronic illness trajectory framework. Journal of Advanced Nursing, 32 (3), 595–602.
Burton C. R., Fisher A., Green T. L. (2009). The organisational context of nursing care in stroke units: A case study approach. International Journal of Nursing Studies, 46 (1), 85–94.
Carlson P. M., Boudreau M. L., Davis J., Johnston J., Lemsky C., McColl M. A., Smith C. (2006). ‘Participate to learn’: A promising practice for community ABI rehabilitation. Brain Injury, 20 (11), 1111–1117.
Danmark Sundhedsstyrelsen. (1997). Behandling af traumatiske hjerneskader og tilgrænsende lidelser: Nuværende og fremtidig organisation: Redegørelse. Kbh.: Sundhedsstyrelsen: købes hos: Komiteen for Sundhedsoplysning.
Edwards G. (2006). Stroke: The training and education of nurses working in stroke care. British Journal of Nursing, 15 (21), 1180–1184.
Engman M., Lundgren S. M. (2009). What does rehabilitation and nursing care implies for patients with stroke? Nordic Journal of Nursing Research and Clinical Studies/Va˚rd i Norden, 29 (3), 32–36.
Garrard J. (2007). The matrix method (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.
Goff D. C. Jr., Brass L., Braun L. T., Croft J. B., Flesch J. D., Fowkes F. G. R., Zheng Z. J. (2007). Essential features of a surveillance system to support the prevention and management of heart disease and stroke: A scientific statement from the American Heart Association Councils on epidemiology and prevention, stroke, and cardiovascular nursing and the interdisciplinary working groups on quality of care and outcomes research and atherosclerotic peripheral vascular disease. Circulation, 115 (1), 127–155.
Gross J. C., Goodrich S. W., Kain M. E., Faulkner E. A. (2001). Determining stroke rehabilitation inpatients’ level of nursing care. Clinical Nursing Research, 10 (1), 40–51.
Hafsteinsdóttir T., Grypdonck M. (2004). NDT competence of nurses caring for patients with stroke. Journal of Neuroscience Nursing, 36 (5), 289–294.
Hedlund M., Ronne-Engstromh E., Ekselius L., Carlsson M. (2008). From monitoring physiological functions to using psychological strategies: Nurses’ view of caring for the aneurysmal subarachnoid haemorrhage patient. Journal of Clinical Nursing, 17 (3), 403–411.
Hjortbak, B. R., & Rehabiliteringsforum Danmark. (2011). Udfordringer til rehabilitering i danmark
(1 udg ed.). @ÅRhus: Rehabiliteringsforum Danmark: eksp. Marselisborgcentret.
Jacobsson C., Axelsson K., Osterlind P. O., Norberg A. (2000). How people with stroke and healthy older people experience the eating process. Journal of Clinical Nursing, 9 (2), 255–264.
Johnson J., Pearson V., McDivitt L. (1997). Stroke rehabilitation: Assessing stroke survivors’ long-term learning needs. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 22 (5), 243–248.
Jones M., O’Neill P., Waterman H., Webb C (1997). Building a relationship: Communications and relationships between staff and stroke patients on a rehabilitation ward. Journal of Advanced Nursing, 26 (1), 101–110.
Jones F., Partridge C., Reid F. (2008). The stroke self-efficacy questionnaire: Measuring individual confidence in functional performance after stroke. Journal of Clinical Nursing, 17 (7B), 244–252.
King R. B., Hartke R. J., Denby F. (2007). Problem-solving early intervention: A pilot study of stroke caregivers. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 32 (2), 68–76.
Kirkevold M. (1997). The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective. Advances in Nursing Science, 19 (4), 55–64.
Kirkevold M. (2010). The role of nursing in the rehabilitation of stroke survivors: An extended theoretical account. Advances in Nursing Science, 33 (1), E27–E40.
Kvigne K., Kirkevold M., Gjengedal E. (2005). The nature of nursing care and rehabilitation of female stroke survivors: The perspective of hospital nurses. Journal of Clinical Nursing, 14 (7), 897–905.
Langum Bredland E., Linge O. A., Vik K. (2002). Det handler om verdighet: Ideologi og praksis i rehabiliteringsarbeid (2 utg, 1 oppl ed.). Oslo, Norway: Gyldendal Akademisk.
Lightbody C. E., Auton M., Baldwin R., Gibbon B., Hamer S., Leathley M. J., Watkins C. L. (2007). The use of nurses’ and carers’ observations in the identification of post stroke depression. Journal of Advanced Nursing, 60 (6), 595–604.
Long A. F., Kneafsey R., Ryan J., Berry J. (2002). The role of the nurse within the multi-professional rehabilitation team. Journal of Advanced Nursing, 37 (1), 70–78.
Lui M. H. L., Mackenzie A. E. (1999). Chinese elderly patients’ perceptions of their rehabilitation needs following a stroke. Journal of Advanced Nursing, 30 (2), 391–400.
Macduff C. N. (1998). Stroke patients’ perceptions of hospital nursing care. Journal of Clinical Nursing, 7 (5), 442–450.
O’Connor S. (1993). Nursing and rehabilitation: The interventions of nurses in stroke patient care. Journal of Clinical Nursing, 2 (1), 29–34.
Portillo M. C., Cowley S. (2011). Working the way up in neurological rehabilitation: The holistic approach of nursing care. Journal of Clinical Nursing, 20 (11–12), 1731–1743.
Pryor J. (2008). A nursing perspective on the relationship between nursing and allied health in inpatient rehabilitation. Disability and Rehabilitation, 30 (4), 314–322.
Pryor J., O’Connell B. (2009). Incongruence between nurses’ and patients’ understandings and expectations of rehabilitation. Journal of Clinical Nursing, 18 (12), 1766–1774.
Schonberger M., Humle F., Teasdale T. W. (2006). Subjective outcome of brain injury rehabilitation in relation to the therapeutic working alliance, client compliance and awareness. Brain Injury, 20 (12), 1271–1282.
Secrest J. S. (2002). How stroke survivors and primary support persons experience nurses in rehabilitation. Rehabilitation Nursing, 27 (5), 403–411.
Section of Physical and Rehabilitation Medicine Union Europeenne des Medecins Specialistes, European Board of Physical and Rehabilitation Medicine, Academie Europeenne de Medecine de Readaptation, & European Society for Physical and Rehabilitation Medicine. (2006). White book on physical and rehabilitation medicine in Europe. Europa Medicophysica, 42 (4), 292–332.
Standal O. F., Jespersen E. (2008). Peers as resources for learning: A situated learning approach to adapted physical activity in rehabilitation. Rehabilitation Nursing, 27 (5), 176.
Sundhedsstyrelsen, Sundhedsdokumentation. (2011a). Hjerneskaderehabilitering @2013 en medicinsk teknologivurdering. hovedrapport. København, Danmark: Sundhedsstyrelsen.
Sundhedsstyrelsen, Sundhedsdokumentation. (2011b). Hjerneskaderehabilitering @2013 en medicinsk teknologivurdering. sammenfatning. København, Danmark: Sundhedsstyrelsen.
Thorn S. (2000). Neurological rehabilitation nursing: A review of the research. Journal of Advanced Nursing, 31 (5), 1029–1038.
Torres-Arreola L., Doubova S. V., Hernandez S. F., Torres-Valdez L., Constantino-Casas N., Garcia-Contreras F., Torres-Castro S. (2009). Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. Journal of Clinical Nursing, 18 (21), 2993–3002.
Turner-Stokes L., Disler P. B., Nair A., Wade D. T. (2005). Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Systematic Reviews (Online), 3 (3), CD004170.
Visser-Meily J. M. A., Post M. W. M., Schepers V. P. M., Ketelaar M., Van Heugten C. M., Lindeman E. (2005). Spouses’ satisfaction with caregiver support in stroke rehabilitation. Scandinavian Journal of Caring Sciences, 19 (4), 310–316.
Wæhrens E., Winkel A., Gyring J. (2006). Neurologi og neurorehabilitering (1 udgave, 1 oplag ed.). København, Danmark: Munksgaard Danmark.
neurorehabilitation; nursing; nursing functions; nursing roles; stroke
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