Family Adaptation to Stroke: A Metasynthesis of Qualitative Research based on Double ABCX Model

PURPOSE: There is growing interest in synthesizing qualitative research. Stroke is a very common cause of disability often leaving stroke survivors dependent on their family. This study reports an interpretive review of research into subjective experience of families with stroke survivors based on the components of the Double ABCX Model including stressors, resources, perception, coping strategies, and adaptation of these families. METHODS: Metasynthesis was applied to review qualitative research looking at stroke family members' experiences and responses to having a stroke survivor as a family member. Electronic database from 1990 to 2013 were searched and 18 separate studies were identified. Each study was evaluated using methodological criteria to provide a context for interpretation of substantive findings. Principal findings were extracted and synthesized under the Double ABCX Model elements. RESULTS: Loss of independence and uncertainty (as stressors), struggling with new phase of life (as perception), refocusing time and energy on elements of recovery process (as coping strategy), combined resources including personal, internal and external family support (as resources), and striking a balance (as adaptation) were identified as main categories. Family members of stroke survivor respond cognitively and practically and attempt to keep a balance between survivor's and their own everyday lives. CONCLUSIONS: The results of the study are in conformity with the tenets of the Double ABCX Model. Family adaptation is a dynamic process and the present study findings provide rich information on proper assessment and intervention to the practitioners working with families of stroke survivors.

Implication of mauk nursing intervention model on coping strategies of stroke survivors

Objective: Stroke is a major event in one's life, and patients will inevitably require the use of coping strategies in order to try to reestablish acceptable life equilibrium. Due to the extensive role that nurses can be active members in the patient's rehabilitation plan, the Mauk model is a model that focuses on stroke patients. For each stage of this model, Mauk has developed appropriate rehabilitation nursing interventions. This study aimed to analyze the effect of implementation of the Mauk nursing rehabilitation model [Agonizing phase, Fantasy phase, Realizing phase] on the coping strategies of stroke patients

Methods: This study is a quasi-experimental one-group pre-test - post-test study. The interventions are identified and coping strategies for patients based on the Mauk model have been trained. Convenience sampling has been done in Imam Khomeini hospital and Tabassom rehabilitation center in 1392. Data collection instruments included a demographic questionnaire and a coping strategies questionnaire for stroke patients. The educational program was implemented in sessions of 45 minutes. The patients' coping strategies, before and after training, were assessed. Data was statistically analyzed using descriptive and inferential tests in SPSS software 16

Results: The mean score for coping strategies before intervention was 111.42 +/- 11.71, and after intervention was 102.14 +/- 12.45 [P<0.05]. The physical, mental and social dimensions in the coping strategies showed significant differences before and after intervention

Discussion: Using the rehabilitation program interventions for effectively dealing with stress, changing and unpredictable behavior patterns in chronic patients is an important component of the treatment protocol, and helps deliver an increase in coping strategies for stroke patients

Impact of nurses training and applying functional and nonstructural hospital safety in preparedness of razi and day hospitals in disasters based on hospital safety index

Background: Hospitals in Iran are not prepared for disasters; the aim of this study was to determine the effect of training functional and nonstructural hospital safety to nurses and their intervention on hospital preparedness in psychiatric Razi Hospital and Day Hospital in Tehran based on Hospital Safety Index [HSI]

Materials and Methods: This semi-experimental study included nurse managers of Razi and Day hospitals as study sample. Research tool was checklist of hospital safety. Validity and reliability of the checklist was determined 93%. At first the checklist was filled out, then preparedness plan including a 1-day workshop about disaster management, functional and nonstructural safety and a table tab maneuvers held. Then, after two months, nonstructural and functional safety of the hospitals was re-evaluated by HSI checklist. Data were analyzed by using Excel file of the tool

Results: Findings showed that scores in most items of nonstructural and functional safety in HSI checklist significantly increased in two hospitals after workshop and nursing performance. Before intervention, these scores were 0.40 and 0.56 for Razi and Day hospitals, respectively which increased to 0.57, 0.86 after training

Conclusion: Results showed that teaching nonstructural and functional safety to nurses and using these principles by nurses can promote hospital safety and preparedness. Comparison between hospitals showed that allocating more budget and executive power to the nurses can increase further the hospital preparedness. Given the key role of nurses in disaster preparedness, it is recommended to teach and apply functional and nonstructural safety of hospitals to nursing managers

Everyday life condition in stroke survivors and their family caregivers in Iranian context

Stroke is an unexpected major life incident that effect on physical functioning and can lead to changes in lifestyle and inability to manage self care, work or leisure. To explore the everyday life situation as experienced by stroke survivors, and their family caregivers, this study was conducted 3-6 month after stroke. Twelve stroke survivors and thirteen family caregivers were interviewed and a qualitative content analysis was conducted to analyze data. The results were categorized into two central themes that were identified as; [1] Being challenged by changes in everyday life situation including; the struggle with physical dysfunctions, inappropriate daily plan for leisure activities, changes in mood, being faced with economical problems and being worried about changing roles [2] striving to cope with new conditions including; trying to preserve self-worth, seeking to support from spirituality, learning and re-learning and regaining independency. Physical dysfunction was the major concern for both the survivors and their family caregivers in their everyday life situation. This problem led to, and forced them, to be dependent on others. Training is needed to teach stroke survivors and their families strategies of how to cope with and overcome ongoing challenges of everyday life after stroke and to re-organize their lives and improve skills of the survivors to deal with the new situation at home. A daily plan for spending their time and leisure activities would ease this work. More investigation will be needed to clarify the process of life after stroke to cover this gap

[Effect of slow stroke back massage [SSBM] on shoulder pain and hand function in patients with stroke]

Shoulder pain is a consequence of hemiplegia among patients with stroke. It makes patient to be dependent to others in their daily living activities. This study aimed to determine the effect of the slow stroke back massage [SSBM] on shoulder pain and hand function among patients with stroke. In this semi-experimental study, 34 patients were recruited among from 70 patients who reffered to rehabilitation center in 2010, according to the inclusion criteria. Participants were randomly allocated into two groups of control and experiment. In the intervention group, the SSBM was implemented for 10 minutes through seven consecutive sessions. Shoulder pain and hand function were measured using the visual pain scale [Visual Analog Scale], and the researcher-made "affected hand function in ADL" instrument, respectively. The measurement was done before and 24 hours after the last session of the intervention. Data were analyzed using descriptive and inferential statistical tests [independent t-test and paired t-test]. At baseline, the mean scores of shoulder pain were 8.4 in both experimental and control groups [P=0.999]. After the intervention, the mean scores of shoulder pain were 1.13 and 8.40 in experimental and control groups, respectively [P<0.001]. At baseline, the mean scores of hand function were 7.46 and 8.93 in the experimental and control groups, respectively [P=0.752]. After the intervention, the mean scores of hand function reached 9.13 and 8.6 in the experimental and control groups, respectively [P=0.918]. According to the results of the study, applying the SSBM as a treatment procedure and care plan by health care providers can be considered as an effective intervention to prevent or reduce shoulder pain and consequently to improve motor function of affected hand in patients with hemiplegia after stroke

Post stroke life in Iranian people: used and recommended strategies

Stroke survivors develop their own strategies to combat disabilities, developing strategies to maintain or reestablish a sense of continuity after the disruptive life event that stroke represents, using strategies to foster hope during the process of adjusting to life after stroke and drawing on spiritual practices. The aim of this study is to identify the used and recommended strategies of life after stroke among Iranian people. A grounded theory approach was recruited using semi-structured interviews with 10 stroke survivors, 12 family caregivers and 6 formal care givers. Five main concepts emerged describing as the used and recommended strategies of the participants including, improving functional performance, re-learning life skills and educational support, accessing to rehabilitative services, socio-economical support and well-suited coping strategies. Participants valued better knowledge and skills regarding the adaptive strategies for stroke survivors and their family care givers are essential in accomplishing with activities of daily living and doing social roles for improving life after stroke. Also developing the socio- economic supports is crucial for assuring a more supportive approach to achieve rehabilitation services and design better educational program for them