Striving for control in eating situations after stroke.

THE STUDY'S RATIONALE: Eating difficulties are common after stroke. However, to better meet individuals' needs, in terms of care, support and rehabilitation after stroke, it was considered important to know more about how patients with stroke experience their eating difficulties while in process of regaining their ability. AIMS AND OBJECTIVES: The aim of this study was to explore the experience of eating difficulties among patients with stroke 3 months after stroke onset. METHODOLOGICAL DESIGN AND JUSTIFICATION: A qualitative interpretive descriptive approach was used. The analysis was based on constant comparative approach, using the principles of grounded theory. RESEARCH METHODS: The study included 14 participants with stroke and eating difficulties. A semi-structured interview guide with open-ended questions and probes was used. The interview guide was gradually modified during the data collection process. The interviews were digital audio recorded and fully transcribed. Memos were documented simultaneously with the analysis. INSTRUMENTS: A structured observation of a meal verified eating difficulties, and semi-structured interviews were conducted. RESULTS: 'Striving for control' emerged as a tentative core category. The participants related their striving for control to 'eating safely', and 'eating properly'; they also had to analyse the consequences of their eating difficulties, being careful when eating, and/or avoiding activities. Some also felt a need of help from others. Those others could remind and provide advice in this matter. CONCLUSION: This study highlights the complexity of having eating difficulties after stroke. Aspects related to the participants' striving for control are based on different strategies to eat safely and properly. Nurses can use this knowledge to support patients in their strive for control by observing them in eating situations. In addition, nurses can also ask them to describe and make explicit the experience of eating situations after stroke.

Elderly persons' experience and management of eating situations 6 months after stroke.

PURPOSE: To explore the experience and management of eating situations among persons affected by stroke, 6 months after stroke onset. METHOD: A qualitative constant comparative approach, influenced by principles of grounded theory, was used to analyse the interviews. Thirteen participants were interviewed in the home setting 6 months after the stroke. RESULTS: Experiences and desire to master eating situations varied, and was related to values and previous habits. Eating difficulties were experienced as disgusting, uncomfortable, strenuous, or unproblematic and not implying shame. Getting help from others could be experienced as embarrassing and undesirable. In particular, eating could be more difficult when eating in company of unfamiliar people. The participants found new ways of mastering eating situations. Some had regained former routines. CONCLUSIONS: Old values and habits and/or involvement of other people were the basis of mastering eating situations. New ways of mastering were found, some accepted, and got used to the new situation. Some regained former routines. This knowledge could contribute to health care personnel's awareness of each patient's individual values and previous habits during the rehabilitation process. A dialogue is needed with the person suffering from eating difficulties after stroke, to help create the best possible individual conditions for mastering eating situations.

Predictors of life situation among significant others of depressed or aphasic stroke patients.

AIM: The aim of this study was to examine predictors of the life situation of the significant other of depressed or aphasic stroke patients. BACKGROUND: Depression and aphasia are common consequences of stroke, and both may put pressure on the significant other who have to deal not only with a possible physical handicap but also with communication and/or serious psychiatric difficulties. DESIGN: Descriptive, cross-sectional study. METHODS: The participants were significant others of 71 depressed and 77 aphasic stroke patients. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder, and degree of aphasia was diagnosed with the Amsterdam Nijmegen Everyday Language Test. Assessments of the life situation, state of depression and aggression, personality change and need of assistance were made through questionnaires issued to the significant others. RESULTS: Perceived need of assistance was the only common predictor of life situation of the significant other in both groups (p < 0.001). With respect to the aphasic patients, perceived personality change (p < 0.001) and living with the patient (p = 0.004) were factors that had a negative effect on the life situation of the significant other. CONCLUSIONS: This study highlights that the perception of the patient's need of assistance is an important factor in predicting the life situation among spouses of depressed as well as aphasic stroke patients. A comparison of the two groups to explain the life situation of the significant others revealed greater explanatory power for the aphasic group. RELEVANCE TO CLINICAL PRACTICE: Assessments of the spouses' perception as well as of the patients' factual situation may identify those significant others at risk. With this new approach, necessary steps may be taken to alleviate pressure on the significant other.

The impact of gender regarding psychological well-being and general life situation among spouses of stroke patients during the first year after the patients' stroke event: a longitudinal study.

BACKGROUND: The informal caregivers perceive lack of choice to take on the role of caregiving, receiving little or no preparation for the caregiving role at home. The typical informal caregiver is female, either a spouse or adult child of the care recipient, and seldom shares the responsibilities of caregiving with other family members. The spouses worry about the ill relative, but also about what consequences the disease might have for their own life. The worries seem to vary with gender and disease. There are, to our knowledge, few previous longitudinal studies that have focused on gender differences among spouses of stroke patients. OBJECTIVES: To explore gender differences among spouses in perceived psychological well-being and general life situation, during the first year after the patients' stroke event. DESIGN: Longitudinal study with three assessments regarding psychological well-being and general life situation during 1 year. SETTINGS: The study took place at a stroke ward, Stockholm, Sweden. PARTICIPANTS: Consecutively 80 female and 20 male spouses of stroke patients admitted to a stroke unit participated. METHODS: Data were analysed using analyses of variance. RESULTS: Female spouses have a negative impact on psychological well-being, while male spouses have a lower occurrence of emotional contacts in their social network. Consistently, the female spouses reported lower quality of life and well-being than the male spouses. CONCLUSIONS: This study generates the hypotheses that there are gender differences among spousal caregivers of stroke patients; female spouses are more negatively affected in their life situation due to the patients' stroke event than the male spouses. It is important to take the individual differences under consideration when designing a nursing intervention, to meet the different needs and demands of male and female caregivers. The interventions should focus on individual support, so that the caregivers can adapt to their new role and be comfortable and effective as informal caregivers.

A multiprofessional education programme for patients with inflammatory bowel disease: a randomized controlled trial.

OBJECTIVE: Health-related quality of life is impaired in patients with inflammatory bowel disease and improved disease-related information can improve this situation. The aims of this study were to create an education programme that could be readily applicable at the clinic and would be suitable for newly diagnosed patients with inflammatory bowel disease, and to investigate whether the programme could improve their health-related quality of life. MATERIAL AND METHODS: Ninety-three patients with inflammatory bowel disease in remission were included and randomized to an intervention group or a control group. The intervention group attended a multiprofessional education programme while the control group received regular information. Four questionnaires were used for measuring health-related quality of life. Both groups completed the questionnaires at baseline and after 6 months. The intervention group also completed the questionnaires after 1 month. RESULTS: No significant differences were found when comparing the two groups at 6 months. However, the multi-professional education programme was highly appreciated by the patients. CONCLUSIONS: In the present study no improvement could be seen in health-related quality of life in patients with inflammatory bowel disease after participating in an education programme in comparison with the control group. This might be due to the fact that the questionnaires were not sensitive enough or that some patients were not in clinical remission. The patients' enthusiasm for the multiprofessional education programme has led to its being part of the regular care at the clinic.

Predictors of psychological health in spouses of persons affected by stroke.

AIM: To identify predictors of psychological health and examine if these predictors change over time in spouses of stroke patients during the first year after stroke. A second aim was to identify gender differences in psychological health among the spouses. BACKGROUND: The impact of burden in long-term caregivers may result in psychological consequences for the spouse. The rehabilitation process for the patient can be negatively affected by a stressed caregiver and result in long-term hospitalization. To identify spouses at risk for physical and psychological distress is, therefore, essential to support those in need. DESIGN: Longitudinal, comparative study. METHODS: One hundred spouses of stroke patients were assessed at baseline, as well as after six and 12 months, regarding psychological health, well-being, own illness, need of assistance from general practitioner and/or district nurse, social network and knowledge about stroke. Stepwise multiple regression analyses were conducted for baseline, six- and 12-month assessments, respectively, with psychological health as the dependent variable. RESULTS: General well-being and presence of illness in spouse were the most prominent predictors of psychological health, throughout the first year. CONCLUSIONS: Enhancing psychological health and preventing medical problems in the caregiver are essential considerations to enable patients with stroke-related disabilities to continue to live at home. RELEVANCE TO CLINICAL PRACTICE: Evaluating the situation for spouses of stroke patients is an important component when planning for the future care of the patient.

Predictors of quality of life among spouses of stroke patients during the first year after the stroke event.

BACKGROUND: Stroke, a disease with severe consequences for patients and their families, often lead to psychosocial stress, and a decline in the quality of life (QoL) among carers. Predicting the QoL is essential in the development of effective nursing support interventions. AIM: The aim of the present study was to identify predicting factors for the general QoL among spouses of stroke patients, and to determine whether these predictors change during the first year after the patient's stroke event. DESIGN: One hundred spouses were followed three times during 1 year regarding QoL, own illness, economic situation, well being, life situation, sense of coherence, social network and the patients' ability in activities of daily living (ADL). Stepwise multiple linear regression analyses were conducted for the baseline, 6- and 12-month assessments respectively, with the present QoL as the dependent variable. RESULTS: Over time during the first year after the patients' stroke event, there were significant differences in the spouses perceived general QoL. Life situation and economic situation were the only predictors of the spouses' QoL, which emerged during the entire year after the patient's stroke event, while well being, education, own illness, social network and ADL ability (patient) emerged at one or two occasions. CONCLUSION: The psychosocial factors -- life situation, well being, social network, education and economy -- are important in predicting QoL among spouses of stroke patients, and these predicting factors change over time. Determining the predictors at an early stage, and continuously over time, will help to focus clinical nursing interventions on the spouses' changing needs.

Spouse's life situation after partner's stroke event: psychometric testing of a questionnaire.

AIM: This paper reports a study to validate and test the reliability of a questionnaire constructed to evaluate the life situation of spouses after their partners have had a stroke. BACKGROUND: Stroke is a disease with great consequences for survivors and their families. Most survivors return home after the hospitalization and rehabilitation due to the stroke event. Relatives, primarily spouses, often feel obligated to care for the survivor at home, providing emotional support or assisting the person in activities of daily living. More specific information is needed about the spouse's life situation after the stroke event in order to develop effective supportive strategies. METHODS: Psychometric testing of the Life Situation Questionnaire was undertaken with 99 spouses of stroke survivors. The 13-item questionnaire consists of four subscales: 'Worries', 'Powerlessness', 'Personal adjustment' and 'Social isolation'. RESULTS: Item analysis showed that each item correlated with its own subscale (r = 0.63-0.78). The instrument had high internal consistency, with Cronbach's alphas of 0.80-0.86 and reasonable high congruent validity when correlated with a Wellbeing instrument, with a correlation of 0.59 (P = 0.001). Exploratory factor analysis confirmed the subscales, accounting for 77% of the variance. CONCLUSION: The Life Situation Questionnaire is a valid and reliable instrument, and could serve as an assessment tool after a stroke event to identify family caregivers who have problems in their life situations and need support from healthcare services.

The impact of a nurse-led support and education programme for spouses of stroke patients: a randomized controlled trial.

AIMS AND OBJECTIVES: The aim of the present study was to determine the impact of a nurse-led support and education programme for improving the spouses' perceived general quality of life, life situation, general well-being and health state. BACKGROUND: Stroke is a disease with great consequences for the patients and their families. The spouses often feel obligated to care for the patient, providing psychological and physical support and having to cope with the patient's physical and cognitive impairments. This might lead to increased problems, as family members struggle to adapt to their new roles and responsibilities. DESIGN AND METHODS: Longitudinal, randomized controlled trial. One hundred spouses were randomly assigned to intervention or control groups, 50 in each group. The intervention group participated in a support and education programme, six times during six months, led by stroke specialist nurses. Both groups were followed for 12 months. RESULTS: No significant differences were found, between intervention and control groups, over time. In the sub analyses, we found that the group attending 5-6 times had a significant decrease in negative well-being and increased quality of life over time, while the group attending fewer times had a significant decrease in positive well-being and health state, similar to the control group, which also had a significant decrease in negative and general well-being. CONCLUSIONS: A support and education programme might have a positive effect on spouses' well-being, on condition that they attend at least five times. RELEVANCE TO CLINICAL PRACTICE: To facilitate the spouses' role as informal caregivers to the stroke patients, further development of the support and education programme used in the present study is needed, including empowerment approach and implementation of coping strategies.

Testing of an audit instrument for the nursing discharge note in the patient record.

OBJECTIVES: This study validates and tests the reliability of an audit instrument constructed to evaluate the content of nursing discharge notes. DESIGN: Instrument validation and reliability testing. MAIN OUTCOME MEASURES: Factor analysis identifying structure through data summarization of the instrument, association between scores in test-retest, and interrater reliability between auditors. VALIDITY: Three factors emerged in the factor analysis: 'General information', 'Planning', and 'Assessment', accounting for 76% of the variance regarding the quantitative aspect and 79% of the variance regarding the qualitative aspect, confirming the distinctiveness. Reliability: The Spearman rank-order correlation coefficient calculated per item in the test-retest ranged from 0.72 to 1.0 (p=0.01). The correlation coefficient for the total score was 0.98 (p=0.01). There were no differences in item scores between the test and retest in 93% of the comparisons (n=486). Between the two auditors, the Spearman rank-order correlation coefficient in each item ranged from 0.83 to 1.00 (p=0.01) and weighted kappa values from 0.70 to 1.00 with the exception of one item in both calculations. The correlation coefficient for the auditors' total score was 0.99 (p=0.01). The Student's paired t-test comparing the two auditors' mean values in five different parts of the instrument showed no significant differences in score. CONCLUSION: The Cat-ch-Ing EPI instrument shows a high reliability and validity as an audit instrument to evaluate the content of nursing discharge notes.