Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.

The sixth update of the Canadian Stroke Best Practice Recommendations for Transitions and Community Participation following Stroke is a comprehensive set of evidence-based guidelines addressing issues faced by people following an acute stroke event. Establishing a coordinated and seamless system of care that supports progress achieved during the initial recovery stages throughout the transition to the community is more essential than ever as the medical complexity of people with stroke is also on the rise. All members of the health-care team engaged with people with stroke, their families, and caregivers are responsible for partnerships and collaborations to ensure successful transitions and return to the community following stroke. These guidelines reinforce the growing and changing body of research evidence available to guide ongoing screening, assessment, and management of individuals following stroke as they move from one phase and stage of care to the next without "falling through the cracks." It also recognizes the growing role of family and informal caregivers in providing significant hours of support that disrupt their own lives and responsibilities and addresses their support and educational needs. According to Statistics Canada, in 2012, eight million Canadians provided care to family members or friends with a long-term health condition, disability, or problems associated with aging. These recommendations incorporate aspects that were previously in the rehabilitation module for the purposes of streamlining, and both modules should be reviewed in order to provide comprehensive care addressing recovery and community reintegration and participation. These recommendations cover topics related to support and education of people with stroke, families, and caregivers during transitions and community reintegration. They include interprofessional planning and communication, return to driving, vocational roles, leisure activities and relationships and sexuality, and transition to long-term care.

The needs of family members of severe traumatic brain injured patients during critical and acute care: a qualitative study.

Traumatic brain injury (TBI) is a devastating injury for both patients and their family members. The goal of this study is to identify the needs expressed by family members, as patients with severe brain injury progress through their recovery. A qualitative study was undertaken with 25 family members who were associated with 15 injured relatives. Data are reported from 44 interviews conducted at two time periods: discharge from ICLI (Time 1) and discharge from acute care facility to home or rehabilitation (Time 2). The findings are part of a larger mixed method study of both qualitative and quantitative data collected over three time periods. Family members identified a variety of need during the acute hospitalization period. Thematic analysis at 1 identified four main themes that described the trajectory of the families' experiences: getting the news, uncertainty, making sense of the news and moving on. At Time 2, themes of the family experience included uncertainty, looking for progress, transition and letting go/building a new connection. Themes that identified the needs of families included managing life, involvement in care, and holding on to hope. Support required by the family included the need for information, professional support and community support. Families had intensive needs in the acute phase of the injury and their needs changed over time. Findings of the study will assist neuroscience nurses in understanding their role in providing for the needs of families of TBI patients.