I S S U E S A N D IN N O V A T I O N S IN N U R S I N G P R A C T I C E
Expanding the role of the stroke nurse: a pragmatic clinical trial Christopher Burton
DPhil PGCertHE BN RGN
Research Fellow, Department of Nursing, University of Central Lancashire, Preston, UK
PhD MSc DipN DipANS RMN RGN
Head of Department, Department of Nursing, University of Central Lancashire, Preston, UK
Accepted for publication 16 March 2005
Correspondence: Christopher Burton, Department of Nursing, University of Central Lancashire, Preston PR1 2HE, UK. E-mail: email@example.com
B U R T O N C . & G I B B O N B . ( 2 0 0 5 ) Journal of Advanced Nursing 52(6), 640–650 Expanding the role of the stroke nurse: a pragmatic clinical trial Aims. This paper reports a study evaluating whether expanding a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery. Background. Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation, although this is limited by the constraints of service organization. Methods. A pragmatic randomized controlled trial was undertaken. Patients with a diagnosis of stroke were randomized to receive continued support from a stroke nurse (n ¼ 87) or usual care and follow-up (n ¼ 89) after discharge from hospital. Patients were recruited from two hospitals in the north-west of England from November 1999 to April 2001. Patient dependence (Barthel Index), general health (Nottingham Health Proﬁle), activities of living (Frenchay Activity of Living Index), depression (Beck Depression Inventory) and carer strain (Carer Strain Index) were assessed at 3 and 12 months after stroke. Results. The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months (median difference 42Æ6, P ¼ 0Æ012), and in particular reduced negative emotional reaction (P ¼ 0Æ037) and perceived social isolation (P ¼ 0Æ002). In addition, the intervention reduced carer strain at 3 months (P ¼ 0Æ045), and reduced deterioration in physical dependence from 3 to 12 months (P ¼ 0Æ049). Conclusion. The provision of continued intervention from a stroke nurse after discharge from hospital, focusing on education and support, has tangible beneﬁts for patients and carers.
Keywords: stroke, patient discharge, nursing role expansion, evaluation, randomized controlled trial
Traditionally, stroke care has been organized around acute and rehabilitation services, where the purpose of rehabilitation is to facilitate sufﬁcient functional independence for patients to cope at home (Speach & Dombovy 1995). Where patient progress is limited, alternative services such as continuing care facilities may be considered. Whilst this 640
model neglects the long-term nature of learning to live with the aftermath of stroke (Burton 2000a, Kirkevold 2002), it can also predispose to discontinuity in care and can leave those affected by stroke feeling dissatisﬁed (Hart 2001). The immense problems that stroke survivors can experience at transfer of care from hospital to the community have been well documented (Hart 2001), and include perceptions of abandonment (Doolittle 1991), and difﬁculties in applying Ó 2005 Blackwell Publishing Ltd
Issues and innovations in nursing practice
Expanding the role of the stroke nurse
rehabilitation tasks and exercises to the home environment (Pound et al. 1998). In addition, considerable emotional and physical demands may be placed on family members who take on a caring role in supporting the stroke survivor (Pound et al. 1999, Kerr & Smith 2001). This paper describes a clinical trial that examined the expansion of an existing nursing role, the stroke nurse specialist, to address some of these issues. Whilst ascribed a range of job titles, this role...
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