Background: Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as\nthey do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and\nimplemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of\nchanges in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation\nwards, barriers and facilitators, and nurses� and auxiliary nurses� view of the implementation.\nMethods: A sequential explorative mixed method design was used including pre-test post-test measures and post\nintervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was\ncollected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and\nQuality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus\ngroups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.\nResults: Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items\nfocusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge\nplanning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant\nimprovement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046),\ndischarge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAIsubscales,\nnamely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and\nPatient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing\nconsistency in care. The implementation process was found to be successful as essential components of nursing\nrehabilitation were defined and integrated into daily care.\nConclusion: Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care,\nwith increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary\nnurses with an important means for evidence based care for patients with stroke. Several challenges of implementing\nthis complex nursing intervention surfaced which mandates ongoing attention.
Loading....