Evidence-Based Educational Guidelines for Stroke Survivors After Discharge Home

Sharon K. Ostwald, PhD RN FGSA; Sally Davis, MSN RN; Gayle Hersch, PhD OTR; Carolyn Kelley, DScPT PT NCS; Kyler M. Godwin, MPH


J Neurosci Nurs. 2008;40(3):173-179,191. 

In This Article

Abstract and Introduction

Stroke survivors today are discharged home from the hospital more quickly than in the past because of shifting economic realities. Survivors continue to experience significant impairments after discharge and families may be poorly prepared for the full extent of caregiving responsibilities. This article describes 39 comprehensive educational guidelines that have been tested with 72 stroke survivors and families during 1,150 home visits throughout the first 6 months after discharge from inpatient rehabilitation. Two case studies illustrate use of the guidelines with stroke survivors and their families.

Stroke is the third leading cause of death and the major cause of long-term disability among older adults in the United States. Approximately 5.7 million stroke survivors live in the United States (American Heart Association [AHA], 2007). The length of inpatient rehabilitation is decreasing, with a change of focus toward community-based rehabilitation (Lincoln, Walker, Dixon, & Knights, 2004), leaving a relatively short time for many stroke survivors and families to absorb all of the information they will need when they go home. Because many stroke survivors have comorbidities such as heart disease and diabetes, their educational needs may be extensive. They require information on risk-factor reduction to prevent future strokes, and also encouragement to live a healthy lifestyle through a wholesome diet, exercise, and stress management.

This article describes a stroke educational program that was offered to 72 stroke survivors and their families as part of an interdisciplinary research study called CAReS (Committed to Assisting with Recovery after Stroke [NR005316]). CAReS was a 5-year randomized clinical intervention study funded by the National Institute for Nursing Research (NINR). As they were discharged home from in-patient rehabilitation, 159 stroke survivors and their spouses were randomized into usual care or home visit groups. Physical and psychosocial data were collected on stroke survivors and spousal caregivers in both groups at discharge and 3, 6, 9, and 12 months after discharge to test for differences between the two groups. All couples received information by mail for 12 months. The group randomized into the home visit group also received home visits for 6 months from nurses and therapists, who used 39 flexible, evidence-based guidelines developed by this article's authors for use with stroke survivors following discharge from inpatient rehabilitation. The guidelines were tested for ease of use and acceptance by stroke survivors and their families during more than 1,150 visits from an interdisciplinary team comprising advanced practice nurses (APNs) and occupational and physical therapists. Case studies illustrate the use of these guidelines based on stroke survivor and family needs. Names of the family members in the case studies have been changed to protect identity.


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