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


Stroke is a catastrophic event for survivors and their families. Because significant numbers of stroke survivors experience limitations after they go home, continuing and targeted education is crucial to minimize stroke's impact. The National Heart, Lung, and Blood Institute's (NHLBI) Framingham Heart Study reported that among stroke survivors 6 months after discharge, 50% had one-sided paralysis, 35% were depressed, 30% were unable to walk without assistance, 25% were dependent in activities of daily living (ADL), and 19% were aphasic (Kelly-Hayes et al., 2003). In a 2006 survey of 523 long-term stroke survivors, the National Stroke Association reported that 87% had ongoing motor problems, 54% had trouble walking, 52% had trouble with hand movements, and 58% experienced spasticity. Forty percent said they had limited success in meeting rehabilitation goals related to mobility and speech (Jones, 2006).

After discharge, stroke survivors have to confront the pervasive effects a stroke may have on their lives. Family members have to learn rehabilitation techniques and adjust to changes in their relationships with the stroke survivor (Coombs, 2007). Although a return to the home environment has distinct advantages for stroke survivors, it also involves less contact with nursing and rehabilitation professionals, resulting in reduced daily professional support for survivors and caregivers. Increased demands on families have been shown to result in decreased mental health for some family caregivers (Andersen et al., 2000; Teel, Duncan & Lai, 2001; White, Poissant, Coté-LeBlanc, & Wood-Dauphinee, 2006). Clark and Smith (1998) reported survivors who were better informed about their stroke and prognosis had less depression and made better functional recoveries than poorly informed patients.

Resources that could help with the transition from hospital to home often are fragmented or lacking. Stroke survivors and their caregivers have difficulty obtaining information about their condition (Andersen et al., 2000), managing special cognitive and behavioral problems without assistance (Grant, Glandon, Elliott, Giger, & Weaver, 2004), and obtaining access to community and rehabilitation services (Ski & O'Connell, 2007). In a National Stroke Association survey, 38% of long-term stroke survivors reported a lack of information about community and rehabilitation resources (Jones, 2006).

Managing comorbidities such as hypertension, heart disease, diabetes, high blood cholesterol, and smoking is essential to prevent recurrent strokes. Some studies have suggested these comorbidities are not equally distributed within the population. A study by the World Health Organization (Mackay & Mensah, 2004) found that stroke survivors with lower socioeconomic status (SES) had more previous strokes and more stroke-related comorbidities. Risk reduction education may need to be targeted to those with lower SES, who often are younger, have less education, and represent a larger percentage of minorities.

A catastrophic event such as a stroke may provide the impetus for important life changes. Research on patients with stroke, hypertension, diabetes, and hypercholesterolemia, however, has shown that adherence to self-care management generally is poor. Most patients do not comply with dietary and exercise guidelines, directives to stop smoking, and self-monitoring unless special attention is given to adherence (Kernan & Inzucchi, 2004; Miller, Hill, Kottke, & Ockene, 1997; NHLBI, 2002; Qureshi, Suri, Kirmani, & Divani, 2004; Siskind et al., 2000). The AHA reports that multicomponent strategies including patient education, contracts, self- monitoring, social support, telephone follow-up, and tailoring the educational content to individual and family needs works most effectively toward gaining compliance (Miller et al.).


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