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

Educational Guidelines

The educational guidelines developed for use in the CAReS project were based on a literature review, clinical experience, and the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality, or AHRQ) Post-Stroke Rehabilitation Clinical Practice Guideline (Gresham et al., 1995). Nurses and physical and occupational therapists examined the literature to develop the multidisciplinary guidelines. The guidelines related to stress and coping also were reviewed by a psychologist, and guidelines related to aphasia and dysphagia were reviewed by a speech therapist. The guidelines were divided into the seven categories illustrated in Figure 1. They were designed to provide education, support, skill training, counseling, and links to social and community resources. The 6-month guideline implementation time frame was chosen to take advantage of the natural window of physiological recovery.

Major Educational Categories with Specific Content-Based Guidelines

The guidelines were flexible so they could be delivered in any order, based on the needs of the stroke survivor and family. The authors found that in the immediate posthospital phase, stroke survivors and caregivers especially needed information about the effects of the stroke on the survivor, assistance with special nursing and therapy techniques, suggestions for adapting the home for safety and independence, support for day-to-day issues, and ways to access community resources. As seen in Figure 1, this content was covered by the guidelines in the areas of Stroke Recovery, Therapeutic Skill Training, Special Problems, and Community Networks. While all participants received information on topics such as type of stroke, stroke prevention, and home safety, only those with specific needs received information on the topics listed on Figure 1 under Special Problems (i.e., aphasia, pain, and spasticity).

By the end of 3 months, rehabilitation progress usually began to slow and available insurance- reimbursable services were decreasing. The survivor and family often expressed feelings of isolation and frustration because the recovery had not been more complete. Guidelines related to managing stress, coping with chronic illness(es), and developing and maintaining a healthy lifestyle were particularly important to reduce excess disability and caregiver burnout. The topics covered under Stress of Stroke, Coping Strategies, and Promotion of a Healthy Lifestyle are included in Figure 1.

The guidelines were developed to help structure home visits and to record the things that transpired during the visit, the caregiver and survivor's understanding of the content, and recommendations for follow-up. A Microsoft Access database was developed for recording and tracking. An abbreviated example of the guideline, Types of Stroke, is shown in Figure 2.

Guideline for Education on Types of Stroke


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