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


Numerous studies show caregivers sustain negative psychological effects during the first year after a stroke survivor is discharged home (Blake, Lincoln, & Clarke, 2003; Burton, 2000; Clark & Smith, 1998; Coombs, 2007; Grant et al., 2004; Ski & O'Connell, 2007). Recent research finds stroke survivors often do not reach their rehabilitation goals and lack of information is a major barrier to continued recovery (Jones, 2006). Consequently, posthospitalization educational programs provided to stroke survivors and their families must be interactive, interdisciplinary, and focused on identified needs. In this program, not only was the content comprehensive, but multiple strategies were used, as suggested by Miller and colleagues (1997). These strategies include one-on-one education reinforced with pictures, diagrams, and written materials and tailored to survivors' and families' needs and level of understanding. Team members demonstrated and encouraged survivors and caregivers to accurately demonstrate self-monitoring techniques such as how to take a pulse and properly use home blood-pressure-monitoring equipment and glucometers and canes, walkers, and wheelchairs. The team followed up on suggestions via telephone and provided additional information by mail. Social support and referrals to groups and agencies that could provide ongoing information and social or financial support also were part of the educational program.

Stroke is a multifaceted disease with physical, psychological, and behavioral problems differing among survivors. Even those with similar types of impairment may experience differences in degree of severity, trajectory of recovery, and social and financial resources. As illustrated in the two case studies, APNs and therapists were able to use the guidelines to educate, support, counsel, train, and link the families to community agencies and financial resources. In doing so, they helped these two families better understand their diseases, control their comorbidities, and decrease their risk of recurrent strokes to progress toward recovery and to garner the many resources necessary to improve their health, safety, and quality of life.


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