Situational Analysis: Community Care for Survivors of Stroke and Suggestions for Improving the Provision of Care
Keywords:
caring situation, cerebrovascular accident, Community care, Stroke, Survivors of strokeAbstract
This descriptive qualitative study aimed to analyze the community care situation for survivors of stroke and provide suggestions for improving care. The study was conducted in a district of Chiang Mai Province. Purposive sampling was employed based on inclusion criteria to select 51 key informants comprised of 1) three health personnel, 2) 13 community leaders, 3) three local government officers, 4) 13 village health volunteers, and 5) 13 caregivers who took care of survivors of stroke. The data collection consisted of in-depth interviews and focus group discussions, based on the Expanded Chronic Care Model. Data were analyzed by content analysis.
The results revealed that community care for survivors of stroke is mainly provided by family members. As well, our analysis revealed for survivors: 1) inadequate personal skills among caregivers and volunteers; 2) inefficient health services; 3) the lack of support for a caring system; 4) incomplete clinical information system; 5) no healthy public policy; and 6) lack of a supportive environment. We suggest that, to improve the care available to survivors of stroke, there needs to be: 1) development of supportive policies at both national and local government levels; 2) development and provision of guidelines for the care; and 3) a supportive caring system that includes health personnel, caregivers, and rehabilitation facilities, as well as support for the home and community-based environment. These results and suggestions will be useful to community nurses and stakeholders who are responsible to design caring for survivors of stroke.
References
1. American Heart Association. Heart Disease and Stroke Statistics. 2018 [cited 2018 February 25]. Available from https://healthmetrics.heart.org/wp-content/uploads/ 2018/02/At-A-Glance-Heart-Disease-and-StrokeStatistics-2018.pdf
2. Stroke Association. State of the nation stroke statistics. 2015 [cited 2018 January 20]. Available from https://www. stroke.org.uk/system/files/sotn_2018.pdf
3. World Health Organization. Top 10 causes of death. 2015 [cited 2017 January 10] Available from https://www. who.int/gho/mortality_burden_disease/causes_death/ top_10/en/
4. World Health Organization. Stroke statistic. 2016 [cited 2018 January 18]. Available from https://www.who.int/ stroke_statistics/.html.
5. Stroke association. Stroke statistics. 2015[cited 2016 January 13] Available from https://www.thepossibilities. co.uk/assets/downloads/stroke-statistics.pdf
6. Suwanwela N. Stroke epidemiology in Thailand. Journal of stroke. 2014; 16(1): 1-7.
7. Brunborg B, Ytrehus S. Sense of well-being 10 years after stroke. J Clin Nurs. 2013; doi: 10.1111/jocn.12324
8. Crichton SL, Bray BD, McKevitt C, Rudd AG, Wolfe CDA. Patient outcomes up to 15 years after stroke: survival, disability, quality of life, cognition and mental health. J Neurol Neurosurg Psychiatry. 2016; 87(10): 1091-98.
9. Cobley CS, Fisher R, Chouliara N, Kerr M, Walker NF. A qualitative study exploring patients’ and carers’ experiences of early supported discharge services after stroke. Clin Rehabil. 2013; 27(8): 750-7.
10. Esri demographic. Average household size in Thailand. 2016[cited 2018 February 2] Available from https:// www.arcgis.com/home/item.html?id=8658f09cf1ae 4a44aaa813fbb687b59f
11. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002; 288:1775-79.
12. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, Salivaras S. The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model. Hosp Q. 2003; 7(1):73-82.
13. Suntayakorn C. Management of care for survivors of stroke in community. Pitsanulok: TrakulThaiKanPim; 2011.
14. Stellefson M, Dipnarine K, Stopka C. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review. Prev Chronic Dis. 2013; 10:1-21.
15. Duangbubpha S, Hanucharurnkul S, Pookboonmee R, Orathai P, Kiatboonsri C. Chronic Care Model Implementation and Outcomes among Patients with COPD in Care Teams with and without Advanced Practice Nurses. Pacific Rim Int J Nurs Res. 2013; 17(2): 102-116.
16. Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012; 169(8):790-804.
17. Pasricha A, Deinstadt Roo TM, Moher D, Killoran A, Rourke SB, Kendall CE. Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review. J Gen Intern Med. 2013; 28(1): 127-135.
18. Gibson MJ, Kelly KA, Kaplan AK. Family Caregiving and Transitional Care: A Critical Review. Family care giver alliance, National Center on caregiving. 2012[cited 2018 January 3] Available from https://www.caregiver.org/ sites/caregiver.org/files/pdfs/FamCGing_TransCare_ CritRvw_FINAL10.31.2012.pdf
19. Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc. 2015; 8: 433-42.
20. Srisuphan W, Chanthai K. Manual for professional nurses in health promoting hospital. Bangkok: Judthong; 2013.
21. Wagner EH, Davis C, Schaefer J, Von KM, Austin B. A Survey of Leading Chronic Disease Management Programs: Are They Consistent with the Literature?. J Nurs Care Qual 2002; 16(2): 67-80.
22. Fiandt K. The chronic care model: description and application for practice. Topics in Advanced Practice Nursing ejournal, 2006; 6(4). Available from https:// www.medscape.com/viewarticle/549040_2
23. Sandelowski M. Whatever happened to qualitative description?. Research in Nursing and Health. 2000 23:334-40.
24. Saraphi hospital. Stroke statistic. Saraphi district. Chiang Mai: Saraphi Hospital; 2015.
25. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24, 105-12.
26 Lincoln SY, Guba EG. Naturalistic inquiry. Newbury Park: Sage Publication; 1985.
27. Phinyo P, Phinyo K, Limtragool P, Tiamkao S, Worawong C, Chuasuan W, et al. Care improvement for patients with stroke through community participation. Songklanagarind Journal of Nursing. 2015; 35(2):93-111.
28. Rungpoth P, Jitbantad W. Village Health Volunteers’ Knowledge and Performance in the Care of People with Disabilities: A Case Study of Nakean Community, Muang Nakhon Si Thamarat. Nursing Journal of The Ministry of Public Health. 2013; 23(2):32-43.
29. Blixen C, Nakibuuka J, Kaddumukasa M, Nalubwama H, Amollo M, Katabira E, et al. Community perceptions of barriers to stroke recovery and prevention in greater Kampala,Uganda: Implications for policy and practice. IJH. 2017; 3(2) doi:10.5430/ijh.v3n2p8.
30. Kuson M. Development of care for family to participate in caring stroke in medical unit NongKai Hospital. Khon Kaen: Khon Kaen University; 2009.
31. Donald RA, Arays R, Elliott JO, Jordan K. The effect of an educational handout on patient knowledge of and intention to discuss screening for obstructive sleep apnea in the ischemic stroke population. Sleep. 2017; 40 (suppl_1): A449. doi.org/10.1093/sleepj/zsx050.1202
32. Kulsawet S. Effectiveness of Implementing Home-based Exercise Nursing Practice Guidelines for Stroke Patient Rehabilitation in Community, Namjo Sub-district, Mae Tha District, Lampang Province. Lampang: Namjo; 2014.
33. Yazdi-Feyzabadi V, Emami M, Mehrolhassani MK. Health Information System in Primary Health Care: The Challenges and Barriers from Local Providers’ Perspective of an Area in Iran. Int J Prev Med. 2015; 6: 57.
34. Pearce JR, Maddison R.. Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations? Int J Equity Health. 2011; 10: 28.
35. World Health Organization. Ottawa Charter for health promotion. [cited 2018 February 1] Available from https: //www.betterhealth.vic.gov.au/health/servicesand support/ottawa-charter-for-health-promotion?view AsPdf=true
36. Ruangmee W, Khupantavee N. Health care situation of stroke patients in community of Khao-Ya Subdistrict, Sribunpot Disttrict, Phatthalung Province. Academic Services Journal, Prince of Songkla University. 2016; 27(3):64-72.
37. Pitthayapong S, Thiangtam W, Powwattana A, Leelacharas S, Waters CM. A community based program for family caregivers for post stroke survivors in Thailand. Asian Nurs Res. 2017; 11:150-7.
38. White CL, Cantu AG, Trevino MM. Interventions for caregivers of stroke survivors: an updated of evidence. Clin Nurs Stud. 2015; 3(3):87-95.
39. Chaiyawata P, Kulkantrakornb K. Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial. Clin Neurol Neurosurg. 2012; 114(7):866-70.
40. Petchrong N, Priyatruk P, Thongkeang V. The study of continuing care for patients with cerebrovascular disease in primary care unit. Journal of The Royal Thai Army Nurses. 2013; 14(1):25-34.
2. Stroke Association. State of the nation stroke statistics. 2015 [cited 2018 January 20]. Available from https://www. stroke.org.uk/system/files/sotn_2018.pdf
3. World Health Organization. Top 10 causes of death. 2015 [cited 2017 January 10] Available from https://www. who.int/gho/mortality_burden_disease/causes_death/ top_10/en/
4. World Health Organization. Stroke statistic. 2016 [cited 2018 January 18]. Available from https://www.who.int/ stroke_statistics/.html.
5. Stroke association. Stroke statistics. 2015[cited 2016 January 13] Available from https://www.thepossibilities. co.uk/assets/downloads/stroke-statistics.pdf
6. Suwanwela N. Stroke epidemiology in Thailand. Journal of stroke. 2014; 16(1): 1-7.
7. Brunborg B, Ytrehus S. Sense of well-being 10 years after stroke. J Clin Nurs. 2013; doi: 10.1111/jocn.12324
8. Crichton SL, Bray BD, McKevitt C, Rudd AG, Wolfe CDA. Patient outcomes up to 15 years after stroke: survival, disability, quality of life, cognition and mental health. J Neurol Neurosurg Psychiatry. 2016; 87(10): 1091-98.
9. Cobley CS, Fisher R, Chouliara N, Kerr M, Walker NF. A qualitative study exploring patients’ and carers’ experiences of early supported discharge services after stroke. Clin Rehabil. 2013; 27(8): 750-7.
10. Esri demographic. Average household size in Thailand. 2016[cited 2018 February 2] Available from https:// www.arcgis.com/home/item.html?id=8658f09cf1ae 4a44aaa813fbb687b59f
11. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002; 288:1775-79.
12. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, Salivaras S. The expanded chronic care model: an integration of concepts and strategies from population health promotion and the chronic care model. Hosp Q. 2003; 7(1):73-82.
13. Suntayakorn C. Management of care for survivors of stroke in community. Pitsanulok: TrakulThaiKanPim; 2011.
14. Stellefson M, Dipnarine K, Stopka C. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review. Prev Chronic Dis. 2013; 10:1-21.
15. Duangbubpha S, Hanucharurnkul S, Pookboonmee R, Orathai P, Kiatboonsri C. Chronic Care Model Implementation and Outcomes among Patients with COPD in Care Teams with and without Advanced Practice Nurses. Pacific Rim Int J Nurs Res. 2013; 17(2): 102-116.
16. Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012; 169(8):790-804.
17. Pasricha A, Deinstadt Roo TM, Moher D, Killoran A, Rourke SB, Kendall CE. Chronic Care Model Decision Support and Clinical Information Systems Interventions for People Living with HIV: A Systematic Review. J Gen Intern Med. 2013; 28(1): 127-135.
18. Gibson MJ, Kelly KA, Kaplan AK. Family Caregiving and Transitional Care: A Critical Review. Family care giver alliance, National Center on caregiving. 2012[cited 2018 January 3] Available from https://www.caregiver.org/ sites/caregiver.org/files/pdfs/FamCGing_TransCare_ CritRvw_FINAL10.31.2012.pdf
19. Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc. 2015; 8: 433-42.
20. Srisuphan W, Chanthai K. Manual for professional nurses in health promoting hospital. Bangkok: Judthong; 2013.
21. Wagner EH, Davis C, Schaefer J, Von KM, Austin B. A Survey of Leading Chronic Disease Management Programs: Are They Consistent with the Literature?. J Nurs Care Qual 2002; 16(2): 67-80.
22. Fiandt K. The chronic care model: description and application for practice. Topics in Advanced Practice Nursing ejournal, 2006; 6(4). Available from https:// www.medscape.com/viewarticle/549040_2
23. Sandelowski M. Whatever happened to qualitative description?. Research in Nursing and Health. 2000 23:334-40.
24. Saraphi hospital. Stroke statistic. Saraphi district. Chiang Mai: Saraphi Hospital; 2015.
25. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24, 105-12.
26 Lincoln SY, Guba EG. Naturalistic inquiry. Newbury Park: Sage Publication; 1985.
27. Phinyo P, Phinyo K, Limtragool P, Tiamkao S, Worawong C, Chuasuan W, et al. Care improvement for patients with stroke through community participation. Songklanagarind Journal of Nursing. 2015; 35(2):93-111.
28. Rungpoth P, Jitbantad W. Village Health Volunteers’ Knowledge and Performance in the Care of People with Disabilities: A Case Study of Nakean Community, Muang Nakhon Si Thamarat. Nursing Journal of The Ministry of Public Health. 2013; 23(2):32-43.
29. Blixen C, Nakibuuka J, Kaddumukasa M, Nalubwama H, Amollo M, Katabira E, et al. Community perceptions of barriers to stroke recovery and prevention in greater Kampala,Uganda: Implications for policy and practice. IJH. 2017; 3(2) doi:10.5430/ijh.v3n2p8.
30. Kuson M. Development of care for family to participate in caring stroke in medical unit NongKai Hospital. Khon Kaen: Khon Kaen University; 2009.
31. Donald RA, Arays R, Elliott JO, Jordan K. The effect of an educational handout on patient knowledge of and intention to discuss screening for obstructive sleep apnea in the ischemic stroke population. Sleep. 2017; 40 (suppl_1): A449. doi.org/10.1093/sleepj/zsx050.1202
32. Kulsawet S. Effectiveness of Implementing Home-based Exercise Nursing Practice Guidelines for Stroke Patient Rehabilitation in Community, Namjo Sub-district, Mae Tha District, Lampang Province. Lampang: Namjo; 2014.
33. Yazdi-Feyzabadi V, Emami M, Mehrolhassani MK. Health Information System in Primary Health Care: The Challenges and Barriers from Local Providers’ Perspective of an Area in Iran. Int J Prev Med. 2015; 6: 57.
34. Pearce JR, Maddison R.. Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations? Int J Equity Health. 2011; 10: 28.
35. World Health Organization. Ottawa Charter for health promotion. [cited 2018 February 1] Available from https: //www.betterhealth.vic.gov.au/health/servicesand support/ottawa-charter-for-health-promotion?view AsPdf=true
36. Ruangmee W, Khupantavee N. Health care situation of stroke patients in community of Khao-Ya Subdistrict, Sribunpot Disttrict, Phatthalung Province. Academic Services Journal, Prince of Songkla University. 2016; 27(3):64-72.
37. Pitthayapong S, Thiangtam W, Powwattana A, Leelacharas S, Waters CM. A community based program for family caregivers for post stroke survivors in Thailand. Asian Nurs Res. 2017; 11:150-7.
38. White CL, Cantu AG, Trevino MM. Interventions for caregivers of stroke survivors: an updated of evidence. Clin Nurs Stud. 2015; 3(3):87-95.
39. Chaiyawata P, Kulkantrakornb K. Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial. Clin Neurol Neurosurg. 2012; 114(7):866-70.
40. Petchrong N, Priyatruk P, Thongkeang V. The study of continuing care for patients with cerebrovascular disease in primary care unit. Journal of The Royal Thai Army Nurses. 2013; 14(1):25-34.
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2018-09-28
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Yaowapanon N, Buddhirakkul P, Srisuphan W, Senaratana W, Potempa K, Chontawan R. Situational Analysis: Community Care for Survivors of Stroke and Suggestions for Improving the Provision of Care. PRIJNR [Internet]. 2018 Sep. 28 [cited 2024 Nov. 16];22(4):372-85. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/77795
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