Redesigning Rural Acute Stroke Care: A Person-Centered Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
- A qualitative research component consisting of patient and family interviews, as well as healthcare staff interviews. The aim of this part of the project was to report on the in-hospital experiences of those receiving and delivering stroke care in Northwest Tasmania.
- A quantitative component highlighting the current state of acute stroke services in Northwest Tasmania, as well as providing a baseline for comparative analyses following the implementation of a redesigned acute stroke care service.
2.2. Setting
2.3. Stakeholder Group (Patient Journey Group)
2.4. Participants
2.4.1. Staff
2.4.2. Users
2.5. Recruitment
2.5.1. Staff
2.5.2. Users
- An information sheet was mailed to these users. This sheet informed and invited users to provide consent for further data collection regarding their health history pertaining to stroke only. Consent was provided in writing.
- Participation selection, from those consented, was according to the criteria identified in the sampling matrix (Table 1). These details were identified from an audit of the digital health records.
2.6. Method—Interviews
2.6.1. Staff
2.6.2. Users
2.7. Data Analysis
- Breaking down the text—developing thematic network,
- Exploring the text—describing thematic network,
- Integration—interpreting the patterns within the thematic network.
3. Results
3.1. Demographic Information
3.2. Thematic Data
3.3. Global Themes
3.3.1. Communication
“Stroke care is not bad, but we have our hands tied” Staff Interview #9.
“There is no personal communication between the hospital and GPs” Staff interview #13.
“Communication among the patient, family, and staff is a priority” User Interview #17.
“The nurse didn’t explain why she was giving me medication—she got upset when I questioned her about it” User interview #2.
“Communication with the family was dreadful” User interview #10.
“I didn’t get any information about strokes. I just wanted to know what caused it, why it happened, but I didn’t get any answers” User interview #11.
3.3.2. Holistic Care
“Get them in, get them well, get them out” Staff interview #26.
“A neuropsychologist would be beneficial for designing effective patient therapy programs” Staff interview #25.
“It’s quite a fight to keep going every day. Mental healthcare is lacking” User Interview #5.
“Patient follow-up should be mandatory—especially for life-changing conditions” Staff interview #19.
3.3.3. Resourcing and Service
“There is no protocol, no stroke pathway, and no thrombolysis program” Staff interview #10
“There is no orientation for nurses around stroke care and no specific training; staff are lacking in confidence” Staff Interview #2
“Good planning equals good implementation” Staff interview #17
“The ladies came around but did nothing” User interview #4
“The doctor came around and we had a long chat which I appreciated. It was the most valuable chat I’ve had with anyone” User interview #15
“Care in ** Hospital was good—nothing to improve” User interview #11
“I was treated respectfully, and my privacy was protected” User interview #13
4. Discussions
4.1. Limitations
4.2. Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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≤1 Medical Risk Factor and/or ≤1 Lifestyle Risk Factor | >1 Medical Risk Factor and/or >1 Lifestyle Risk Factor | |||
---|---|---|---|---|
Medical risk factors | TIA, atrial fibrillation, diabetes, fibromuscular dysplasia | |||
Lifestyle risk factors | High blood pressure, high cholesterol, smoking, excessive alcohol consumption, obesity, lack of exercise | |||
65+ years | <65 years | 65+ years | <65 years | |
Ischemic | 3 | 3 | 3 | 3 |
Hemorrhagic | 1 | 1 | 1 | 1 |
Transferred From H1/H2 ** | 1 | 1 | 1 | 1 |
Transferred to H1/H2 *** | 1 | 1 | 1 | 1 |
Bought in by ambulance (BIBA) | 1 | 1 | 1 | 1 |
Private car | 1 | 1 | 1 | 1 |
Mild severity * | 1 | 1 | 1 | 1 |
Moderate severity * | 1 | 1 | 1 | 1 |
Severe * | 1 | 1 | 1 | 1 |
Staff Role | Number of Interviews | Healthcare Organization |
---|---|---|
Registered nurse | 9 | H1/H2 |
Enrolled nurse | 1 | H1 |
Consultant (general medical) | 1 | H2 |
Registrar | 1 | H1 |
Physiotherapist | 2 | H1/H2 |
Occupational therapist | 2 | H1/H3 |
Speech pathologist | 2 | H1/H2/H3 |
Social worker | 2 | H1 |
Clinical nurse educator/coordinator | 2 | H1/H2 |
General practitioner | 2 | H3 |
Pharmacy | 2 | H1 |
Radiology | 1 | H3 |
Staff | Users |
---|---|
Health education creates a healthy environment | Perception of overall healthcare depends on experience |
Organized stroke care saves lives | Information is a key component of recovery |
Communication is a strength | Channels of communication influence experience |
Mental health matters | Mental health matters |
Service inefficiencies | Reliability of service provision creates a motivational arena for users |
Ongoing, quality care | User follow-ups provide a sense of support and reassurance |
Human interactions are an integral part of a healthcare service |
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Prior, S.J.; Mather, C.A.; Campbell, S.J. Redesigning Rural Acute Stroke Care: A Person-Centered Approach. Int. J. Environ. Res. Public Health 2023, 20, 1581. https://doi.org/10.3390/ijerph20021581
Prior SJ, Mather CA, Campbell SJ. Redesigning Rural Acute Stroke Care: A Person-Centered Approach. International Journal of Environmental Research and Public Health. 2023; 20(2):1581. https://doi.org/10.3390/ijerph20021581
Chicago/Turabian StylePrior, Sarah J., Carey A. Mather, and Steven J. Campbell. 2023. "Redesigning Rural Acute Stroke Care: A Person-Centered Approach" International Journal of Environmental Research and Public Health 20, no. 2: 1581. https://doi.org/10.3390/ijerph20021581