School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
School of Occupational Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada.
Clin Rehabil. 2023 Jun;37(6):851-863. doi: 10.1177/02692155221144891. Epub 2022 Dec 21.
The objective of this study was to identify essential aspects of exemplary post-discharge stroke rehabilitation as perceived by patients, care partners, rehabilitation providers, and administrators.
We carried out an exploratory qualitative, multiple case study. Stroke network representatives from four regions of the province of Ontario, Canada each nominated one post-discharge rehabilitation program they felt was exemplary.
The programs included: a mixed home- and clinic-based service; a home-based service; a clinic-based service with a stroke community navigator and; an out-patient clinic-based service.
Participants included 32 patients, 16 of their care partners, 23 providers, and 5 administrators.
We carried out semi-structured qualitative interviews with patients and care partners, focus groups with providers, and semi-structured interviews with administrators. Health records of patient participants were reviewed. Using an interpretivist-informed inductive content analysis, we developed overarching categories and subcategories first for each program and then across programs.
Across four regions with differing types of programs, exemplary care was characterized by three essential components: stroke and stroke rehabilitation knowledge, relationship built through personalized respectful care, and a commitment to high quality, person-centered care.
Exemplary post-discharge care included knowledge regarding identification and treatment of stroke-related impairment, that is, information found in best practice guidelines. However, expertise related to building relationship through providing personalized respectful care, within a mutually supportive, improvement-oriented team was also essential. Additionally, administrators played a crucial role in ensuring continued ability to deliver exemplary care.
本研究旨在确定患者、护理伙伴、康复提供者和管理者认为的模范出院后脑卒中康复的基本方面。
我们进行了探索性的定性、多案例研究。来自加拿大安大略省四个地区的脑卒中网络代表各自提名了一个他们认为模范的出院后康复项目。
这些项目包括：混合家庭和诊所服务；家庭服务；设有脑卒中社区导航员的诊所服务；以及门诊诊所服务。
参与者包括 32 名患者、16 名患者的护理伙伴、23 名提供者和 5 名管理者。
我们对患者和护理伙伴进行了半结构化定性访谈，对提供者进行了焦点小组讨论，对管理者进行了半结构化访谈。对患者参与者的医疗记录进行了审查。使用解释主义启发的归纳内容分析，我们首先为每个项目，然后跨项目开发了总体类别和子类别。
在具有不同类型项目的四个地区，模范护理的特点是三个基本组成部分：脑卒中及脑卒中康复知识、通过个性化尊重护理建立的关系，以及对高质量、以患者为中心的护理的承诺。
模范出院后护理包括与识别和治疗与脑卒中相关的损伤有关的知识，即最佳实践指南中的信息。然而，通过提供个性化尊重护理建立关系的专业知识，以及在相互支持、以改进为导向的团队中，也是至关重要的。此外，管理者在确保继续提供模范护理的能力方面发挥了关键作用。
