Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.

Implications for Rehabilitation

• Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.

• Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.

• Nurses can routinely incorporate rehabilitation principles in their care.

• Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

• Q-methodology
• qualitative research
• rehabilitation nursing
• stroke
• stroke units

Acknowledgements

We would like to thank the stroke unit staff in the following NHS Trusts for so generously giving up their time to participate in this study: Airedale NHS Foundation Trust; Lancashire Teaching Hospitals NHS Trust, Pennine Acute Hospitals Trust. Thanks also to Anne Forster, Mary Godfrey and Michelle Briggs for their contribution to synthesising the role descriptions, which underpinned the Q sort statements, and to the reviewers for their helpful comments and suggestions.

Declaration of interest

The authors report no conflicts of interest.

This study was funded by the Stroke Association (England) Grant reference: TSA SRTF 2010/01. The views expressed are those of the authors and not necessarily those of the Stroke Association. The funder had no involvement in the study design; the collection, analysis or interpretation of data; the writing of the report; or the decision to submit the paper for publication. The corresponding author had full access to all the data and had final responsibility for the decision to submit for publication.

Supplementary material available online