Chinese elderly patients' perceptions of their rehabilitation needs following a stroke.
ABSTRACT Stroke is the third leading cause of death and disability among Chinese elderly patients in Hong Kong and yet the rehabilitation needs of these patients are rarely explored. The aim of this study was to identify the rehabilitation needs of Chinese elderly patients following a stroke. The study adopted an ethnographic approach, information being gathered by the researcher through interviews with 15 key informants selected by purposive sampling. The perceptions of patients as to their own needs were sought at three stages of recovery - in the acute and rehabilitation settings and at 1 month following discharge. Ethical approval was gained from the Chinese University Faculty of Medicine ethical committee and access agreed by the hospital authorities. Verbal approval was gained from the patients before each interview, following confirmation of the voluntary nature of participation and assurance of confidentiality and anonymity. The researcher's role was also clearly stated. Analysis of the interview data produced five categories of patient need at the three stages of recovery, namely informational, physical, psychological, social and spiritual. The most frequently stated, but largely unmet, need in all settings was the need for information, particularly information about the reasons for stroke and about the activities that promote recovery. In the acute and rehabilitation settings patients' responses indicated a need to be respected as individuals, to be addressed by name and to be provided with privacy. Although the Barthel Index administered during interviews charted recovery at different rates, nurses did not always make links between the level of functional ability and the help needed with physical tasks. They also failed to recognize the relationship between physical and psychological needs and the equal importance of both in recovery from stroke. As Chinese elderly patients tend to take a passive role in seeking help and information, nurses play a significant role in the identification of individual rehabilitation needs. Implications for nursing practice are discussed.
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ABSTRACT: Abstract Aim: The aim of this paper is to explore approaches used to address some stroke rehabilitation interventions and to examine the potential use of one of the life-span theories called the Baltes' model of selective optimisation with compensation (SOC) as a potential framework. Key findings and implications: Some of the key considerations for a stroke rehabilitation intervention framework are highlighted including accommodating for the life management changes post stroke, alterations in self-regulation, acknowledge losses and focusing on a person-centred approach for transition from acute rehabilitation to the home or community setting. The Baltes' SOC model is then described in terms of these considerations for a stroke rehabilitation intervention framework. Conclusions and recommendations: The Baltes' SOC model may offer further insights, including ageing considerations, for stroke rehabilitation approaches and interventions. It has potential to facilitate some of the necessary complexities of adjustment required in stroke rehabilitation. However, further development in terms of empirical support is required for using the model as a framework to structure stroke rehabilitation intervention. Implications for Rehabilitation There is a scarcity of theoretical frameworks that can facilitate and be inclusive for all the necessary complexities of adjustment, required in stroke rehabilitation. In addition to motor recovery post stroke, rehabilitation intervention frameworks should be goal orientated; address self-regulatory processes; be person-centred and use a common language for goal planning, setting and attainment. The Baltes' SOC model is one such framework that may address some of the considerations for stroke rehabilitation, including motor recovery and other life management aspects.Disability and Rehabilitation 05/2013; · 1.54 Impact Factor
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ABSTRACT: Abstract Purpose: This study explored health professionals' views about the influence of Muslim religious beliefs on Kuwaiti patients' self-efficacy within stroke rehabilitation. It also explored their confidence in discussing religious issues with patients during rehabilitation. Method: Qualitative semi-structured interviews were conducted with 10 expatriate health professionals of various religious faiths working in stroke rehabilitation (five nurses, four physiotherapists and one physician). Data were analysed thematically. Findings: Health professionals considered that self-efficacy in stroke rehabilitation was strengthened by patients' feelings of partnership with God, which evoked hope and strength by retaining continuity of the moral self, and by viewing disability as a test of resilience. Fatalistic beliefs and the belief that stroke is a punishment from God were thought to undermine self-efficacy. Health professionals sought to foster patients' experience of religious empowerment by using religious phrases during rehabilitation, and encouraging religious observance. Nurse participants considered that discussing religious issues with their patients was intrinsic to culturally competent care. Conclusions: It is known that patients' self-efficacy in rehabilitation can be strengthened through a number of strategies such as goal-setting and feedback. This study suggests that for Muslim patients in Kuwait, health professionals also need to be mindful of their need for religious empowerment. Implications for Rehabilitation Muslim religious beliefs may influence self-efficacy in stroke patients in the Kuwaiti context. Patients who regard themselves as working in partnership with their God may feel empowered and more confident to achieve goals in rehabilitation. Patients who regard their stroke as a divine punishment may have lower self-efficacy. Health professionals might support religious patients to retain a sense of their unimpaired moral selves (e.g. by enabling religious observance) as a means of enhancing self-efficacy in rehabilitation.Disability and Rehabilitation 02/2014; · 1.54 Impact Factor
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ABSTRACT: Background The development, validation, and psychometric properties of the Wake Forest Physician Trust Scale (WFPTS)-equivalent instrument for Chinese patients were investigated. Material and Methods We approached 3442 randomly selected outpatients at 3 Shanghai (China) general hospitals, treated ≥2 times per year by the same physician, for participation between November 2008 and December 2008. A Chinese version of the WFPTS (C-WFPTS) was prepared and administered to eligible and consenting patients, and subjected to validity assessment using 5 patient behaviors: (1) recommendation of the physician; (2) occurrence of dispute; (3) seeking a second opinion; (4) treatment adherence; and (5) consideration of switching physicians. Results A total of 352 (M: F, 149: 203; mean age, 40.67±17.31 years; age range, 14-94 years) consenting and eligible patients were included in the analysis. The unidimensionality and internal consistency of C-WFPTS was confirmed (Cronbach's α=0.833). Physician trust correlated significantly with physician satisfaction (r=0.73, P<0.001) and all 5 behaviors (1: r=0.453, 2: r=0.209, 3: r=0.406, 4: r=0.444, 5: r=0.471; P<0.001 for all), indicating validity and predictive validity, respectively. Patient trust increased significantly with increasing age and physician visits (P>0.05), but was not related to gender, birthplace, or insurance type. Conclusions C-WFPTS has good psychometric properties, reliability, and validity for the evaluation of patient trust in the patient-physician relationship, and thereby provides an essential tool for the characterization of patient-physician relationships in China, which is necessary for healthcare reform.Medical science monitor: international medical journal of experimental and clinical research 01/2014; 20:1142-1150. · 1.22 Impact Factor