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: 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
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ABSTRACT: Purpose: To determine the physiotherapy-related needs of people with stroke at discharge, 6 months after discharge, and 1 year after discharge from hospital, and to examine the results stratified by participants' acute Functional Independence Measure (FIM) scores. Methods: A total of 241 adults with recent stroke were recruited into this longitudinal cohort study. As well as participating in a semi-structured interview that included questions about mobility needs and barriers, participants were asked to complete and return a closed-ended needs-assessment survey. Results: During the interview, participants reported needs and barriers related to motor control, walking, stairs, fatigue, prevention of falls, and access to physiotherapy services. The survey identified many more needs, including transfers, wheelchair use, higher-level balance and mobility skills, and access to physiotherapy and suitable exercise facilities. Frequencies of needs and barriers tended to be lower among participants with higher acute FIM scores. There was no consistent trend for needs and barriers to decrease over time. Conclusions: Over the first year after discharge from hospital, people with stroke report a large and varied number of persistent mobility-related needs. Physiotherapists have a role to play in advocating for adequate follow-up services and informing health policy with respect to the needs of their patients with stroke.Physiotherapy Canada 01/2013; 65(3):204-214. · 0.61 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; · 1.84 Impact Factor