Psychosocial nursing intervention to promote self-esteem and functional independence following stroke

Promoting the maximum level of independence in patients who survive a stroke is becoming an increasingly important area for health professionals given the greater number of survivors following a stroke. Nurses in the rehabilitation setting have a high level of intimate contact with stroke patients and thus have the potential to influence the recovery of these patients. Trials comparing stroke unit with general ward rehabilitation programmes have provided clear evidence of the effectiveness of the stroke units in reduced mortality and improving functional independence. However there are few research studies and little evidence of improved psychosocial outcomes following any rehabilitation programme. A more comprehensive approach to stroke rehabilitation is one that can integrate psychosocial with the physical components.; The aim of this study was to examine the effects of a new psychosocial nursing intervention in assisting the rehabilitation of stroke patients. The emphasis in the new intervention was on the presence and attention of the nurse, patient participation in care planning and in reinforcing patients' rehabilitation activities. The study was designed in two phases, the first to establish the outcomes for patients receiving the usual nursing care and the second phase used a nonequivalent, pretest-posttest, control group design to compare the effects of the new nursing intervention between an experimental and a control group.; Data were collected from stroke patients who met the inclusion criteria within 48 hours of admission to a rehabilitation hospital, at 2-weeks and 3-months. The number of patients agreeing to participate in phase I of the study was 131 and there were 170 who agreed to participate in phase 2 of the study.; Phase I results indicated significant and positive correlations (p < 0.05) between stroke patients' functional ability and state self-esteem. There were significantly positive correlations (p < 0.05) between functional ability and satisfaction with social support at baseline and 3-months. There were significantly positive correlations between state self-esteem and social support at all stages of data collection (p < 0.001). No significant differences were found between the designated experimental and control groups for the functional ability and state self-esteem outcomes.; In phase 2 the stroke patients in the experimental group had significantly (p < 0.05) higher levels of performance state self-esteem than the control group at 2-weeks and 3-months after admission. Multiple regression analysis revealed that 2-week state self-esteem, baseline social support and heart disease explained 49% of the variance in state self-esteem at 3-months. Further regression analysis indicated that 2-week performance state self-esteem and social support satisfaction, heart disease and receiving the new treatment explained 52% percent of the variance in performance state self-esteem at 3-months.; The main finding of a significant difference in the performance state self-esteem for stroke patients receiving the new nursing intervention in this study was discussed in relationship to previous findings and in the context of intervention studies. The implications of the findings for nursing practice highlight the contribution nurses can make to the rehabilitation of the stroke patient and the importance of using nursing sensitive outcomes and determining the dose of the nursing intervention in future nursing intervention research.