Registed Nurses' Association of Ontario

Transitioning home from the acute stroke unit: A mental well being perspective

Gillian Maguire
McMaster University and Hamilton Health Sciences

-Summary of fellowship:
This fellowship took place at the Hamilton General Hospital (HGH) within the integrated stroke program through collaboration between McMaster University and Hamilton Health Sciences(HHS). HHS is a regional stroke center that provides acute, rehabilitation and prevention services across the stroke continuum through its integrated stroke model. This fellowship focused on the band 6 pathway that includes patients from the acute stroke unit who do not require inpatient rehabilitation, and are able to be safely discharged home with community services as needed as determined by an interdisciplinary team.Upon discharge from the acute stroke unit band 6 patients receive a two week telephone follow up with the Nurse Practitioner(NP) and a 3 month in person follow up with the Stroke Prevention Clinic nurse and Stroke Neurologist. If applicable the patient may also be seen through outpatient rehabilitation services and/or the stroke research program. The fellowship utilized a research perspective to assess the mental well being of band 6 patients during hospitalization and the first month after discharge home to inform improvements to the existing care pathway. Through collaboration of research and clinical staff we developed a study protocol, obtained ethics approval and conducted a small mixed methods research study entitled mental well-being and experIence of minor isChemic and hemorrhAgic stroke patients recently dischaRged home after a brief stay in an urban acute strokE unit: A mixed methods approach (ICARE). The key findings of this study and a review of the current literature was used to inform development of a standardized documentation tool and enhanced communication strategy for the 2-week NP telephone follow up. Education, key findings and positive participant feedback was
presented to staff on the acute stroke unit to promote openness, awareness and facilitate communication about mental well being after stroke.My overall learning goal was to enhance my leadership skills through obtaining knowledge, skill and expertise in the area of nursing led stroke research as it relates to post stroke mental health, patient engagement and enhancing patient care. Through attending the McMaster University School of Nursing Qualitative Health Research Bootcamp, I gained basic skills and knowledge in designing applied qualitative research studies. Through designing the mixed methods research protocol with input from my mentor, mentorship team and McMaster School of Nursing faculty, I was able to apply my knowledge in a real-world context. My attendance at the Canadian Stroke Congress enabled me to better understand the current landscape of research on stroke care transitions, mental health and rehabilitation. I applied this knowledge to our research study and knowledge translation strategy. My participation in a health research and evaluation graduate course encouraged me to think about the design and scientific rigor of future quantitative studies in this population