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Volume 25, Issue 2, 2003

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The Codman Award Paper: Quality of life in stroke survivors and their spouses: Predictors and clinical implications for rehabilitation teams

Anna Bluvol, RN, MScN

Abstract

Valuing and promoting quality of life after stroke is an essential component of practice for neuroscience nurses and other clinicians working in rehabilitation settings. Although some research studies have addressed factors that contribute to quality of life post-stroke, the majority of studies have focused on stroke survivors, not their spouses. Additionally, little attention has been given to family strengths associated with quality of life. In this paper, the investigator presents the findings of a recent descriptive, correlational study that was based on the conceptual framework of the Developmental Model of Health and Nursing (DMHN) (Allen & Warner, 2002; Ford-Gilboe, 2002a). This was the first study to examine the relationships among hope, family health promoting activity, and quality of life. They study was conducted with a convenience sample of 40 stroke survivors with moderate to severe functional impairments and their spouses. Participants had completed a rehabilitation program. Spouses’ employment status, number of supports, and functional independence at discharge were common predictors of quality of life for both partners. However, hope was found to contribute to quality of life for both partners. However, hope was found to contribute to quality of life of stroke survivors, but not their spouses. THe different patterns of findings are discussed and the key implications for clinical and research practice are addressed.

AXON, 25(2), 10–19.

Do we need stimulation programs as a part of nursing care for patients in “persistent vegetative state”? A conceptual analysis

Patrizia Tolle and Marlene Reimer

Abstract

The rehabilitative care of persons suffering long-lasting effects of brain injury is a significant challenge for nurses as they are the health professionals who usually spend the most time with them. Historically in Germany, the term “apallic syndrome” has been commonly used for what Plum and Posner (1980) termed the persistent vegetative state, that is awake but not aware, for more than six months, they seldom receive active therapy except what nurses or families may provide. Stimulation programs have been advocated for these persons, but there is still no reliable evidence as to their effectiveness, and the conceptual basis of the two main types of programs has been poorly understood. The multisensory stimulation approach, such as the Coma Recovery Program or Coma Arousal Therapy, is based on behaviourism with the belief that intensive stimulation provided to all senses will enhance synaptic reinnervation and stimulate the reticular activating system to increase brain tone. In contrast, the sensory regulation approach is based on information processing and mediation of reaction to sensory information with emphasis on enhancing selective attention by regulating the environment rather than providing high degrees of stimulation. What both approaches have in common is the belief that the person in a persistent vegetative state may, at some level, be able to perceive and begin to process information and that external stimulation may enhance that process. Nurses interacting with persons in persistent vegetative state are encouraged to think about how they can regulate sensory input to enhance meaning and facilitate information processing for these persons.

AXON, 25(2), 20–26.


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