Paper on Improving Stroke Rehabilitation: Assessing Nurses' Integration After Educational Initiative

Introduction

Statistically, the annual population affected by stroke globally is 15 million. The disorder is associated with a variety of consequences such as social, mental, and physical. In most cases, stroke patients majorly require rehabilitation. Rehabilitation entails a process encompassing the specific patient, their relatives, and professionals towards excising a time-delimited activity. Moreover, the process should be dictated by meaningful and well-stated goals developed in conjunction with the patient. The specific goals for rehabilitation are not necessarily to eradicate the existence of symptoms and diseases but to help individuals undertake social activities independently. On the other hand, stroke patients need attention from specialized personnel due to their complex nature consisting of speech, motor, behavior, and cognitive issues, which complicate their approach to rehabilitation procedures.

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In the interdisciplinary team specified for a rehabilitation process, nurses have significant input. However, their role in the rehabilitation process extensively is unclear. In a scenario involving stroke rehabilitation, they fail to fully exploit their potential as they have difficulties incorporating rehabilitation approaches into their routines.

The study below is essential. It assesses nurses' ability to incorporate rehabilitative measures in their daily routine after being participants in a 24/7 stroke rehabilitation educational initiative. The study is relevant as there have been underdeveloped interventions by nurses in their routines. That is one of the significant reasons their input has difficulties showing effect. Also, there has been a poor integration of the rehabilitation aspect in real-time practice. The study's applicability is through the development of theoretical and evidence-structured interventions that will be implemented from the stroke management initiative's commencement.

Objectives

This study will develop a theoretical and evidence-characterized intervention with the manipulation of the British Medical Research Council (MRC). That is to ensure the development of a systematic and evidence-based intervention encompassing Michie's Behavior Change Wheel (BCW), and the intervention will address change in behavior for stroke patients. That entails identifying self-perceived distortions in nurses in particular facility behavior concerning Capability, Opportunity, and Motivation (COM-B) factors.

Operational Definition

Data Saturation

Data saturation is the point where no more data in research is observed or obtained. There will be data saturation during the interviews conducted in the research, and the aspect will also be guided sampling. Its measurement is when during the exercise, on interviewing a certain number of interviewees, there will be no new data being observed (Nelson, 2017). That will be when the interviewer and the first author conclude that they have reached the data saturation point and should, therefore, stop the interviews. The outcome of this variable will be a cessation of interviews.

Com-B Factors

COM-B factors comprise of Capability, Opportunity, and Motivational Behaviors of workers. The measurement of these variables is by identifying how they influence the nurses' working environment handling acute stroke patients and how they could incorporate a rehabilitative approach to handling the same patients (Loft et al., 2018). The outcome of applying these variables will be achieved after a sensitization initiative by implementing an educative approach for the nurses in the acute stroke department. After the exercise, the nurses will be able to confess to improvement in COM-B factors. They will improve their capabilities, they have more opportunities, and they will feel motivated due to the educative initiative.

Matrix

A matrix is a system comprising rows and columns in research whereby variables in research are intended to fit. The matrix majorly comprises methodology, analysis, and targeted conclusions. The research variable will be first developed based on COM-B variable factors, and the matrix will then be used as a lens to analyze the data. In the research, the matrix concept will be used to formulate the research theme based on the data filled in the matrix, which comprises the nurses' capabilities, exploitation, and availability of opportunities and motivational factors behind their work (Tan et al., 2019). Secondly, during data analysis which will be obtained from the interviews, the researchers will match the responses to the information already in a matrix. That will be to ascertain that the interview questions are practical and in line with the objectives. That is why any information coinciding with the matrix will be coded and recorded in the intended categories. Further to applying this concept, any information that will not coincide with the variables in the matrix will be put under discussion, and the researchers will have to come to a consensus.

Hypothesis

The two variables in discussion in this study are acute stroke and rehabilitative measures. The two variables are related as the rehabilitative measures are intended to manage stroke's impact on patients by enabling them to execute treatment independently.

There is a problem in implementing the strategy as the nurses are not aware of their roles during rehabilitation strategies for stroke patients (Afsar et al., 2018). Secondly, the nurses are also not aware of the sequential procedure to implement when executing rehabilitative measures on stroke patients. Interventional studies encompass the development of an educative measure, which is formulated with an application of the COM-B variable.

The cohort's application in this study will be to establish the implications of undefined approaches by uninformed nurses toward the application of rehabilitative measures in stroke patients. The cohort will also be aiming to identify the link between the variable and the outcome after application (Dobbins et al., 2020). As it will be identified from the cohort, risk factors are likely to be the nurses' lack of know-how results in inefficiency in the treatment of stroke. Secondly, the variable COM-B inappropriate implementation in the working environment has adverse implications.

Controlling the effects of ineffective and undescribed approaches toward the management of stroke disorder will entail the development and implementation of an educative program. The research will also aim to identify the impacts of the current measures for the treatment of stroke, which nurses are not familiar with. The research will still aim to identify the implications of a conversant strategy in nurses toward the application of rehabilitative measures when dealing with stroke patients. Therefore, the case-control will entail applying a conversant rehabilitative approach involving the patient, relatives, and professionals.

Materials and Methods

Study Design

The study design in the research will be the convergence of a mixed-method approach, which will include a questionnaire for collecting quantitative data. There will also be the application of interviews, which will not be detailed to collect qualitative data (Loft et al., 2018). The reason for adopting the mixed-method design is due to the need for identification of the need and effectiveness of the combination of several methods. That will then help in a vivid perception of the complicated context of the environment towards healthcare provision.

Setting

The research will take place in a healthcare facility, specifically in the stroke acute wing, where the educative program will be conducted in one of the halls. The setting's selection is because the nurses will still on duty and will not be able to move out of the hospital. If an issue requires their immediate attention, they will be available to address the issue accordingly. Secondly, they will need to attend to the already available patients in the facility and therefore cannot move. Another factor is that the program will not be based on the government education department but organized by a group of researchers. The setting will also be necessary as there is availability of equipment and specific space for practical sessions (Loft et al., 2018). The answering of the questionnaire will also take place in the hall. However, there will be a few measures put in place, such as spacing to ensure privacy when answering the questions.

On the other hand, the interview will be conducted in the same institution but in seclusion in one of the offices. That is because the responses are meant to be confidential, and only the researchers will be supposed to access them. That encompasses the involvement of one nurse at a time.

Duration of the Study

The intervention will be an educational initiative encompassing three workshops' participation, each lasting three hours. The workshops will be inclusive of work-in-practice interceptions. There will also be an over-course, which will take place for three months during the 2016 spring.

Sample Size

The study will encompass the involvement of all registered nurses (RNs) who total to (n=19) and all nurse assistants (NAs) totaling to (n=18). Therefore, the total sample size will be an inclusion of 37 nurses. The sample size will be explicitly from a 15-bed acute stroke department with enrollment in the education program. Participation in the initiative will therefore be mandatory with an exemption of substitute staff.

Sampling Technique

The sampling technique that will be administered in this study will be systematic sampling. The technique involves an adherence to set dynamics towards the selection of participants. In this study, the dynamics include nurses' mandatory participation in the 15-bed acute stroke department and the exclusion of substitute staff. Regarding their educational background, nurses with less than two years after graduation will be seven. Nurses with two to five years after graduation will be five. Nurses with more than five years after graduation were 25. Nurses with supplementary education will be 16, while those without any form of supplement education will be 21. Considering their government's permanent employment, nurses with less than two years of work experience in the public sector will be 13. Nurses with a work experience between two and five years will be ten, and nurses with more than five years serving in the public sector will be 14.

Sample Selection

The participating population's inclusion criteria are only the registered nurses' and assistant nurses' involvement. On the other hand, the exclusion criteria will encompass the restriction of substitute staff from participating in this study.

Data Collection Procedure

Generally, RNs and NAs who will be involved in the study will be required to answer the questionnaire before and after completing the 3-month educational program. Secondly, there will be a selection of RNs and NA nurses for the semi-structured interview. That will be to develop a purposive sample towards the achievement of breadth and perspectives' variety. Therefore, the selection of the RNs and NAs will be guided by varying degrees of age and seniority. There will be the application of the principle of data saturation.

Focusing on specifications, the first data collection scope for analyses will be the questionnaire. The questionnaire will be under the inspiration of COM-B, which will entail self-evaluation towards answering. The questionnaire will also be under the same influence, consisting of a behavioral diagnosis form, which will be part of the data collection scope. The participants will be expected to fill out the two sections diligently and accura...