From the Department of Nursing Studies (A.J., E.K.C., J.W.-B.) and
Physiotherapy Group (D.J.N.), King's College, London, UK.
Correspondence to Anne Jones, Department of Nursing Studies, King's College, University of London, Cornwall House, Waterloo Road, London SE1 8WA, UK. E-mail c.anne.jones{at}kcl.ac.uk
Background and Purpose—There is
agreement, although little evidence, that consistently
positioning stroke patients in allegedly reflex-inhibiting positions is
therapeutic and will enhance functional recovery. The nursing staff,
therefore, needs to know and implement these postures and understand
their potential underlying value. We examined nurses' knowledge of and
practice in positioning stroke patients before and after a formal
teaching intervention.
Methods—In a quasi-experimental study, 38 stroke patients and 59
nursing staff members (44 trained nurses and 15 healthcare assistants)
from 6 wards were studied. The wards were randomly allocated to
experimental or control status. Patients were assessed on entry into
the study by use of a range of measures to establish group equivalence.
Nineteen aspects of their position were documented at intervals
throughout their stay with a previously developed observational tool.
One thousand sets of observations of patient position were made. Using
2 questionnaires, the nurses' knowledge of the terminology used to
denote posture and of issues relating to the moving and positioning of
stroke patients was assessed before, immediately after, and 3 months
after a package of formal teaching was implemented on the experimental
wards. Nurse knowledge and patient position were used as the main
outcome measures.
Results—Immediately after teaching, nurses in the experimental
group scored significantly higher than those in the control group on
the terminology questionnaire (P<0.05) and the moving
and positioning questionnaire (P<0.001). Three months
later, the experimental group scored higher on the latter questionnaire
only (P<0.005). The positioning of patients in the
experimental group was improved overall after the teaching
(P<0.0005), and improvements to specific parts of the
body were noted.
Conclusions—It was possible to effect a degree of change in the
nurses' knowledge of and practice in the positioning of stroke
patients. However, the quality of patient positioning remained
variable. More effective ways of improving positioning need to be
developed. Only then can the effects of recommended positioning be
evaluated.
© 1998 American Heart Association, Inc.
Original Contributions
Positioning of Stroke Patients
Evaluation of a Teaching Intervention With Nurses
Key Words: nurses • positioning • rehabilitation • stroke
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