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
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.
The effect of recommended positioning on outcome after stroke has yet
to be evaluated.5 Furthermore, although nurses
have been urged to help stroke patients maintain the positions regarded
as therapeutic,6 7 little is known about their
attention to this aspect of care in the lengthy intervals between
formal sessions of rehabilitation. The limited available evidence
suggests that patients are not consistently positioned
according to the ideals suggested in the
literature.8 It could be argued that this
indicates that either the nurses' knowledge is insufficient or that
their theoretical knowledge is not being translated into practice. An
educational program could increase their knowledge of and active
participation in the positioning of patients in recommended ways.
Unless an improvement in the positioning of patients is achieved, the
role of posture in determining outcome after stroke cannot be
investigated.
We therefore conducted a quasi-experimental study to document the
positioning of patients after stroke and to evaluate the effect of a
formal teaching intervention aimed at improving nurses' knowledge and
practice in this area. The following questions were posed: Does
undertaking the teaching package improve nurses' knowledge about
positioning patients following a stroke? Are patients who receive care
from nurses who have undertaken the teaching package positioned in
recommended ways more often than those cared for by nurses who have
not?
Nurse Data
Patient Data
Data on the patients' positions were collected repeatedly by a single
observer using an observational schedule developed and tested in an
earlier study.20 The schedule requires
observation of 19 aspects of posture thought to be important in
influencing the return of normal movement after a
stroke21 and records in 1 of 4 positions:
sitting, lying supine, or lying on affected or unaffected side.
Patients were observed at intervals throughout their stay according to
their availability, pilot work having indicated that rigid scheduling
of observations was not feasible in these clinical settings. Where
multiple sets of observational data were collected on individual
patients in any 1 day, these were made at intervals of at least 30
minutes.
Intervention
The teaching intervention was carried out by a lecturer in nursing with
specialist experience in stroke rehabilitation. It consisted of two
2-hour lectures, with an accompanying workbook for each nurse to
complete and keep for personal reference. Care was taken to ensure that
the content of the teaching program reflected issues covered in the 2
questionnaires assessing nurses' knowledge. The first lecture focused
on the definition and etiology of stroke, factors influencing recovery,
the multidisciplinary team's role in rehabilitation, and the influence
of ergonomics on movement and positioning. Participation and
questioning was encouraged throughout. The second lecture began with a
short revision of the first lecture, but it was primarily a practical
session during which nurses were taught and helped to develop skills in
moving and appropriately positioning patients with stroke. They were
also helped to appraise each other's techniques.
The content of the workbook reflected material covered during the
lectures. A copy was given to each nurse at the beginning of the first
lecture, with an explanation of its function and how to complete it.
The workbook used an open-learning approach with a bias toward
reflection, but nurses were also expected to do some self-directed work
requiring discussion with other professionals and among themselves and
to complete some short question-and-answer exercises. The workbook was
used during the lectures; once completed, it also provided a revision
aid and resource tool.
A total of 25 separate teaching sessions were given over a period of 13
weeks in order to include all nurses working on the experimental
wards.
Procedure
Statistical Analysis
The correctness of each patient's observed position was determined by
comparison with the positions recommended by the physiotherapist as
suitable for that individual. Each physiotherapist was asked to
complete a revised set of recommended positions whenever these
changed.
Changes in the frequency with which patients were positioned correctly
were sought in 2 ways. First, for each set of observations, the
percentage of aspects of posture that were correct (ie, positioned as
recommended by the physiotherapist) was calculated. Comparisons between
groups were made using the Mann-Whitney U test. Second, to
determine whether any improvements in positioning were specific to
certain parts of the body, the 19 aspects of posture within each set of
observations were considered individually and the percentage of correct
positions calculated for each. Group comparisons were made using the
Nurses' Knowledge
For the questionnaire exploring nurses' knowledge of the terminology
used to denote posture, the median scores at baseline were identical.
Immediately after the teaching, the median score for the experimental
group increased whereas that for the control group remained the same,
representing a significant difference (P<0.05).
Three months after the teaching, however, the median score for the
control group increased. Although the median score for the experimental
group also increased slightly, the difference between the groups'
scores was no longer significant.
For the questionnaire dealing with knowledge of moving and positioning
stroke patients, the median scores in both groups increased over time,
but, overall, the nurses in the experimental group scored significantly
higher than those in the control group both immediately after the
teaching (P<0.001) and 3 months afterward
(P<0.005).
The data from the experimental and control groups were divided into
subgroups to give a more detailed picture of the effect of the teaching
intervention on both RGNs and HCAs.
For the "terminology used to denote posture" questionnaire (Figure 1
The HCAs in the 2 groups also scored similarly to each other at
baseline on this questionnaire (P=NS) but with median scores
slightly lower than those of the RGNs. Immediately after the teaching,
the median score for the HCAs in the experimental group increased by 4
points, deteriorating slightly after 3 months but still remaining
higher than the median score at baseline. The median score of the HCAs
in the control group showed little improvement during the study.
However, the differences between the groups were not significant at
either of these assessment points.
Scores of the RGNs on the "moving and positioning" questionnaire
(Figure 2
The difference in the baseline scores of the HCAs in the experimental
and control groups was not significant. Although the median score of
the HCAs in the experimental group improved by 3 points immediately
after the teaching and was sustained at this level for the next 3
months, the differences in scores between the 2 groups remained not
significant throughout the study.
Patients
Patients Position
During the preintervention phase there was no significant difference
between the experimental and control wards in the proportions of
correct positions within each set of observations. Patients in group E
Pre were positioned correctly for a median of 55.6% (range, 17.6% to
100%) of the aspects of posture within each set (n=472) and those in
group C Pre for a median of 57.9% (range, 16.7% to 89.5%; n=174).
After the teaching, a small but highly significant improvement
(P<0.0005) in the proportions of correct positions within
each set of observations was found on the experimental wards (group E
Post), with the median percentage increasing to 61.1% (range, 15.8%
to 94.7%; n=202). In contrast, positioning in the control group in the
postteaching phase (group C Post) showed a significant deterioration
(P<0.05), with the median percentage of correct positions
falling to 48.7% (range, 20.0% to 84.2%; n=152).
The percentages of individual aspects of posture observed as
correct are shown in Table 2
Comparison of groups C Pre and C Post revealed no improvement on the
control wards in the postteaching phase, with group C Post scoring
significantly higher than Group C Pre for only 1 aspect of posture
(thumb: abduction [P<0.05]). In contrast, when compared
with group E Pre, the experimental wards (group E Post) scored
significantly higher after the teaching intervention on 8 aspects of
posture (head: lateral flexion [P<0.05], head: rotation
[P<0.0005], trunk: lateral flexion
[P<0.0005], elbow: flexion [P<0.0005],
forearm: pronation [P<0.0005], wrist: flexion
[P<0.0005], hip: rotation [P<0.0005], and
hip: abduction [P<0.0005]). Group E Post also scored
significantly higher than group C Post for 6 aspects of posture (trunk:
rotation [P<0.0005], shoulder: protraction
[P<0.0005], forearm: pronation [P<0.0005],
wrist: flexion [P<0.0005], hip: rotation
[P<0.025], and hip: abduction
[P<0.0005]).
Overall, an improvement in patients' posture after the nurses had
received the teaching was demonstrated. However, even after the
teaching the percentage of correct positioning remained variable on
the experimental wards, ranging from 23.7% (for thumb: abduction) to
86.9% (for forearm: pronation).
When considering the groups as a whole, the use of the formal teaching
intervention produced small but significant improvements in the
nurses' knowledge of moving and positioning stroke patients and of the
terminology used to denote posture in stroke care. Nurses in the
experimental group scored significantly higher than those in the
control group on both questionnaires immediately after they had
received the teaching and on one questionnaire 3 months later. The
increased median scores achieved by both RGNs and HCAs in the
experimental group following the teaching were sustained 3 months later
for both questionnaires. However, some of the median scores of the
nurses in the control group also improved over time. This could have
resulted from the nurses' participation in the study, and the presence
of the researcher may have initiated an increased awareness and
interest in stroke care. In addition, their completion of
questionnaires at baseline may have motivated them to look up answers
to questions they were unsure of, thus independently increasing their
level of knowledge. It is important to note, however, that although the
knowledge of the nurses in the control group may have improved during
the course of the study, their practice did not.
HCAs tended to score lower than the RGNs. This has implications for the
design of future teaching programs. Furthermore, despite fairly large
improvements in the median scores of the HCAs in the experimental group
immediately after the teaching compared with little or no improvement
in the median scores of the HCAs in the control group, the differences
between the groups were not significant. This may have been due to the
small size of these subgroups.
Our study has identified the presence of poor positioning on both
stroke rehabilitation units and general wards. The results also
indicate that nurses' practice in the positioning of stroke patients
can be improved through a formal teaching intervention. However, the
educational package tested in this study did not effect improvement in
all of the aspects of positioning thought to be important, and some of
the improvements obtained were fairly small. Overall, therefore, there
is scope for further enhancement of nurses' practice in this
potentially important aspect of care.
Lincoln et al8 also found evidence of poor
positioning of stroke patients. However, these researchers made an
overall rating of patients' posture using the categories "good,"
"poor," and "not possible to say." In contrast, our study used
a more focused observational technique that considered the specific
positioning of individual aspects of the body. This approach has 3
advantages. First, comparing observed positions with those which
physiotherapists specifically recommend for each patient means the
individuality of patients can be taken into account. Second, it
highlights which areas of the body are being positioned in recommended
ways and which are not. Third, the data gained in this way can provide
a baseline from which realistic goals for the improvement of
positioning can be made, and they can be used to guide the
content of educational programs for clinical staff.
There were some limitations to the study. The patient sample was small,
although the number of observations carried out was large. The sample
of nurses was compromised because of the withdrawal of nurses from one
of the experimental wards who experienced difficulty attending the
teaching sessions. It was not possible for the observer to remain blind
to the control or experimental status of the wards. In retrospect,
possible bias could have been minimized by use of a second researcher
to collect the physiotherapists' recommendations for patients'
positions and withhold this information from the observer. This
strategy should be considered for use in any future studies.
Overall, the results of our study indicate that it is possible to
effect a degree of change in both nurses' knowledge of and their
practice in the positioning of stroke patients through the use of a
formal teaching intervention. However, there remains much room for
improvement. It is imperative that such improvement is achieved;
without access to a group of patients who are consistently
positioned well, research evaluating the effect of positioning on
outcome after stroke cannot be undertaken. The findings of this study
highlight the need for further consideration of how nursing practice
may be influenced.
Received March 17, 1998;
revision received May 18, 1998;
accepted May 18, 1998.
2.
Keith RA, Cowell KS. Time use of stroke patients in
three rehabilitation hospitals. So Sci Med.. 1987;24:529–533.
3.
Lincoln NB, Gamlen R, Thomason H. Behavioural
mapping of patients on a stroke unit. Int Disability Stud. 1989;11:149–154.[Medline]
[Order article via Infotrieve]
4.
Tinson DJ. How stroke patients spend their days.
Int Disability Stud. 1989;11:45–49.[Medline]
[Order article via Infotrieve]
5.
Wade DT. Stroke. In: Goodwill CJ, Chamberlain MA, eds.
Rehabilitation of the Physically Disabled Adult. London, UK:
Croom Helm; 1988:323–341.
6.
Myco F. Nursing Care of the Hemiplegic Stroke
Patient. London, UK: Harper & Row; 1983.
7.
Gee ZL, Passerella PM. Nursing Care of the
Stroke Patient: A Therapeutic Approach Based on Bobath Principles.
Pittsburgh, Pa: Aren Publications; 1985.
8.
Lincoln NB, Willis D, Philips SA, Juby LC, Berman P.
Comparison of rehabilitation practice on hospital wards for stroke
patients. Stroke. 1996;27:18–23.
9.
Demeurisse G, Demol O, Robaye E. Motor evaluation in
vascular hemiplegia. Eur Neurol. 1980;19:382–389.[Medline]
[Order article via Infotrieve]
10.
Collen FM, Wade DT, Robb GF, Bradshaw CM. The Rivermead
Mobility Index: a further development of the Rivermead Motor
Assessment. Int Disability Stud. 1991;13:50–54.[Medline]
[Order article via Infotrieve]
11.
Mahoney FI, Barthel DW. Functional evaluation: the
Barthel Index. Md State Med J. February 1965:61–63.
12.
Barer DH, Edmans JA, Lincoln NB. Screening for
perceptual problems in acute stroke patients. Clin Rehabil. 1990;4:1–11.
13.
Stone SP, Wilson B, Wroot A, Halligan PW, Lange LS,
Marshall JC, Greenwood RJ. The assessment of visuo-spatial neglect
after acute stroke. J Neurol Neurosurg Psychiatry.. 1991;54:345–350.
14.
Sunderland A, Harris JE, Baddeley AD. Do laboratory
tests predict everyday memory? A neuropsychological study. J
Verbal Learning Verbal Behav. 1983;22:341–357.
15.
Wade DT. Stroke. In: Goodwill CJ, Chamberlain MA, eds.
Rehabilitation of the Physically Disabled Adult. London, UK:
Croom Helm; 1988:chap 20.
16.
Syder D, Body R, Parker M, Boddy M. Sheffield
Screening Test for Acquired Language Disorders. Windsor,
UK; NFER-Nelson; 1994.
17.
Zigmond AS, Snaith RP. The hospital anxiety and
depression scale. Acta Psychiatr Scand. 1983;67:361–370.[Medline]
[Order article via Infotrieve]
18.
Katzman R, Brown T, Fuld P, Peck A, Schechter R,
Schimmel H. Validation of a short Orientation-Memory-Concentration test
of cognitive impairment. Am J Psychiatry. 1983;140:734–739.
19.
Spreen O, Strauss E. A Compendium of
Neuropsychological Tests: Administration, Norms and
Commentary. Oxford, UK: Oxford University Press; 1991.
20.
Carr EK, Kenney FD. Observing seated posture after
stroke: a reliability study. Clin Rehabil. 1994;8:329–333.
21.
Carr EK, Kenney FD. Positioning of the stroke patient:
a review of the literature. Int J Nurs Stud. 1992;29:355–369.[Medline]
[Order article via Infotrieve]
22.
Gould D. Knowledge, opinions and practice of essential
infection control measures: a comparative study of nurses in different
clinical settings. London, UK: Department of Nursing Studies, King's
College; 1993. PhD thesis.
© 1998 American Heart Association, Inc.
Original Contributions
Positioning of Stroke Patients
Evaluation of a Teaching Intervention With Nurses
Abstract
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
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.
Key Words: nurses • positioning • rehabilitation • stroke
Introduction
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Arecommended strategy
to discourage physical complications of stroke and to improve recovery
is to encourage "reflex-inhibiting" patterns of
posture.1 While there is consensus among
clinicians that encouraging such positions is therapeutic and may
enhance recovery, it is believed that only consistently good
positioning will be effective. It has been demonstrated that
hospitalized stroke patients often spend long periods of time in
passive pursuits on the ward, such as sitting unoccupied, lying down,
or watching television, and very little time in active
rehabilitation.2 3 4 Thus, the main responsibility
for attending to the positioning of patients clearly lies with the
nursing staff, who are the only group of health professionals
continuously present. As such, and through teaching and involving
both patients and their caregivers, they have the greatest opportunity
to influence stroke patients' posture directly.
Subjects and Methods
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Subjects
Data were collected on 6 wards in 2 London teaching hospitals.
Two wards specialized in stroke rehabilitation and 4 were general
medical wards. All nurses from these wards, comprising registered
general nurses (RGN) and healthcare assistants (HCA), were recruited
into the study. All patients admitted after a stroke and with a
hemiplegia were invited to participate in the study during the first
week of their admission to the ward. Written informed consent was
sought from all patients or their caregivers, and the study had the
approval of the ethics committees.
Baseline descriptive data were collected from each nurse. These
comprised age, gender, grade, number of years qualified, length of time
in current post, experience in the field of stroke care, level of
education, and completion of relevant postregistration study. In
addition, their perceived quality of the ward as a learning environment
and their level of job satisfaction were assessed with use of visual
analogue scales. Nurses' knowledge of issues relating to stroke
patient positioning was assessed using 2 questionnaires developed for
the study. One focused on moving and positioning stroke patients and
the other on the terminology used to denote posture. Each had a
potential score of 20.
Patients were assessed on entry into the study with use of a
range of measures to determine group equivalence. These included
demographic details as well as measures of stroke sequelae likely to
have an effect on the patients' ability to adopt and maintain
recommended positions. The following measures were used: Motricity
Index,9 Rivermead Mobility
Index,10 Barthel Index,11
confrontation test,12 star cancellation
test,13 paragraph recall
test,14 thumb-finding
test,15 Sheffield Screening Test for Acquired
Language Disorders,16 Hospital Anxiety and
Depression Scale,17 Short
Orientation-Memory-Concentration Test,18 and
Taylor Complex Figure
Test.19
View larger version (13K):
[in a new window]
Figure 1. Line graph showing median scores of RGNs and HCAs
on the "terminology used to denote posture" questionnaire before
and after the teaching intervention. There was a significant difference
between RGN experimental ( 
) and control (
) groups immediately
after teaching (P<0.01) but not after 3 months.
Although HCA experimental (
) group scores improved after teaching,
there was no significant difference at any time point compared with the
HCA control (
) group.
The research team felt that teaching nurses about positioning
stroke patients in isolation from the wider aspects of rehabilitation
care would be unsatisfactory and contrary to the ideal of holism. The
content of the teaching package was developed accordingly.
The specialist units and the general wards were assigned to
control or experimental status through block randomization so that both
groups comprised 1 of the units and 2 of the wards. Baseline data were
then collected from all nurses, and 20 patients were recruited,
assessed, and observed repeatedly throughout their stay. Nurses in the
experimental group then received the teaching intervention, following
which both questionnaires were readministered to all nurses. A further
sample of 20 patients was recruited from all wards, assessed, and
observed. Finally, nurses were asked to complete the questionnaires at
3 months after intervention. The following 4 patient groups were
produced: group E Pre, baseline experimental; group C Pre, baseline
control; group E Post, postteaching experimental; and group C Post,
postteaching control.
Nurse and patient data were analyzed separately. The
Mann-Whitney U test was used to detect differences in age,
relevant postregistration study, perceived quality of the ward as a
learning environment, level of job satisfaction, and in levels of
knowledge between the experimental and control groups as a whole, and
when subdivided into RGN and HCA, at baseline and following the
intervention. The 
2 test was used to detect
differences in other personal characteristics between the experimental
and control groups of nurses. The Kruskal-Wallis test was used to
detect significant differences between groups in patients'
characteristics. 2 test. Differences were labeled as
statistically significant at the conventional value of
P
0.05.
Results
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Nurses
One hundred sixteen nurses were initially included in the study.
There was a reduction in sample size over time as nurses left the
hospital (n=26), moved to a different ward (n=4), declined to complete
questionnaires (n=6), or were absent due to illness (n=1). One ward was
excluded from the study after nonattendance at the teaching sessions,
and this meant the loss of follow-up data from an additional 20 nurses.
Ultimately, 59 nurses (44 RGN and 15 HCA) completed questionnaires at
all 3 data collection points. There were 30 nurses in the experimental
group and 29 in the control group. A statistically significant
difference (P<0.01) was found between the groups in
nurses' perceived quality of their ward as a learning environment,
with the experimental group rating this more positively. The groups
were similar in all of the other personal characteristics
considered.
The median scores at each time point on the 2 questionnaires are
shown in Table 1. At baseline there were
no significant differences between the experimental and control groups
in nurses' scores on either questionnaire.
View this table:
[in a new window]
Table 1. Median Score, Median % Correct, and Range From
Nurses' Questionnaires 
), the RGNs in the 2 groups had similar
scores at baseline (P=NS). Immediately after the teaching,
the median score for the RGNs in the experimental group increased,
generating a significant difference between the groups
(P<0.01). Three months later the RGNs in the experimental
group retained this improved median score, but that for the RGNs in the
control group increased, so that the difference between the groups was
no longer significant. ) showed a significant
difference between the groups at baseline (P<0.005), with
the experimental group producing the higher median score. Both groups
improved their median scores at the postteaching assessment point, but
the experimental group continued to score higher (P=0.0001).
In both groups these improved scores were maintained 3 months
later.
View larger version (14K):
[in a new window]
Figure 2. Line graph showing median scores of RGNs and HCAs
on the "moving and positioning stroke patients" questionnaire
before and after the teaching intervention. There was a significant
difference between RGN experimental ( ) and control () groups at
baseline (P<0.005), immediately after teaching
(P=0.0001), and 3 months after teaching
(P=0.0001). Although HCA experimental () group scores
improved after teaching, there was no significant difference at any
time point compared with the HCA control () group scores.
Forty patients entered the study. Two patients were later excluded
because no specific positioning recommendations were made for them by
the ward physiotherapists. The remaining sample of 38 patients (13 in
group E Pre, 7 in group C Pre, 10 in group E Post and 8 in group C
Post) had a mean age of 73 years (range, 48 to 86 years). Twenty-eight
(74%) were women. There were no significant differences between the
groups in terms of age, number of days between stroke and first
observation of position, length of admission on study ward, or mean
time spent receiving formal physiotherapy. There was no significant
difference between the groups in any of the baseline measures of stroke
sequelae apart from the paragraph recall test–immediate recall
(P<0.05).
One thousand sets of observations of patients position were
obtained. These were related to the 4 groups as follows: E Pre, n=472;
C Pre, n=174; E Post, n=202; and C Post, n=152. Of these sets, 208
(20.8%) were of patients lying supine or laterally and 759 (75.9%)
were of patients sitting either in a chair or wheelchair. The remaining
33 (3.3%) sets were made while patients were sitting in bed. It was
not possible to collect data on all 19 aspects of posture for every set
of observations made. This resulted from parts of the body being
obscured by bedding or clothing, the patients moving parts of their
body independently, or to no specific recommendations being made by the
physiotherapist. In total, 17 854 individual aspects of posture were
observed. . Again,
groups E Pre and C Pre were comparable. Group E Pre scored
significantly higher than group C Pre for 4 aspects of posture (trunk:
rotation [P<0.001], shoulder: protraction
[P<0.001], shoulder: abduction [P<0.01],
and forearm: pronation [P<0.05]), and Group C Pre scored
higher for 5 aspects (head: lateral flexion [P<0.05],
head: rotation [P<0.01], trunk: lateral flexion
[P<0.05], shoulder: flexion [P<0.01], and
wrist: flexion [P<0.05]).
View this table:
[in a new window]
Table 2. Number of Aspects of Posture Observed and Percentage
Positioned Correctly by Group
Discussion
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
This study sought to evaluate a teaching package designed to
improve nurses' knowledge of and practice in positioning stroke
patients. The quasi-experimental design used the nurses and patients on
6 wards, those within the experimental group being well matched with
those in the control group in all personal characteristics. The one
exception was that the nurses in the experimental group rated the
learning environment of their wards higher than those in the control
group. This might have been expected to enhance the standard of
clinical practice on these wards.22 Nevertheless,
at baseline there were no significant differences between the groups as
a whole in their level of knowledge about issues relating to
positioning or the positions in which patients were nursed. It is
possible, however, that working in a learning environment perceived as
positive contributed to the success of the teaching.
Acknowledgments
This study was funded by South East Thames Regional Health
Authority. We thank Roberta Taylor of Nene University College,
Northampton, for the development of her original teaching material and
for carrying out the teaching intervention and Fiona Kenney for her
contribution to the project.
References
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
1.
Bobath B. Adult Hemiplegia: Evaluation and
Treatment. 3rd ed. Oxford, UK: Heinemann Medical Books; 1990.
This article has been cited by other articles:
 |
|
 |
|
  I. Davidson, V. F Hillier, K. Waters, T. Walton, and J. Booth A study to assess the effect of nursing interventions at the weekend for people with stroke Clinical Rehabilitation, February 1, 2005; 19(2): 126 - 137. [Abstract] [PDF]
|
|
|
|
|
|
A Jones, K Tilling, J Wilson-Barnett, D J Newham, and C D. Wolfe Effect of recommended positioning on stroke outcome at six months: a randomized controlled trial Clinical Rehabilitation, February 1, 2005; 19(2): 138 - 145. [Abstract] [PDF]
|
|
|
|
 |
|
 R Mc Govern and A Rudd Management of stroke Postgrad. Med. J., February 1, 2003; 79(928): 87 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E K Carr, F D Kenney, J Wilson-Barnett, and D J Newham Inter-rater reliability of postural observation after stroke Clinical Rehabilitation, March 1, 1999; 13(3): 229 - 242. [Abstract] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||