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Table 5 Nurses view of the usefulness of the Stroke Nursing Guideline and Implementation process (N=16)

From: Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study

Mean   Themes Descriptions Quotes
Usefulness of the Stroke Nursing Guideline
Mean = 7.7
Range = 5.5–9.0
1. Improved quality of care This theme described how the SNG generally improved nursing care generally. “The SNG has improved the way we work, especially when assisting patients with moving and positioning”.
“The SNG has both improved the care, we think more about how we approach patients and how we help them with movement and ADL”. “We do not only think about physical care but also psychological care, like depression”.
“We ask patients more about how they feel, − their psychological well being”.
“We make much more use of scales now”.
“We think more about the emotional par now and not only about the phhysical”.
  2. Content known to staff The content of the SNG was generally known to staff and already used to an extent in daily care. “The SNG had not so much new things in it, but very good to have everything set up like this”.
“Some things were known to us already, but others are new, − like more emphasis on scales and of course depression”.
  3. Convenient and concise The SNG was convenient and teh text was concise, effortless to read, handy and practical, particularly for new staff and students. “The recommendations are convenient and really very practical and fit very well with how we work on the wards”.
“The guideline is very easy to use. They (the recommendations) are not so extensive, they are short and easy to use”.
“The guideline is very easy to use”.
“We have had much new nursing staff and then it is very good to have the guideline”.
  4. More use of instruments Screening tools make staff focus more systematically on respective components e.g., depression, anxiety, risk of fall, and nutritional status, to be accurate in communicating about patients‘symptoms, as well as to evaluate patients‘progress. “We use instruments more, especially the PHQ-9”.
“We are using the scales much more now with the guideline”.
“Now we use scales for most things like walking ability, falls, depression”.
“The scales are very easy and practical to use”.
  5. More consistency The SNG makes staff do things the same way, which is a quality issue, and with consistent intensity and frequency e.g., in doing physcial exercises with more rigorousness in the evenings and weekends. “After following SNG and the training, we are all working in the same way, − there is much more consistency in how we move patients”.
“It is good that we are all working in the same way. For example when we are taking patients out of bed. Before the guideline we did this very differently”.
  6. Illustrative and instructive Concenring the layout of the SNG, the photos and diagrams are illustrative and instructive a) for staff who uses better ergonomics and b) for patients who are mobilized in a convenient and consistent way and c) for family members who can trust that patients receive the right care. “We use the photos to show patients and family when patients go home for the weekend”.
“Good positions for in bed or when sitting, but also concerning the pain”.
“We can use the SNG much more with family”.
Implementation process
Mean = 7.5
Range
6.0–8.5
1. Nursing rehabilitation defined and integrated Through the SNG, essential components of nursing rehabilitation have been defined and integrated into daily nursing care, e.g., going to the toilet is an opportunity to exercise stand up and sit down, rather than only being the fullfilment of a basic human need. “The SNG is very compact. There is not so much new, − but it is much more clear now. Very clear guideline”.
“All these elements of nursing, like moving and ADL, screening for falls, mobility or depression, which were somehow hidden, are more clear now”.
“Integrating exercise into daily activities is so good for the patients”.
“We now say: Do you need to go to the toilet? Yes, great! That is exercise (laughs)”.
“We now do much more of general training, − activating patients”.
  2. Physical exercise Individualized Physcial exercise guidelines have made individualized instructions from physical therapists less needed. “The mobililty ADL part of the guideline is very good, gives good instruction on how to mobilize patients. Also positioning, − especially the arm”.
“Very good to have the photo‘s on mobility and positioning, − we are becoming much better in helping and instructing on how to move and do excercies”.
  3. Enhanced patient and family teaching Enhanced patient and family teaching, with particularly good teaching material (booklet), bringing forth a request for structured family interviews. “It is much better to teach patients and family about mobility and integrating exercises into daily activities when having this written down and digital”.
“I like to have this in a printed map, which you can take with you and show to patients and family”.
  4. Coherent and consistent leadership Leadership of the charing group during implementation of the SNG was coherent and consistent. “The implementation went very well”.
“The implementation was well led by the chairing group, − they did a very good follow up on things”.
“They (the charing group) really were in charge of things”.
  5. Improved staff education The SNG resulted in good/improved staff education, which needs to be repeated consistently throughout the care continuoum. “The educational and training sessions for staff were very good, − but it needs to be repeated regulary”.
“It is much better to have an active training like this, − you need to do the things and not only read about them”.
“We need to have the training sessions repeated regularly to refresh things, − you tend to forget”.
  6. Less visible nursing care received attention Through the SNG, previous less visible aspects of nursing care have received attention and recognition among all staff, particularly its contribution to the success of patient rehabilitation. “Posters with photo‘s on positioning and mobilizing of patients have been put on the walls for patients and famly as well for staff. Nursing and what we do in rehabilitation is now more visible for all staff”.
“The guideline has made elements of nursing care much more visible to other staff as wel”.
“What we nurses are doing in rehabilitation, like mobilizing and stimulating patients to exercise is now much more visible to the other staff”.