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Rent from Deepdyve. Share feedback. Unfortunately, not all caregivers are proactive in providing this information to the rehabilitation team, and often, team members do not seek this information. When a truly interactive partnership exists, it is possible to attenuate barriers associated with conflicting treatment goals. Without such a model in place, caregivers must often manage their needs and experiences on their own; those who take more passive roles may not receive the necessary preparation as they wait for providers to initiate critical interactions Creasy et al.
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Further, allowing families—to the extent desired by patients and families—to be present during provider rounds would provide additional information for and engagement with families. It should also be acknowledged that family caregivers may have other responsibilities outside of the caregiving role such as preparing the home for discharge, work, or other family or personal needs.
Providers may be faced with the dilemma of who the actual patient is—the individual or the family unit—in addition to responsibility issues that arise when tasks are delegated to family members. Other barriers include possible mismatch between provider and patients' needs and goals for treatment Irwin and Richardson, and inconsistent communication about the roles and expectations of caregivers in the clinical setting Coyne, Without such system redesign, providers may be faced with difficulty in changing their practice.
The planning and delivery of care should be determined through collaborative partnership among providers, patients, and families IPFCC, Are these realistic and, if not, how can we work together to develop a plan that is realistic and acceptable to all? Can this person do what we are asking them to do regarding caring for the stroke survivor?
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Does the family caregiver have the knowledge, needed skills, resources, and capacity to provide the care for the stroke survivor? Is this family caregiver committed to and accepting of this new role? However, we have identified some strategies that may be implemented by individual rehabilitation nurses working in rehabilitation settings. One strategy would be to conduct a thorough assessment of caregivers' strengths, capacity to provide care, and gaps in their needs and ability to perform the caregiving tasks that are expected of them.
Therefore, assessment is not a onetime event, but rather a continual process. One strategy for identifying caregivers' needs is to simply ask them. Providers must also assess patients' and caregivers' expectations about rehabilitation outcomes and life postdischarge. This knowledge may help providers work with patients and caregivers to identify the needs and resources required to meet these expectations, or to help families develop realistic goals for recovery and poststroke life.
Close collaboration among all rehabilitation healthcare providers—including nurses, physicians, and occupational, physical, and speech therapists—is necessary to gain a complete picture of families' postdischarge needs.
Edited by Shane J. Lopez and C.R. Snyder
In addition to patient assessments conducted within the inpatient rehabilitation setting, an assessment of the home environment to identify other needs would be beneficial. It is not enough to assess patients and caregivers' expectations and needs; providers must work with these families to address these issues and activate the appropriate resources.
Various resources are already available to assist nurses and other rehabilitation healthcare providers in the assessment of and engagement with stroke patients and their family caregivers. These include recruiting patients and family members to be members of advisory committees to help improve quality, and implementing strategies to improve continuity of care across shifts and communication with all stakeholders.
Family Centered Policies Practices International Implications 2001
The toolkit also includes a basic tool for discharge planning. While the toolkit was developed to be used in acute care institutions, the tools could be easily revised for application to inpatient rehabilitation and skilled nursing settings. For example, nursing staff could recruit family members of stroke patients for a focus group to get feedback on issues and concerns that family members identified during a past stay on a rehabilitation unit.
Following the focus group, an advisory panel that includes staff, family members, and previous patients could be convened to developed strategies to address concerns. Nurses working on the unit could also initiate bedside shift reports that include family members and patients to help improve continuity of care. Finally, anticipatory guidance strategies may be helpful to help prepare caregivers for the transition home and changes they might expect. Even thorough assessments cannot identify all potential needs that these families may face. Nurses and other rehabilitation providers should work with patients and families to help them anticipate postdischarge needs and provide information and support resources for issues that may be identified after discharge.
This may include information about mental health issues i. When stroke survivors are discharged home, most of the care provided will be by family members; the inclusion of family caregivers in treatment planning and needs assessments in the rehabilitation setting should therefore be implemented. Despite this, families are not generally included as integral within the trajectory of stroke care. Why is this? Analyzing the critical juncture of family-centered policy and practice, this book places the universal institution of the family in a global context.
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