Feasibility of creating an enriched environment and subsequent impact on activity levels for stroke patients in an acute stroke unit

2019 ◽  
Author(s):  
Ingrid Rosbergen-Wildemors
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Enriched Environment ◽  
Activity Levels ◽  
Stroke Patients ◽  
Acute Stroke Unit

Embedding an enriched environment in an acute stroke unit increases activity in people with stroke: a controlled before–after pilot study

2017 ◽  
Vol 31 (11) ◽  
pp. 1516-1528 ◽  
Author(s):  
Ingrid CM Rosbergen ◽  
Rohan S Grimley ◽  
Kathryn S Hayward ◽  
Katrina C Walker ◽  
Donna Rowley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Adverse Events ◽  
Acute Stroke ◽  
Usual Care ◽  
Stroke Unit ◽  
Enriched Environment ◽  
Activity Levels ◽  
Stroke Patients ◽  
Serious Adverse Events ◽  
Acute Stroke Unit

Objectives: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. Design: Controlled before–after pilot study. Setting: An acute stroke unit in a regional Australian hospital. Participants: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. Intervention: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. Main Measures: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. Results: The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in ‘any’ activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). Conclusions: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.

The impact of environmental enrichment in an acute stroke unit on how and when patients undertake activities

2018 ◽  
Vol 33 (4) ◽  
pp. 784-795 ◽  
Author(s):  
Ingrid CM Rosbergen ◽  
Rohan S Grimley ◽  
Kathryn S Hayward ◽  
Sandra G Brauer
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Environmental Enrichment ◽  
Control Group ◽  
Activity Levels ◽  
Stroke Patients ◽  
Group Activities ◽  
Acute Stroke Unit ◽  
Communal Areas ◽  
The Impact

Objectives: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). Design: This is a substudy of a controlled before–after observational study. Setting: The study was conducted in an Australian acute stroke unit. Participants: The study included stroke patients admitted to (1) control and (2) environmental enrichment period. Intervention: The control group received standard therapy and nursing care, which was delivered one-on-one in the participants’ bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours. Main measures: Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups. Results: Higher activity levels in the enriched group ( n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity ( P < 0.001), weekday non-scheduled activity ( P = 0.007) and weekends ( P = 0.018) when compared to the control group ( n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. ( P = 0.324). The enriched group spent more time on upper limb ( P < 0.001), communal socializing ( P < 0.001), listening ( P = 0.007) and iPad activities ( P = 0.002). No difference in total staff assistance during activities was observed ( P = 0.055). Conclusion: Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit.

scholarly journals The effect of an enriched environment on activity levels in people with stroke in an acute stroke unit: protocol for a before-after pilot study

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Ingrid C. M. Rosbergen ◽  
Rohan S. Grimley ◽  
Kathryn S. Hayward ◽  
Katrina C. Walker ◽  
Donna Rowley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Enriched Environment ◽  
Activity Levels ◽  
Acute Stroke Unit

Resource utilization and costs for treatment of stroke patients in an acute stroke unit in Greece

2016 ◽  
Vol 142 ◽  
pp. 8-14 ◽  
Author(s):  
Persefoni Kritikou ◽  
Konstantinos Spengos ◽  
Nikolaos Zakopoulos ◽  
Yannis Tountas ◽  
John Yfantopoulos ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Resource Utilization ◽  
Stroke Unit ◽  
Stroke Patients ◽  
Acute Stroke Unit

scholarly journals Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018226 ◽  
Author(s):  
Ingrid C M Rosbergen ◽  
Sandra G Brauer ◽  
Sarah Fitzhenry ◽  
Rohan S Grimley ◽  
Kathryn S Hayward
Keyword(s):  
Change Management ◽  
Acute Stroke ◽  
Health Professionals ◽  
Stroke Unit ◽  
Allied Health ◽  
Management Strategies ◽  
Enriched Environment ◽  
Allied Health Professionals ◽  
Acute Stroke Unit ◽  
The Impact

ObjectiveAn enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit.DesignA descriptive qualitative approach.SettingAn acute stroke unit in a regional Australian hospital.ParticipantsWe purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes.ResultsThree themes were identified. First, staff perceived that ‘the road to recovery had started’ for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, ‘it takes a team’ to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, ‘keeping it going’ was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies.ConclusionInvestigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their new work practice, careful selection of change management strategies are critical to support clinical translation of an enriched environment.Trial registration numberANZCTN12614000679684; Results.

scholarly journals Five Years of Acute Stroke Unit Care: Comparing ASU and Non-ASU Admissions and Allied Health Involvement

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Isobel J. Hubbard ◽  
Malcolm Evans ◽  
Sarah McMullen-Roach ◽  
Jodie Marquez ◽  
Mark W. Parsons
Keyword(s):  
Length Of Stay ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Allied Health ◽  
Stroke Patients ◽  
Stroke Units ◽  
John Hunter ◽  
Acute Stroke Unit ◽  
Allied Healthcare ◽  
Over Time

Background.Evidence indicates that Stroke Units decrease mortality and morbidity. An Acute Stroke Unit (ASU) provides specialised, hyperacute care and thrombolysis. John Hunter Hospital, Australia, admits 500 stroke patients each year and has a 4-bed ASU.Aims.This study investigated hospital admissions over a 5-year period of all strokes patients and of all patients admitted to the 4-bed ASU and the involvement of allied health professionals.Methods.The study retrospectively audited 5-year data from all stroke patients admitted to John Hunter Hospital(n=2525)and from nonstroke patients admitted to the ASU(n=826). The study’s primary outcomes were admission rates, length of stay (days), and allied health involvement.Results.Over 5 years, 47% of stroke patients were admitted to the ASU. More male stroke patients were admitted to the ASU (chi2=5.81;P=0.016). There was a trend over time towards parity between the number of stroke and nonstroke patients admitted to the ASU. When compared to those admitted elsewhere, ASU stroke patients had a longer length of stay (z=−8.233;P=0.0000) and were more likely to receive allied healthcare.Conclusion.This is the first study to report 5 years of ASU admissions. Acute Stroke Units may benefit from a review of the healthcare provided to all stroke patients. The trends over time with respect to the utilisation of the John Hunter Hospitall’s ASU have resulted in a review of the hospitall’s Stroke Unit and allied healthcare.

Abstract 100: Effects of time to Physical Therapy Order on Length of Stay and Discharge NIH Stroke Scale Scores in an Acute Stroke Unit

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Emmanuel B John ◽  
Daniel J Gaskell ◽  
Robert K Herbertson
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Length Of Stay ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Previous History ◽  
Care Facility ◽  
Health Care Facility ◽  
Stroke Patients ◽  
Acute Stroke Unit

Introduction: Early physical therapy (PT) consults and subsequent rehabilitation services have been shown to improve functional and mobility outcomes post stroke. Shortage of PT staff may impact how soon patients can be seen after a physician’s order (PO) and rehabilitation outcomes. The current preliminary study purposed to assess the effects of time elapsed between PO for PT services and the first PT consult ≤ or >48 hours (time to PT order = TPO), on patient’s length of stay (LOS) and scores on the NIH Stroke Scale (NIHSS) at discharge, in a busy acute stroke unit of a regional health care facility. It was hypothesized that TPO of ≤48 hours after initial PO for PT services will show better LOS and NIHSS scores (at discharge) outcomes compared to TPO >48 hours. Methods: A total of 291 stroke patients who presented at an acute hospital were retrospectively placed in either a TPO ≤ 48 hours group, G1 (n=147), or a TPO >48 hours group, G2 (n=144) based on the time of their first PT consult after a PO. The LOS and NIHSS data were subjected to statistical analysis. Results: There were no significant differences in LOS (G1=5.5 ± 4.61 vs. G2= 5.9 ± 5.62 days; p=0.6542 ) and discharge NIHSS scores ( p=0.6728 ) of either groups. A post hoc regression analysis to examine impact of factors such as demographics (age, gender, weight, etc), number of PT visits (PTV) and discharge destination (DD) revealed that TPO ( p<0.0001 ), PTV (p<0.0001) and DD (p<0.0001) were significant contributors to observations in group G1; while PTV ( p<0.0001 ) and DD ( p<0.0001 ) were the only significant contributors to observations in the G2 group, TPO was not significant ( p=0.0646 ). Conclusions: Ideally, stroke patients should be evaluated for physical therapy services within 24 hours of a PO. Shortage of PT staff in a busy health care facility may impact how soon patients can be seen. Although the current pilot study did not reveal significant changes in LOS, and NIHSS scores of stroke patients at discharge irrespective of whether patients were seen by physical therapists ≤ or >48 hours after a PO, severity of the stroke, previous history of stroke or TIAs, and other co-morbidities that could have confounded the results were not examined. Future study design will take into account these potential confounding variables and other outcome measures.

Management of Fever, Hyperglycemia, and Dysphagia in an Acute Stroke Unit

2016 ◽  
Vol 41 (6) ◽  
pp. 313-319
Author(s):  
Teresa Kenny ◽  
Christopher Barr ◽  
Kate Laver
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Acute Stroke Unit

Assessment of Regional Acute Stroke Unit Care in Italy: The PROSIT Study

2003 ◽  
Vol 15 (1) ◽  
pp. 16-18 ◽  
Author(s):  
Roberto Sterzi ◽  
Giuseppe Micieli ◽  
Livia Candelise
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Acute Stroke Unit ◽  
Stroke Unit Care
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