Improving the Provision of home-based stroke rehabilitation and support in Brunei Darussal: The potential roles and educational needs of nurses in the community

Abstract

Background: stroke is the second most common cause of morbidity and mortality worldwide. In Brunei, the establishment of the first National Stroke Centre has improved patients’ survival rates. A multidisciplinary stroke rehabilitation provision, to support patients and caregivers at home, is therefore increasingly crucial. The research aims to explore different aspects of home-based, stroke rehabilitation service provision in order to identify areas for improvement.

Method: a two phase, convergent, extended mixedmethods design was employed. The first phase, using new and piloted methods of inquiry, involved a set of data which was simultaneously collected through interviews with stroke survivors (n=21) and their carers (n=18), and a survey questionnaire for community nurses (n=101), to explore areas needed for service improvement. Key findings from the first phase were discussed with six expert healthcare professionals (n=6) at the second phase of study. The NVivoTM 10 and IBM SPSS version 22 facilitated analysis of data following Thematic Analysis and descriptive statistical tests.

Results: six key findings, identified from mixing of the interview and questionnaire data, were presented to the expert healthcare participants. Majority agreed that the stroke education for the patients, carers and nurses are lacking. It also revealed that the Malay culture and the changing family unit may impede recovery of the stroke patients. There were differing views with regard to roles of nurses in stroke rehabilitation. All participants indicated that involvement of non-government organisation for stroke care is essential.

Conclusion: this study highlighted considerable gaps in the existing rehabilitation service provision for stroke in one specific country. The implications of cultural practices and religious belief of the stroke patients and their carer for improvement of the rehabilitation service delivery need consideration. Establishment of a multi-sector stroke team is needed. Future study is requires to expand findings of this research.

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