Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review.

To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. A systematic review and meta-synthesis. A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.

Chen L ，Xiao LD ，Chamberlain D ，Newman P ... -  《-》

An integrative review: Challenges and opportunities for stroke survivors and caregivers in hospital to home transition care.

To identify challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. Due to shortened hospital stays, stroke survivors and caregivers must take responsibility for complex care on discharge from hospital to home. Gaps exist in the literature that synthesizes studies on hospital to home transition care. A systematic integrated review. Six databases were searched systematically between 18 June 2018 - 31 October 2018 including Medline, CINAHL, Web of Science, ProQuest, Scopus and Science Direct. The search did not have a date limit. Studies that met the selection criteria were critically reviewed. Data were extracted from the studies for analyses. A convergent qualitative synthesis approach using inductive thematic synthesis was applied to the review. The analysis of 23 studies identified three major findings. First, health and social care systems influence transition care by either enabling stroke survivors and caregivers to manage transition care via well-coordinated services or preventing them from accessing services. Second, health professionals' partnership with stroke survivors and caregivers largely decides tailored support for them. Successful partnerships and engagements with stroke survivors and caregivers depend on organizational resources. Third, survivors and caregivers are at different levels of readiness to cope with challenges. Individualized support for them to develop resilience is highly regarded. Stroke survivors and caregivers encounter enormous challenges in self-management of hospital to home transition care. Further research is required to address their expectations of support during transition care. There is a lack of synthesis of studies on factors affecting hospital to home transition care for stroke survivors. Health and social care system designs, health professionals' commitment to individualized care and the self-management capability of stroke survivors and their caregivers have a profound influence on the transition care experiences.

Chen L ，Xiao LD ，Chamberlain D 《-》

The experience of stroke survivors and caregivers during hospital-to-home transitional care: A qualitative longitudinal study.

Stroke survivors and their caregivers experience different difficulties that arise from certain physical, psychological, social aspects and caring burdens during the hospital-to-home transitional period. Although there are abundant studies that focus on stroke transitional care, there are limited qualitative studies that synthesize the experience of hospital-to-home transitional care for stroke survivors and their caregivers in China. To evaluate the experience of stroke survivors and their family caregivers during hospital-to-home transitional care in China. A qualitative longitudinal study based on semi-structured interviews were implemented to address the research objective. Interviews were conducted at two stages, (1) when stroke survivors were close to discharge, and (2) within two months post-discharge. Participants were recruited from one tertiary hospital between April and September 2019. Data were analyzed using reflexive thematic analysis. Twenty-three stroke survivor/caregiver dyads participated, totaling 92 individual interviews. The thematic framework based on the experience of stroke survivors and caregivers reveals a three-phases of the hospital-to-home trajectory: survived, living in the mist, and crisis at home. The study identified one key theme (the optimism and hope) in the first phase, four key themes in the second (the pre-discharge emotional concerns and reactions, lack of stroke knowledge and stroke care information, difficulties of performing home-based healthcare, expectation of hospital pre-discharge) and in the third phase (high level of post-discharge stress, inaccessible postdischarge care services and health resources, interpersonal relationship disruption and lifestyle changes, financial burdens) respectively. In addition, several interconnected subthemes for stroke survivors' and caregivers' experiences were identified in each phase. The experience of stroke survivors and caregivers during hospital-to-home transitional care is a dynamic process with enormous challenges in each phase. These findings have implications for policymakers and health care systems regarding developing an enabling environment that supports successful hospital-to-home transitional care. Collaboration with health care professionals, accessible rehabilitation services and follow-up support after discharge, and available community and social support are warranted to be integrated into transitional care to help stroke survivors and caregivers to facilitate their hospital-to-home trajectory.

Lin S ，Wang C ，Wang Q ，Xie S ，Tu Q ，Zhang H ，Peng M ，Zhou J ，Redfern J ... -  《-》

Stroke survivors', caregivers' and nurse coaches' perspectives on health coaching program towards hospital-to-home transition care: A qualitative descriptive process evaluation.

To explore the perspectives of stroke survivors, caregivers and nurse coaches on a health coaching program during hospital-to-home transitional care. Stroke is a major public health problem that seriously affects the health and safety of people in China. Nurse-led health coaching is a promising support option in enabling smooth hospital-to-home transition for stroke survivors and family caregivers. A qualitative study is valuable for gaining insight into their perspectives on using this program. An exploratory, descriptive qualitative process evaluation was conducted parallel with a former randomised controlled trial. Data were obtained from 26 stroke survivors, 33 caregivers and four nurse coaches with semi-structured interviews. The inductive reflexive thematic analysis approach was used for data analysis. The COREQ checklist was followed in reporting this study. Seven themes were generated from the data: (1) the applicability of individualised health coaching sessions, (2) driving self-efficacy to establish self-care skills, (3) the key role of nurse coaches, (4) coordination among healthcare teams during the transition, (5) adequate community and social support, (6) insufficient rehabilitative services after discharge and (7) perceived extra workload for nurse coaches. The study captured perspectives on a nurse-led health coaching program towards hospital-to-home transition care from stroke survivors, caregivers and nurse coaches. Individualised health coaching sessions and driving self-efficacy were perceived as facilitators for empowering the self-care skills of stroke survivors and caregivers. The key role of nurse coaches in coordinating healthcare teams and adequate community and social support were detected as the power frame of the program's implementation. However, health system obstacles, such as insufficient rehabilitative services and the high workload of nurses, still need to be addressed to ensure the sustainability of health coaching intervention in transitional care. The study suggested the feasibility of implementing nurse-led health coaching to smooth post-stroke hospital-to-home transitional care. The findings also highlighted the importance of qualitative process evaluation when implementing evidence-based interventions in health care. The trial was registered with the Australia New Zealand Clinical Trials Registry (ID: ACTRN12619000321145).

Lin S ，Xie S ，Zhou J ，Tu Q ，Wang C ，Chen L ... -  《-》

A nurse-led health coaching intervention for stroke survivors and their family caregivers in hospital to home transition care in Chongqing, China: a study protocol for a randomized controlled trial.

Lin S ，Xiao LD ，Chamberlain D 《Trials》