The effects of a transitional care programme using holistic care interventions for Chinese stroke survivors and their care providers: A randomized controlled trial.

摘要

A transitional care programme (TCP) was designed with six-strands of Holistic Care Interventions (HCIs). It aimed to provide better coordination and continuity of holistic care for stroke survivors by appointed senior community nurses namely Holistic Care Managers (HCMs).;Method: This was a randomized controlled trial conducted in one cluster in Hong Kong. A total of 108 stroke patients were randomly allocated into control group with usual care and study group undergoing the TCP with protocols-driven HCIs which included pre-discharge holistic health assessment, family meetings, structured home visits and telephone follow-ups provided within 4- week post-discharge. A patient self-management log book was also developed in line with the HCIs. Patient-related and clinical outcomes were evaluated at baseline, 4-week and 8-week post-discharge. A qualitative study using focus groups was adopted to explore the caregiving experiences of the family caregivers and health care providers. The qualitative data served to illuminate the findings of the statistical outcomes.;Results: Significant changes were found in the quality of life (QoL) and holistic health in the study group over time, as shown in physical function (p= 0.002), mental health (p= 0.005), spiritual QoL (p< 0.001) and three facets of the holistic health status (p<0.004). Patients in the study group showed a significantly higher level of satisfaction with care and with lower readmission and emergency reattendance.;Thematic expressions of the focus groups were aggregated into four themes: (1) caregiving challenges to the caregivers, (2) caring for stroke sufferers as a growing process, (3) HCM as a healer, and (4) enhancing the inner strength. The pivotal role of connectedness between the HCMs and clients was identified.;Conclusion: This study is the first study employing a holistic transitional care approach for Chinese stroke survivors. The empirical results demonstrate the effectiveness of this programme in improving their holistic health and quality of life. Qualitative results assert the connecting role of the HCMs to enhance the family caregiving capacity. Family involvement plays an important part in the patient's coping with his illness. Spiritual resources are necessary in building a positive world view, so that the patient can lead a new, fulfilling stroke life. This study has provided evidence for a service model that advocates the effectiveness of holistic transitional care which makes the sum of whole is greater than the parts.