22. European Stroke Conference 2031 Stroke care problems Stroke unit team members’ preferences and usage of strategies for handling ethical problems in sudden and unexpected death by stroke Å. Rejnö1, E. Danielson2, L. Berg3 The stroke unit, Skaraborg Hospital Skövde, Skövde, SWEDEN1, Institute of Health and care Sciences, University of Gothenburg, Göteborg, SWEDEN2, Institute of Health and care Sciences, University of Gothenburg, Göteborg, SWEDEN3 Background In end of life care ethical decisions often come to the fore not least when death occurs suddenly and unexpected. Research on ethical problems in the care of dying patients has been carried out exten-sively but not from the perspective of stroke care. From the area of stroke research the main focus of ethics has not been on issues related to end-of-life. Methods Stroke team member’s (carers) preferences and usage of strategies for handling ethical problems were explored utilizing a study-specific form and interviews. Participants were carers in stroke unit care; physicians, registered nurses and enrolled nurses from two associated county hospitals in west-ern Sweden, providing both acute and rehabilitative stroke care. Twenty-four expressions for ways of handling ethical problems were listed in the form and the carers were asked to state their prefer-ence and usage for each. The filled out forms served as starting point for the individual interviews. Content analysis with both quantitative and qualitative parts was utilized in the analysis. Results Through the analysis the 24 ways of handling ethical problems were reduced to nine strategies, of which six were preferred and three were not preferred by the carers (table 1). A shift from how the strategies were preferred to how they were used was noted. The analysis further revealed eight hin-drances to use the strategies as preferred, stated by the carers. The hindrances can be ordered from internal to external hindrances (table 2). Conclusion The preferred strategies hold the ethical principles of beneficence and human dignity as key con-cerns. Even the not preferred strategies rest on the ethical principle to do good. The carers reasons for using the not preferred strategies was stated to be, to do what was perceived to be in the patient’s best interest. The shift in responses from how strategies are preferred to how they are used, was shown to be affected by perceived hindrances to use strategies the preferred way. Table 1 Preferred and not preferred strategies Preferred strategies Not preferred strategies Change decisions made if the situation changes Continue treatment (e.g., drip) Discuss with next of kin or the team Decide against the will of next of kin Inform next of kin Withhold decision Meet the requests of next of kin Support next of kin Unanimity with next of kin or within the team Table 2 Hindrances to use the strategies as preferred, presented from internal to external hindrances Hindrances to use the strategies as preferred Own shortcomings and personal characteristics Knowledge and experience Communication Next of kin and their reactions influence and direct Approaches to work/organization/routines Resources and priorities Limitations and prerequisites inherent in the professional role Conditions of reality 212 © 2013 S. Karger AG, Basel 7. Nurses & AHP‘s Meeting 2032 Stroke care problems Task specific home based training to improve balance and mobility in patient with chronic stroke - a case report P. Kumar1 University of West of England, Bristol, UNITED KINGDOM1 BACKGROUND AND PURPOSE: People with hemiparesis following a stroke tend to show delayed reactions which often comprises their dynamic balance and result in potential falls. The purpose of this case report is to demonstrate the application of task-specific functional rehabilitation to improve balance and reduce the incidence of fall in a patient with stroke. CASE DESCRIPTION: The patient was a 64 year-old woman with left sided-hemiparesis resulting from a thalamic bleed 2 years ago.She reported recent falls (n=3) at home in the preceding 2 weeks prior to the assess-ment. Examination revealed decreased balance and reduced confidence with activities of daily living (ADL), especially getting in and out of bathtub. Six weeks of home-based rehabilitation included dynamic balance exercises, task specific exercises (sit to stand, step-up, stairs), functional exercises in standing and manipulation of objects during walking. Pre-treatment and post-treatment outcome measures included timed single leg stance, Berg Balance Scale (BBS) score, number of falls, and self-reported patients’ perception of improvement. The treatment time was 45 minutes/day, three times a week which was administered by a neuro-physiotherapist. OUTCOMES: Improvement in timed single leg stance (3 seconds to 9 seconds), BBS score (38 to 49), and number of falls (3 to 0) was noted. Patient noted overall improvement and felt more confident in carrying out ADL’s at home. Patient now felt independent in getting in and out of the bathtub. DISCUSSION: This case report demonstrates potential benefits of a 6 weeks home based task-specific functional training to improve balance, mobility and ADL’s in a chronic patient with stroke. Conclusion: Encouraging improvements such as these strongly suggest the need for larger studies that would explore this type of intervention in more detail.
Karger_ESC London_2013
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