Family Nursing and Stroke Rehabilitation

This assignment delves into the crucial role of family nursing in the context of stroke rehabilitation. It examines key aspects such as patient-centered care, effective communication strategies employed by nursing teams with aphasia patients, and the process of bridging family nursing knowledge with clinical practice. The provided resources offer valuable insights into these concepts, shaping a comprehensive understanding of family nursing's impact on stroke recovery.

0Running head: EVIDENCE BASED NURSING RESEARCH
Evidence based nursing research
Name of the student:
Name of the University:
Author’s note

1EVIDENCE BASED NURSING RESEARCH
Discussion on method to enhance Emma’s health care needs with strength based
nursing care (SBNC):
Emma journey:
Emma Gee was a 24 years old girl with a charming childhood and interest in running.
However, her life changed all of a sudden when she suddenly became a stroke victim and
completely dependent on the medical system for speech, movement and other life activities.
There were different transitions to her journey starting from a young vibrant girl to suffering
from disturbing symptoms. She witnessed tragedy in her life too when she suffered a
debilitating stroke during brain surgery and went into coma. The next story is about her life
post stroke when she had to fight a daily battle with poor vision, balance and mobility (Gee
2017). The main focus of this report is to analyse the usual care provided to Emma and
implement strength based nursing care strategies to address Emma’s health care need. The
report will mainly focus on addressing her health care needs after coma when she struggled
mainly in her daily life activities such as speech, mobility and showering and was completely
dependent on the hospital staffs for her activities of daily living (ADLs).
Strength based nursing care and its relation to Emma’s case:
The strength based nursing care mainly focuses on a value based approach to care
based on the five principles of patient centred care, empowerment, health promotion and
healing, collaborative practice and innate capacities for health and healing (Gottlieb et al.
2012, pp. 38-50). A predominant shift to strength based nursing is seen recently because of
the deficits in the biological model of health care system. Unlike past health care models
which focused only on physical needs of health, the strength based nursing care (SBNC)
model focuses on holistic approach to care by focussing on what will work best for a patient
and analysing the care strategy based on the context of the individual patient’s and family’s

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circumstances and abilities. The utilisation of each of the principles in the SBNC promotes
developing a negotiated care plan to meet specific person’s health needs (Gottlieb 2012).
SBC mainly recognize utilize and develop a person’s strength to promote health and
recovery.
In the context of Emma, focussing on SBC to address the deficits in her daily life
activities is likely to have significant impact on her recovery. Gee (2017) has presented that
Emma was diagnosed with stroke along with many of the deficits like dysphasia, mobility
deficits, dysarthria and sensory balance deficits. Presence of all these symptoms in Emma
mainly implies that she had difficulty in swallowing foods (dysphagia), making speech
(dysarthria), left side paralysis and right side facial paralysis. All this meant that her balance
and mobility would be seriously affected after stroke and she would face mainly difficulties
in ADLs. The usual care that she received was the support of a physio and two nurses while
walking and finally she was given a wheel chair as she had great difficulty in walking. She
was also under catheter due to incontinence deficits. Hence, her life revolved and dominated
around the hospital staffs. It is planned to replaced her usual care treatment by adopting
SBNC strategies to promote health and well being in Emma.
Strategies to implement SBNC for Emma’s care:
To approach Emma’s recovery by using SBNC approach, the three critical transition
point chosen is her life after coma, experience with daily life activities and psychological
struggle with the disease. The major focus is on using strength based approach to addresse
challenges in ADLs and the strategies will be mainly formulated with the core assumption
that every person is unique and they have their own sense of understanding about experiences
and environments (Gottlieb, Gottlieb & Shamian 2012).. Hence, the first strategy will be to
engage in appropriate communication with Emma Gee and her family members to understand

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the vulnerabilities, weakness as well of strengths of patient and family. This exercise can be
complete by the family strength assessment. The identification of weakness and suffering will
help to formulated appropriate care plan whereas the identification of strength will promote
health and building resilience skill in patients like Emma (Kitson et al. 2013, pp. 4-15) As
part of SBNC principles, the important strategy will be to help Emma recognize and discover
her strengths and then capitalize on them to minimize the limitations of weakness in patient.
The next strategy after communication will be to train Emma on improving her
capacity to ADLs by employing compensatory strategies. As stroke patients mainly lose their
capability to motor control, new approach will be implemented to incorporate task specific
training. The goal will be to enrich daily activity and independence in Emma and focus on
intensive practice to build strength, speed and endurance in physical movement. Her mobility
related activities will be mainly strengthened by repetitive practice under the optimal
conditions favourable for Emma and reinforcing the new behaviour permanently in patient.
Use of these SNBC strategies is likely to address serious functional limitation in patient
(Dobkin & Dorsch 2013, p. 331). In addition, the hospital environment and engagement of
hospitals staff all around Emma was a traumatizing experience for Emma which took a toll
on her psychological health. With the use of SNBC approach, she will get all kinds of
rehabilitative support from the comforts of her home and her coping skills be strengthened to
deal with stroke in a better way (Azeem et al. 2011, pp.11-15.).
SBNC for Emma with focus on family functioning (Think family):
The review of Gee (2017) has revealed that Emma was also always surrounded by
nurses and hospital staffs and she was always put into some new medical activity before
recovering from one activity. However, it would be essential to understand the support that
Emma got from her family members as collaboration with family members is also a focus of

4EVIDENCE BASED NURSING RESEARCH
SBNC. One of the closest family member of Emma is her mother, Lyn and conducting family
strength assessment with her will support the nurse to understand unique strength present in
the family and this identification may promote incorporating family strength in her care
planning and treatment. The importance of using Australian Family Strength Assessment tool
for nurse is that it will assist the nurse to identify patient’s relationship and closeness with
family and utilize the family strength during the delivery of care (Svavarsdottir et al. 2015,
pp.5-15).
The family strength assessment with Emma’s mother will mainly focus on identifying
nine positive attributes in family functioning such as togetherness, support, commitment,
resilience, sharing activities, affection, communication, acceptance and spiritual wellbeing
(Smith & Ford 2013, pp. 98-105). Hence, question related to family functioning in response
to current health care needs for Emma and methods taken to help each other during difficult
times may help to complete the assessment. In addition, there are separate set of question for
each of the nine attributes and this will assist the nurse in identify family strengths related to
Emma’s case (Smith 2017). Based on the information available in the book, it can be said that
Emma had a close relationship with her mother as she revealed that her parent instilled her a
positive and accepting approach towards life. Her mother was a down to earth person also
available to support Emma (Gee 2017). The narration by Gee (2017) also revealed
importance of family values and focus of togetherness in Emma’s family. Hence, involving
her mother in the care process will be critical to enhance the recovery of Emma and build her
mental strength in coping with the illness.
The strategies that can be taken by nurse to involve Emma’s family member’s in care
will include educating her mother about active involvement in care planning to address risk
of depression and social isolation in Emma. Considering the condition of Emma where her
speech, mobility and balance has been severely impaired, she needs great support from her

5EVIDENCE BASED NURSING RESEARCH
family members to avoid any complications. Hence, during implementing SBNC care plan
for Emma, close interaction will be done with Lyn to understand the best coping strategies
that Emma can apply to overcome the daily challenges associated with strokes. Education to
parent can also help Lyn to identify multiple ways by which she can get involved in care and
get all care options individualized specific to the unique needs of Emma. The nurse can also
involve Emma’s mother in needs assessment to better understand immediate needs of Emma
and increase her satisfaction with care (Dehghan Nayeri et al. 2014, pp.88-96). The usual
treatment that Emma received never satisfied her as she always felt traumatized by them,
however when family members will get involve to individualize the care, then Emma will
quickly move to the stage of healing and recovery. The above approach is also reflective
SNBC model because it gives emphasis to personal meaning of illness for patients and
empowering patient and family members to take responsibility in decision making. Family
dynamics and strength and coping strategies will be enhanced by proper interaction with the
nurses and this will increase the quality life of patient (Creasy et al. 2015, pp. 349-359).
SBNC for Emma with focus on relationship in nursing practice:
To promote healing and empowerment of Emma, it will be necessary for nurse to
establish an effective therapeutic relationship with patient. The advantage of better
connectedness with patient is that patient develops trust with the care provided and tends to
respond better to the care provisions. In the usual care provide to Emma, nurses were just
doing their job and connection or strength based interaction with patient was missing. Hence,
focusing on building relationship with patient is importance to enhance Emma’s satisfaction
with care. The nurse can also utilize therapeutic communication strategies to build connection
with patient. Some of the examples of such form of communication includes always
providing feedback to patient and rearranging the physical environment around patients based
on their comfort level. Nurse can also assess patient’s motivation towards any rehabilitation

6EVIDENCE BASED NURSING RESEARCH
process before initiating them. This will help to analyse patient’s preparedness for it and if
Emma is not prepared, the nurse can passionately advice her regarding the intense need for
specific treatment process (Kabasinguzi & Anyangwa, 2014). By this means, patient support
and empowerment can be achieved as therapeutic communication promotes patient to cope
and adjust with their situation.
SBNC plan for Emma on 1 to 3 critical transition points:
The SBNC plan for Emma mainly focus on the 3 transition points of:
1. Her difficulties with activities of daily living such as walking and balance post
stroke
2. The revelation of the deficits in speech in patient (dysarthria or dysphasia)
after experiencing disturbing sysmptoms
3. Her horrific experience during operations and living in hospital (psychological
distress)
With the focus on above three transition points in Emma’s life, the main aim is to
address the following issues:
1. Daily challenges experienced by Emma in ADLs post stroke
2. speech deficits experienced by Emma
3. Emotional and mental trauma experiences by Emma due to stroke
The use of SOAP framework supports in the developments of care planning for Emma. The
detailed SBNC plan in the three transition areas are as follows:
S (Subjective data):

7EVIDENCE BASED NURSING RESEARCH
1. Difficulties with ADLs post stroke: The symptoms associated with strokes such as
difficulty in speech, swallowing, left side paralysis and sensory balance deficits was
the main cause of challenges in Emma’s ADL’s. The time first she walked after
stroke, she has to take the support of physio and two nurses. She struggled coordinate
her limbs. In the first week, after stroke she lost her ability to basic personal needs
such washing her hair and the nurse had to tie her hair. She also struggles to convey
her needs due to dysphasia.
2. Speech difficulty: The speech therapist had given her a communication board to point
to any pictures however she could not see the pictures and due to ataxia, she felt
difficulty in pointing to the pictures too.
3. Psychological distress: Emma always narrated her stay at hospital and being
surrounded with hospital staffs and medical team as a traumatic experience. She
always used to cry and felt responsible for the suffering for her parents.
O (Objective data):
1. ADLs issue: The medial examination of Emma after stroke revealed about all the
deficits like mobility deficits, speech deficits, double incontinence, left side
paralysis and right side paralysis
2. Speech difficulty: Emma suffered a devastating stroke and the medical
examination revealed her problem of dysarythria and ataxia both causing
difficulty in speech and communicating with others.
3. Psychological distress: No medical diagnosis to prove this, use of mental distress
too may help to evaluate the severity of mental stress on patient
A (Assessment):

8EVIDENCE BASED NURSING RESEARCH
1. ADLs issue: The main assessment is that Emma is in immediate need of support in
ADLs.
2. Speech difficulty: Nursing assessment is that communication device given to Emma
for communicating needs to be changes and other alternative communication modes
needs to be identified for Emma.
3. Psychological distress: Use of psychological distress tool to evaluate severity of
trauma and assessment of other factors causing mental trauma.
P (Plan)
1. ADLs issue: To address the ADLs issue of Emma, multiprofessional collaboration will be
necessary to identify the resilience skills and strength of Emma and level of support
needed in daily activities.
While supporting equipments to Emma for ADLs, it will be necessary to take her feedback
regarding using those equipments. This will help to identify any issues that Emma may be
facing with the equipments and changes may be brought according to her own personal needs
(Fens et al. 2014, pp.7-15).
 To avoid risk and injury to patient, her physiological functions will be monitored and
environment surrounding Emma will be modified according to her preference. This
will ensure patient centred care and patient satisfaction with care (Kim et al. 2014,
pp.417-419).
2. Speech difficulty: As communication board did not supported Emma in communicating with others, the
SBNC plan is to teach non verbal communication techniques to Emma by use of
gestures, touch and proximity to bodies.

9EVIDENCE BASED NURSING RESEARCH
 Therapeutic and compassionate way of communication will be critical to reduce risk
of poor outcome in patient. Use of gestures can help to decode Emma’s message and understand her satisfaction
with care (Souza & Arcuri 2014, pp.292-298)
Psychological distress:
 Provide emotional care and support to patients by engagement of family members in
care
 Implement trauma prevention program by involving other interprofessional staffs to
avoid risk in patient (Cavalcante et al. 2011, pp.1495-1500)
Reflection on Emma’s experience and outcome from SBNC model:
The review of usual care provided to Emma mainly revealed that biomedical model of
care was followed for her where main emphasis was on causing relief from biological
ailments. However, it did not focused on evaluating strength or empowerment of patient
during care. No feedback regarding care process was taken and patient centeredness in the
delivery of care was missing. However, with the delivery of care by the use of SBNC model,
it is evident that Emma will be more satisfied with care as this focussed mainly on the patient
related factors and her personal strength for recovery. This is likely to develop trust of patient
in care and empower them to give feedback and take her own decision in care (Fens et al.,
2014, pp. 7-15). The mental stress and trauma associated with usual care will be significantly
decrease by the use of SBNC model.
Conclusion on role of strength based nursing in patient and family empowerment
From the activity to plan SBNC for Emma, it is understood that strength based
nursing is an effective and innovative strategies to enhance patient outcome and empower

10EVIDENCE BASED NURSING RESEARCH
patients in the care process. It focuses on the individual needs of patients and their unique
needs in recovery. Use of such approach and incorporation of family strength and
interpersonal therapeutic skills ensure that negative experience for Emma is minimized and
she has a positive care experience that motivates her towards fast recovery and high quality
of living.

11EVIDENCE BASED NURSING RESEARCH
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14EVIDENCE BASED NURSING RESEARCH
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