Nursing Assignment: Critical Appraisal of Research on Stroke Care

This nursing assignment critically appraises a research paper by Ekstam et al. (2014) focusing on the perspectives of stroke patients and their caregivers regarding rehabilitation needs one year after a stroke. The assignment explores the research question of how caregivers can effectively suppor...Read More

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the student:
Name of the University:
Author’s note

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Introduction
Evidence based practice is the judicious use of research evidence to inform practice. It
involves analysis of research evidence and determines it applicability to any clinical situation
and scenario (LoBiondo-Wood & Haber, 2017). This essay is in relation to the case study of
Aunt Sue-Anne, a 67 year old lady who suffered from stroke six months ago. She is a retired
school teacher, who independent and heavily involved in activities to raise funds for homeless
people before stroke. However, after 1 year of intervention therapy, Sue is dejected and she
expresses that her rehabilitation needs are not met and she is dependent on others for daily
activities like cleaning and cooking. In response to the issue, the aim of the essay is to address
the research question of ‘How may a caregiver effectively support family member with her
activities of daily living following a stroke?’ by conducting a critical appraisal of the research
article by Ekstam, et al. (2014). The essay also examines barriers in the application of evidence.
Part A:
Authorship
The review of authorship in a research paper is necessary to understand whether author’s
have the expertise in similar areas related to the topic of interest or not. This type of assessment
increases the reliability of the research work. The article of interest was written by three authors
and they were all affiliated from departments similar to rehabilitation such as Department of
Clinical Neuroscience, Division of physiotherapy and Department of Neuroscience and
rehabilitation needs, Department of Occupational Therapy and Department of Clinical Research
(Ekstam, et al. 2014) Hence, based on author’s affiliation, it can be said that the research can
provide novel outcome as experience in author’s respective departments can add value to the

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research. More than two authors have qualification in rehabilitation related field. For example,
Lisa Ekstam is Ph.D qualified in occupational therapy. Hence, they can add value to the research
process. There is no conflict of interest found in the research article based on different
qualification of authors.
Research Question:
The research question for the study is to find out the perception related to stroke
rehabilitation needs and care giving burden among dyad group of person with stroke and their
formal caregiver. The need for research in this area was provided by Ekstam et al. (2014) by
giving an overview of the prevalence of perceived unmet rehabilitation needs among people 1
year stroke and by identifying gaps in research done for dyad perspective on the issue. As
reported in the research article, about 33-49% stroke patient feel that their rehabilitation needs
are not met 1 year after stroke. Exploring the reason for this is dependent on getting information
related to how caregivers perceive rehabilitation needs of their family members and provide right
care and support to stroke patient. Olai, Borgquist and Svärdsudd (2015) argues that informal
caregivers play an important role in rehabilitation for stroke patient and patients are dependent
on their formal caregivers. However, gap found in past research is that no studies have explored
dyad’s perspective on rehabilitation need after stroke. Hence, the rational for research is
understood from the discussion.
Research Design:
Ekstam et al. (2014) use mixed method research design using both quantitative and
qualitative data to evaluate research outcome. The researcher collected quantitative data on
patient’s satisfaction with care and sense of Coherence (SOC). In addition, qualitative data was

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collected on daily life challenges 1 year after stroke and strategies to handle the problem. Mixed
method research design is used when the purpose is to analyze research from multiple
perspectives. Studies using mixed method are able to get a deeper and broader understanding of
the phenomenon of interest (McKim 2017). The article by Ekstam et al. (2014) had multiple
research objectives. The first objective was to find links between caregivers and stroke patients
perception related to rehabilitation needs. In addition, the research also had the aim to review
personal experience of everyday life changes for stroke patient and their caregivers after stroke
and evaluate strategies that they took to handle stroke. Hence, considering the research objective,
the use of mixed method research design is considered appropriate to address the research
objective and research question.
Research methods
The technique used to recruit sample, collect research data and analyze participant’s
response determines the credibility and validity of the research work. For each of these stages,
consideration regarding eliminating biases is necessary to enhance the reliability of the research
findings (Creswell & Creswell, 2017). In the article by Ekstam et al. (2014), research sample for
the study were same participants who took part in the LAS-1, a prospective observational study
of the rehabilitation process after stroke. In the study, all participants who were admitted to
stroke units were recruited and data for caregivers were collected by home visits. Use of sample
from the LAS-1 is relevant because the sample group meets the population of interest for the
study. Meeting ethical considerations such as informed consent is also important during the
recruitment process. The review of the research article gives the idea that patient consent was
taken. However, information regarding the process used to provide information related to the
research participants is missing.

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The strength of the data collection process is that reliable tools were used to collect
quantitative data and the questionnaire which was used previously in studies of people with
stroke was taken. For example, the Barthel index was use to categorize stroke severity and the
tool has been used in many studies. The questionnaire regarding satisfaction with health care
service was taken from previous study which used five graded Likert scale to evaluate scores.
Furthermore, the use of open-ended question for management of daily activities after stroke and
strategies for handling problem helped to explore the research topic in-depth (Ekstam et al..
2014). The strength of the data analysis process is that statistical tools helped to effectively
analyze quantitative data. For qualitative research data, content analysis process was adapted.
The bias in analysis process was addressed by involving one author in coding process and
including other co-author in interpretation of codes and participant’s response.
Results:
The review of findings suggests that the research helped in getting answer to the research
question. The findings of research showed that participants perception related to met
rehabilitation needs differed based on severity of stroke and care giving burden. For example,
dyads who perceived met rehabilitation needs had large number of people with mild stroke. In
addition, caregivers perceived less care giving burden in dyads where rehabilitation needs were
met. Hence, association between dyads perspective of rehabilitation needs was found due to
difference in stroke severity and experience of major life events. Therefore, the research findings
addressed the research question and the finding is consistent with other studies as Gbiri, Olawale
and Isaac (2015) also reported that care giving burden increases with severity of stroke.
Part B:

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The research by Ekstam et al. (2014) gave answer to the association between dyad’s
perspective on rehabilitation needs. However, the research findings cannot be applied in clinical
setting due to recruitment biases. Lack of consideration of purposeful sampling technique and
relying on samples from LAS-1 study reduce validity and generalizability of the work. Not
taking participants from multiple centers can lead to institutional barrier in applying the research
evidence. The personal barrier to the application of evidence is that the study does not shed light
on ways to support caregivers to identify rehabilitation needs of their family caregivers. Hence,
ways to support stroke patient 1 year after stroke can be difficult.
Conclusion:
The essay presented a critical evaluation of research paper by Ekstam et al. (2014)
understand how family caregivers can identify unmet rehabilitation needs of stroke patient. The
evaluation of different stage of research process revealed association between perspectives
related to rehabilitation needs of dyads. However, certain limitations in the work such as
limitations in sample recruitment and lack of information related to strategies to identify
rehabilitation needs influence the validity of work. Future studies must focus on identifying
effective intervention to support informal caregivers to identify specific rehabilitation needs of
stroke patient.

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Reference:
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed
methods approaches. Sage publications.
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined
perceptions of people with stroke and their carers regarding rehabilitation needs 1 year
after stroke: a mixed methods study. BMJ open, 5(2), e006784.
Gbiri, C. A., Olawale, O. A., & Isaac, S. O. (2015). Stroke management: Informal caregivers’
burdens and strians of caring for stroke survivors. Annals of physical and rehabilitation
medicine, 58(2), 98-103.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
McKim, C.A., 2017. The value of mixed methods research: A mixed methods study. Journal of
Mixed Methods Research, 11(2), pp.202-222.
Olai, L., Borgquist, L., & Svärdsudd, K. (2015). Life situations and the care burden for stroke
patients and their informal caregivers in a prospective cohort study. Upsala journal of
medical sciences, 120(4), 290-298.