POSITIONING OF STROKE PATIENTS - EVALUATION OF A TEACHING INTERVENTION WITH NURSES

Background and Purpose-There is agreement, although little evidence, t hat consistently positioning stroke patients in allegedly reflex-inhib iting positions is therapeutic and will enhance functional recovery. T he nursing staff, therefore, needs to know and implement these posture s and understand their potential underlying value. We examined nurses' knowledge of and practice in positioning stroke patients before and a fter a formal teaching intervention. Methods-In a quasi-experimental s tudy, 38 stroke patients and 59 nursing staff members (44 trained nurs es and 15 healthcare assistants) from 6 wards were studied. The wards were randomly allocated to experimental or control status. Patients we re assessed on entry into the study by use of a range of measures to e stablish group equivalence. Nineteen aspects of their position were do cumented at intervals throughout their stay with a previously develope d observational tool. One thousand sets of observations of patient pos ition were made. Using 2 questionnaires, the nurses' knowledge of the terminology used to denote posture and of issues relating to the movin g and positioning of stroke patients was assessed before, immediately after, and 3 months after a package of formal teaching was implemented on the experimental wards. Nurse knowledge and patient position were used as the main outcome measures. Results-immediately after teaching, nurses in the experimental group scored significantly higher than tho se in the control group on the terminology questionnaire (P<0.05) and the moving and positioning questionnaire (P<0.001). Three months later , the experimental group scored higher on the latter questionnaire onl y (P<0.005). The positioning of patients in the experimental group was improved overall after the teaching (P<0.0005), and improvements to s pecific parts of the body were noted. Conclusions-It was possible to e ffect a degree of change in the nurses' knowledge of and practice in t he positioning of stroke patients. However, the quality of patient pos itioning remained variable. More effective ways of improving positioni ng need to be developed. Only then can the effects of recommended posi tioning be evaluated.