Unpacking the 'black box' of a nurse-led stroke support service

Objectives: To describe in detail the nature of the specialist nurse Interv entions: to increase understanding of the principal problems facing stroke patients and their care-givers In the first year following stroke and to de monstrate how these problems may change over time: and to Investigate the v alue of qualitative research methodologies within the context of a randomiz ed trial. Methods: Specialist nurses providing support in the year following stroke ! ;were asked to maintain comprehensive written records of their involvement with all patients and care-givers participating in a randomized controlled trial. Qualitative methods were used to examine the problems faced by strok e patients and their care-givers, and the actions taken by nurses rn respon se. Results: Specialist nurses commenced 120 records. As 19 patients died or le ft the area during the year-long Interventions, we obtained 101 complete re cords. The problems encountered by stroke patients and their care-givers we re numerous, diverse, complex and changed over time. Initially, practical d ifficulties were noted; over time, these were accompanied by growing number s of psychological needs. The nurses responded by providing information, ad vice, support and monitoring using a flexible, Individualized approach. The nurses also collaborated or liaised with 17 other professional groups and provided direct support to care-givers. Conclusion: The need for many stroke patients and their care-givers to be p rofessionally supported during the stages of stroke adjustment, for at leas t the first year and probably beyond, was emphasized by this study.