Implications for nursing management
Nurse managers play a pivotal role for quality stroke
care. Our findings suggest organisation of care within
and across care settings should be a priority for nurse
managers. This study elaborates on previous studies’
recommendation of providing stroke care in designated
units. Our results suggest that a designated
stroke unit is not enough. How care is organised
within these units is also important. Organisation that
fosters interdisciplinary collaboration is important for
each patient’s progression and rehabilitation. Organised
collaboration supports continued quality care
throughout the continuum of care and also protects
patients from fragmented uncoordinated care.
Fragmentation is mentioned by the American Stroke
Association as a possible consequence of inadequate
integration of facilities and collaboration of professionals,
which can contribute, to high morbidity,
mortality and costs (Schwamm et al. 2005). Whereas other studies do not address the organisation of stoke
care at the unit level, recommendations include maintaining
continuity of stroke care. The European Stroke
Strategies group regards a continuous chain of care
from the moment stroke occurs and throughout the
entire rehabilitation as essential for quality care
(Schwamm et al. 2005, Kjellstro¨m et al. 2007).
The nurses expressed that stroke patients have a
better outcome if they have a permanent designated
nurses who coordinates the same interdisciplinary
team both in the hospital and after discharge. More
models of health care delivery are needed where
nurses lead and coordinate interdisciplinary teams
focusing on care continuity across provider settings.
Organising care across the care continuum cannot
only benefit stroke patients but all patients.