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Clinical Rehabilitation, Vol. 14, No. 2, 160-171 (2000)
DOI: 10.1191/026921500672130349

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

George Dowswell

John Lawler

Nuffield Institute for Health, Leeds, Bradford, UK

John Young

St Luke's Hospital, Bradford, UK

Objectives: To describe in detail the nature of the specialist nurse interventions; to increase understanding of the principal problems facing stroke patients and their care-givers in the first year following stroke and to demonstrate how these problems may change over time; and to investigate the value of qualitative research methodologies within the context of a randomized 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 stroke patients and their care-givers, and the actions taken by nurses in response.

Results: Specialist nurses commenced 120 records. As 19 patients died or left the area during the year-long interventions, we obtained 101 complete records. The problems encountered by stroke patients and their care-givers were numerous, diverse, complex and changed over time. Initially, practical difficulties were noted; over time, these were accompanied by growing numbers of psychological needs. The nurses responded by providing information, advice, 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 professionally supported during the stages of stroke adjustment, for at least the first year and probably beyond, was emphasized by this study.


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L. Robinson, J. Francis, P. James, N. Tindle, K. Greenwell, and H. Rodgers
Caring for carers of people with stroke: developing a complex intervention following the Medical Research Council framework
Clinical Rehabilitation, May 1, 2005; 19(5): 560 - 571.
[Abstract] [PDF]

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 StrokeHome page
C. McKevitt, J. Redfern, F. Mold, and C. Wolfe
Qualitative Studies of Stroke: A Systematic Review
Stroke, June 1, 2004; 35(6): 1499 - 1505.
[Abstract] [Full Text] [PDF]