By Lila Zitouni and Debbie Gravelle
Patients are admitted to the Bruyère Continuing Care (Bruyère) stroke rehabilitation program after having experienced a major life-changing event—one that not only affects the person having suffered the stroke, but also the family and friends who support them.
Following a stroke, a patient’s condition is stabilized in an acute care setting before they are admitted to Bruyère’s stroke rehabilitation program, where their recovery journey begins in preparation for their return home.
In the past, patients have been so ill in acute care, that by the time they arrived in rehabilitation, they reported a sense of uncertainty, a lack of understanding about what’s happened to them and about what the future holds for them and their loved ones. This resulted in patients and families having many questions about Bruyère’s rehabilitation program upon admission.
To alleviate their uncertainties, Bruyère held focus groups and interviews with patients and caregivers to understand what really mattered to them. Some of the recurring themes expressed included:
- Being familiar with what their new health care environment had to offer them
- Learning about the next steps in their stroke rehabilitation journey
- Finding out about the community resources available to support their return home
This key information, combined with a long-standing desire to address the needs expressed, inspired clinical manager Lila Zitouni to implement a tailored and welcoming orientation program that better addresses the needs of our patients and families.
Lila and the committed members of the interprofessional care team collaborated with patients and caregivers to co-design the program. The orientation is conducted weekly and infuses knowledge about the stroke rehabilitation program, hope about the future and concrete steps that patients and caregivers can take to prepare for their return home. The program also includes an orientation to the unit and an early introduction to the care team members.
Information from various trusted sources was compiled to develop this new program—delivered in part by Bruyère’s volunteer ambassadors. These specially-trained volunteers take pride in welcoming new patients, answering their non-medical questions and providing them with a guided tour of their unit and of the hospital’s common areas.
Part of the program is also delivered by the clinical manager, who welcomes new patients and families, and explains the roles and expectations of the care team. The unit’s social worker and nurses deliver their part of the program by using a PowerPoint presentation that allows time for discussion. Since returning home is a priority for patients, their orientation content also includes information about the Home First Philosophy and about community resources available to help support their return home.
We hold the weekly orientation session on the unit immediately after lunch so it is convenient for new patients and families to attend. The session lasts approximately 30 minutes, with an additional 15 minutes that allows team members to circulate and answer questions. We record all questions from the patients and families and the appropriate care team member is responsible for following up. We offer refreshments, which gives patients and families an opportunity to socialize and share their story. We consider attendance at orientation a priority as part of a patient’s ongoing therapy. Not only do we invite family members to attend, but we encourage them to.
We hand out a comprehensive information package to each new patient. It contains a list of staff, a copy of the Heart and Stroke’s publication titled Your Stroke Journey1, a map of the unit, instructions on how to reach the clinical manager and who to contact if they have any questions or concerns. Because remaining positive is one of the contributing factors to a successful recovery, we also post inspirational quotes on several of the unit walls—to help motivate patients and caregivers.
After completing the program, patients and families fill out an evaluation, which is used to continually improve the orientation. The results have been overwhelmingly positive with patients and families reporting leaving the sessions feeling empowered and motivated to achieve their rehabilitation goals.
Over a four-month period, 98 patients and 57 family members attended the orientation. When possible at a later date, Bruyère stroke survivors and their families are invited to return to the unit to share their experience. Other patients admitted in our care have found that listening to their perspective and recovery journey has been a valuable and inspirational experience.
Lila Zitouni, BSc, PT is clinical manager, Stroke Rehabilitation and Ambulatory Stroke Clinic and Debbie Gravelle, RN, BSCN, MHS is senior vice-president, Clinical Programs, chief nursing executive and chief of Allied Health Professions at Bruyère Continuing Care.