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Patients in stroke units have better outcomes, but receive less personal nursing care

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QUESTION: Which aspects of the process of care help to explain the improved outcomes of patients treated in stroke units?


Case study of 3 care settings for stroke patients.


An elderly care unit (ECU), a general medical ward (GMW), and a stroke unit in teaching hospitals in the same city in the UK.


Nurses, physiotherapists (PTs), occupational therapists (OTs), and consulting physicians were observed caring for patients with stroke.


Using a qualitative non-participant observation method, the researcher recorded full descriptions of everything she saw and heard. Meetings and observation periods were conducted throughout the week, primarily during ward rounds, multidisciplinary team meetings, therapy sessions and assessments, and general activity on early and late shifts during a 2–3 month period in each setting. Observation included 40 hours at both the ECU and GMW, and 66 hours at the stroke unit. Data were content analysed by setting, then by event or activity, and then compared among the 3 settings.

Main findings

The philosophy of stroke rehabilitation …

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  • Source of funding: the Stroke Association.

  • For correspondence: Dr Shah Ebrahim, Department of Social Medicine, Canynge Hall, Whiteladies Road, Bristol, UK. Fax +44 (0)117 928 7325.