FULLTEXT01

FACULTY OF HEALTH AND OCCUPATIONAL NURSING DEPARTMENT,
STUDIES MEDICINE AND HEALTH COLLEGE

Department of Caring Sciences Lishui University, China
Nursing interventions for patients with stroke
A descriptive review
Jing Chen (Claire)

Peiwen Qiu (Patience)
Year 2023
Student thesis, Bachelor degree, 15 credits

Nursing Degree Thesis in Nursing
Supervisor: Li Xiaoyan (Kate)

Examiner: Maria Engström
Abstract
Background: Stroke is a global health problem, which affects more than 15 million
people each year worldwide and leads to high mortality and disability rates. The
prevalence and incidence of stroke in an aging population continued to rise, and some
scholars estimated that by 2030, the incidence of stroke was expected to increase to
about three times the current incidence. As the second leading cause of death
worldwide, stroke could have long-term negative effects on patients and higher medical
costs, seriously impairing people's quality of life.
Objective: The aim of the descriptive review was to describe the nursing interventions
for patients with stroke.
Methods: By using the search terms ‘stroke’ ‘nursing intervention’ and ‘cerebral
infarction’, 10 publications on nursing interventions related to stroke survivors were
systematically searched in PubMed to address the research questions.
Results: Our findings are divided into four themes: (1) general clinical care interventions
(2) new care interventions (3) reminiscence therapy (4) theory or model-led care
interventions. 10 nursing interventions, including monitoring, activity interventions,
patient care pathways, integrated care interventions, environmental interventions, new
care interventions, reminiscence therapy, PDCA and Orem self-care theory and evidence-
based care have been shown to help stroke patients improve their condition, relieve the
suffering caused by the disease and have a good prognosis.
Conclusion: Even though a variety of methods have been found to treat and prevent stroke,
each intervention has its own scope of application in clinical practice, so nursing
practitioners also need to provide nursing interventions that take into account the patient's
psycho-physical condition in order to better manage the symptoms and complications of
stroke and improve quality of life. In addition to this, new internet-based and theory-based
nursing interventions can also be used to treat and prevent stroke patients.
Key word: cerebral infarction, nursing intervention, stroke

摘要
背景：中风是一个每年影响着全球 1500 多万人，导致高死亡率和残疾率的全球性
健康问题。在老龄化人口中，中风的患病率和发病率继续上升。一些学者估计，
到 2030 年，中风的发病率预计将增加到目前发病率的三倍左右。中风作为全球第
二大死亡原因，可对患者产生长期的负面影响和更高的医疗费用，严重损害人们
的生活质量。
目标：这篇描述性综述的目的是描述中风患者的护理干预措施。
方法：通过使用搜索词“中风”、“护理干预”和“脑梗死”，在 PubMed 上系
统地检索了 10 篇与中风幸存者相关的护理干预的出版物，以解决研究问题。
结果：我们的研究结果分为四个主题：(1)一般的临床护理干预(2)新的护理干预(3)
回忆疗法(4)理论或模型主导的护理干预。10 个护理干预措施包括监测、活动干预、
病人护理路径、综合护理干预、环境干预、新的护理干预、怀旧疗法、PDCA 和
Orem 自我护理理论和循证护理，这些护理干预已被证明可以帮助中风患者改善他
们的条件，缓解疾病造成的痛苦，有一个良好的预后。
结论:虽然我们发现各种各样的方法可以治疗和预防中风，但在临床应用的实践中，
每种干预措施都有其适用范围，因此护理工作者还需要结合患者生理心理的具体
情况给予相应的护理干预，以更好地控制中风的症状以及并发症的发生并改善生
活质量。除此之外互联网相关的新护理以及以理论为基础的护理干预也能治疗预
防中风患者的病情。
关键词：脑梗死，护理干预，中风
Catalogue
Abstract ..............................................................................................................................2
1. Introduction ...................................................................................................................2
1.1 Background..............................................................................................................2
1.2 Definition .................................................................................................................2
1.3 The nurse’s role .......................................................................................................3
1.4 Theory ......................................................................................................................4
1.5 Earlier reviews of the topic......................................................................................5
1.6 Problem statement ...................................................................................................5
1.7 Aim and research questions .....................................................................................5
2. Methods .........................................................................................................................6
2.1 Design ......................................................................................................................6
2.2 Search strategy.........................................................................................................6
2.3 Selection criteria ......................................................................................................7
2.5 Data analysis ............................................................................................................9
2.6 Ethical considerations ..............................................................................................9
3. Result ...........................................................................................................................10
3.1.1 Monitoring ..........................................................................................................10
3.1.2 Activity intervention ...........................................................................................11
3.1.3 Patient's nursing path ..........................................................................................12
3.1.4 Comprehensive nursing intervention ..................................................................13
3.1.5 Environmental intervention ................................................................................14
3.4.1 PDCA and Orem Theory ....................................................................................16
3.4.2 Evidence-based nursing ......................................................................................17
4. Discussion....................................................................................................................19
4.1 Main result .............................................................................................................19
4.2 Result discussion ...................................................................................................19
4.3 Method discussion .................................................................................................21
4.6 Suggestions for future research .............................................................................24
5. Conclusion ...................................................................................................................24
References ................................................................. Fel! Bokmärket är inte definierat.
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1. Introduction
1.1 Background
Stroke is a global health problem, which affects more than 15 million people each year
worldwide and leads to high mortality and disability rates (Thrift et al., 2017; Feigin et
al., 2017). The prevalence and incidence of stroke in an aging population continues to
rise, and some scholars estimate that by 2030, the incidence of stroke is expected to
increase to about three times the current incidence (Han & Yu, 2021; Norrving &
Kissela, 2013). As the second leading cause of death worldwide, stroke can have long-
term negative effects on patients and higher medical costs, seriously impairing people's
quality of life. (World Health Organization, 2020). Stroke causes common changes
such as anxiety, depression, functional impairment, motor, sensory, cognitive and
communication difficulties, placing a huge burden on the patient in relation to physical,
cognitive and emotional disability (Oliveira et al., 2013; Rangel et al., 2013; World
Health Organization, 2020).
1.2 Definition
1.2.1 Stroke-definition
Stroke is a condition in which a part of the brain is suddenly and severely damaged by
an interruption of the blood supply, due to infarction (thrombus or embolus) or
hemorrhage (cerebral or subarachnoid) (Theofanidis & Gibbon, 2016). As a common
cerebrovascular disease seen in clinical treatment, acute stroke has a high mortality and
disability rate and imposes a great threat to patients' life (Han & Yu, 2021). In recent
years, with the changes of people's lifestyle, dietary structure and living habits, the
incidence rate of acute stroke has increased significantly, and the age of onset has
gradually decreased (Yu et al., 2018). The main risk factors of stroke include
hypertension, coronary heart disease, diabetes, hyperlipidemia, smoking, drinking and
obesity. In addition, patients with acute stroke often suffer from cognitive impairment,
poor memory, inattention, poor orientation, etc., seriously affecting the patients
(Wilkins et al., 2018; Ren et al., 2019).
1.2.2 Nursing intervention-definition
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Nursing interventions is the action that a nurse takes to implement their patient care
plan, including any treatments, procedures, or teaching moments intended to improve
the patient’s comfort and health (Keane, 2003). Medical dictionaries define nursing
interventions simply as “any act by a nurse that implements the nursing care plan.” Far
from the drama-filled situations you might have envisioned, nurses perform
interventions on a daily basis. Many interventions are just part of the routine, such as
turning patients to prevent bedsores, helping a patient control their pain level and
assisting patients to prevent falls (Ashley, 2019). Nursing intervention is an action that
nurses are responsible for to benefit patients or clients. Nursing intervention is a
planned step in the nursing process. This step involves all aspects of actual caring for
the patient and requires full knowledge of the assessment and planning stages of the
nursing process. The goals of nursing intervention are stated in the planning step of the
nursing process. Included in this step are patient care in the areas of hygiene and mental
and physical comfort, including assistance in feeding and elimination; controlling the
physical aspects of the patient's environment; and instructing the patient about the
factors important to his or her care and what actions to take to facilitate recovery. After
the patient's acute and immediate needs are met, he or she should be instructed
concerning actions that could be taken to help prevent a recurrence of the condition
(Keane, 2003).
1.3 The nurse’s role
Stroke is regarded as one of the common conditions with higher incidence rates,
estimated to occur at 76 to 119 for every 100,000 population every year; and result in
higher mortality and disability rates among affected populations (Thrift, et al, 2017).
Stroke is estimated to cause many symptoms (such as hemiplegia, weakness, perceptual
dysfunction, disturbance of vision and/or speech, and loss of control of the bowel and
bladder.) and can severely impair people's quality of life, causing “mental, physical,
functional, and psychological disorders, and high cost of medical care.” (De et al.,
2007). Therefore, it is very important for nurses to carry out professional nursing
evaluation and give corresponding nursing intervention to patients. Timely and effective
nursing intervention is helpful to help the recovery and prevention of stroke patients. In
addition, the nurse, as an educator, must recognize the profile of caregivers and identify
their difficulties and facilities in order to direct learning to provide quality care, improve
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health and prevent a new stroke (Smith et al., 2008). Actively developing new nursing
knowledge and clinical practice is not only conducive to the development of nursing,
but also an important responsibility of nurses. Appropriate use of new nursing
interventions is an important part of nursing, which can help reduce painful behavior
and increase patient comfort (Contrada et al., 2021).
1.4 Theory
Self-care theory is a nursing theory put forward by American nursing theorist Dorothy
Orem. To maintain and promote the self-care of the clients to the greatest extent around
the goal of nursing. The theory of self-care includes five basic concepts such as self-
care, self-care capacity, self-care body, therapeutic self-care needs and self-care needs.
The theory also emphasises that the ultimate goal of care is to restore and enhance a
person's ability to care for themselves. (1) Self-care is a series of spontaneous regulatory
behaviours adopted by individuals to maintain their structural integrity and normal
function, and to maintain the normal processes required for growth and development.
(2) Self-care: The ability of a person to carry out self-care activities, i.e., to engage in
self-care. (3) Self-care body is a person who performs self-care activities. (4)
Therapeutic self-care needs is a general term for self-care activities at a particular time,
i.e. a range of related behaviours that are carried out in an effective manner to meet self-
care needs. (5) Self-care needs: are all activities undertaken to meet self-care needs
including general needs, growth needs and self-care needs in times of ill health. It
includes four related theories: self-care theory, dependent care theory, self-care defect
theory structure and nursing system theory structure (Alligood, 2014). Self-care deficit
nursing theory expresses the relationship between a person's ability to perform the
actions necessary to meet their self-care requirements and their therapeutic self-care
needs. A self-care deficit exists if a person's ability to perform the required actions does
not equal the therapeutic self-care needs. The theory of the nursing system helps
individuals to overcome or compensate for existing and emerging self-care deficits and
it incorporates both the theory of self-care deficits nursing and the theory of self-care.
Through this theory, we can understand the self-care defects and self-care needs of
stroke patients through the basic condition factors of patients, provide therapeutic self-
care for patients with self-care defects, and meet the needs of stroke patients through
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corresponding nursing intervention, so as to promote health development, prolong life
and improve quality of life.
1.5 Earlier reviews of the topic
Earlier reviews of stroke and nursing interventions have focused on the treatment of the
main symptoms of stroke and the treatment during the illness. Many treatments have led
to the increase of treatment costs. In addition, two of the reviews also focused on the
intervention in the occurrence of stroke and the intervention in a certain symptom
(Thomas et al., 2008; Meyers et al., 2011). In addition, the review also mentioned that a
number of treatments have brought high costs, and there are few studies on the cost of
nursing intervention (Demaerschalk et al., 2010). Therefore, the purpose of this study is
to understand the nursing intervention of stroke patients, and to further understand the
nursing of stroke prognosis and prevention intervention before stroke, as well as the
cost of stroke nursing intervention.
1.6 Problem statement
At present, stroke patients have a high mortality and disability rate, stroke is the second
leading cause of death in the world, and its symptoms seriously affect the physical and
mental health of patients. In recent years, the age of stroke patients generally decreased
due to the influence of environmental factors and life habits, so effective care
interventions were important to alleviate the symptoms of stroke patients. Nurses need
to be aware of and provide various nursing interventions to help stroke patients with
symptom relief. Early reviews have focused on the treatment of the main symptoms of
stroke and the treatment during the illness. Many treatments have led to the increase of
treatment costs. The current review will add to the current research results. The present
review will add to current research by research into monitoring, preventing, and
managing measures to improve the quality of life and complications of stroke survivors
(Bautista, 2020; Han & Yu, 2021).
1.7 Aim and research questions
The aim of the descriptive review was to describe the nursing interventions for patients
with stroke.
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What nursing interventions did patients with stroke receive?
2. Methods
2.1 Design
The present review would use a descriptive design (Polit & Beck, 2017).
2.2 Search strategy
The electronic database PubMed was used. Search terms include stroke, nursing
interventions, nursing care and cerebral infarction. The following search terms were
MeSH-term: stroke, Cerebral infarction. The Boolean operators AND were used to
combine the search terms. We used the limitations 10 years and English. Finally, we
preliminarily read the abstracts and titles of 33 articles, and selected 11 of them for
review, see Table 1.
Table 1. Search results.

Database + Limits Search terms Number of Potential
Date of hits articles
search (excluding
doubles)
Medline English and Stroke 171432
through 10 years
PubMed
2022-05-11
Medline English and Nursing 158109

through 10 years intervention
PubMed
2022-05-11
Medline English and Cerebral infarction 16595
through 10 years
6
PubMed
2022-05-11
Medline English and Stroke (MeSH) 21 6
through 10 years AND Nursing
PubMed intervention
2022-05-11 (Title/Abstract)
Medline English and Stroke 27 4
through 10 years (Title/Abstract)
PubMed AND Nursing
2022-05-11 intervention
(Title/Abstract)
Medline English and Stroke (MeSH) 82 20
through 10 years AND Nursing care
PubMed (Title/Abstract)
2022-05-11
through 10 years (MeSH) AND
PubMed Nursing
(Title/Abstract)
Medline English and Cerebral infarction 4 3
through 10 years (Title/Abstract)
PubMed AND Nursing
(Title/Abstract)
through 10 years (MeSH) AND
PubMed Nursing care
2022-05-11 (Title/Abstract)
Total:139 Total:33
2.3 Selection criteria
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Inclusion criteria were scientific empirical studies, quantitative studies, qualitative
studies, English-language literature on nursing interventions for stroke patients. There
were no restrictions on the age, race or gender of the participants.
Exclusion criteria were treatment other than nursing interventions, all reviews and
protocols related to nursing interventions for stroke patients. See Table 2 for selection
criteria.
Table 2. Selection criteria for studies included in the review

Criteria Inclusion Exclusion
Population Registered nurse, nurse and Nurse managers, student
enrolled nurses directly nurses, nurse assistants,
involved in patient care, physicians, personnel who are
patients who have been not directly involved in patient
diagnosed with stroke care
Exposure Working in hospital, Nursing home, rest homes,
Exposure to stroke disease non-health care settings and
the community
Outcomes Nursing intervention of stroke
Study design Quantitative studies, Review, protocol, systematic
qualitative studies review, commentaries
Year of 2012-2022 Before 2012 and after 2022
publition
2.4 Selection process and outcome regarding possible articles

139 articles were searched based on keywords related to the research purpose. Based on
the inclusion and exclusion criteria, quickly read the title and abstract of the identified
article to understand the overall idea of the article, and then read the article in detail to
determine whether it can answer the research questions in the literature review. The
author will carefully consider the selection process of this potential article. We deleted
106 articles, including non-English articles, articles unrelated to the research content,
newspapers, etc. Finally, we retained 33 articles, of which 10 were selected as the most
consistent with the research question. (See Figure 1 for a flowchart of the selection
process and results of potential articles).
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Identification of studies via databases and registers
Records removed before screening:

Identification
Duplicate records removed (n =31 )

Records identified from
Pub Med (n =139)
Exclusion of records of irrelevant

articles by title and abstract :
Review,protocol and
commentary(n=29);
The content of the article does not
address nursing interventions for stroke
patients(n=31);
Records screened Articles not related to stroke
(n = 108) patients(n=14);
Research on non-human subjects(n=1).
Screening
Excluded articles passed full text :

The original article was not found (n =7
Reports assessed for eligibility )；
(n =33) The article's intervention was not
specifically described(n = 9);
Articles on Interventions Implemented
by Non-Nurses (n =2);
The subjects were family caregivers or
nursing home caregivers of stroke
Included
Reports of included studies patients(n=5).

(n =10)
Figure 1 Flow chart over selection process and outcome of potential articles
2.5 Data analysis
The different interventions of the selected articles were categorised and a table was
formed to make them clearer. We evaluated article variables including the following
main aspects: (1) author, country of publication and year of publication; (2)
experimental design; (3) sample size; (4) experimental data collection methods; (5)
experimental data analysis methods; and (6) specific intervention methods, intervention
duration and intervention requirements. We have classified and compared different
stroke care interventions. The acceptable nursing interventions for stroke patients and
their efficacy were carefully read and summarised.
2.6 Ethical considerations
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We would complete the project with honesty, integrity, objectivity and rigorous attitude
to ensure the objectivity and accuracy of independent completion. Eliminated the
phenomenon of plagiarism, fabrication and forgery of data.
3. Result
This study summarised the specific care interventions and effectiveness for stroke
patients. It is divided into four themes: general clinical nursing interventions, new
nursing interventions, reminiscence therapy and theoretical or model-oriented nursing
interventions. General clinical care interventions included monitoring, activity
interventions, patient care pathways, comprehensive care interventions, and
environmental interventions that were based on the patient's physical condition and
functional status. Theory or model oriented nursing interventions include evidence-
based nursing, PDCA combined with Orem self-care theory. Guided the patient to recall
the past in a pleasant environment is reminiscence therapy. The new nursing
intervention was a web-based intervention that personalises care for the patient. The
results showed that these 10 interventions can reduce the incidence of complications,
improved physical functional status, psychological status and improve quality of life in
stroke patients. (See Tables 3 and 4 for details)
3.1 General Clinical Nursing Intervention
3.1.1 Monitoring
In a study by Rhudy, the nurse participants in this study used a monitoring intervention,
and the goal of monitoring was to use the cues from the shift switching information to
form a psychological image of what a patient looks / looks like and to express the
monitoring by comparing the state of the patient and the psychological image of the
patient. The first was the creation of a patient's psychological image during the shift
change and modified by observation, thinking loud, interaction with the patient, the
psychological image formed during these processes could serve as a baseline for the
assessment of the patient's current status. Monitoring as a method for purposeful and
continuous acquisition, interpretation, and synthesis of patient data for clinical decision-
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making enabled nurses to play a large role in early identification and action to prevent
or reduce complications(Rhudy & Androwich, 2013).Under the medium monitoring
mode, the patient's condition changed can be displayed more intuitively. According to
the monitoring data, the nursing staff could identify, prevent and reduce the occurrence
of patients' complications such as nutritional disorders as soon as possible, so as to
ensure that patients can obtain more perfect nursing intervention and health protection.
(After verification, it was found that the P value was not indicated in the literature for
this measure)
In the article of Middleton, 19 hospitals participated in the study. All participants

received the QASC (The Quality in Act Stroke Care) trial intervention, monitored and
recorded their vital signs within the 90 days. The participants in the intervention group
(n=10) had both the hospital nursing process data and the 90-day result data, and
conducted temperature monitoring, fever management, blood glucose monitoring,
hyperglycemia management and dysphagia management after admission. The control
group (n=9) had only 90 days of monitoring results.
The result was patients of control group had significantly lower odds of 90-day
independence if, within the first 72 hours of stroke unit admission, they had one or
more: febrile event (>37.5°C) (P<0.0001), higher mean temperature (P<0.0001) finger-
prick blood glucose reading >11 mmol/L (P=0.0002), higher mean blood glucose (P =
0.0006), or failed the swallowing screen (P<0.0001). Patients of intervention group had
greater odds of independence when: venous blood glucose was taken on admission to
hospital or within 2 hours of stroke unit admission (P=0.04); finger-prick blood glucose
was measured within 72 hours of stroke unit admission (P=0.03); or when swallowing
screening or assessment was performed within 24 hours of stroke unit admission
P=0.0006). This study showed the importance of monitoring the temperature, blood
sugar and swallowing status of patients to improve the prognosis of 90-day stroke.
Routine nursing could significantly reduce death and dependence after stroke
(Middleton et al., 2018).
3.1.2 Activity intervention
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In this literature, 46 participants were randomly divided into two groups. The
experimental group (n=20) carried out a pleasant, competitive and rewarding activity or
a group exercise under the guidance of the nurse, for example, the experimental group
were given a nurse-led intervention using children's toys for about 30-40 minutes at
about 4 p.m., once every other day, and for two weeks. The scores of patients in the two
groups in terms of baseline functional status (motor, cognitive and total function),
fatigue, sleep disorder and depression were recorded. and collected data on the
functional status, fatigue, sleep and depression of the participants before and two weeks
after the intervention. The control group (n=25) received intervention from community
or long-term care institutions after discharge. The data collection time of functional
status, fatigue, sleep and depression of participants in the control group was more than 2
months. After 2 weeks of intervention, the improvement of all outcome variables in the
experimental group was significantly higher than that in the control group, except for
cognitive function. In addition, the improvement of functional status in the experimental
group was higher than that in the control group (p=0. 00). Although the fatigue and
sleep disorders of the two groups were improved, the improvement of the experimental
group was significantly higher than that of the control group. These differences were
statistically significant (p=0. 00 and p=0. 01). Depression in the experimental group also
improved more than that in the control group (p=0. 05)(Kim, 2012)
The research found that there are competitive and rewarding activities and group
activities. For example, activities organized with golf or football sets. These pleasant
interventions can make patients laugh while moving, and can improve the functional
status, fatigue, sleep and depression of stroke patients. Appropriate sports interventions
can improve the symptoms of hemiplegia and promote the health of stroke patients.
3.1.3 Patient's nursing path
This article described the health transition nursing path experienced by stroke patients,
starting from the detection of the initial symptoms and evolution of stroke, through
transportation to hospital, hospitalization and discharge preparation. And identify
important events in this path. Thirteen patients who became dependent after a stroke
participated in the research of semi-structured interviewed technology based on Mei's
mid-range theory from January to October 2013. After analyzing the data through the
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method of content analysis, the data showed that the patient's nursing path from
identifying symptoms to preparing for discharge has brought about the important event
of the need for new abilities. The study found that for stroke patients, it is not easy to
integrate into the hospital environment and daily life, but the positive relationship with
medical professionals is conducive to this transition process.
According to patients' conditions, nurses, especially rehabilitation nurses, met the needs
expressed by the subjects, were responsible for training the adaptability of patients and
caregivers, to help establish the transitional knowledge of post-stroke dependents, thus
improving nursing knowledge and nursing practice. This was of great help in helping to
improve the care of stroke patients, including the onset, recovery and rehabilitation, as
well as home care (Faria et al., 2017). (After verification, it was found that the P value
was not indicated in the literature for this measure)
3.1.4 Comprehensive nursing intervention
The Comprehensive nursing intervention was not based on the nursing staff's
experience, fully respecting the patient's subject position and innovating nursing
methods to make up for the shortcomings of traditional nursing and provide more
comprehensive scientific nursing services for the patients. Patients in both groups were
given neurotrophic treatment, circulatory improvement therapy, lipid-lowering therapy
and gastric mucosal protection therapy. The control group was given conventional
neurological care post-thrombolysis. The comprehensive nursing intervention for the
observation group was divided into three stages, namely Pre- thrombolysis, during
thrombolysis and after thrombolysis. Pre-thrombolysis care: The patient's physical
condition including pupils, consciousness, blood pressure, blood oxygen, respiration,
skin rash and other adverse reactions and bleeding symptoms should be monitored
during the administration of the drug and dealt with in a timely manner. Thrombolytic
care: At the end of the thrombolytic treatment the patient was instructed to rest and
monitored. Provide patients with health education, functional exercise and
psychological guidance to eliminate adverse psychological barriers and provide self-
relaxation therapy. Assessed the patient's National Institutes of Health Stroke Scale
(NIHSS) score 2h, 24 h and 7 days after thrombolysis. Post-thrombolysis care: Patients
were given a routine CT plain film scan to identify the area of interest for computed
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tomography perfusion imaging (CTPI). Time-density curves were obtained after
contrast injection into the patient, and pseudo-colour images of cerebral blood flow
(CBF), blood volume (CBV) and other parameters were obtained by CT perfusion post-
processing software. 52 patients with conventional care were included in the control
group, and 47 patients with comprehensive nursing intervention were included in the
observation group. The influence characteristics, Barthel score, serum MMP-9(matrix
metalloproteinase 9) level, and NIHSS score were compared between the two groups.
The results showed that after the comprehensive nursing intervention, the total
efficiency, total satisfaction, psychological status, and Barthel score of the observation
group were significantly higher than those of the control group (P < 0.05). The serum
MMP-9 level and NIHSS score were significantly lower than those of the control group
(P < 0.05) (Sun et al., 2022).
3.1.5 Environmental intervention
In this article, 60 patients with acute stroke were divided into initial routine nursing
control period, enriched environment period and sustainable period. The routine care
group received routine acute stroke management, providing participants with
approximately one hour of therapy, including speech, occupational and physiotherapy.
The enriched environment group provided with public areas for stimulating resources,
food, social activities and daily group activities. The change management strategy was
used to implement a rich environment within existing staffing levels. Behavioural
mapping was used to estimate patient activity levels across groups. Participants were
observed every 10minutes between 7.30 am and 7.30 pm within the first 10days after
stroke. Adverse and serious adverse events were recorded using a clinical registry
(Rosbergen et al., 2017).
It turned out that the enriched environment group (n=30) spent a significantly higher
proportion of their day engaged in ‘any’ activity (P=0.005) compared to the usual care
group (n=30). They were more active in physical (P<0.001), social (P=0.007) and
cognitive domains (P=0.002) and changes were sustained six months post
implementation. The enriched group experienced significantly fewer adverse events
(P=0.001), with no differences found in serious adverse events (P=0.309). To sum up, a
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rich environment was embedded in the acute stroke unit, which increases the activities
of stroke patients (Rosbergen et al., 2017).
3.2 New nursing intervention
In the study,90 patients with ACI（Acute Cerebral Infarction） were used as study
subjects and were equally divided into experimental group (EG) and control group (CG)
according to the order of admission. Both CG and EG received routine care, including
basic nursing care, medication instruction, health education and dietary interventions,
monitoring of patients' vital indicators and effective treatment measures. EG also has to
accepted (1) comfort intervention care model under quality nursing intervention: care
for environmental comfort, care for physical comfort, care for psychological comfort
and care for dietary comfort; and (2) Internet mobile health: after patients download the
designated APP, nursing staff and patients regularly uploaded data on patients' physical
conditions to the APP and analyse the data in a timely manner in order to develop a care
and treatment plan for adjusting patients, and provide health education to patients
through the APP and WeChat.
The stroke-Specific Quality of Life Stroke (SS-QOL) scale, Mental Status Scale in
Nonpsychiatric Settings (MSSNS) scale, Exercise of Self-Care Agency Scale (ESCA),
National Institute of Health Stroke Scale (NIHSS), Kolcaba’s General Comfort
Questionnaire (GCQ) was used to evaluate QOL, overall psychological status, self-care
ability, neurological function, and comfort level in both groups after the intervention,
respectively. Compared with CG, EG after intervention achieved obviously higher SS-
QOL, ESCA, and GCQ scores (P < 0.001), and lower MSSNS and NIHSS scores (P <
0.001) (Gu et al., 2022).
3.3 Reminiscence therapy
For the study, Eligible patients were randomly assigned to RT (reminiscence therapy)
group (N = 108) or control group (N = 108) with 1:1 ratio. Patients in control group
received conventional rehabilitation training once a month for 60 minutes, including
physical function rehabilitation, attention training, memory training, orientation
training, calculation training, problem solving and executive skills training. In RT
group, patients received additional reminiscence therapy theme on the basis of receiving
15
conventional rehabilitation training. Patients were discharged to the rehabilitation centre
for regular rehabilitation training, once a month, each intervention lasting 120 min for
12 months, with reminiscence therapy for the first 60 min and the same regular
rehabilitation training as in the control group for the remaining 60 min. Patients in the
reminiscence therapy group were discharged from hospital to a rehabilitation centre to
receive rehabilitation training once a month, with each intervention lasting 120 min for
12 months, with the first 60 min of reminiscence therapy and the remaining 60 min of
regular rehabilitation training as in the control group. The therapy consisted of 12
predetermined chapters, one for each month. The sessions were conducted in a
comfortable and pleasant environment, with the nurse taking the lead in allowing the
patient to actively recall past scenes.
The Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale
(HADS) and Zung self-rating anxiety scale (SAS) / self-rating anxiety scale (SDS)
scales were assessed at discharge (M0), 3 months (M3), 6 months (M6), 9 months (M9)
months and 12 months (M12) respectively. Reminiscence therapy group showed higher
MMSE score at M9 and M12, lower cognitive impairment rate by MMSE at M12
compared to control group. As to anxiety, HADS-anxiety score and anxiety rate by
HADS were of no difference at each time point, while SAS score and anxiety rate by
SAS were lower at M12 in reminiscence therapy group compared with control group.
Regarding depression, HADS-depression score and depression rate by HADS at M12,
SDS score at M9 and M12, and depression rate by SDS at M12 were all lower in
reminiscence therapy group compared with control group. In terms of RFS (recurrence-
free survival, the time interval from the initiation of intervention to disease recurrence
or death), it was similar between reminiscence therapy group and control group (Li &
Liu, 2022). (After verification, it was found that the P value was not indicated in the
literature for this measure)
3.4 Theory-guided interventions
3.4.1 PDCA and Orem Theory
In this article,126 patients were divided into control group (n=61) and observation
group (n=65) according to the time of admission. The control group received routine
care; in addition to conventional treatment, the observation group also adopted Orem
16
self-care model and PDCA nursing management combined with nursing intervention.
Patients in the observation group were cared for with the Orem self-care model on the
basis of conventional care. Nursing care helped prevent the development of self-care
deficits and provides therapeutic self-care for people with self-care deficits (Khatiban et
al., 2018; Li et al., 2020). According to the patients' ADL scores, patients with scores ≤
40 were given a complete compensation system, in which nursing staff provided
comprehensive care to patients; patients with scores 40-60 were given a partial
compensation system, in which nursing staff encouraged patients, helped them build
confidence in their rehabilitation, and enabled them to gradually master the daily
activities of the affected limbs to improve their self-care ability. Patients with scores
greater than 60 were given an educational support system where nursing staff educate
patients on skills to improve their sense of achievement and self-worth. During the care
period, the PDCA (Plan, Do, Check and Act) cycle was used to enhance the patient's
care. Subsequently, the changes of daily living ability (ADL score), neurological
function (GCS score, NIHSS score) and cognitive function (MoCA and MMSE score)
of the two groups of patients before and after receiving nursing care were compared (Si
et al., 2021).
It was found that after the implementation of nursing measures, the ADL scores of the
two groups improved dramatically than before (P<0.05), and observation-group had
obviously higher post-intervention scores than that of the control-group (P<0.05). 2)The
GCS scores of the two groups were remarkably higher than those before nursing
(P<0.05), and the observation-group had critically higher post-intervention scores than
those of the control-group (P<0.05).3)The National Institutes of Health Stroke Scale
(NIHSS) score of the two groups decreased substantially than before (P<0.05), and the
observation-group had dramatically lower scores than the control-group (P<0.05).4)The
MMSE score in two groups increased remarkably than before nursing (P<0.05), and the
post-intervention score of observation-group was significantly higher than that of
control-group (P<0.05).
3.4.2 Evidence-based nursing
In a study by Liu, participants were randomly divided into intervention group and
control group. The two groups of patients were treated with conventional nursing, while
17
the intervention group received evidence-based nursing on the basis of conventional
nursing. Evidence-based nursing was the “the conscientious, explicit and judicious use
of theory-derived, research based information in making decisions about educational
options and approaches with individuals or groups and in consideration of individual or
group needs and preferences” (Ingersoll, 2000). Conventional nursing care included
close observation of the patient's condition, health education, nutritional support,
psychological counselling and rehabilitation training. The evidence-based care team
collected relevant care literature and conducts group discussions to generate evidence
for care, which was then used to develop an individualised care plan for the patient
based on the patient's needs and experience of care practice. Evidence based nursing
teams provide evidence-based nursing care through psychological rehabilitation, health
education and rehabilitation interventions. Psychological rehabilitation required
understanding the needs and psychological changes of the patient, answering or
addressing the questions posed by the patient, and encouraging the patient to fully
express his or her feelings. Psychological rehabilitation required understanding the
needs and psychological changes of the patient, answering or addressing the questions
posed by the patient, and encouraging the patient to fully express his or her feelings. In
health education, the selection of appropriate health education methods and the content
of education was needed. Early rehabilitation care such as flipping and massaging the
limbs was implemented to patients with stable conditions.
All baseline data were comparable between the two groups according to the study
contrast Statistics. The NIHSS scores, the levels of TNF - and IL-6 in both groups
decreased after four weeks of intervention and eight weeks of follow-up, and the scores
in the intervention group were lower than those in the control group; After 4 weeks of
intervention and 8 weeks of follow-up, FMA (Fugl-Meyer assessment) and ADL
(activities of daily living) scores increased in both groups, with higher scores in the
intervention group than in the control group (P > 0.05). It followed that the
psychological rehabilitation, health education, and rehabilitation interventions involved
in the evidence-based nursing intervention resulted in better improvements and
facilitation of neurological function, motor function, activities of daily living, and serum
levels of inflammatory cytokines in stroke patients compared with those in usual care.
18
4. Discussion
4.1 Main result
This study summarized the specific nursing interventions for stroke patients and the
effects. It summarized four kinds of nursing intervention, including general nursing
intervention, theoretical or model-guided nursing intervention, new nursing intervention
and recollection therapy. These nursing interventions have a better effect on improving
functional status of stroke patients, early recognition and prevention of complications,
and promoting rehabilitation of stroke patients.
4.2 Result discussion
4.2.1 General Clinical Nursing Intervention
Acute physiological monitoring and nursing interventions and transfer to an

appropriately skilled stroke unit setting were two of the core care requirements of the
Third International Stroke Trial (IST-3) for patients treated with thrombolysis in acute
ischaemic stroke (Innes, 2003). IST-3 recommends timely and effective monitoring and
care of the patient before, during and after thrombolysis, mainly through observation,
routine vital signs testing, relevant assessment scales and CT scans (Innes, 2003). The
importance of monitoring patients' physiological data has been demonstrated in studies
(Middleton er al., 2019). Current methods of monitoring patients' physiological data
include, in addition to thinking aloud and interacting with the patient to form a mental
image of the patient to assess the patient's current state (Rhudy & Androwich, 2013). It
was important that patients received comprehensive assessment and rehabilitation in a
stroke centre, which provides specialist stroke team care and an environment conducive
to stroke treatment and rehabilitation (Innes, 2003). As demonstrated by Rosbergen et
al, in their study that providing a good environment in an acute stroke unit is conducive
to increased activity levels and improved prognosis. However, lack of knowledge about
stroke thrombolysis care and fear of intracranial haemorrhagic side effects during care
were barriers to the introduction of thrombolysis services in hospitals, meaning that
nursing staff lacked the relevant knowledge and skills and need relevant training before
19
entering work on stroke units (Innes, 2003). However, this situation has now improved
and stroke unit nursing staff are trained or have some experience in this field.
4.2.2 Theory or model-guided nursing intervention
In a study on the autonomy of stroke patients in hospital rehabilitation, a "change

autonomy" model developed in the grounded theoretical research was described, the
three dimensions of autonomy (self-determination, independence and self-care) were
determined, and the factors that promote or restrict the autonomy of stroke patients were
studied(Proot et al., 2000). Proot et al.'s study showed that patients with stroke are
dependent on others. When self-care is insufficient, support was described by the
concept of social autonomy, that was, support from health professionals and informal
caregivers. This was similar to the study of Si et al., when patients lack self-care ability,
nursing staff take care of patients. The research of Proot et al. collected and analyzed
patient data through interviews. Compared with the research of Si et al., it was more
flexible and informative, but the interviewees were vulnerable to the influence of the
surrounding environment. In the research on the autonomy of stroke patients, it was
pointed out that the autonomy of patients is affected by patient factors and
environmental factors. Health professionals could provide support, assess ADL,
attention and respect, parental style (making decisions for patients), provide information
and team cooperation for patients. These methods were in line with the evidence-based
nursing mentioned in Liu et al. 'research, pay attention to the needs and psychological
changes of patients according to their individual needs and preferences, and through
psychological rehabilitation There was a big difference between health education and
rehabilitation intervention in providing individualized care.
4.2.3 New Nursing Intervention
A previous study of family caregivers of stroke patients has shown that social problem
solving therapy has the potential to help family caregivers be more positive and upbeat
in providing care for stroke survivors (Grant et al., 2001). Providing training in social
problem solving skills over the phone was beneficial as it does not require caregivers to
leave their homes to attend counselling sessions also reduces the associated costs (Grant
et al., 2001). The Social Problem-Solving Telephone Partnership (SPTP) intervention
requires an experienced health care professional to remain in contact with the family
20
carer for an extended period of time so that the family carer's problem solving skills can
be developed and trained (Grant et al., 2001). These family carers who develop effective
social problem solving skills could evaluate care situations more objectively and use
these skills to manage care issues effectively (Grant et al., 2001). Compared with this
study, Gu et al.'s research on high-quality nursing intervention combined with online
mobile health has embodied individualized nursing for stroke patients. However, the
research of high-quality nursing intervention combined with online mobile health
proposed by Gu et al. was more accurate and effective than the results analyzed by
Grant et al.'s telephone intervention research. In addition, the research proposed by Gu
et al. focused more on providing patients with a comfortable nursing environment,
effectively improving the quality of life of patients, and reducing the negative emotions
of patients.
4.2.4 Reminiscence therapy
Stroke has a huge impact on physical, psychological and social functioning. One of the
most common psychological disorders associated with stroke is depression
(Korpershoek et al., 2011). Experiencing isolation due to loss of work and free time
activities could increase the risk of post-stroke depression and further deteriorate
functional status and quality of life (Korpershoek et al., 2011). Reminiscence therapy
helped stroke patients to reduce cognitive impairment, anxiety and depression by
actively recalling scenes from the past (Li & Liu, 2022). In contrast, earlier
interventions proposed by Korpershoek et al. to enhance self-efficacy using four
sources: (1) successful completion of tasks (2) modelling (3) social (4) physiological
state, enhance a person's confidence in performing social tasks. However, both help
patients from a psychological perspective to alleviate depression increased patients'
confidence in social activities thereby improving health and promoting recovery.
4.3 Method discussion
4.3.1 Strengths
This review was a quantitative literature review of the effectiveness of nursing

interventions for people with stroke, and also includes a small number of qualitative
21
studies. A total of 10 English language studies were conducted between 2012 and 2022
in 1949 stroke patients in six countries. These included 1 non-synchronized,
nonequivalent control group pre- and post-test study, 1 single-blind cluster randomised
control trial, 1 Controlled before–after pilot study, 2 descriptive exploratory studies and
5 randomized controlled studies. This study has the following strengths:
(1) The literature content was novel, all within a 10-year period, real-time fit medical
research has evolved, and the research search sources are reliable and the content and
topic confluence.
(2) Subjects were strictly classified with screening statistics to ensure more accurate
study data were available in the study.
(3) To ensure the safety of patients, most studies were carried out collaboratively under
the guidance of experts.
(4) The types of interventions mentioned in the study were rich and varied, including
new nursing interventions, which to some extent promoted the development of new
nursing.
(5) This study detailed 10 nursing interventions and evaluates their effectiveness and
implementation capabilities.
4.3.2 Limitations
The following keywords were often used in the abstract and title of the article: "stroke",
"nursing intervention" and "nursing care". "Cerebral infarction" was rarely used as a
keyword to narrow the scope. The analysis and discussion of the results in the selected
articles were limited to the following.
(1) Experimental data (p-values) were not represented in some of the findings, making it
impossible to accurately assess the effectiveness of nursing interventions for stroke
patients.
(2) Some studies described a new type of nursing intervention, but this kind of nursing
intervention has less data and practice, so its reliability is slightly low.
(3) The study only used English, which was relatively simple, and may lack the
comparison of special interventions in other cultural backgrounds, as well as the
expansion of other research evidence.
(4) It was difficult to sufficiently make comparisons between interventions due to the
extensive research design and outcome measures applied in the study.
22
(5) A significant discrepancy in the sample volumes of stroke patients and nurses from
one study to another has made it challenging to identify the feasibility of extending the
research to other stroke populations.
4.4 The relationship between Orem’s Self-care Theory and results
Nursing interventions were used throughout the treatment and rehabilitation process of a
stroke patient, with the aim of providing disease prevention, treatment and health care.
In order to provide better nursing interventions, it was necessary to first understand the
patient's physical condition, where monitoring the patient's vital signs and various tests
provides a comprehensive understanding of the patient's condition and provides
appropriate treatment. Throughout this process, the patient's awareness of self-care
helps in early detection, prevention, timely access to medical care and later
rehabilitation. For example, it was important to maintain good habits in daily life, to
regularly check and monitor health conditions, and to learn about stroke to prevent it
from happening. If you have a stroke and faint from vomiting, you could be treated at a
stroke centre in time to prevent the condition from worsening. In addition, rehabilitation
exercises and good eating habits with family members could also help to reduce the
pain of the disease, for example, some patients with hemiplegia can recover from their
activities.
Our findings suggested that monitoring interventions, activity interventions,

environmental interventions and some new care interventions could help stroke patients
reduce their pain and help them to achieve effective treatment and rehabilitation, and in
combination with their awareness of self-care, helped them to seek timely medical
attention to reduce the damage caused by the disease and improve their quality of life.
4.5 Clinical Significance - Implications for Nursing
The nursing interventions of this study were mainly to provide high-quality care to
patients to prevent new stroke and enhance rehabilitation care after stroke. Nurses'
physical, psychological, social measures such as new health education modalities
through monitoring, integration with the Internet, reminiscence therapy, improvement
of the environment of stroke units and nursing interventions guided by Orem's self-care
theory in combination with PDCA care compared to usual care have highlighted the
23
importance of improving functional status of stroke patients by reducing stroke risk and
mortality, improving knowledge of stroke risk and comorbid conditions, early
identification and prevention of complications better improvements were found in
fatigue, sleep and depression, increased self-efficacy and improved quality of life. This
study helped patients learn more about the disease, provided psychosocial support to
patients, and improved their self-care ability.
4.6 Suggestions for future research
After reviewing the various studies of effective nursing interventions for stroke patients,
it could be found that the relevant nursing interventions for stroke patients have great
potential to be developed regardless of the leading nursing interventions, there are many
more directions it can explore. The nursing interventions for stroke patients found in the
ten studies we used are very limited, although the effectiveness of these nursing
interventions has been explained; but most of these interventions are aimed at this group
of stroke patients, where complications, clinical or psychological individual differences
and other variables can not be fully explained, more literature and studies with different
variables will be needed to prove this. In terms of obtaining data, studies with shorter
intervention follow-up time were selected to improve the efficiency of data analysis,
while the likely intervention effective time and the intensity of change before and after
stroke intervention were only partially demonstrated, therefore, the long-term follow-up
of the data and results of the effectiveness of in-depth analysis is also necessary. In
addition, some of these studies were theory-guided nursing interventions, based on
which nursing intervention programs are designed, but many of these intervention
programs form a framework and were practiced on a small scale, therefore, the data
obtained in practice were not reliable. Therefore, we could expand the application scope
of these nursing intervention plans based on theory and obtain more data for analysis,
more effective and reliable interventions can be applied to the actual clinical care. The
research of new nursing intervention was helpful to open up new directions and develop
new nursing thinking, but it was still in the research stage, and further study is needed to
ensure its practicability and validity. But as development progresses, exploring new
types of nursing interventions might be able to drive health care to some extent.
5. Conclusion
24
This review describes all of the above interventions that are effective in alleviating the
symptoms and complications of stroke patients, as well as some of the preventive
interventions. In studying theory-related nursing interventions, its use of theoretical
knowledge to help alleviate stroke patients but its inadequate sample size needs to be
explored in depth by increasing the sample size, refining stroke assessment methods,
extending the trial period, and better analysing the intervention modalities and effective
intervention duration. Clinical caregivers should monitor to understand the patient's
needs, condition and vital signs, implement individualised nursing management
protocols and consider nursing interventions that are appropriate for the individual. In
addition, nursing interventions using new types of nursing, using internet technology as
a medium to enhance patient self-care from a psychological perspective, help with
deeper issues, improve quality of life and enhance comfort are also a way to achieve
targeted outcomes.
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Table 3 Authors, title, design, participants, data collection methods and data analysis methods
Author(s)
Design
year/country Participants Data collection Data analysis
Title (approac
of (time / methods / other scales) method(s)
h)
publication
Lori M Surveillance A Total: 20（ 10 patients and 10 nurses） Gender: Data collection time: 1. Content analysis
Rhudy 1, Ida as an descriptiv unlimited 1.change-of-shift handoff 2. The think-aloud
Androwich Intervention e Age: unlimited 2.initial assessment data were examined
in the Care explorator Inclusion criteria: 3.end of the shift (within 90 minutes to identify core
Year: 2013 Of Stroke y design 1) Patients in the first 72 hours of admission for of the end of the 8-hour shift) concepts and themes
Country: Patients stroke. Data collection methods: that answered each
USA A 2) RNs providing care to stroke patients on the 1.A lapel microphone research question.
qualitativ specified 2.A mini digital recorder 3. Adhere to the
e unit. 3.Electronic communication tool rigor of qualitative
approach. 3) RNs who employed on the study unit for a Data collection scale: research to ensure
minimum of 12 weeks to ensure completion of 1.Nonverbal data reliability and
orientation. 2.General observations validity
Exclusion criteria: 3.Electronic medical record
1
1) Nurses employed in the float staff or floating
from another unit
2) Nurses who had not yet completed orientation
to the unit
Inja Kim Effects of an Total: 46 Gender: unlimited Data collection time: 1.SPSS 18+
Year: 2012 Enjoyable A Age: unlimited Experimental group data were
Country: Nurse-Led nonsynch Inclusion criteria: collected before and 2 weeks after
USA Intervention ronized, (1) were in the rehabilitation unit and had been intervention.
to nonequiv diagnosed with stroke, Data collection methods:
Promote alent (2) had mild to moderate limb movement 1. Functional Independence
Movement control limitation on one side, Measurement
in Poststroke group (3) had no serious perceptual or cognitive 2. the Brief Fatigue Inventory
Inpatients pre- and dysfunction based on the Mini Mental State 3. the Pittsburgh Sleep Quality
post-test Examination-Korea (MMSE-K; score > 20; Index
design Kwon, & Park, 1989), 4. the State Depression Scale
A (4) wanted and consented to participate in the 5. CES-D
quantitati study.
ve No Exclusion criteria.
approach.
2
Faria, Adca Care path of Descripti Total: 13 Gender: unlimited Data collection method and scale: 1.Content analysis
Martins, person with ve Age: unlimited 1.Semi-structured interview 2.The interviews
Mmfpds stroke: from explorator Recruiting time: January and October 2013 2.The interviews were recorded in a were read in depth,
Schoeller, S. onset to y research Inclusion criteria: digital recorder, after authorization and the categories
D. rehabilitation A Diagnosis of a stroke of the middle encephalic of the interviewees and had duration emerged. 3.The
Matos, L. O. qualitativ artery between the 1st and 10th day of its of approximately 40 minutes. analysis and
Year: 2017 e occurrence, causing functional dependence. 3.Each interview was transcribed interpretation of the
Country: approach. Exclusion criteria: and assigned a registration number information obtained
Brazil Diagnosis of multifocal stroke, with aphasia or according to the order in which the consisted in the cut-
disorientation. interviews were conducted. off points of the
transcriptions and
codification and
categorization of the
information found.
Middleton Vital sign A single- Total: 1126(Nineteen stroke units) Data collection time: 1) SAS 9.4 (SAS
Sandy, monitoring blind Gender:unlimited 1.Within the first 72 hours of stroke Institute Inc.,
McElduff following cluster Age:≥18 unit admission Cary, NC, USA)
Patrick, stroke randomis Inclusion criteria: 2. Improved stroke 90 days later 2) undertook the
Drury Peta, associated ed control Had a diagnosis of ischaemic stroke or Data collection method and scales
with trial intracerebral haemorrhage and arrived at a 1. medical record access
3
D’Este 90-day A participating stroke unit within 48 hours of stroke 2. telephone survey randomisation using
Catherine, A. independenc quantitati onset. random number
Cadilhac e: a ve Exclusion criteria: generating software
Dominique, secondary approach. Those who were for palliation only or who did not 3）The modified
Dale Simeon, analysis of have a telephone Rankin Scale
M. the QASC 4）Multiple logistic
Grimshaw cluster regression models
Jeremy, randomized
Ward trial
Jeanette,
Quinn Clare,
Cheung N.
Wah, Chris
Levi
Year:2018
Country:
Australia
Yaping Liu,, Effects of an A Total: 116 Gender: unlimited Data collection time: 1.SPSS 21.0
Mingwei Qu, evidence- Randomiz Age:unlimited 1. before intervention (T1) 2.Either unpaired t
4
Nan Wang based ed Inclusion criteria: 2. after intervention(T2) test or Mann–
and Limin nursing controlled (1) Diagnosed with cerebral infarction through 3. after follow-up (T3) Whitney test as
Wang intervention trial transcranial CT and MRI examinations; Data collection method and scales appropriate
on (2) With fifirst acute episode cerebral infarction 1. group discussion to obtain 3.Two-way ANOVA
Year:2021 neurological A of onset within 6 hours; nursing evidence was conducted test
Country: function and quantitati (3) Treated by intravenous thrombolytic therapy; 2. Individualized patient care plan 4.Tukey’s multiple
China serum ve (4) Expected survival time ≥ 3 months; was formulated according to the comparisons test
inflammator approach. (5) With no obvious complications, no needs of patients and nursing 5.The scores of
y cytokines coagulation dysfunction, no drug allergy, and no practice experience. NIHSS
in patients severe liver or kidney damage; 3. Detect the changes of various 6.The scores of FMA
with acute (6) With no neurological dysfunction, no hearing indicators
cerebral impairment, and no aphasia;
infarction: A (7) Was literate and able to read and understand
randomized the informed consent.
controlled Exclusion criteria:
trial (1) With congenital immunodeficiency;
(2) With severe inflammatory or infectious
diseases;
(3) With cardiac, hepatic or renal insufficiency;
(4) With malignant tumor;
5
(5) Allergicto the drugs in the therapy against
cerebral infarction;
(6) With mental disease or family history of
mental illness;
(7) With language or hearing dysfunction.
Shengqin Effect of A Total: 90 Gender: unlimited Data collection method 1.Comparison of
Gu,1 New Randomiz Age: more than 45 years. 1) Regularly upload patient data to Baseline Data
Xiaomei Nursing on ed Recruiting time: June 2019-June 2020 Cardio-Cerebrovascular 2.Comparison of SS-
Gao,1 Wei Patients with controlled Inclusion criteria: Steward App QOL Scores after
Gu,1 Mulei Acute trial (1) Patients met the diagnostic criteria of ACI in 2) Observation Indexes Intervention
Jiang,1 and Cerebral the Sixth National Academic Conference on Data collection scales 3.Comparison of
Dongmei Qi Infarction A Cerebrovascular Diseases and were confirmed by 1. Comfortable Intervention-Based MSSNS Scores after
Year:2022 quantitati brain MRI and CT, with the clinical Nursing Mode under the Quality Intervention
Country: ve manifestations including Nursing Intervention 4.Comparison of
China approach. aphasia, disturbance of consciousness, and brain 2. Internet Mobile Health ESCA Scores after
edema; Intervention
(2) the admission time after onset was less than 5.Comparison of
72 h; NIHSS Scores after
(3) patients had no communication barriers; (4) Intervention
patients had no serious dysfunctions in the heart,
6
liver, and kidney, or other serious diseases such as 6.Comparison of
malignant tumors; GCQ Scores after
(4) patients had the first onset Intervention
Exclusion criteria: 7.Software SPSS
(1) Patients with a definite history of dementia or 20.0 and graphed by
cognitive impairment; GraphPad
(2) patients in the active phase of chronic Prism 7 (GraphPad
infectious diseases or those with acute infectious Software, San Diego,
diseases; USA)
(3) patients with intracranial tumorlesions;
(4) patients with hemiplegia or muscle strength of
the affected limb > grade 3;
(5) patients with audiovisual impairment and
those who could not cooperate with the
researchers;
(6) patients participating in other trials.
7
Ingrid CM Embedding Controlle Total: 60 Gender: unlimited Data collection method 1. A one-way
Rosbergen, an enriched d before– Age: unlimited 1.The activity level measured as the analysis of
Rohan S environment after pilot Inclusion criteria: primary outcome was determined covariance
Grimley, in an acute study (1) aditted within 24–72hours after onset of using the behavior mapping (ANCOVA)
Kathryn S stroke stroke (ischaemic or haemorrhagic, first and/or protocol adapted by Janssen et al 2. covariates of age
Hayward, unit A recurrent stroke), 2.Behavioural mapping 3. stroke severity
Katrina C increases quantitati (2) able to complete a transfer from bed to chair 3. telephone interview (NIHSS)
Walker activity in ve with 4. premorbid
Donna people approach. assistance of two persons or less, modified Rankin
Rowley, with stroke: (3) able to follow single stage commands, Scale
Alana M a controlled (4) requiring assistance for basic activities of 5. sensitivity
Campbell, before–after daily living (ADL's), analysis
Suzanne pilot study (5) were premorbidly independent (self-report), 6. IBM SPSS
McGufficke, indicated by a Functional Ambulation Category15 Statistics for
Samantha T score ⩾4 and a modified Rankin Score (mRS)16 Macintosh version
Robertson, of 0–2. 24.0(IBM Corp.,
Janelle Exclusion criteria: Armonk, N.Y.,
Trinder, (1) concurrent diagnosis of rapidly deteriorating USA)
Heidi disease
Janssen and (2) extensive psychiatric history.
8
Sandra G (3) stroke patients were also excluded if
Brauer discharge was expected within two days of
admission to the stroke unit.
Year: 2017
Country:
Australia
Li, A. Reminiscenc A Total: 216 Gender: unlimited Data collection time: 1.Intention-to-treat
Liu, Y. e therapy Randomiz Age: 45–80 years old 1.At the discharge from hospital (ITT) principle
Year: 2022 serves as an ed Inclusion criteria were as follows: (M0), 3 months (M3), 6 months 2.the last observation
Country: optional controlled (1) diagnosed as first episode AIS; (M6), 9 months (M9), and carried forward
Ireland nursing care trial (2) age 45–80 years old; 12 months (M12) (LOCF) method
strategy in (3) able to complete assessment questionnaires of 2.After 12-month intervention, all 3.LOCF method
attenuating cognitive, anxiety, and depression; patients were continuously followed
9
cognitive A (4) not participating in other clinical trials. up for another 24 months (totally up 4.SPSS 21.0
impairment, quantitati Exclusion criteria: to statistical software
anxiety, and ve (a) history of mental disease before AIS onset; 36 months) or until death 5.GraphPad Prism
depression in approach. MiniMental State Examination (MMSE) Data collection method: 7.01 software
acute score < 20; (c) complicated with malignant 1. Record the basic characteristics 6.Student’s t test
ischemic tumors, other cerebral diseases, or other of the patient 7.chi-square test
stroke uncontrolled diseases; and (d) other condition that 2. Telephone follow-up 8.Fisher exact test,
patients was not suitable for participation of the current 3. Clinic visits or Wilcoxon rank
study judged by investigator. Data collection scale: sum test
1. MMSE score
2. HADS scale and Zung selfrating
SAS/SDS scale
Sun, Z. Effect of A Total:99 Gender: unlimited Data collection time: 1.SPSS 22.0
Jiang, H. Comprehensi Randomiz Age:40–80 years 1.When administered (before statistical software
Chen, C. ve Nursing ed Recruiting time: December 2019 to December thrombolysis)
Fan, Y. Intervention controlled 2020 2.Every hour during thrombolysis
Year: 2022 on the Effect trial Inclusion Criteria: 3.at 2 h, 24 h, and 7 d after
Country: of CT- 1.Age 40–80 years; thrombolysis
China Guided A 2.clinical symptoms conforming to the diagnostic Data collection method:
Intravenous quantitati 1.Scale evaluation
10
Thrombolysi ve criteria of ischemic cerebrovascular disease, onset 2.Serum test
s in Acute approach. within 3.self-made questionnaire
Cerebral 3–9 h; Data collection scale:
Infarction 3.NIHSS score between 4 and 24, symptoms 1.Self-Rating Anxiety Scale (SAS)
lasting and Self-Rating Depression Scale
more than 30 min, no significant improvement of (SDS) Scores
symptoms before thrombolysis; 2.NIHSS Score
4.patients with MTT/CTA or CBF/CTA >20%, 3.Barthel Scores
and the descending CBV area <1/3 of the middle
cerebral artery blood supply area;
5.patients’ family members signed the informed
consent.
Yuexiu Si The A Total: 126 Gender: unlimited Data collection method and scales 1. statistical
, Hong Yuan combinative Randomiz Age: 35-75 years old. 1.Barthel index (BI) software SPSS 25.0
, Ping Ji effects of ed Recruiting time: January 2019 to March 2020 2.the Glasgow Coma Index (GCS) 2. The comparison
, Xiaoyan orem self- controlled Inclusion criteria: and the National Institutes of Health of measurement data
Chen care theory trial (1) Patients that confirmed with presence of Stroke Scale (NIHSS) was performed by t-
Year: 2021 and cerebral infarction, and met the diagnostic test, and the
Country: criteria of AIS in Chinese Expert Consensus on comparison of
11
China PDCA A Emergency Diagnosis and Treatment of Acute 3.The Montreal Cognitive enumeration data
nursing on quantitati Ischemic Stroke; Assessment Scale (MoCA) and the was carried by χ2
cognitive ve (2) Patients ranged from 35 to 75 years; Mini-mental State test.
function, approach. (3) Patients who have had a stroke for the first Examination (MMSE)
neurological time;
function and (4) Patients who voluntarily signed the informed
daily living consent.
ability in Exclusion criteria:
acute stroke (1) Patients with blood system diseases or
coagulopathy; (2) Patients with heart, lung, liver
or kidney dysfunction; (3) Patients with malignant
tumors;
(4) Patients with congenital or autoimmune
diseases; or (5) Those who already had cognitive
impairment
and limb dysfunction before illness.
RN (registered nurse), MMSE-K (Mini Mental State Examination-Korea), CES-D (Center for Epidemiologic Studies Depression Scale), NIHSS
(National Institutes of Health Stroke Scale), FMA (Fugl-Meyer assessment), ACI (acute cerebral infarction), SS-QOL (Stroke-Specific Quality of
12
Life Stroke), MSSNS (Mental Status Scale in Nonpsychiatric Settings), ESCA (Exercise of Self-Care Agency Scale), GCQ (General Comfort
Questionnaire), AIS (acute ischemic stroke), MMSE (MiniMental State Examination), HADS (Hospital Anxiety and Depression Scale), SAS (self-
rating anxiety scale), SDS (self-rating depression scale), MTT (mean transit time of the contrast agent ), CTA (CT examination), CBF (cerebral
blood flow), CBV (blood volume)
Table 4. Aims and results of selected articles
Authors Aim Intervention Outcome Results

(content, time, specialist, place etc.)
Lori M. The purpose When providing care to a stroke Nurses form mental representations of patients by thinking The findings
Rhudy, of this study patient, the nurse makes an initial aloud during the nursing process, and use this as a baseline to suggest that
Ida was to assessment of the patient when the evaluate and monitor patients, and finally evaluate the nurses in this
Androwi explore the report is received and thinks aloud at relationship between patient status and initial expectations. study used
ch nursing the end of the shift. With this approach, nurses are able to purposefully and surveillance.
intervention continuously acquire, interpret, and synthesize patient data for Using cues
of clinical decision-making. from change-
surveillance of-shift handoff
in the care of information, a
stroke mental image
patients. of what the
13
patient would
look/be like
was
formed. This
mental image
served as a
baseline for the
evaluation of
the patient’s
current state.
Inja Kim To A non-synchronous, non-equivalent 1)There were no differences in demographic and clinical The enjoyable
developed an control group was used for the pre- characteristics between the two groups. nurse-led
enjoyable and post-test design. Twenty 2)The groups did not differ significantly with respect to these intervention
nurse-led participants were recruited for the baseline variables. was effective in
intervention experimental group and 25 for the 3)After 2 weeks of intervention, all outcome variables except improving
for control group. All participants in the for cognitive function were significantly more improved in the functional
poststroke control group were discharged from experimental group than in the control group. status and
inpatients to the hospital and started the 4)Functional status was more improved in the experimental reducing (i.e.,
promote intervention. Data for the group than in the control group (p = .00). improving)
14
physical experimental group were collected 5)Fatigue and sleep disturbance were improved in both groups, fatigue, sleep
activity pre-intervention and 2 weeks post- those were much more improved in the experimental group than disturbance,
enough to intervention. Participants all in the control group. and depression
improve participated in a nurse-led 6)Depression was also more improved in the experimental among
movement of intervention using children's toys. 20 group than in the control group (p = .05). poststroke
plegic limbs participants participated in a 30- to inpatients with
as well as 40-minute team game on the ward, 3 hemiparesis.
related times a week for 2 weeks. Measures
problems. of functional status (cognitive, motor
and total status), fatigue, sleep and
depression were taken.
Faria, To describe Based on transition theory, nurses Nurses, especially rehabilitation nurses, meet the needs There are
Adca the care path facilitate the care, treatment, and early expressed by the subjects, are responsible for training the positive effects
Martins, of the person recovery of stroke patients. adaptability of patients and caregivers, and adjust the houses in the results.
Mmfpds with stroke Rehabilitation nurses respond to the according to the patients' conditions to help establish the
Schoelle goes through needs expressed by subjects, train transitional knowledge of post-stroke dependents, thus
r, S. D. and to patients and caregivers to adapt, and improving nursing knowledge and nursing practice. This is of
Matos, identify the make adjustments to the patient's great help in helping to improve the care of stroke patients,
L. O. important situation. including the onset, recovery and rehabilitation, as well as
home care.
15
events in this
path.
Middleto To examine Using a computer assisted telephone 1)Patients had significantly lower odds of 90-day independence Strong
n, S. associations interview to examine 90-day if, within the first 72 hours of stroke unit admission, they had evidence
McElduf between 90- survival and independence using the one or more: febrile event (>37.5°C) (OR 0.47; 95%CI:0.35- demonstrates
f, P. day death modified Rankin Scale. Examine five 0.61; P<0.0001), higher mean temperature (OR:0.25; the importance
Drury, P. and in-hospital processes of stroke 95%CI:0.14-0.45; P<0.0001), finger-prick blood glucose of monitoring
D'Este, dependency, care: temperature monitoring; fever reading >11 mmol/L (OR: 0.61; 95%CI: 0.47-0.79; patients' body
C. and management; glucose monitoring; P=0.0002), higher mean blood glucose (OR 0.89; 95%CI:0.84- temperature,
Cadilhac monitoring hyperglycaemic management; and 0.95; P = 0.0006), or failed the swallowing screen (OR 0.35; blood glucose,
, D. A. and dysphagia management. 95%CI:0.22-0.56; P<0.0001). and swallowing
Dale, S. treatment 2)Patients had greater odds of independence when: venous status in
Grimsha processes of blood glucose was taken on admission to hospital or within 2 improving 90-
w, J. M. in-hospital hours of stroke unit admission (OR 1.4; 95%CI:1.01-1.83; day stroke
Ward, J. nursing P=0.04); outcomes.
Quinn, stroke care 3)finger-prick blood glucose was measured within 72 hours of Routine care
C. targeted in stroke unit admission (OR 1.3; 95%CI:1.02-1.55; P=0.03); significantly
Cheung, the 4)or when swallowing screening or assessment was performed reduces
N. W. trial. within 24 hours of stroke unit admission (OR 1.8; 95%CI:1.29- mortality and
Levi, C. 2.55; P=0.0006).
16
dependence
after stroke.
Liu, Y. To Control group: 1)Demographic characteristics of two groups were comparable Evidence-based
Qu, M. investigate receive conventional nursing (all p > 0.05). nursing has a
Wang, the effect of Intervention group: 2)Before intervention, no difference was observed between the positive effect
N. evidence- On the basis of conventional nursing, 2 groups. After the 4-week intervention, NIHSS scores in both on the
Wang, based the intervention group also received groups were decreased, while treatment of
L. nursing on evidence-based the score of the intervention group was significantly lower than patients with
the recovery Nursing. the control group. After 8 weeks of follow-up, NIHSS scores in acute cerebral
of evidence-based nursing was as both groups were further infarction,
neurological follows: decreased and the score of the intervention group was also which
function (1) Psychological rehabilitation significantly lower than that of the control group. decreases the
and serum (2) Health education to choose 3)During intervention and followup, FMA scores in both level of serum
inflammator appropriate health education methods groups were elevated and the intervention group exhibited inflammatory
y cytokines (3) Rehabilitation intervention significant higher FMA score than the control group. cytokines and
in patients 4)After 4 weeks of intervention and 8 weeks of follow-up, both contributes to
with acute groups had a higher ADL score than baseline, and the score of the recovery of
cerebral the intervention group was dramatically higher than that of the neurological
infarction. control group. function,
17
5)The levels of TNF-α in both groups were decreased after 4 motor function
weeks of intervention and 8 weeks of follow-up and activities of
6)The intervention group showed significantly lower TNF-α daily living.
level than
the control group during intervention and follow-up.
7)After 8 weeks of follow-up, IL-6 level in the intervention
group was significantly lower than the control group.
Gu, S. To explore Control group: Compared with CG, EG after intervention achieved obviously The application
Gao, X. the effect of routine nursing higher SS-QOL, ESCA, and GCQ scores (P < 0:001), and lower of the
Gu, W. the Experimental group: MSSNS and NIHSS scores (P < 0:001) comfortable
Jiang, comfortable the comfortable intervention-based intervention-
M. intervention- nursing mode under the quality based nursing
Qi, D. based nursing intervention combined with mode under the
nursing Internet mobile health. quality nursing
mode under intervention
the quality
18
nursing combined with
intervention Internet mobile
combined health
with Internet effectively
mobile improves QOL
health on the and alleviates
quality of the negative
life (QOL) emotions of
and patients.
psychologica
l status of
patients with
acute
cerebral
infarction
(ACI).
Ingrid To determine Usual care participants: 1)The enriched environment group (n=30, mean age 76.7±12.1) Embedding an
CM whether an usual one-on-one allied health spent a significantly higher proportion of their day engaged in enriched
Rosberg enriched intervention and nursing care ‘any’ activity (71% vs. 58%, P=0.005) compared to the usual environment in
en, environment care group (n=30, mean age 76.0±12.8). an acute stroke
19
Rohan S embedded in The enriched environment 2)They were more active in physical (33% vs. 22%, P<0.001), unit increased
Grimley, an acute participants: social (40% vs. 29%, P=0.007) and cognitive domains (59% vs. activity in
Kathryn stroke unit Provide with stimulating resources, 45%, P=0.002) and changes were sustained six months post stroke
S could communal areas for eating and implementation. patients.
Hayward increase socializing and daily group activities 3)The enriched group experienced significantly fewer adverse
, Katrina activity events (0.4±0.7 vs.1.3±1.6, P=0.001), with no differences found
C levels in in serious adverse events (0.5±1.6 vs.1.0±2.0, P=0.309).
Walker acute stroke
Donna patients and
Rowley, reduce
Alana M adverse
Campbel events.
l,
Suzanne
McGuffi
cke,
Samanth
aT
Robertso
n,
20
Janelle
Trinder,
Heidi
Janssen
and
Sandra
G Brauer
Li, A. To explore Control group: 1)Reminiscence therapy group showed higher MMSE score at Reminiscence
Liu, Y. the effect of conventional rehabilitation training M9 and M12, lower cognitive impairment rate by MMSE therapy cripples
reminiscence including: body function at M12 compared to control group. cognitive
therapy on rehabilitation and cognitive 2)As to anxiety, HADS-anxiety score and anxiety rate by impairment,
cognitive function rehabilitation HADS were of no difference at each time point, while SAS anxiety, and
impairment, Reminiscence therapy group: score and anxiety rate by SAS were lower at M12 in depression, but
anxiety, additional reminiscence therapy on reminiscence therapy group compared with control group. does not affect
depression, the basis of receiving conventional 3)Regarding depression, HADS-depression score and RFS in AIS
and rehabilitation training depression rate by HADS at M12, SDS score at M9 and M12, patients,
disease and depression rate by SDS at M12 were all lower in indicating its
recurrence in reminiscence therapy group compared with control group. potential for
AIS patients. 4)In terms of RFS, it was similar between reminiscence therapy post-stroke
group and control group. management.
21
Sun, Z. To Routine blood and urine 1)81 (81.82%) patients had mild or severe encephalopathy and The use of
Jiang, H. investigate examinations, liver and kidney 83 (83.84%) patients had leukoaraiosis. comprehensive
Chen, C. the effect of function, coagulation function, 2)The serum MMP-9 level in both groups was higher than the nursing
Fan, Y. comprehensi blood glucose, electrocardiogram, and normal baseline level (88.23 ng/mL), and plasma interventions in
ve nursing head CT were performed in 2 groups. MMP-9 in the control group was higher than that in the the CT-guided
intervention Patients in both groups observation group at different time periods (P < 0.05). intravenous
on the effect were given nerve nutrition, circulation 3)The SAS score and SDS score of patients in the observation thrombolysis
of CT-guided improvement, lipidlowering, and group were significantly reduced, while the SAS score and SDS treatment of
intravenous gastric mucosa protection treatments. score of patients in the control group showed no significant ACI
thrombolytic Control group: change. patients
therapy for rt-PA thrombolysis and routine 4)The observation group and the control group were reduced the
acute neurological care significantly improved at 24 h, 72 h, and 7d after thrombolysis degree of
cerebral Observation group: compared with those before thrombolysis (P < 0.05). NIHSS neurological
infarction. oral aspirin 200 mg/d and anticipatory scores of the observation group were lower than those of the impairment,
nursing intervention control group at 24 h, 72 h, and 7 d after thrombolytic therapy improved the
(P < 0.05). therapeutic
5)The Barthel score of the observation group was higher than effect,
that of the control group. increased
6)The satisfaction of the observation group reached 96.15%, nursing
which was significantly better than that of the control group
22
(80.85%). satisfaction,
and
enabled better
control of the
condition of
patients with
cerebral
infarction,
which is worth
promoting
research.
Yuexiu To explored control-group: 1)After the implementation of nursing measures, the ADL On the basis of
Si , the combined routine nursing care scores of the two groups improved dramatically than before Orem Self-care
Hong effects of observation-group: (P<0.05), and observation-group had obviously higher theory, the
Yuan , Orem Self- in addition to conventional treatment, post-intervention scores than that of the control-group (P<0.05). application of
Ping Ji , care Theory applied with the Orem Self-care 2)The GCS scores of the two groups were remarkably higher PDCA nursing
Xiaoyan and PDCA model for nursing according to their than those before nursing (P<0.05), and the observation-group in daily nursing
Chen nursing on score of ADL. Patients with a score of had critically higher post-intervention scores than those of the work to acute
cognitive ≤40 were given a complete- control-group (P<0.05). stroke patients
compensation system, those with a
23
function, score of 40-60 were treated with 3)The NIHSS scores of the two groups decreased substantially can actively
neurological partial-com-pensation system, and for than before (P<0.05), and the observation-group had improve
function and rest with over 60 were given an dramatically lower scores than the control-group (P<0.05). their cognitive
daily living educational support system. The 4)The MMSE score in two groups increased remarkably than function,
ability of PDCA cycle method was adopted to before nursing (P<0.05), and the post-intervention score of neurological
patients. strengthen observation-group was significantly higher than that of control- function and
the care of stroke patients. group (P<0.05). daily life
ability.
24

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FACULTY OF HEALTH AND OCCUPATIONAL NURSING DEPARTMENT,

STUDIES MEDICINE AND HEALTH COLLEGE

Nursing interventions for patients with stroke

Jing Chen (Claire)

Student thesis, Bachelor degree, 15 credits

Supervisor: Li Xiaoyan (Kate)

Key word: cerebral infarction, nursing intervention, stroke

1.2.2 Nursing intervention-definition

1.3 The nurse’s role

1.5 Earlier reviews of the topic

1.6 Problem statement

1.7 Aim and research questions

2.2 Search strategy

Table 1. Search results.

Medline English and Nursing 158109

2.3 Selection criteria

Table 2. Selection criteria for studies included in the review

2.4 Selection process and outcome regarding possible articles

Records removed before screening:

Duplicate records removed (n =31 )

Exclusion of records of irrelevant

Excluded articles passed full text :

Reports of included studies patients(n=5).

2.5 Data analysis

2.6 Ethical considerations

3.1 General Clinical Nursing Intervention

In the article of Middleton, 19 hospitals participated in the study. All participants

3.1.2 Activity intervention

3.1.3 Patient's nursing path

3.1.4 Comprehensive nursing intervention

3.1.5 Environmental intervention

3.2 New nursing intervention

3.3 Reminiscence therapy

3.4 Theory-guided interventions

3.4.1 PDCA and Orem Theory

3.4.2 Evidence-based nursing

4.1 Main result

4.2 Result discussion

4.2.1 General Clinical Nursing Intervention

Acute physiological monitoring and nursing interventions and transfer to an

4.2.2 Theory or model-guided nursing intervention

In a study on the autonomy of stroke patients in hospital rehabilitation, a "change

4.2.3 New Nursing Intervention

4.2.4 Reminiscence therapy

4.3 Method discussion

This review was a quantitative literature review of the effectiveness of nursing

4.4 The relationship between Orem’s Self-care Theory and results

Our findings suggested that monitoring interventions, activity interventions,

4.5 Clinical Significance - Implications for Nursing

4.6 Suggestions for future research

Table 4. Aims and results of selected articles

Authors Aim Intervention Outcome Results

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