CHAPTER 4: RESULTS
4.13 Additional Findings
4.13.1 Challenges in different rehabilitation areas
Qualitative data revealed certain challenges in the following areas:
Patients felt that nursing staff were not adequately trained in caring for stroke survivors;
they were not efficient in their services and “not always available when needed”. This
statement was confirmed by doctors who expressed that “there is a need for nursing staff who are well-educated in respect of stroke care”.
Patients were unhappy with the low intensity of therapy offered to them in the post-acute rehabilitation setting (this included patients who went to a post-acute rehabilitation centre and one patient who received domiciliary treatment).
Patients found that there was a lack of recreational space in the post-acute rehabilitation centres.
Two patients complained about the choice of the post-acute rehabilitation centre, since “it was situated far away from the relatives’ home whereas there was another rehabilitation centre situated much closer to home”.
The standard of post-acute rehabilitation as well as acute rehabilitation was criticised by four doctors (11.4%).
4.13.2 Accuracy of diagnosis
The researcher made one very important finding through the additional comments. Six participants (12.5%) stated that the diagnostic skills of general practitioners were lacking when it came to detecting stroke warning signs. One stated “the general practitioner needs to improve his skills in terms of making the right diagnosis”. All six patients went to the doctor with severe headache. Two of them had additional speech problems and one showed some weakness in his right leg. Four of the patients were diagnosed with “head flu” and received medicine for flu. (Later one of patient was told “that medicine for “cold”
increases blood pressure”). The fifth patient, while being away from home, was diagnosed with severe migraine. When she returned home, her husband immediately contacted their general practitioner, who confirmed the diagnosis. The following day the patient was admitted to hospital, having suffered a severe stroke. The sixth patient was diagnosed with alcohol abuse. He had not consumed any alcohol at that time, but, when questioned on assessment, his daughter said that “her father likes his drink on Sundays”. He was rushed to hospital three days later with an irreversible stroke.
These findings were supported through qualitative data from the doctors’ questionnaires.
Asked whether he wanted to add any comments on the rehabilitation process for acute
stroke patients, one doctor mentioned the “ignorance of the general practitioners”. He complained, that “general practitioners do not refer early enough or sometimes not at all”.
The researcher heard one positive story where a patient experienced the same symptoms as mentioned above. He was rushed to hospital, diagnosed by a specialist who
immediately gave him anticoagulant medication. He was one of the patient participants who suffered from no impairments or functional limitations on discharge.
4.14 Summary
The doctor population – thirty-one males and four females with a mean age of 47, consisted of twenty-one physicians, twelve neurologists and two general practitioners.
None of them had any rehabilitation qualification.
Patients – thirty-three males and fifteen females with a mean age of 64 years, were mainly white, English-speaking South Africans, well-educated and retired. Nearly all of them lived in a house prior to the stroke and had medical insurance. The majority suffered a right CVA. The mean value of activity limitations at the time of the interview was eight with mobility being the most affected area.
Almost 50% of doctors used a set protocol. Almost all (86%) were willing to try a new set protocol as they saw the advantages of using such a protocol while 57% also saw
disadvantages. The multidisciplinary team work approach was used by 57% of doctor participants, while 91% indicated that they would prefer to work within an interdisciplinary team. Only 6% included the patient and family as team members whereas all doctors included the physiotherapist. The most common means of communication among team members was verbal (80%).
The majority of doctors (97%) stated that they informed the patient and family members regarding the diagnosis (80%), prognosis (89%), risk factors (63%) and on the post-acute rehabilitation options (66%). This was not supported by statements given by patients (50 - 27%). Less than 50% of the participants – doctors or patients – stated that information regarding discharge timing was discussed. Doctors and patients agreed that the method by which information was disseminated was mostly verbal but disagreed with regards to the frequency and duration of information sessions.
LOS in the acute-care hospital showed a mean of 12.3 days, no statistical significance could be found in the difference between the various hospitals or the varying disability levels of different patients.
The decision on the post-acute rehabilitation facilities was mostly done by doctors or the Medical Aid but doctors consulted other health care professionals beforehand. Most of the patient participants were satisfied with both, the decision approach as well as the choice of the post-acute setting.
Additional findings, obtained from qualitative data, revealed dissatisfaction voiced by both study groups with regard to some areas such as the quality of nursing staff, the therapy given (physiotherapy, occupational therapy and/or speech and language therapy) and in particular, the diagnostic skills of doctors.