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Biomedical subjects

E K Carr

Publications and source records attributed to E K Carr.

9 recordsLinked to original sources
PubMed1999

Inter-rater reliability of postural observation after stroke.

OBJECTIVE: To explore the inter-observer reliability of bedside observations of stroke patients' posture using two versions of a pictorial tool. DESIGN: Three projects were conducted. The initial version of the tool was used in project 1. The modified version was used in projects 2 and 3. In each project a pair of observers (comprising the main observer and one of five co-observers with varying degrees of experience in observing posture) used the tool to make simultaneous observations of 19 aspects of the posture of a sample of stroke patients. Each patient was observed in one or more of four positions (seated, supine and lying on the affected and unaffected side). The degree of inter-observer agreement was sought by calculating kappa values and percentage agreement. SETTING: Medical wards, care of the elderly wards and a stroke unit. SUBJECTS: A convenience sample of 57 stroke patients. RESULTS: Four hundred and forty paired sets of observations were made (200 in project 1, 140 in project 2 and 100 in project 3). The main observer was in every pair. The co-observers made between 50 and 135 sets of observations each. When the results from all three projects were amassed, acceptable percentage agreement (i.e. > or =70%) was obtained for 67% (n = 78) and 73% (n = 55) of the results collected on aspects of the posture of the affected upper and lower limbs respectively. In contrast, acceptable percentage agreement for observations relating to the head, neck and trunk was obtained for only 34% (n = 50) of the results collected. Uneven distributions in the data made kappa values difficult to interpret. Inter-observer agreement was not noticeably higher for pairs in which both observers had prior experience of observing posture after stroke than for pairs in which one observer was relatively inexperienced. CONCLUSIONS: The tool has potential as a quick and simple means of collecting information at the bedside about stroke patients' posture. Refinements, additional training in using the tool for observers and further testing are suggested before its wider use is advocated.

Adult↗
PubMed1998

Positioning of stroke patients: evaluation of a teaching intervention with nurses.

BACKGROUND AND PURPOSE: There is agreement, although little evidence, that consistently positioning stroke patients in allegedly reflex-inhibiting positions is therapeutic and will enhance functional recovery. The nursing staff, therefore, needs to know and implement these postures and understand their potential underlying value. We examined nurses' knowledge of and practice in positioning stroke patients before and after a formal teaching intervention. METHODS: In a quasi-experimental study, 38 stroke patients and 59 nursing staff members (44 trained nurses and 15 healthcare assistants) from 6 wards were studied. The wards were randomly allocated to experimental or control status. Patients were assessed on entry into the study by use of a range of measures to establish group equivalence. Nineteen aspects of their position were documented at intervals throughout their stay with a previously developed observational tool. One thousand sets of observations of patient position were made. Using 2 questionnaires, the nurses' knowledge of the terminology used to denote posture and of issues relating to the moving and positioning of stroke patients was assessed before, immediately after, and 3 months after a package of formal teaching was implemented on the experimental wards. Nurse knowledge and patient position were used as the main outcome measures. RESULTS: Immediately after teaching, nurses in the experimental group scored significantly higher than those in the control group on the terminology questionnaire (P < 0.05) and the moving and positioning questionnaire (P < 0.001). Three months later, the experimental group scored higher on the latter questionnaire only (P < 0.005). The positioning of patients in the experimental group was improved overall after the teaching (P < 0.0005), and improvements to specific parts of the body were noted. CONCLUSIONS: It was possible to effect a degree of change in the nurses' knowledge of and practice in the positioning of stroke patients. However, the quality of patient positioning remained variable. More effective ways of improving positioning need to be developed. Only then can the effects of recommended positioning be evaluated.

Aged↗
PubMed1992

Positioning of the stroke patient: a review of the literature.

Stroke is a common and disabling illness, adversely affecting the quality of life of hundreds of people each year. While there are many therapeutic approaches to stroke patient rehabilitation, encouraging patients to adopt "reflex-inhibiting" patterns of posture is a widely advocated strategy for helping patients to avoid complications of hemiplegia such as spasticity and contractures. However, while the central role of nurses in thus helping patients is recognized, the influence of posture on recovery from stroke has never been evaluated. Prior to undertaking such an evaluative study, texts on stroke patient care were reviewed to clarify the received view about the recommended positioning for patients with hemiplegia. Consensus on some issues was evident (such as positioning the patient with the affected shoulder protracted, spine straight, fingers extended and avoiding external rotation of the affected hip). However, opinion was divided on others and a number of potentially important aspects were ill-covered. This paper integrates a summary of the findings of this review with the physiological rationale for the recommendations. The main areas of agreement are highlighted and issues as yet unanswered are raised for further consideration.

Cerebrovascular Disorders↗
PubMed1991

A comparison of the mealtime care given to patients by nurses using two different meal delivery systems.

This study explored the mealtime care given to stroke patients and general patients on the medical wards of two hospitals which operated different meal delivery systems. Overall, nurses in Hospital 1 (in which the patients' food was plated by catering staff in the main hospital kitchen) tended to be less involved in mealtimes than those in Hospital 2 (in which the nurses plated the food on the wards). This was particularly so for the qualified staff and applied to many aspects of mealtime care including meal trolley supervision, the serving and delivery of food, checking patients' well-being, observing their feeding difficulties, providing assistance during mealtimes, and observing the contents of discarded dishes. These differences were not related to staffing levels or the prevalence of feeding problems. It is possible, therefore, that a meal delivery system designed to free nurses from the 'non-nursing' duty of serving food may have an adverse effect on their involvement in other aspects of mealtimes.

Cerebrovascular Disorders↗
PubMed1991

Perceived needs of general practitioners and practice nurses for the care of diabetic patients.

This study compared the aims and needs of General Practitioners (GPs) and practice nurses who wished to improve the service they provided for non-insulin-treated diabetic patients. Contact was made with 242 GPs in 110 practices in Central and North Nottingham, and a questionnaire was sent to the 149 (62%) who requested one. Completed questionnaires were returned by 110 (74%) of these, and by 48 (80% of 60) of their practice nurses. Only 19 GPs ran a specific diabetic clinic, but nearly all (95%) wanted to improve the service they provided for diabetes care. In doing so, many wished for involvement of opticians, chiropodists, and dietitians, and all wished to involve the practice nurse. The need for involvement of hospital-based diabetes specialist nurses was perceived by only 37% GPs. More than two-thirds (69%) of practice nurses wanted more input into the care of diabetes. Both GPs and practice nurses felt that the role of the practice nurse should include screening for complications, although there was some disagreement about the extent of this involvement. GPs envisaged that patient education would be a major problem in establishing a diabetes service, but only 58% identified education as a task that could be accomplished by the practice nurse.

Attitude of Health Personnel↗
PubMed1990

The study of psychological factors in couples receiving artificial insemination by donor: a discussion of methodological difficulties.

Artificial insemination by donor (AID) may be the only means by which many infertile couples are able to have a child. However, the treatment is not invariably successful and it is postulated in the literature that psychological factors may be implicated when conception does not occur. Further investigation is required to establish the nature of any relationship between psychological stress and conception after AID but designing an adequate study is confounded by many methodological difficulties. These include issues relating to ethics, recruitment, measurement and logistics. In this paper, such aspects are examined and the importance of research in this field for nursing is highlighted.

Ethics, Medical↗
PubMed1988

Lip function and eating after a stroke: a nursing perspective.

The social and psychological effects of eating and drinking difficulties are often overlooked. The collection of food around the lips during meals is an example of a little discussed but embarrassing and unsightly problem commonly experienced after a stroke. In a group of 20 stroke patients, the incidence of this problem was significantly higher than that found in a group of medical patients of similar age and sex (P less than 0.001). It was a cause of some distress to patients. Analysis of the care given to this group of patients at mealtimes would suggest that there is scope for nurses to contribute more to the rehabilitation of patients' lip function after stroke. The efficacy of therapy has yet to be evaluated.

Adult↗
PubMed1988

Inter-rater reliability of the Rey figure copying test.

To determine the inter-rater reliability of scoring the Rey figure copying test, two raters independently scored copies of version B of the Rey figure completed by 17 non-brain damaged general medical patients and 23 stroke patients. There was very high agreement between the total scores for each patient (rs = 0.99, P less than 0.001) and there was agreement for all patients as to whether these scores were within the normal range. It is concluded that, though subjective, the standard system for scoring the Rey figure copying test can be reliable between raters.

Adult↗