Moving from a hospital to home is a huge transition for anyone who has survived a stroke. It is a time when patients and their families often feel overwhelmed by the demands of daily life. New data suggests that when nurses lead the transition care, it can make a real difference in how patients manage their day-to-day activities.
The review looked at programs where nurses took the lead during the move home. These programs showed that patients were better at performing daily tasks at one and three months after leaving the hospital. These improvements in daily life were linked to higher patient satisfaction and fewer hospital readmissions during the first three months.
While the results are promising, the evidence is not yet certain. Some improvements in mental health and physical limitations were only seen in certain timeframes. Because the overall certainty of the evidence is low to very low, these findings are a starting point for improving how we support stroke survivors and their caregivers.
Common questions
How does nurse-led care help stroke survivors?
Nurse-led transitional care can help older stroke survivors perform activities of daily living better at one and three months after leaving the hospital. It also helps increase patient satisfaction and can reduce the number of times a patient is readmitted to the hospital within the first three months.
Can this type of care help with mental health or physical limits?
The data suggests that mental component scores may improve at one month, and roles limited by physical problems or general health may improve at six months. However, because the certainty of this evidence is low to very low, these specific improvements are not yet fully confirmed.
Is this care safe for older patients?
The study did not report any specific adverse events or safety concerns regarding nurse-initiated transitional care. Because the evidence certainty is low to very low, you should talk to a healthcare provider to discuss the best care plan for a specific patient.
