Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.2
,
Jun
e
2
015
, pp
. 88
~93
I
S
SN
: 225
2-8
8
0
6
88
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Independency Models of
Nursing Self-Care f
o
r
Ischemic Stroke Patient
Fery Agusm
a
n
Me
ndr
ofa
1
, Ch
at
ari
n
a
U
.
Wah
y
u
n
i
3
, N
u
rsal
am
2
,
Ha
san Ma
chfo
ed
4
, Kuntor
o
3
, Hari
Basuki Notob
r
oto
3
,
Ra
c
h
ma
d
H
a
rgo
n
o
3
, B
agu
s
Wi
d
j
o
n
ark
o
5
1
Departm
e
nt
of
Nursing Scienc
e
s
, Kar
y
a
Husa
da
Institut
e
of
He
al
th Sci
e
nce
,
In
do
nesia
2
Department of
Nurs
ing Science, Airlangga
Univ
ersity
, Indonesia
3
Department of Public
Health
Scienc
e, Airlangg
a University
, Indo
nesia
4
Medicine Facu
lty
,
Airlangg
a U
n
iversity
, Indon
esia
5
Department of
Public Health
Scie
nce, Diponego
ro University
, In
donesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Feb 17, 2015
Rev
i
sed
Mar
c
h 20
,
20
15
Accepted Apr 26, 2015
S
t
roke injur
y
s
u
ch as
ph
ys
i
cal
a
nd ps
y
c
holo
g
i
cal disorders
was required
a
ssi
st
a
n
c
e
suc
h
a
s
t
h
e
c
o
mmuni
ty
,
nursi
ng profe
ssi
ona
l
a
nd fami
ly
.
Fa
mily
and s
o
cial f
acto
r
s
pla
y
an
im
portant rol
e
in ind
e
penden
ce s
t
rok
e
s
s
u
ch as
support family
members provid
e
encourag
ement for self care.The objectiv
e
of aim the stud
y
wasto assess indicator
of self
car
e and model f
a
mily
suppor
t
re
late
d se
lf ca
re.
A c
r
oss-se
c
tiona
l survey
re
se
arc
h
de
sign wa
s use
d
.
Da
ta
was collected with interviews by
home
visited method.
Data
were an
aly
zed
wi
t
h
c
onfi
r
ma
tory
a
n
a
l
y
s
i
s
for de
t
e
rmi
n
e
d
of va
l
i
d
i
t
y
and re
l
i
a
bi
lity
indicator, models analy
zed
b
y
SEM (
Structur
al Equation M
odel
).
Fa
mily
support such as
information
,
in
strumental, rew
a
rd and
emotio
n were v
a
lid
indicator for fam
i
l
y
support. Self car
e i
ndicato
rs such as eat, bath, t
itiv
ate,
dress, defecating
,
urination
and tr
ansfer
to buildin
g of self-care. In
dicators of
eat
ing, b
a
thing
,
t
itiva
t
e
,
dress,
de
feca
te
, urin
ation
,
and tr
ansfer
is a
n
indic
a
tor
for self
car
e. It
could be conclud
e
d th
at
ea
ting,
b
a
thing
,
orna
te
, d
r
ess, and
the
transfer
is valid and reliab
l
e. Mode
l s
howe
d
that
s
e
lf-c
are
needs
wer
e
improved of self
-carep
atients with through f
a
mily support.
Keyword:
Family Su
p
port
Mo
d
e
l S
e
lf
-
C
ar
e
Nu
rsin
g Ca
re
Stroke Disease
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Fery
A
g
usm
a
n M
e
n
d
r
o
fa
,
Depa
rt
m
e
nt
of Nu
rsi
n
g Sci
e
nc
es,
Karya Hu
sad
a
In
stitu
te o
f
Health
Scien
c
e,
Jl
. I
n
t
a
n R
a
y
a
No
1
Ke
d
u
n
g
m
undu,
Sem
a
rang
–
5
0
0
0
0
,
I
n
d
o
n
esi
a
.
Em
a
il: fery
m
e
n
d
ro
fa@stik
es.k
aryah
u
s
ad
a.ac.id
1.
INTRODUCTION
B
a
sed
on
t
h
e
WH
O
re
po
rt
t
h
at
i
n
I
n
do
nesi
a
est
i
m
a
t
e
d 1
2
3
.
68
4
pe
opl
e
di
e
d
ca
use
d
st
r
o
k
e
di
sease
f
o
r
2
003
, co
m
p
ar
ed
w
ith
o
t
h
e
r
co
un
tr
ies su
ch
as Malaysia es
ti
m
a
te o
n
l
y 1
0
.16
9
p
e
o
p
l
e an
d
Th
ailand
24
.810
people. Inci
de
nce
rate of disability
each da
y in Indonesia
esti
m
a
ted 8/1000
patients [1]. People
with suffere
d
a st
roke l
o
n
g
t
i
m
e
have di
st
urbe
d p
h
y
s
i
cal
, psy
c
h
o
l
o
gi
cal
,
soci
al
, and en
vi
r
onm
ent
a
l
funct
i
o
n
s
[2]
.
St
ro
ke
p
a
tien
t
s
h
a
v
e
d
i
fficu
lty co
mm
u
n
i
catin
g
(51
%
), co
gn
itiv
e
i
m
p
a
irm
e
n
t
(6
4%), lo
ss of
in
d
e
p
e
nd
en
ce
(86
%
),
fal
l
s
(8
7%
),
de
creased i
nde
pe
nde
nce i
n
be
d
(8
8%
), m
u
scl
e
di
so
rde
r
s
(8
6%
), em
ot
i
onal
i
m
bal
a
nce (83
%
), a
n
d
weakness
(92%)
[3
].
St
ro
ke i
n
ju
ry
suc
h
as phy
si
cal
and psy
c
h
o
l
o
gi
cal
disorders
was re
quired a
ssistance
such as the
com
m
uni
t
y
, nu
rsi
n
g
pr
ofe
ssi
o
n
al
an
d
fam
i
ly
. Fam
i
l
y
m
e
m
b
ers c
oul
d c
h
an
ges
gi
ve
ser
v
i
c
e n
u
rsi
n
g
h
o
m
e
care
wi
t
h
t
r
ai
ne
d
m
e
t
hod.
O
n
e
of
way
s
m
e
t
h
o
d
k
n
o
wl
e
d
ge t
r
a
n
sfe
rre
d
wi
t
h
T
r
ai
ni
n
g
o
f
t
r
ai
ner
(TO
T
)
.
Im
pl
em
ent
e
d
of r
o
l
e
s o
f
n
u
rsi
ng sy
st
em
i
s
supp
ort
i
n
g
educat
i
o
n. F
a
m
i
ly
m
o
t
i
v
at
ion
has i
m
provem
e
nt
e
m
o
tio
n
a
l an
d
p
s
ycho
log
i
cal to
ind
e
p
e
nd
en
cy activ
ity d
a
ily
at ho
m
e
[4
]. So
cial factors
p
l
ay an
im
p
o
r
tant ro
l
e
in
ind
e
p
e
nd
en
ce strok
e
s su
ch
as supp
ort fam
ily
m
e
m
b
ers provi
de e
n
courage
m
ent for self
care [5].
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
In
de
pen
d
e
n
cy
Mo
del
s
of
N
u
r
s
i
n
g
Sel
f
-
C
a
re
f
o
r Is
che
m
i
c
St
roke P
a
t
i
e
nt
(
F
ery Ag
us
m
a
n
M.)
89
Di
so
rde
r
s
of
p
h
y
s
i
cal
and
ps
y
c
hol
o
g
i
cal
d
u
r
i
n
g st
r
oke at
t
ached
, fam
i
l
y
sup
p
o
rt
hav
e
been m
a
i
n
foc
u
se
d fo
r su
st
ai
nabl
e n
u
rsi
ng care
post
d
i
scarge
r ho
spi
t
al
i
s
at
i
on. Nu
rs
i
ng ser
v
i
ce su
st
ai
nabl
e rel
a
t
e
d t
o
fam
i
l
y
suppo
rt
duri
n
g st
ro
ke
pat
i
e
nt
at
hom
e:
Fam
i
l
y
supp
ort
p
r
o
g
r
am
t
h
ro
u
gh e
ducat
i
o
n pr
o
g
ram
especi
al
y
for fam
ily an
d
co
mm
u
n
ity; fa
mil
y
su
pp
ort prog
ram
to
gu
ide th
e ti
m
i
n
g
of d
e
liv
eri
n
g
nu
rsin
g
serv
ice throug
h
education
and
support t
o
m
e
e
t
car
egi
v
ers
’
e
vol
ving needs [3].
M
odel
s
sel
f-ca
r
e ser
v
i
ces
fo
r
st
ro
ke
pat
i
e
nt
s wh
o
ha
ve rec
e
nt
l
y
foc
u
se
d
on
t
h
e m
e
di
cal
aspect
s a
n
d
atte
m
p
t reco
v
e
ry o
f
d
i
sab
ility co
nd
itio
ns. Self-care serv
ice b
a
sed
fo
r treat
men
t
to
i
m
p
r
ov
ing
ab
ility self care
of pat
i
e
nt
an
d fam
i
l
i
e
s didn
’t
foc
u
se
d.
The st
u
d
y
aim
s
t
o
det
e
rm
i
n
e co
m
pon
ent
s
bui
l
d
i
n
g
m
odel
s
i
nde
pen
d
e
n
cy
sel
f
care
of
st
ro
ke
pat
i
e
nt
s
and
det
e
rm
i
n
e t
h
e i
n
depe
n
d
e
nce m
odel
s
o
f
n
u
r
s
i
n
g sel
f
-
care i
n
st
ro
ke pat
i
e
nt
s.
2.
R
E
SEARC
H M
ETHOD
A c
r
os
s-sect
i
o
nal
s
u
r
v
ey
re
se
arch
desi
g
n
wa
s use
d
.
P
o
p
u
l
a
t
i
on
st
u
d
y
wa
s r
e
qui
red
st
r
oke
pat
i
e
nt
w
h
o
vi
si
t
e
d t
o
t
h
e
h
o
spi
t
a
l
o
n
cl
i
n
i
c
of
dr C
i
pt
oan
dge
ne
ral
ho
spi
t
al
regi
o
n
o
f
S
e
m
a
rang
.Sam
pl
e was req
u
i
r
e
d
wi
t
h
i
n
cl
usi
o
n a
nd
excl
usi
on c
r
i
t
e
ri
a. I
n
cl
usi
on
cri
t
e
ri
a as st
ro
ke pat
i
e
nt
s
wi
t
h
t
h
e
di
ag
nosi
s
of C
T
sca
n
s,
st
ro
k
e
pat
i
e
nt
s w
h
o had
pre
v
i
ousl
y
t
r
eatm
e
nt
i
n
hos
pi
t
a
l
st
udy
was co
n
duct
e
d, st
r
o
ke pat
i
e
nt
s cu
rre
nt
l
y
act
i
v
e
treat
m
e
n
t
. Ex
cl
u
s
ion
criteria as p
a
tien
t
s st
roke du
ring
t
h
e st
u
d
y
p
r
o
cessare no
t elig
ib
le research, Patien
t
s with
str
o
k
e
f
r
o
m
h
o
sp
ital car
e
r
e
f
e
r
r
a
l
f
r
o
m
an
o
t
her
h
o
s
p
ital study.
Sam
p
l
e
was ca
l
c
ul
at
ed
usi
n
g
fo
rm
ul
a [6]
:
Based
ona sam
p
le size calc
u
lation
with a
c
o
nfi
d
ence
l
e
vel
of
9
5
%,
sam
p
l
e
was
cal
cul
a
t
e
d
base
d
on
t
w
o st
rat
a
s h
o
s
pi
t
a
l
st
at
us:
g
ove
rm
ent
hos
p
i
t
a
l
t
y
pe and
no
n
g
ove
rm
ent
hos
pi
t
a
l
.
B
a
s
e
d
on
f
o
rm
ul
a was
req
u
i
r
e
d
o
f
6
5
sam
p
l
e
s. Sam
p
l
e
col
l
ect
ed wi
t
h
sy
st
em
ati
c
rand
om
sam
p
l
i
ng m
e
t
hod.
Da
t
a
was col
l
ect
ed wi
t
h
i
n
t
e
rvi
e
ws by
hom
e vi
si
t
e
d m
e
t
hod. T
h
e d
a
t
a
charact
eri
s
t
i
c
s such as age
,
sex, l
e
n
g
t
h
of
st
roke
, fre
q
u
e
n
cy
fal
l
s
co
llected
with
in
terv
iew b
y
st
ru
ct
u
r
ed
q
u
e
sti
o
nn
aire
gu
ide
d
and m
e
dical record
history.T
h
e re
searc
h
variable
data s
u
ch as
fa
mily support, s
e
lf-care
,
self-c
are a
g
ency
, nur
sing
car
e
an
d
self
car
e
was co
llected
b
y
in
t
e
rv
iew
with
p
a
tien
t
and
fam
i
lies. Self care
v
a
riab
le
m
easuri
n
g wi
t
h
bart
hel
i
n
dex
i
n
st
r
u
m
e
nt
.
Data were an
alyzed
with
co
nfirm
a
to
ry an
alysis
fo
r d
e
termin
ed
o
f
v
a
lidity an
d
reliab
ility
in
d
i
cator
suc
h
as
fam
i
ly support, self-c
are, sel
f-ca
r
ea
gency,
nursing care a
n
d self
care. M
o
d
e
ling in
teraction
v
a
riab
le
was analyzed
by SEM (
St
ruc
t
ural
Eq
u
a
t
i
o
n
Model
) to
d
e
t
e
rm
in
ate
th
e a
p
pro
p
riate
m
o
d
e
l related
to
self care
treat
m
e
n
t
o
f
strok
e
p
a
tien
t
s
with
a con
f
iden
ce in
terv
al
(
C
I) 95
%,
l
e
ve
l
of si
g
n
i
f
i
can
ce
val
u
e
o
f
p <0.
0
5
.
Descri
p
tiv
e statistics were
u
s
ed
to d
e
p
i
ct th
e
p
a
ttern
s (frequen
c
y,
p
e
rcen
t).
3.
RESULTS
A
N
D
DI
SC
US
S
I
ON
3.
1.
Results
The st
u
d
y
was
co
nd
uct
e
d
on
6
5
pat
i
e
nt
s
w
i
t
h
st
r
oke
w
h
o
pe
rf
orm
ho
spi
t
al
cl
i
n
i
cal
vi
si
t
e
d at
Pa
nt
i
W
ilasa dr
. Cipto
an
d g
e
n
e
r
a
l
g
o
v
e
r
n
m
e
n
t
hosp
ital of
Sem
a
r
a
ng
. D
e
scr
i
p
t
i
o
n ch
ar
acter
ist
i
c o
f
su
bj
ect sh
own
Tabl
e 1.
Tab
e
l
1
.
C
h
aracteristic su
bj
ect su
ch
as
sex, ed
u
cation
and
occu
p
a
tion
No
Subjec
t
characteristic
Frequen
c
y Percen
t
1
Sex
Male
Fe
m
a
le
43
22
66.
2
33.
8
2
Education
E
l
em
entar
y
school
Junior
high sch
ool
High school
Acade
m
ic
9
13
35
8
13.
8
20.
0
53.
8
12.
3
3
Occupation
Private e
m
ployees
E
n
tr
epr
e
neur
ship
M
e
r
c
hant
Far
m
e
r
16
13
28
8
24.
6
20.
0
43.
3
12.
3
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90
Tabl
e 1 co
ncl
ude
s t
h
at
st
rok
e
pat
i
e
nt
dom
inat
ed by
m
a
l
e
, hi
g
h
sch
ool
,
and m
e
rchant
occu
pat
i
o
n.
B
a
sed
on
st
r
o
k
e
cha
r
act
eri
s
t
i
c
suc
h
as
fal
l
s
i
n
week
, m
oon
or
pe
ri
o
d
of
st
r
oke
s
h
o
w
n
i
n
Tabl
e
2.
Tabel
2. C
h
ara
c
t
e
ri
st
i
c
of st
ro
ke s
u
c
h
as
fal
l
s
an
d st
r
o
ke
per
i
od
No
Stro
k
e
charact
eri
stic
Nu
m
b
er
Percen
t
1
Falls in Last W
e
e
k
s
Yes
No
17
48
26.
2
73.
8
2
Falls in Last Moon
Yes
No
28
37
43.
1
56.
9
3
Period of s
t
ro
k
e
1 years
2 years
3 years
4 years
5 years
42
9
7
5
2
64.
6
13.
8
10.
8
7.
7
3.
1
Tab
e
l
3
.
Valid
i
t
y an
d
reliab
ility in
d
i
cators
o
f
self-care n
e
ed
s v
a
riab
le in stro
k
e
p
a
tien
t
s
Self Care
N
eeds
Validity Reliability
Status
1-
δ
Phy
s
ical
0.
76
7.
27
0.
41
5.
65
Valid & r
e
liable
psy
c
hology
0.
98
10.
90
0.
04
5.
34
Valid & r
e
liable
Em
otion
1.
00
11.
30
0.
00
0.
65
Valid &Not r
e
liable
Spir
itual
1.
00
11.
22
0.
01
2.
89
Valid & r
e
liable
Fa
m
ily sup
p
ort
I
n
form
ation
0.
87
8.
63
0.
24
4.
12
Valid & r
e
liable
I
n
str
u
m
e
ntal
0.
86
8.
58
0.
25
4.
18
Valid & r
e
liable
Rewar
d
0.
86
8.
63
0.
24
4.
13
Valid & r
e
liable
Em
otion
0.
86
8.
45
0.
26
4.
28
Valid & r
e
liable
Self Care
Agency
Phy
s
ical
1.
00
11.
27
0.
00
1.
99
Valid & r
e
liable
psy
c
hology
0.
99
11.
11
0.
02
4.
73
Valid & r
e
liable
Em
otion
0.
97
10.
68
0.
06
5.
41
Valid & Not r
e
liable
Spir
itual
0.
99
11.
19
0.
01
3.
97
Valid & r
e
liable
Nursing Care
Self Efficacy
0.
98
10.
80
0.
05
5.
37
Valid & r
e
liable
Self Management
1.
00
11.
38
-
0
.
01
-
2
.
01
Valid & r
e
liable
Self R
e
gulation
0.
99
11.
10
0.
02
4.
33
Valid & r
e
liable
Tabl
e 2 sh
o
w
s
t
h
at
est
i
m
a
t
e
d 26% s
u
b
j
ect
was fal
l
s
i
n
w
eek an
d 4
3
% i
n
m
oon
. Lo
n
g
peri
o
d
of
strok
e
m
a
j
o
rity sub
j
ect
was at
tach
in
g
fo
r
on
e year. Ba
sed
on
co
m
p
on
en
ts was n
u
rsing
self-care bu
ilt
such
as
self-care
needs
,
nursing ca
re, self-ca
r
e a
g
e
n
cy, self-c
ar
e an
d f
a
m
ily su
pp
or
t as
show
n in
Tab
l
e
3
.
Tab
l
e 3
sh
ow
s th
at physical, p
s
ych
o
lo
g
i
cal, em
o
t
i
o
n
a
l and
sp
i
r
itu
al ar
e v
a
lid
f
o
r
self
car
e n
eeds in
d
i
cator
s, bu
t
em
ot
i
on n
o
t
rel
i
a
bl
e fo
r sel
f-care
needs
i
ndi
cat
ors
.
B
a
sed o
n
fa
m
i
ly
supp
ort
such as i
n
f
o
rm
at
i
on,
i
n
st
rum
e
nt
al
, r
e
war
d
a
nd em
ot
i
on
was
val
i
d
i
n
di
cat
or
f
o
r
fam
i
l
y
supp
or
t
.
Sel
f
care i
n
di
cat
ors
suc
h
as eat
,
bath, titivate, dress,
de
fecating,
urination a
n
d tra
n
sfer t
o
buildi
ng
of self-c
are shown Ta
ble 4.
Tab
l
e
4
.
Valid
i
t
y an
d
reliab
ility test o
f
self-care in p
a
tien
t
s with
strok
e
Self Care
Validity
Reliability
Status
1-
δ
E
a
t 0.
88
8.
89
0.
23
4.
81
Valid
&r
eliable
Bath 0.
85
8.
47
0.
27
4.
55
Valid
&r
eliable
Titivate
0.91
9.
40 0.17
4.48
Va
lid &reliable
Dr
ess
0.
84
8.
22
0.
30
5.
08
Valid
&r
eliable
Def
ecate
0.90
9.22
0.19
4.62 Valid
&reliable
Ur
ination 0.
83
8.
15
0.
31
5.
10
Valid
&r
eliable
T
r
ansfer 0.
88
8.
92
0.
22
4.
79
Valid
&r
eliable
Table 4
shows that
indicat
ors of
eatin
g, bathi
n
g,
titivate, dre
ss, defecate,
urination, a
n
d tra
n
sfe
r
is a
n
i
ndi
cat
o
r
f
o
r s
e
l
f
care. C
oncl
ude
d t
h
at
eat
i
n
g,
bat
h
i
n
g,
or
nate, d
r
ess, an
d th
e tr
an
sf
er is v
a
lid
and
reliab
l
e.
Analyzed for m
odeling
suc
h
as
self-car
e
,
fa
m
i
ly
supp
o
r
t
,
s
e
l
f-carea
ge
ncy
,
nursing care
,
andself-ca
r
ewa
s
aim
s
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I
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6
In
de
pen
d
e
n
cy
Mo
del
s
of
N
u
r
s
i
n
g
Sel
f
-
C
a
re
f
o
r Is
che
m
i
c
St
roke P
a
t
i
e
nt
(
F
ery Ag
us
m
a
n
M.)
91
to
d
e
term
in
eth
e
m
o
d
e
l was effectiv
ely fo
r treat
m
e
n
t
stro
k
e
d
i
sease. Th
e resu
lts o
f
th
e an
alysis o
f
th
e
m
o
d
e
l is
sho
w
n i
n
Fi
gu
r
e
1.
Note:
KebSC =
Self Care
nee
d
SCA =
S
elf Care
Age
n
cy
SC =
Self care
Aske
p
=
Nu
rsi
n
g ca
re
Dkel
=
F
am
i
l
y
Supp
o
r
t
Fi
gu
re 1.
I
nde
p
e
nde
ncy
of
n
u
r
s
i
n
g
sel
f-ca
r
e M
odel
s
f
o
r St
r
oke
Pat
i
e
nt
s
Figure 1 s
h
own that that self care ne
e
d
s was
im
pacted on s
e
lf-care a
g
enc
y
λ
=0.95, self-care
λ
=0.71,
fam
i
ly su
p
ported
λ
=
1
.
0
1
.
Nursing
carei
s
no
t sign
ifican
tly i
m
p
act o
n
fam
ily su
p
port
λ
=-
0.
08
,
sel
f
-
careage
n
cy
λ
=-
0.
01a
n
d
sel
f
-ca
r
e
λ
=-0.02. Self-care age
n
cy is not si
gni
ficant
l
y im
pac
t
on thes elf-ca
r
e
λ
=-
0.16
and
fam
i
l
y
suppo
rt
si
g
n
i
f
i
cant
l
y
affect
sel
f-c
are
λ
=0.5. Resu
lts o
f
A
n
alyzed
show
ed t
h
at self-care
needs were
im
pro
v
ed
o
f
s
e
l
f-care
pat
i
e
n
t
s wi
t
h
t
h
r
o
ug
h
fam
i
l
y
sup
p
o
rt
.
It
i
s
seen
fr
om
t
h
e pat
h
of
sel
f
ca
re
nee
d
s
si
gni
fi
ca
nt
l
y
i
m
prove
d sel
f
-c
are t
h
ro
u
g
h
fa
m
i
ly
sup
p
o
rt
λ
= 1.01, i
f
c
o
mpare
d
directly
affect self-ca
r
e
λ
=0.71.
3.
2.
Discussion
C
o
m
p
rehen
s
i
v
el
y
t
r
eatm
e
nt
was effect
i
v
el
y
i
nvol
ved r
o
l
e
s
of pat
i
e
nt
, fa
m
i
ly
,
m
e
di
cal
pers
o
nnel
a
n
d
m
e
di
cal
. Fam
i
ly
m
e
m
b
ers can r
o
l
e
pl
ay
suc
h
as i
n
f
o
rm
at
ional
s
u
p
p
o
rt
, i
n
st
r
u
m
e
nt
al
, awar
ds, a
nd em
ot
i
onal
sup
p
o
rt
. S
u
pp
ort
i
n
fo
rm
ati
on suc
h
as i
n
fo
rm
ati
on ab
out
ho
w t
o
car
e d
u
ri
ng at
h
o
m
e
. Sup
p
o
rt
i
n
st
r
u
m
e
nt
al
suc
h
as provi
dingequipm
en
t. Support an
award suc
h
as
praise
for the
success of activities under
taken.
Support em
otion s
u
ch as rei
n
forcem
en
t and encouragem
ent to encounter a
tt
ack of st
ro
ke
pat
i
e
nt
s. Fam
i
ly
and
soci
al
fact
o
r
s
pl
ay
an i
m
port
a
nt
r
o
l
e
i
n
t
h
e
m
a
i
n
t
e
nance
of i
nde
pe
nde
n
c
y
[5]
.
C
r
oni
c
di
seases
pat
i
e
n
t
post
d
i
scarg
e
ho
sp
italisatio
n
n
eed for ho
listic serv
ices thu
s
an
serv
ices was co
labo
ration to
o
t
h
e
r tem
s
lik
es
nu
rsi
n
g,
fi
si
ot
e
r
ap
hi
s, o
ccu
pat
i
on t
h
e
r
api
s
t
a
nd m
e
di
cal
. C
r
oni
c
di
sease p
a
t
i
e
nt
post
di
s
carge
ho
spi
t
a
l
i
s
at
i
on
effectiv
e fo
r tea
m
s’ serv
ices an
d th
e team
was
im
p
r
o
v
e
d
q
u
ality o
f
life an
d satisfactio
n [7].
Post
stroke discarge
r needs sust
ain
a
b
l
e nur
sing
ser
v
ices du
r
i
ng
at
home. Nursing s
e
rvices
wa
s
su
stain
a
b
l
e throug
h
m
u
lti-discip
lin
es services su
ch
asnu
rses, p
h
y
si
o
t
h
e
rap
y
, p
s
ycho
log
y
, o
ccup
a
tio
n
a
l.
Pr
ev
iou
s
study sh
ow
th
at su
stain
a
b
l
e
n
u
r
s
ing
serv
ice is i
m
p
o
r
tance cau
sed
p
o
st d
i
sch
a
rg
er str
o
k
e
hos
pi
t
a
l
i
s
at
i
on
di
ffi
c
u
l
t
fo
r ge
t
nursi
ng se
rvi
ce at
hom
e. It
’s con
d
i
t
i
on ca
use
d
di
st
ri
b
u
t
i
on
of
nu
rsi
n
g
bet
w
e
n
r
u
r
a
l and ur
b
a
n in
b
a
lan
c
ed
.
Nu
r
s
i
n
g in ur
b
a
n 24
.6
% and
r
u
ral o
n
l
y
19
.2
%
w
a
s
ho
m
e
car
e serv
ice
p
r
actice [8
].
Nu
rsi
n
g
di
st
ri
but
i
o
n
one
of
fact
or
s cause
d
nu
rsi
n
g h
o
m
e
sy
st
em
di
ffi
cul
t
e
d f
o
r i
m
pl
em
ent
e
d speci
al
y
for
st
ro
ke po
st
di
s
carge
r ho
spi
t
a
l
ser
v
i
ce.
Evaluation Warning : The document was created with Spire.PDF for Python.
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06
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PH
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o
. 2
,
Jun
e
201
5
:
8
8
–
93
92
Main problem
for stroke
patient at
hom
e is daily activities
because Mu
scl
e
disorde
r
. Falls are one
of
th
e
m
o
st co
mm
o
n
u
n
e
xp
ect
ed
exp
e
rien
ced
b
y
su
rv
ivors o
f
strok
e
and
m
a
y
b
e
relate
d
to
co
gn
itiv
e an
d
or
m
o
t
o
r defi
ci
t
s
.
Ap
pr
o
x
i
m
at
ely
10%
of s
u
r
v
i
v
o
r
s
of st
r
o
kee
xpe
ri
ence
d at
l
east
one
fal
l
aft
e
r t
h
ei
r st
r
oke
t
h
at
was seriou
s eno
ugh
to
requ
ire treat
m
e
n
t
in
h
o
s
p
ital [9
]. Ph
ysical activ
ity is fo
cu
sed
for stro
k
e
m
o
b
ilizatio
n
ext
r
em
i
t
i
e
s. Muscl
e
di
so
r
d
er
cause
d p
h
y
s
i
cal
depen
d
e
n
ce f
o
r
pat
i
e
nt
s wi
t
h
st
ro
ke. P
h
y
s
i
cal
and psy
c
ho
l
ogi
cal
disorde
r
s
nee
d
ed assista
n
ce
from
vari
ous
parties suc
h
as
th
e co
mm
u
n
i
t
y
, th
e
nu
r
s
i
n
g pr
of
ession
, a
f
a
m
i
ly
m
e
m
b
er o
r
a c
o
m
b
i
n
at
i
on
of
t
h
e n
u
r
si
n
g
pr
o
f
essi
o
n
a
n
d
fa
m
i
ly
. In
de
pen
d
e
ncy
o
f
st
ro
ke
pat
i
e
nt
t
o
nee
d
s m
u
l
t
i
aspect
suc
h
as
soci
al
su
pp
ort
,
copi
ngm
echani
s
m
s
, co
m
m
unicat
i
on,
phy
si
ca
l
funct
i
o
n.
H
o
l
i
s
t
i
c
pro
b
l
e
m
sol
v
e
d
in
d
e
p
e
nd
en
cei
n
carrying
ou
t
d
aily activ
ities
[2
].
Ind
e
p
e
n
d
en
ce
o
f
st
rok
e
p
a
tien
t
s is fu
l
f
ill
m
e
n
t
d
a
ily
liv
in
g
su
ch
as eating
,
b
a
th
ing
,
titiv
ate, d
r
ess,
d
e
fecate, u
r
i
n
atio
n, an
d
t
h
e tran
sfer. In
terv
en
tion
fo
r
strok
e
patien
t
su
ch
as eatin
g
,
bowel eli
m
in
atio
n
,
m
o
b
ilizatio
n
,
sk
i
n
care, d
a
ily liv
in
g
activ
ity is
m
a
in
req
u
i
remen
t
.
M
obi
l
i
zat
i
on f
o
r st
ro
ke pat
i
e
nt
s
i
s
very
i
m
po
rt
ant
.
Im
m
o
b
ilizatio
n
cau
s
ed
sk
in
tissu
e
d
eath
.
Patien
t
s with
co
nd
itio
ns
was tissu
e
d
eath
exp
e
rien
ced b
y
st
rok
e
p
a
tien
t
s
req
u
i
re sk
in
care [1
0
]
.
Post
-st
r
o
k
e pa
t
i
e
nt
s sho
w
ed
dem
o
t
i
onal
and
beha
vi
o
r
al
pro
b
l
e
m
s
whi
c
h di
ffe
re
nce
s
bef
o
re t
h
e
stroke state. Som
e
of the circum
stances such as
em
otions labile, decrease tolera
nce, and fam
i
ly not
u
n
d
e
rstand
the p
a
tien
t
's cond
itio
n
[1
1
]
.
Po
sitiv
e em
o
tio
n
a
l su
ppo
rt
for
p
a
tien
t
stro
ke is v
e
ry im
p
o
r
tan
t
,
p
o
s
itiv
e im
p
act o
n
stren
g
t
h
e
nin
g
m
o
to
r and
co
gn
itiv
e fun
c
tio
n
s
. Mo
tor fun
c
tio
n
i
s essen
t
ial fo
r fu
lfilled d
a
ily
liv
in
g
and
some research
su
gg
ests th
at in
d
e
p
e
n
d
e
n
ce
w
ith
reg
a
rd
to in
creased
q
u
ality
o
f
life of strok
e
p
a
tien
t
s. Su
ppo
rt po
sitiv
e em
o
t
io
n
s
can
red
u
ce t
h
e risk
of on
set d
i
sab
i
l
ity an
d
i
m
p
r
ove
m
o
to
r fu
nctio
n
and
co
gn
itiv
e stat
us [1
2
]
. Th
is sug
g
e
sts th
at surv
ivo
r
s who
are b
e
i
n
g d
i
sch
a
rg
ed
ho
m
e
with
these im
p
a
irmen
t
s
will n
eed
closer sup
e
rv
ision an
d
t
h
eir famil
y
careg
iv
ers. Nu
rses m
u
st id
en
tify th
e
p
o
t
en
tial
m
ed
icatio
n
s
,
ex
trin
sic and
en
v
i
ron
m
en
tal
factors th
at
can
co
n
t
ri
b
u
t
e to
falls, and in
itiatein
terd
iscip
lin
ary
d
i
sch
a
rg
e
education to a
d
dress these
fa
ctors.
Nursing
services
was d
e
l
i
v
ered
onl
y
nu
rsi
n
g se
rvic
es caused
reliance on
n
u
rses
fo
r add
r
essin
g
nu
rsing
serv
ice
d
a
ily activ
ities o
f
strok
e
p
a
tien
t
. Th
e ro
le
o
f
serv
ice p
r
ov
id
ers (nu
r
ses)
n
o
t
on
ly as serv
ice pro
v
i
d
e
rs b
u
t
tran
sfer
o
f
k
nowle
dg
e. Activ
ities tran
sfer of
kno
wl
ed
g
e
with
supp
ortiv
e
educat
i
v
e n
u
rs
i
ng t
h
ro
u
gh t
r
ai
ni
ng
of t
r
ai
ner f
o
r pat
i
e
n
t
or fam
i
ly
.
Nu
rsi
n
g p
r
ofe
ssi
on
pl
ay
s a rol
e
i
n
com
m
uni
cat
i
on a
n
d
co
o
r
di
n
a
t
i
on
bet
w
ee
n
pr
o
v
i
d
er
s
of
n
u
rsi
n
g
care
t
eam
and pat
i
e
nt
,
fam
i
ly
and
so
ci
et
y
.
Comm
unicatin
g a
n
d coordi
na
ting
very im
portant in the e
f
fo
rt t
o
s
u
ccess
f
ul treatm
e
nt
of stroke
patients
.
Post
st
ro
ke
ho
spi
t
a
l
di
scar
ge
r
nee
d
f
o
r e
ducat
i
o
n f
o
r s
u
r
v
i
v
o
r
s
of
st
r
o
k
e
a
n
d
t
h
ei
r ca
regi
ve
rs
pri
o
r t
o
di
sc
har
g
e.
Ed
ucat
i
on
wa
s foc
u
se
d f
o
r l
i
f
est
y
l
e
, n
u
rsi
ng
ser
v
i
ces st
rat
e
gi
c a
nd
refe
rral
s
t
h
r
o
ug
h
out
i
n
pat
i
e
nt
reh
a
b
ilitatio
n
[9
].
Req
u
i
red
of nursing
serv
ices is d
ecreased
ab
i
lity
se
lf care to
m
a
in
tain
th
e q
u
a
n
tity an
d
q
u
ality
o
f
th
e
th
erap
eu
tic sel
f-care su
stai
n
a
b
ility in
d
a
ily l
i
v
i
n
g
.Sel
f-care n
eed
s
of th
e
hu
m
a
n
regu
lato
ry fu
n
c
ti
o
n
b
a
sed
on
an
in
d
i
v
i
du
al's ab
ility
to
p
e
rfo
r
m
m
a
in
ten
a
nce th
em
se
lv
es [13
]
. Treatm
e
n
t
o
f
strok
e
p
a
ti
en
ts in
vo
lv
es m
u
l
ti-
di
sci
p
l
i
n
es
su
ch as
n
u
r
s
es,
p
h
y
s
i
o
t
h
e
r
ap
y
,
psy
c
hol
ogy
, occ
u
pat
i
o
nal
an
d s
p
i
r
i
t
u
al
[
14]
.
Occ
u
p
a
t
i
ona
l
interve
n
tion for
perform
fi
ne m
o
tor m
ovem
e
nts t
hus increase
d
da
ily act
iv
ities.Speech t
h
era
p
y
helps
comm
unication
role. Nursing se
rvice
focused t
o
e
n
cour
a
g
ethe
ability to self-eff
icacy, self-m
anagement a
n
d
self-re
gulation
[15]. T
h
e em
phasized the i
n
depende
n
ce
of s
e
lf-efficacy in
physical e
x
erci
se [16].
Post
st
r
oke
di
s
carge
r was e
f
f
ect
i
v
e to
f
a
m
i
l
y
su
pp
or
t serv
i
ces in
or
d
e
r
with
Tr
an
sf
er
of k
now
ledg
e
educat
i
o
n m
e
tho
d
. P
r
e
v
i
o
us
st
udy
co
n
duct
e
d i
n
C
a
na
da
w
a
s concl
ude
d t
h
at
ed
ucat
i
on
f
o
r st
r
o
ke fam
i
ly
was
im
pro
v
i
n
g t
h
ei
r pe
rcept
i
o
n
of
bei
n
g su
p
p
o
r
t
e
d an
d em
ot
i
onal
wel
l
-
bei
n
g.
Educat
i
on
gui
del
i
n
e f
o
r
fam
i
l
y
i
s
efectiv
e
for tran
sitio
n
s
ho
spitalisat
io
n
d
i
sch
a
rg
er [17
]
. Tran
sition
s
for
serv
ice
with fa
m
i
l
y
su
ppo
rt
m
o
re
efectiv
e
b
y
eco
n
o
m
ic asp
ect. Reh
a
b
ilitatio
n
n
u
rses are
cru
c
ial to
p
r
eparing
su
rv
ivors of st
rok
e
and
their
fam
i
l
y
m
e
m
b
ersf
or
dem
a
ndi
ng a
nd c
h
al
l
e
ngi
ng
post
-
di
s
c
har
g
e care at
hom
e. Fam
ily
was sup
p
o
r
t
i
ng a
n
provide s
o
m
e
evide
n
ce
for t
h
e
need
fo
r
tho
r
ou
gh
risk
assessm
en
ts,
earlyi
m
p
l
e
m
en
tati
o
n
of risk
redu
ctio
n
strateg
i
es an
d lifestyle ed
u
cati
o
n, an
d co
mmu
n
ity
referralsth
r
ou
gho
u
t
i
n
p
a
tien
t
reh
a
b
ilitatio
n
[1
7
]
.
In
co
mm
u
n
ity
strok
e
in
terv
entio
n
was fo
cused
fo
r
falls in
o
r
d
e
r st
rok
e
daily activ
it
y. Falls stro
k
e
freq
u
e
n
tly was serio
u
s
ly in
juries, th
u
s
in
terv
en
tion
wa
s f
o
cu
sed f
o
r fa
m
i
ly
or com
m
uni
t
y
cl
osed p
a
t
i
e
n
t
st
ro
ke. Pr
eve
n
t
i
ng fal
l
s
i
n
pe
opl
e af
fect
ed b
y
st
roke i
s
an i
m
port
a
nt
nu
rsi
ng ca
re g
o
al
. I
n
or
de
r n
u
rsi
n
g care
serv
ice effective in
vo
lv
ed
family su
p
p
o
r
t. Tran
sfer of
k
n
o
w
l
edge i
n
t
e
rve
n
t
i
on sc
hed
u
l
e
t
o
fam
i
l
y
one of
sol
v
e
pr
o
b
l
e
m
wi
t
h
di
scha
rge
.
N
u
r
s
i
ng t
r
a
n
sfe
rre
d k
n
o
w
l
e
d
g
e i
s
im
port
a
nce t
o
u
nde
rst
a
n
d
i
n
g fam
i
ly
when
fal
l
s
fol
l
o
wi
n
g
di
sc
har
g
e
h
o
spi
t
a
l
.
Treat
m
e
nt
of
st
ro
ke
pat
i
e
nt
s
at
h
o
m
e
can b
e
d
one
by
a fa
m
i
ly
m
e
m
b
er so t
h
a
t
the inde
pende
n
ce of the
treat
ment can
b
e
carried ou
t
b
y
famil
y
m
e
m
b
ers. Falls in
co
mmu
n
ity-d
welling strok
e
su
rv
ivors
are
a
freq
u
e
n
t
o
ccurren
ce fo
l
l
o
w
ing
o
n
p
a
tien
t
reh
a
b
ilitatio
n
.
In
terv
en
tio
n
was
effectiv
ely
pre
v
e
n
ted falls
am
ong pe
ople
affected
by strokes [18]. The pr
ovision of
nursing care s
u
pport for fam
ilies to
take care
of el
derly relatives
would appea
r
t
o
be esse
n
tial for an effective
nursing a
n
d s
o
cial care system
[8].
Lo
w fam
i
l
y
supp
o
r
t
caus
e
d
st
ro
ke
pat
i
e
nt
s
d
e
pen
d
e
n
cy
o
f
self-care
in
order d
a
ily
activ
iti
es.
Sup
p
o
r
t
p
o
s
itiv
e em
o
t
i
o
n
s
im
p
acted
o
n
th
e stren
g
t
h
e
n
i
n
g
o
f
t
h
e
m
o
to
r and
cogn
itiv
e fun
c
tion. Self-care effo
rt si
n
pri
n
ci
pl
es p
r
es
sure a
n
i
n
di
vi
dual
m
i
cro l
e
vel
and m
acro l
e
vel
such as
fam
i
l
y
, co
m
m
uni
t
y
an
d soci
al
[1]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
In
de
pen
d
e
n
cy
Mo
del
s
of
N
u
r
s
i
n
g
Sel
f
-
C
a
re
f
o
r Is
che
m
i
c
St
roke P
a
t
i
e
nt
(
F
ery Ag
us
m
a
n
M.)
93
Ind
e
p
e
nd
en
cy for ind
i
v
i
du
al
lev
e
l p
r
essure
ab
ility to
fu
lfilled
d
a
ily n
e
eds. Self-relian
c
e o
n
fam
i
l
y
as
p
ects
in
clu
d
e
ind
e
p
e
n
d
e
n
ce i
n
p
r
o
v
id
in
g care and
su
ppo
rt t
o
p
a
tien
t
s in
cl
u
d
e
d
fin
a
n
c
ial fu
lfillmen
t, in
d
e
p
e
nd
en
ce
on the s
o
cial aspects include
d
inde
pe
nde
nc
e in form
i
ng the group receive
d stroke patients. Self care
needs
effectiv
ely i
m
p
r
ov
e th
e ab
ility o
f
p
a
tien
t
s in
self-care thro
ug
h
fam
ily
su
ppo
rt. Su
ppo
rt famil
i
es p
r
ov
id
e
m
o
ra
l
sup
p
o
rt
a
n
d
fa
m
i
ly
can re
pl
a
ce r
o
l
e
o
f
nu
rs
es i
n
i
nde
pe
nd
ency
ser
v
i
ces
o
f
st
r
o
ke
pat
i
e
nt
s.
4.
CO
NCL
USI
O
N
Factors
ass
o
ci
ated
with the
i
nde
pe
nde
nce
s
e
lf-care
of
t
h
e
stroke
patient
suc
h
as
self-ca
r
e, s
e
lf-ca
r
e
agency
,
n
u
r
si
n
g
ca
re a
n
d
fam
i
l
y
sup
p
o
r
t
.
M
odel
i
nde
pe
nd
e
n
ce
of
st
r
oke
p
a
t
i
e
nt
s i
s
effe
c
t
i
v
el
y
an i
m
provi
ng
sel
f-care
pat
i
e
nt
wi
t
h
st
r
oke
t
h
r
o
u
g
h
fam
i
l
y
su
pp
o
r
t
.
Ap
pr
op
ri
at
e t
r
eat
m
e
nt
sel
f
-care
f
o
r
st
ro
ke
pat
i
e
nt
s by
i
m
proving the
ability of fam
i
l
i
es and
patients throug
h self-efficacy,
sel
f
-managem
ent and self-re
gulati
o
n.
ACKNOWLE
DGE
M
ENTS
The a
u
t
h
or
s
w
oul
d l
i
k
e t
o
t
h
a
n
k
al
l
pa
rt
i
c
i
p
ant
s
f
o
r t
h
ei
r
wi
l
l
i
ngness
t
o
sh
are t
h
ei
r
e
xpe
ri
ences.
COMPETING INTE
REST
S
The a
u
thors
de
clare that they
have
n
o
c
o
m
p
et
i
ng i
n
t
e
rest
s.
REFERE
NC
ES
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WHO,
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e in the Contex
t of Pr
imary
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rt
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y
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n
c
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how
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o
s
m
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r
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l
ar J
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a
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a
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e
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e
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Ew
a B., J
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anna
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a
s
z
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“
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om
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n
al
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is
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pect
ed dem
a
nds
for nurs
i
ng care s
e
rvices
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