Vis enkel innførsel

dc.contributor.authorMathisen, Torgeir Solberg
dc.date.accessioned2022-05-25T11:52:46Z
dc.date.available2022-05-25T11:52:46Z
dc.date.issued2022
dc.identifier.issn2535-5252
dc.identifier.urihttps://hdl.handle.net/11250/2996240
dc.description.abstractBackground Stroke is a leading cause of death and disability in Norway and internationally. Many functions can be affected by stroke and vision is one of them. Visual impairments (VIs) affect 60% of all stroke survivors, and includes reduced visual acuity, eye movement disorders, visual field defects and perceptual deficits. Post-stroke VIs can lead to a number of negative consequences. It reduces the effect of general rehabilitation, cause immobilisation and reduced participation in activities, and reduced quality of life. Vision rehabilitation and individually adapted information for the stroke survivor and their caregivers can reduce the negative effects of post-stroke VIs. Post-stroke VIs are often overlooked by the stroke survivors and healthcare professionals. To identify post-stroke VIs, the visual function needs to be assessed. Even so, visual assessment is not an integral part stroke care. This represents a gap between knowledge about post-stroke Vis and the current practise in Norway. Aim The main aim of this project was to improve stroke care by implementing structured vision assessment in Kongsberg municipality using an adapted version of the KROSS (a Norwegian acronym standing for Competence and Rehabilitation of Sight after Stroke) vision assessment tool. Another aim was to increase the competence and awareness post-stroke VIs among health care personnel. The aims of the three sub-studies are based on different parts of the implementation process. Sub-study 1 explores stroke survivors’ experiences of vision care in within stroke health services. The second study assess barriers and facilitators to the implementation of a structured vision assessment in the municipal health care service. In the third study, the implementation outcomes are evaluated. Methods We used the Knowledge To Action (KTA) model to plan and organise the implementation project. The KTA model describe the different components in the implementationprocess, and consists of a ‘Knowledge Creation’ part and an ‘Action Cycle’ part. We applied a collaborative approach to the implementation and the three sub-studies and included relevant stakeholders in all parts of the implementation. All three sub-studies are qualitative studies. Sub-study 1 is a qualitative interview study with in-depth interviews of 10 stroke survivors with post-stroke VIs. Study 1 and 2 were analysed using inductive content analysis. Sub-study 2 include individual interviews with 11 health professionals and managers. In addition, we included data from two workshop discussions with a total of 26 participants. The results from sub-study 1 and 2 were used in planning and organising the implementation. Sub-study 3 consisted of four focus group interviews. The study had a deductive-inductive approach, and we used a framework for implementation outcomes. Results ‘Invisible’ vision problems – was the main theme in sub-study 1. The theme represents how the participants experienced post-stroke VIs as an unknown and difficult symptom of stroke. The participants experienced a lack of attention to, and follow-up of their VIs in the health services. VIs was highlighted as a main hinder returning to living the life they had before the stroke. In sub-study 2, individual and contextual barriers and facilitators were identified. The individual barriers were related to the participants' experiences of having low competence of visual function and assessment. They considered themselves as generalists, not stroke experts. Some participants were reluctant due to previous experiences with unsuccessful implementation projects. Individual facilitators were the belief that including vision assessment would improve their services for stroke survivors. If the tool was perceived as useful and evidence based, it would be easier to implement. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties related to include the vision tool in the medical records were other contextual barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. In sub-study 3, the participants expressed that the structured visual assessment with the KROSS tool was acceptable in their clinical practice. They were motivated to use the new routine because they acknowledged that the visual function influenced other functions, such as mobility and activities of daily living. Most of the participants reported having adopted KROSS, except for the home care service which experienced that they saw few stroke survivors in their service. They all reported increased attention and awareness to post-stroke VIs. The KROSS assessment was considered to be most appropriate in the rehabilitation services where they already perform many function assessments. Although vision assessment was new to all participants, they felt they became more confident in performing the assessment when they used the tool frequently. The good user manual and supervision in their own practice, they experienced the vision assessment as feasible. That the vision assessment was included in the existing routines and systems was important to promote a sustainable implementation. Conclusion This knowledge translation project and the three sub-studies have generated new and important insight about the implementation of structured vision assessment after stroke. The three studies provided insight to the gap between knowledge and action from the perspectives of the stroke survivors, but also from the health care personnel who described that they lacked knowledge and skills about visual function and assessment. Stroke survivors from several organizations participated throughout the project and contributed with their experiences and acted as demo patients in the workshops. This was emphasized by the health care personnel as especially motivating. We developed many different strategies to implement the KROSS tool, especially important was the workshops to promote knowledge and skills in assessing vision. In addition arrangements made to supervise the participants practising the KROSS tool were also valuable. The KROSS tool has been adopted in the rehabilitation unit and home rehabilitation in Kongsberg municipality, a stroke unit and the rehabilitation hospital. Using the KTA model to plan and complete the implementation was important for the outcome of the project, because it provided an overview of important elements of the implementation process. The collaborative approach was important for involving and create enthusiasm from health care managers and practitioners in the implementation, promoting a sustainable routine for vision assessment in the municipalityen_US
dc.language.isoengen_US
dc.publisherUniversity of South-Eastern Norwayen_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/4.0/deed.en
dc.subjectstrokeen_US
dc.subjectvision impairmentsen_US
dc.subjectrehabilitationen_US
dc.subjectimplementationen_US
dc.subjectknowledge translationen_US
dc.subjectknowledge to actionen_US
dc.subjectqualitative researchen_US
dc.titleImplementing structured vision assessment in stroke care services: The KROSS knowledge translation projecten_US
dc.typeDoctoral thesisen_US
dc.description.versionpublishedVersionen_US
dc.rights.holder© The Author, except otherwise stateden_US
dc.subject.nsiVDP::Medisinske Fag: 700::Helsefag: 800::Andre helsefag: 829en_US


Tilhørende fil(er)

Thumbnail

Denne innførselen finnes i følgende samling(er)

Vis enkel innførsel

http://creativecommons.org/licenses/by-nc-sa/4.0/deed.en
Med mindre annet er angitt, så er denne innførselen lisensiert som http://creativecommons.org/licenses/by-nc-sa/4.0/deed.en