Development and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke

Santos, Naiana Oliveira dos; Predebon, Mariane Lurdes; Bierhals, Carla Cristiane Becker Kottwitz; Day, Carolina Baltar; Machado, Diani de Oliveira; Paskulin, Lisiane Manganelli Girardi

doi:10.1590/0034-7167-2018-0894

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (Suppl 3) • 2020 • https://doi.org/10.1590/0034-7167-2018-0894 copy

Development and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke

Construcción y validación de un protocolo de asistencia de enfermería con intervenciones educativas para personas mayores de carrera después de un Accidente Cerebrovascular

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

development and validation the content of a nursing care protocol with educational interventions for family caregivers of elderly people after stroke.

Methods:

a methodological study conducted in three stages: (1) protocol development through literature review; (2) pretest with multidisciplinary team, analyzed with literature articulation; (3) protocol validation by the Delphi Technique.

Results:

the protocol was structured in the following areas: Disease Guidelines; Emotional Support; Using the Health Care Network; Diet; Airways; Medications; Hygiene; Skin Care; Disposal; Dressing/Undressing; Positioning and Transfer; Fall Prevention. In the pretest, eight experts assessed protocol clarity and content. In validation, there were two rounds by the Delphi Technique. The validated protocol consisted of 12 domains, containing 42 items and 240 care guidelines.

Conclusion:

the protocol qualifies the transition of care after hospital discharge assisting nurses in home care practice.

Descriptors:
Stroke; Aged; Caregivers; Validation Studies; Home Nursing

Protocol of Educational Interventions for Family Caregivers of Elderly People after Stroke
DOMAINS	ITEMS
1 Stroke Guidelines	1. General guidelines
2 Emotional Support	1. Caregiver support
	2. Emotional support to the caregiver and elderly
	3. Reduction of caregiver and elderly anxiety
3 Using the Health Care Network	1. Health network access
	2. Special medication
	3. Enteral diets or nutritional supplements
	4. Diaper
	5. Dressing material
4 Diet	1. Oral
	2. Enteral nutrition
	3. Nutrition gastrostomy/Jejunostomy
	4. Preparation of artisan diet
	5. Administration of artisanal and industrialized diet
	6. Diet preparation: utensil care
	7. Problems with probes in general (NET, GAS, JEJ)
5 Airways	1. Tracheostomy cleansing
	2. Tracheostomy aspiration
	3. Nasopharyngeal and oropharyngeal aspiration
	4. Nasopharyngeal aspiration
	5. Oropharyngeal aspiration
	6. Vacuum cleaner and vacuum cup cleaning
6 Medications	1. General medication guidelines
	2. Via probe: caution in medication administration
	3. Oral route: caution in medication administration
	4. Oral anticoagulant: caution in medication administration
	5. Subcutaneous - Insulin Care
7 Hygiene	1. Shower bath care
	2. Bed bath care
	3. Oral hygiene and mouth care
	4. Foot hygiene
8 Skin Care	1. Avoiding pressure ulcers
8 Skin Care	2. Diaper rash care
9 Disposals	1. Diaper change
	2. Toilet use
	3. Bladder probe
	4. Bladder cateter
	5. Colostomy/ileostomy bag
10 Dressing/Undressing	1. General guidelines
11 Positioning and Transfer	1. Positioning in bed for dependent elderly
11 Positioning and Transfer	2. Transfer
12 Fall Prevention	1. General guidelines

DOMAIN 6: MEDICATIONSITEM: GENERAL MEDICATION GUIDELINES
1. Separate medications into bags labeled with medication names and times of administration and do not unpack them in their original packaging to control their expiration date and to avoid mixing.
2. Do not use expired medications. Keep medicines in appropriate places away from heat and moisture. Those in need of refrigeration should be stored in the refrigerator (medicines should not be stored near the freezer and refrigerator door). E.g., insulin.
3. Dressing materials and medicines such as ointments, gauze, bandages, tape and saline should be stored in a box with a lid, separated from other medicines.
4. Misting materials should be stored in a plastic box with a lid and always dry.
5. Keep the latest prescription always close to where your medications are stored for easy reference. If in doubt about how to take your medication, ask for help from a family member/caregiver or health care team.
6. Do not modify your prescription by reducing or increasing medication doses, or stop taking a continuous medication yourself without the advice of a qualified professional.
7. Turn on the light whenever you are preparing or giving medication to avoid changes.
8. Tell the health care team if the elderly person often uses natural teas, herbal and homeopathic formulas. Plants can interfere with the action of some medicines by increasing or decreasing the desired effect (E.g., Ginseng, Ginkgo Biloba).
9. Always read the name of the medicine before giving it.
10. Do not use medicines on your own or as directed by others, as trying to help may worsen your health.
11. Use a guideline with the name and time of the medications to be administered. To help you remember your medication schedules, adjust your intake schedules with daily activities such as brushing your teeth, mealtimes, or bedtime.
12. If you experience any of these symptoms during treatment: nausea, vomiting, skin changes, changes in your bowel habits and poor appetite, be sure to inform your doctor.

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[1] Corresponding author: Naiana Oliveira dos Santos. E-mail: naiaoliveira07@gmail.com