To prevent post-stroke complications, the function of the liaison nurse can help reduce their problems. Stroke patients and their family face many problems after discharge, do not have normal life and are dependent on others. Nurses are in an ideal position to help in these situations, because they are constantly in clinical practice and are a mediator between the patient, family, and health care team (22).The aims of liaison nursing are to improve the communications between hospital and home care and continuity and consequently improve the quality of care (12).
In this study, the effect of the liaison nurse performance on the prevention of the occurrence of infections stroke complications including pneumonia and UTI, was investigated.
Infections complications, most often pneumonia, contribute to increased mortality from stroke, prolong hospitalization, difficulties in care, reduce functional performance improvement and increased the cost of treatment (23(.
The results of this study showed that the rate of pneumonia in liaison nurse group in two months was 11.6% less than in control group (19.2%). The incidence of complications from stroke is different in studies. It seems that the length of follow-up periods is effective in these differences. In a six-year period study of in-hospital stroke complications, reported the incidence of pneumonia to be 9% (8). A multicentre study confirmed that at seven days after the acute stroke onset pneumonia occurred in 7.4% patients while during the first three months occurred in 13.6% of patients (24). Other studies presented a range of incidence for pneumonia regardless to follow up period: 10–20% (25), 1–33% (23), and 7–22% (26).
To prevent of aspiration pneumonia, the liaison nurse with practical education on how to feed the patient with a gastric tube, usually on the last day of hospitalization and during discharge, sought to increase the awareness of the family care givers. Care givers must be assessed for their capacity to provide the needed care and their readiness to assume the care giving role at home (2). We found that Involving the caregiver from the first day of admission prevent confusion and can provide better living conditions for the patient and his/her family. The results of this study showed that the presence of the liaison nurse in the patient’s bedside, education of the correct way and engaging the patient's caregiver for suction, oral hygiene, mouthwash and tooth brushing that usually less considered after discharge, can reduce the incidence of pneumonia.
UTI, another commonly reported complication after stroke, has been shown to be associated with a poor outcome and mortality in the patient with stroke (27).
The results of this study showed that liaison nursing care resulted in a significant difference in the incidence of UTI between the groups.
The majority of UTIs in acute stroke are associated with the use of indwelling catheters; therefore prolonged ones should be avoided. The risk of UTI is 3–10% per day of catheterization, approaching 100% after 30 days. Urinary incontinence and retention are common after stroke (29–58%), and limited mobility increases the likelihood of being catheterized (7). The use of a Foley catheter for more than 48 hours after stroke increases the risk of urinary tract infection (20).
Despite the efforts of the liaison nurse for preventing our patients from having a permanent urinary catheter with a low level of consciousness, obtaining the consent of the physician for inserting a temporary catheter, and teaching how to insert it to the patient's family, a limited number of family caregivers were willing to do the procedure. Although programs are designed to train family members in caring skills, they often lack the preparation and support to take on a caring role (2).
In this study, we obtained the better results in relation to the performance of liaison nurse in prevention of UTI. Although most patients had a permanent catheter, the incidence of UTI is 0% over the entire two month follow up period in the intervention group. In other studies, the incidence of UTI was reported to be 11% (27), 2–27% (23), 16–27% (7), and 7–28% (26), or even up to 43%.
Most studies have reported incidence of post-stroke complications, and few interventions have been conducted to prevent these complications. Some studies also examine the impact of community-based nursing interventions on other aspects of stroke patients' lives. A randomized controlled trial of a nurse-led community-based self management program for improving recovery among community-residing stroke survivors reported that 4 weeks program including home visit and follow-up phone calls improving self-efficacy, outcome expectation, and performance of stroke self-management behaviors (29). In another study, tested phone-based intervention under nurse guidance after stroke is effective in improving blood pressure control and medication adherence among Ghanaian stroke patients within 1 month of symptom onset compared with standard of care (30).
In our study, once again, shown involving the family in the care of stroke patients has good results. Recommend that the family/caregiver of the stroke patient, as essential members of the rehabilitation team, should be informed and involved in decision making and treatment planning as early as possible, and throughout the duration of the rehabilitation process (20).
To the best of the authors’ knowledge, this is the first randomized controlled trial which examines the liaison nurse performance among Iranian community-residing stroke survivors.
Since this project was a student thesis, we were faced with a time and budget limit. It seems that in order to determine the effect of interface liaison nurse performance in stroke patients, designing and conducting long-term and large-scale studies may produce different results and more persuasive evidence. The other limitations of this study were convenience sampling and also because of the nature of the study, it was not possible for patients to be blinded to being in the intervention or control group.
Education and most importantly, not leaving the patient alone after the discharge, continuing care and monitoring of the patient at home are interventions by the liaison nurse.