title: Unpacking the 'black box' of a nurse-led stroke support service.
abstract: OBJECTIVE
  To describe in detail the nature of the specialist nurse interventions; to increase understanding of the principal problems facing stroke patients and their care-givers in the first year following stroke and to demonstrate how these problems may change over time; and to investigate the value of qualitative research methodologies within the context of a randomized trial.
  
  
  METHODS
  Specialist nurses providing support in the year following stroke were asked to maintain comprehensive written records of their involvement with all patients and care-givers participating in a randomized controlled trial. Qualitative methods were used to examine the problems faced by stroke patients and their care-givers, and the actions taken by nurses in response.
  
  
  RESULTS
  Specialist nurses commenced 120 records. As 19 patients died or left the area during the year-long interventions, we obtained 101 complete records. The problems encountered by stroke patients and their care-givers were numerous, diverse, complex and changed over time. Initially, practical difficulties were noted; over time, these were accompanied by growing numbers of psychological needs. The nurses responded by providing information, advice, support and monitoring using a flexible, individualized approach. The nurses also collaborated or liaised with 17 other professional groups and provided direct support to care-givers.
  
  
  CONCLUSIONS
  The need for many stroke patients and their care-givers to be professionally supported during the stages of stroke adjustment, for at least the first year and probably beyond, was emphasized by this study.
authors.affiliation: Nuffield Institute for Health, University of Leeds, UK.
authors.forename: G
authors.initials: G
authors.lastname: Dowswell
authors.forename: J
authors.initials: J
authors.lastname: Lawler
authors.forename: J
authors.initials: J
authors.lastname: Young
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009737:Nursing Records; D020521:Stroke / Q000451:nursing*; D013997:Time Factors