title: Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team.
abstract: OBJECTIVE
  To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team.
  
  
  BACKGROUND
  Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care.
  
  
  METHODS
  This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis.
  
  
  METHODS
  Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team.
  
  
  RESULTS
  One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care.
  
  
  CONCLUSIONS
  Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge.
authors.affiliation: School of Nursing & Midwifery, University of Sheffield, Sheffield, UK.
authors.forename: Tony
authors.identifier: http://orcid.org/0000-0002-8549-3101
authors.initials: T
authors.lastname: Ryan
authors.affiliation: School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Harrison
authors.affiliation: School of Nursing & Midwifery, University of Sheffield, Sheffield, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Gardiner
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D020521:Stroke / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D017741:Survivors / Q000523:psychology*
keywords: family caregivers; hospital care; interpersonal care; nursing; qualitative research; stroke