The organisational context of nursing care in stroke units: A case study approach

Burton, Christopher R., Fisher, Andrea, & Green, Theresa L. (2009) The organisational context of nursing care in stroke units: A case study approach. International Journal of Nursing Studies, 46(1), pp. 86-95.

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Internationally the stroke unit is recognised as the evidence-based model for patient management, although clarity about the effective components of stroke units is lacking. Whilst skilled nursing care has been proposed as one component, the theoretical and empirical basis for stroke nursing is limited. We attempted to explore the organisational context of stroke unit nursing, to determine those features that staff perceived to be important in facilitating high quality care.


A case study approach was used, that included interviews with nurses and members of the multidisciplinary teams in two Canadian acute stroke units. A total of 20 interviews were completed, transcribed and analysed thematically using the Framework Approach. Trustworthiness was established through the review of themes and their interpretation by members of the stroke units.


Nine themes that comprised an organisational context that supported the delivery of high quality nursing care in acute stroke units were identified, and provide a framework for organisational development. The study highlighted the importance of an overarching service model to guide the organisation of care and the development of specialist and advanced nursing roles. Whilst multidisciplinary working appears to be a key component of stroke unit nursing, various organisational challenges to its successful implementation were highlighted. In particular the consequence of differences in the therapeutic approach of nurses and therapy staff needs to be explored in greater depth. Successful teamwork appears to depend on opportunities for the development of relationships between team members as much as the use of formal communication systems and structures. A co-ordinated approach to education and training, clinical leadership, a commitment to research, and opportunities for role and practice development also appear to be key organisational features of stroke unit nursing. Recommendations for the development of stroke nursing leadership and future research into teamwork in stroke settings are made.

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12 citations in Scopus
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6 citations in Web of Science®

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ID Code: 85066
Item Type: Journal Article
Refereed: Yes
Keywords: article; Canada; clinical competence; cooperation; education; evidence based nursing; health care quality; health personnel attitude; health services research; hospital subdivisions and components; human; model; nonbiological model; nurse attitude;, nursing; nursing evaluation research; nursing methodology research; nursing staff; organization and management; patient care; psychological aspect; public relations; qualitative research; questionnaire; stroke
DOI: 10.1016/j.ijnurstu.2008.08.001
ISSN: 0020-7489
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Deposited On: 30 Jun 2015 23:36
Last Modified: 03 Jul 2015 04:53

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