Nursing theories in the care of stroke patients: a scoping review

to map and synthesize nursing theories and conceptual frameworks that have been applied in the practice of nursing care for stroke patients in hospital settings.

Methods:

a scoping review was conducted in October 2022 using the MEDLINE (accessed via PubMed), CINAHL, Scielo, and Web of Science databases, following The Joanna Briggs Institute guidelines.

Results:

nine studies incorporated six nursing theories and three conceptual frameworks, which were employed to enhance stroke patient care. The objective of these theories and conceptual frameworks was to facilitate the identification of the patient’s psychobiological, psychosocial, and psychospiritual needs, elucidate the nurse’s role and expand their perspective on rehabilitation, and acknowledge the survivor’s process of transition.

Final Considerations:

this mapping exercise identified major nursing theories, middle-range theories, and conceptual frameworks applied to the care of stroke patients.

Descriptors:
Nursing Theory; Stroke; Nursing Care; Nursing; Review

Characterization of included studies
ID Code	Country / Year	Title	Study Type / LE	Objective	Context
S1(¹⁶16 Ribeiro AA, Silva ALNV, Ferreira AM, Rodrigues JSM. Cuidado de enfermagem sistematizado ao portador de acidente vascular encefálico de acordo com a teoria das necessidades humanas básicas. Enferm Brasil [Internet]. 2011 [cited 2022 Nov 18];10(5):302-8. https://doi.org/10.33233/eb.v10i5.3878 https://doi.org/10.33233/eb.v10i5.3878... )	Brazil 2011	Systematized nursing care for individuals with stroke according to the theory of basic human needs	Qualitative study Level 6	Presenting the operationalization of Nursing Care Systematization (NCS) for a patient with stroke	Intensive Care Unit
S2(¹⁷17 Li N, Wang J, Zheng M, Ge Q. Application value of rehabilitation nursing in patients with stroke based on the theory of interactive standard: a randomized controlled study. Evid Based Complement Alternat Med. 2021;2021:9452765. https://doi.org/10.1155/2021/9452765 https://doi.org/10.1155/2021/9452765... )	China 2021	Application Value of Rehabilitation Nursing in Patients with Stroke Based on the Theory of Interactive Standard: A Randomized Controlled Study.	Non-randomized clinical trial Level 3	Exploring the value of applying rehabilitation nursing based on the theory of interactive patterns in patients with stroke	Hospital unit for stroke recovery
S3(¹⁸18 Kitson AL, Muntlin Athlin A. Development and preliminary testing of a framework to evaluate patients' experiences of the fundamentals of care: a secondary analysis of three stroke survivor narratives. Nurs Res Pract. 2013;2013:572437. https://doi.org/10.1155/2013/572437 https://doi.org/10.1155/2013/572437... )	Australia 2013	Development and preliminary testing of a framework to evaluate patients’ experiences of the fundamentals of care: a secondary analysis of three stroke survivor narratives	Qualitative study Level 6	Develop and test a framework that describes the interrelation of three key dimensions (physical, psychosocial, and relational) in the provision of care to patients.	Intensive care
S4(¹⁹19 Si Y, Yuan H, Ji P, Chen X. The combinative effects of orem self-care theory and PDCA nursing on cognitive function, neurological function and daily living ability in acute stroke. Am J Transl Res [Internet]. 2021 [cited 2022 Nov 20];13(9):10493-500. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507085/ https://www.ncbi.nlm.nih.gov/pmc/article... )	China 2021	The combinative effects of Orem self-care theory and PDCA nursing on cognitive function, neurological function and daily living ability in acute stroke	Non-randomized clinical trial Level 3	Explore the combined effects of Orem’s Self-Care Theory and PDCA nursing on cognitive function, neurological function, and daily living ability in patients.	Hospital unit
S5(²⁰20 Costa CPV, Luz MHBA, Bezerra AKF, Rocha SS. Aplicação da teoria de enfermagem de Callista Roy ao paciente com acidente vascular cerebral. Rev Enferm UFPE. 2016;10(Supl. 1):352-60. https://doi.org/10.5205/reuol.7901-80479-1-SP.1001sup201622 https://doi.org/10.5205/reuol.7901-80479... )	Brazil 2016	Application of Callista Roy’s nursing theory to patients with stroke	Descriptive study Level 6	Report the experience of applying the nursing process implemented in light of Callista Roy’s Theory to a patient affected by stroke.	Emergency unit
S6(²¹21 Kirkevold M. The role of nursing in the rehabilitation of stroke survivors: an extended theoretical account. ANS Adv Nurs Sci. 2010;33(1):27-40. https://doi.org/10.1097/ANS.0b013e3181cd837f https://doi.org/10.1097/ANS.0b013e3181cd... )	Norway 2010	The Role of Nursing in the Rehabilitation of Stroke Survivors An Extended Theoretical Account	Ethnographic study Level 6	Propose a revised and expanded theoretical account of the nursing role in stroke rehabilitation.	Specialized Stroke Unit
S7(²²22 Brauer DJ, Schmidt BJ, Pearson V. A framework for care during the stroke experience. Rehabil Nurs. 2001;26(3):88-93. https://doi.org/10.1002/j.2048-7940.2001.tb02211.x https://doi.org/10.1002/j.2048-7940.2001... )	United States 2001	A Framework for Care During the Stroke Experience	Literature review Level 7	Guide the selection and design of nursing activities that will facilitate the health of individuals with stroke and their families.	Hospital Unit
S8(²³23 Faria ACA, Martins MMFPS, Schoeller SD Matos LO. Care path of person with stroke: from onset to rehabilitation. Rev Bras Enferm. 2017;70(3):495-503. https://doi.org/10.1590/0034-7167-2016-0579 https://doi.org/10.1590/0034-7167-2016-0... )	Brazil 2017	Care pathway for individuals with stroke: from onset to rehabilitation	Qualitative study Level 6	Describe the trajectory followed by individuals with Stroke and identify the significant findings along this pathway.	Specialized Stroke Care Unit
S9(²⁴24 Vieira LA. Diretrizes de enfermagem para alta hospitalar de pacientes acometidos por acidente vascular encefálico fundamentadas em Wanda Horta[Dissertação]. Fortaleza. Universidade Estadual do Ceará; 2017.)	Brazil 2017	Nursing guidelines for hospital discharge of patients with stroke based on Wanda Horta	Descriptive study Level 6	Develop nursing guidelines for the hospital discharge of patients affected by Stroke based on basic human needs.	Specialized Stroke Care Unit

Description of nursing theories
ID Code	*Title/Theory Type^ * According to scope; ID - Identification; S - Study.**	How the theory was used	Main applied concepts	Outcome and applicability for nursing care to the patient with stroke
S1	Human Basic Needs Theory (HBNT)/ Middle-range theory	Used the theory to underpin the Nursing Care Systematization (NCS)	Patient needs; environment; nursing	Identification of psychobiological, psychosocial, and psycho-spiritual needs and planning appropriate interventions.
S2	Interactive Systems Theory/ Grand theory	The nursing team received training based on the theory for the implementation of interactive nursing rehabilitation care	Patient’s personal, interpersonal, and social systems; Nursing process	atients who received interactive nursing care achieved better neurological function and improved quality of life; Provides nurses with a clear understanding of recovery goals.
S3	Conceptual framework/Not applicable	The framework allowed for the identification of factors that could explain the care experiences of stroke survivors, including acute hospital care	Fundamentals of care; Physical, psychosocial, and relational dimensions	Useful as a predictive framework to indicate when care will not be integrated or person-centered Demonstrates the interaction of physical, psychosocial, and relational experiences for care to be positively experienced.
S4	Theory of self-care/ Grand theory	It underpinned the implementation of the PDCA (Plan-Do-Check-Act) strategy to enhance care for patients with acute stroke.	Self-care; Patient; Care deficit	It can actively improve patients’ cognitive function, neurological status, and daily living capacity. Empowerment of self-care; Assists the nursing team in formulating and implementing plans to enhance the care process.
S5	Roy’s Adaptation Model/ Grand theory	The theory was used to support the application of the nursing process.	Nursing diagnosis; Goal setting; Intervention; Evaluation.	It contributes to effective nursing care for patients affected by stroke and emphasizes the importance of stimuli that trigger responses requiring patient adaptation.
S6	Conceptual framework/ Not applicable	The framework allowed for the identification of the nursing role in stroke rehabilitation based on a review of recent research on stroke.	Fundamentals of nursing care for patients in stroke rehabilitation.	It elucidates the nurse’s role in stroke rehabilitation and expands the focus of nursing care for patients with stroke to include the acute and early rehabilitation phase.
S7	Conceptual framework/ Not applicable	The framework allowed for the identification and organization of nursing care in the context of stroke.	Fundamentals of nursing care.	It is useful for increasing nurses’ knowledge about the stroke experience and helping them recognize and articulate their roles in the care of individuals with stroke.
S8	Theory of Transitions by Meleis/ Mid-Range	The theory was used to deepen the understanding of the patient’s transition after stroke.	Nature of the transition; Conditions of the transition; Patterns of response to the transition.	Recognition of the stroke transition process and the necessary care; integration of the patient with the hospital environment and routine.
S9	Theory of Basic Human Needs/ Mid-Range	The theory was used to develop nursing guidelines for hospital discharge.	Patient needs; Environment; Nursing	Identifies the psychobiological, psychosocial, and psycho-spiritual demands during hospitalization that have an impact on home care.

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[1] Corresponding author: Josefa Nayara de Lima, E-mail: josefa.lima@urca.br