Observing the process of care: a stroke unit, elderly care unit and general medical ward compared

Background and purpose: patients on stroke units have better outcomes but it is not known why. We investigated the process of care on a stroke unit, an elderly care unit and a general medical ward. Methods: comparison of the three settings was by non-participant observation of 12 patients in each. Data were analysed using multi-level modelling methods. Results: stroke unit patients spent more time out of bed and out of their bay or room, and had more opportunities for independence than patients on the medical ward. There were more observed attempts on the stroke unit than on the general medical ward to interact with drowsy, cognitively- or speech-impaired patients. Stroke unit patients spent more time with visitors. Most of these aspects of care were also found on the elderly care unit, where patients also spent less time asleep or 'disengaged', more time interacting with nurses, and were given appropriate help more often than those elsewhere. Stroke unit patients received less eye contact, were ignored and treated in a dehumanizing way more frequently and had more negative interactions or activities than those elsewhere. Conclusions: we have identified some aspects of the process of care which may help explain the improved outcomes on stroke units. These aspects were also observed in the elderly care unit.