AU-QAD-DC-FRM-002
2017/03/01-02 : ر ق م و ت ا ر ي خ ا ل ص د ا ر
Family and Community Health
Nursing
Incidence of Complications Following
Acute Stroke Among Adult Patients
Proposal for Community Health Nursing
Supervisors
Staff of Community Health Nursing Department
Faculty of Nursing- Assiut University
2025-2026
Prepared By:
أ ح م د خ ي ر ى م ح م د ا ل س ي د ا ح م د ا ب و ا ل ن و ر1/
ا ح م د س م ي ر ح س ي ن ع ب د ا ل ر ا ض ي 2/
م د ع ب د ا ل ر ح م ن ا ل م ر س ى م ح م د س ع د ي ه 3/ ا ح
ا ح م د ع ب د ا م ص ط ف ى ا ح م د م ص ط ف ى 4/
ا ح م د ع ب د ا م ن ص و ر ع ث م ا ن 5/
ا ح م د ع ز ا ب و خ ط و ه ح س ن 6/
ا ح م د ع ز ت ع ب د ا ل ب ا ر ي ع ل ى 7/
ا ح م د ع ل ى ع ب د ا ل ح م ي د م ح م د ش ح ا ت ه 8/
ا ح م د ف ر ح ا ن ع ل ى ح س ن 9/
ا ح م د م ح م د ر ج ب م ص ط ف ى 10/
ا ح م د م ح م د ع ل ى س ا ل م 11/
ا ح م د م ح م د م ح م د ص د ي ق12/
ا ح م د م ح م و د ا ن و ر م ح م و د 13/
ا س ا م ه م ح م د ا ل ب ه ى ع ب د ا ل ع ظ ي م 14 /
ا س ر ا ء ا ب و ا ل ن و ر ا ح م د ا ب ر ا ه ي م 15 /
ا س ر ا ء ا ح م د م ج ل ى ع ب د ا ل ل ه 16/
ا س ر ا ء ع ب د ا ل ر ا ز ق ع ب د ه ب خ ي ت 17/
س ر ا ء ع ب د ا ل ه ا د ى ا د و ل ف ع ب د ا ل ح م ي د 18/ ا
ا س ر ا ء ع ل ى م ح م و د م ح م د 19/
ا س ر ا ء و ا ئ ل ب د ر ى ع م ر 20/
ا س م ا ء ح س ا ن ي ن ع ب د ا ل ج ل ي ل م ح م د 21/
ا س م ا ء ح ش م ت ع ب د ا ل م ا م م ح م د 22/
س م ا ء س ا م ح ع ب د ا ل ع ا ط ى ع ب د ا ل ر ح ي م 23/ ا
ا س م ا ء ص ل ح ع ب ا س م ح م و د 24/
ا ش ر ق ت س ل م ه س ي د ا ب و ا ل س ع و د 25/
ا ل س ي د ج م ا ل م ح م د ح س ا ن 26/
ا ل ش ي م ا ء ع ا د ل م ح م د س ي د 27/
ا م ا ن ى ع ا ط ف ر ش ي د د ر و ي ش 28/
م ن ي ه م ح م د ع ل ى ع ب د ا ل ع ا ط ى ا ل ص و ه 29/ ا
أ م ي ر ة ع ل ء ا ح م د ف ؤ ا د 30/
أ م ي ر ة م ل ك م خ ت ا ر ش ا ك ر 31/
ا ن د ر ا و س ح ش م ت ش و ق ى ش ك ر ا 32/
ا ن ط و ن ي و س ه ا ن ى م ن ي ر ا س ح ا ق 33/
Introduction :
Stroke is a sudden neurological deficit caused by an
interruption of blood supply to the brain, leading to
death of brain cells and loss of function. It is considered
one of the leading causes of morbidity, mortality, and
long-term disability worldwide. Stroke is generally
classified into two main types: ischemic stroke, which
results from occlusion of a cerebral artery, and
hemorrhagic stroke, which results from rupture of a
blood vessel and bleeding into the brain tissues.
Globally, stroke affects approximately 15 million people
annually, with 5 million deaths and 5 million survivors
suffering permanent disability. The incidence increases
significantly with age and is more common among
individuals with hypertension, diabetes mellitus, atrial
fibrillation, smoking, and hyperlipidemia. According to
recent statistics, stroke is the second leading cause of
death in middle- and low-income countries.
Stroke often leads to several complications such as
motor and sensory deficits, dysphagia, impaired
mobility, speech difficulties, cognitive impairment, and
secondary complications like aspiration pneumonia,
pressure ulcers, urinary tract infections, and deep vein
thrombosis. Early detection, prompt management, and
effective rehabilitation programs are essential to reduce
disability and improve functional outcomes.
Nurses play a major role in stroke care through
continuous assessment, early detection of
complications, patient education, and implementation
of rehabilitation protocols to enhance recovery and
improve the quality of life of stroke patients.
Significance of the Study:
Stroke is a major health problem that significantly
affects patients, families, and the healthcare system.
Many stroke survivors experience persistent functional
limitations that interfere with daily activities, leading to
increased dependence, long hospital stays, and high
healthcare costs. Complications such as aspiration
pneumonia, contractures, infections, and
thromboembolic events are common during
hospitalization and the early recovery period.
Early nursing intervention and rehabilitation protocols
have been shown to reduce the incidence of
complications and improve functional independence.
Assessing the needs of stroke patients and
implementing appropriate nursing care can enhance
recovery, reduce mortality, and increase patient
satisfaction with the care provided.
Therefore, studying the incidence of complications
following acute stroke and evaluating the effect of a
nursing rehabilitation protocol is essential for improving
patient outcomes and enhancing the quality of nursing
care.
Aims of the Study:
This study aims to:
Evaluate the effect of implementing a nursing
rehabilitation protocol on the incidence of
complications following acute stroke.
Assess the level of patient satisfaction with the quality
of nursing care provided.
Research Hypothesis:
To fulfill the aim of the study, the following research
hypotheses were formulated:
1. The incidence of post-stroke complications after
implementation of the rehabilitation protocol in the
study group will be lower than that in the control group.
2. Patients in the study group will be more satisfied with
the quality of nursing care provided than those in the
control group.
Subjects and Methods:
Research Design
A descriptive research design will be utilized in this
study to assess the incidence of complications following
acute stroke and to evaluate the effect of implementing
a nursing rehabilitation protocol.
Setting
The study will be conducted in the Neurology Unit and
the Stroke Care Unit at (University Hospital in Asyut ).
These units provide acute stroke management and
follow-up care for hospitalized patients.
Subjects
The study will include a convenience sample of 60 adult
patients (male and female) diagnosed with acute stroke
and admitted to the neurology or stroke unit. Their ages
will range from 18 to 70 years.
The sample will be divided into two equal groups:
Study group (30 patients): will receive the nursing
rehabilitation protocol designed by the researcher.
Control group (30 patients): will receive the routine
hospital care only.
Inclusion Criteria
Adult patients aged 18–70 years.
Diagnosed with acute ischemic or hemorrhagic
stroke.
Conscious and able to communicate verbally or
nonverbally.
Medically stable to participate in rehabilitation.
Exclusion Criteria
Recurrent stroke.
Severe cognitive impairment or coma.
Patients with terminal illnesses.
Patients with pre-stroke severe disability (mRS ≥ 4).
Tools:
Tool I: Patient's Health Needs Assessment Sheet
This tool consists of three parts and will be used four
times (on admission, two weeks, one month, and three
months post-stroke).
Part 1: Sociodemographic characteristics
Includes patient name, age, gender, marital status,
education, occupation, residence, medical history,
lifestyle habits… etc.
Part 2: Stroke Severity Assessment – NIH Stroke Scale
(NIHSS)
Used to measure stroke severity. It includes assessment
of:
Level of consciousness
Visual fields
Facial palsy
Motor arm
Motor leg
Sensory function
Limb ataxia
Language
Dysarthria
Extinction and inattention
Part 3: Functional Independence – Barthel Index
Used to assess:
Feeding
Bathing
Grooming
Dressing
Bowel and bladder control
Toilet use
Transfers
Mobility
Stairs
Higher scores indicate better functional status.
Tool II: Patient Satisfaction with Nursing Care
Quality Questionnaire
This questionnaire includes 22 items based on a 5-point
Likert scale (poor → excellent). It assesses:
Response and communication
Respect and privacy
Professional competence
Information provided by nurses
Overall satisfaction with nursing care during
hospitalization
Methods:
The study tools and nursing rehabilitation protocol will be
developed by the researcher after thorough review of
literature.
Content validity will be reviewed by a panel of medical–
surgical nursing and neurology experts.
An official permission will be obtained from the hospital
administration to conduct the study.
Patients’ voluntary participation will be obtained, and the
purpose of the study will be explained clearly.
Data will be ensured confidentiality and anonymity.
A pilot study will be conducted on 10% of the sample to
test feasibility and clarity.
The nursing rehabilitation protocol will include:
Positioning and turning
Passive and active range-of-motion exercises
Swallowing exercises
Chest physiotherapy
Mobility training
Prevention of pressure ulcers
Education on lifestyle, follow-up, and medication
Patients will be followed up at:
Two weeks – One month – Three months post-stroke
to evaluate the incidence of complications and functional
improvement.
Ethical Considerations:
Approval will be obtained from the Ethical
Committee of the Faculty of Nursing.
Participation is voluntary without any risk to the
patients.
Patients have the right to withdraw at any time
without giving reasons.
Privacy, confidentiality, and anonymity will be
maintained at all times.
Data will be used only for the purpose of the
research.
Statistical Design:
Data will be analyzed using appropriate
statistical methods including frequency,
percentage, mean, standard deviation, chi-
square test, and t-test.
Results will be presented in tables and figures
where appropriate.
Discussion:
Discussion of results will be performed in
relation to current literature and previous
research. The findings will be interpreted
according to the research hypotheses and the
observed statistical outcomes.
Conclusion:
Appropriate conclusions will be written based
on the results of the study, focusing on the
effect of the nursing rehabilitation protocol on
reducing stroke complications and improving
patient satisfaction.
Recommendations:
Based on the results of the study, the following
recommendations will be suggested:
Implementing structured nursing rehabilitation
protocols for all stroke patients.
Continuous training programs for nurses in
stroke care.
Early functional assessment using standardized
tools.
Providing patient and family education
regarding stroke prevention and rehabilitation.
Summary:
A brief summary of the entire research
process, findings, and recommendations
will be presented
References
American Stroke Association (2022). Stroke Statistics
Update.
Adams HP, del Zoppo G, et al. (2018). Guidelines for
the Management of Acute Stroke.
Johnston SC, et al. (2020). Global burden of stroke.
Neurology Journal.
Quinn TJ, Langhorne P. (2019). Barthel Index
Assessment in Stroke.
Brott T, et al. (1989). NIH Stroke Scale Reliability Study.