Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.6 No.2. April 2023. Page.130-136 130 The Importance of Discharge Planning in Stroke Patients: Literature Review Anie Tri Indiartinie1*, Eppy Setiyowati2, Yurike Septianingrum3, Abdul Muhith4, Ima Nadatien5, Umdatus Soleha6, Rusdianingseh7 1 Student Master of Applied Nursing at Nahdlatul Ulama University, Surabaya, Indonesia 2,3,4,5,6,7 Department of Nursing and Midwifery, Nahdlatul Ulama University, Surabaya, Indonesia *Corresponding author: indiartinie@gmail.com ABSTRACT Background: Stroke causes neurologic disturbances that can cause changes in quality of life. Quality of life is mental, physical, social health and regardless of disease. In order to achieve a good quality of life, there must be a role for health workers. Discharge planning in stroke patients is preparing patients for treatment in healing and improving the health status of stroke patients. Purpose: The purpose of the literature review is to find out the importance of discharge planning in stroke patients. Methods: The research stage is to make a selection by paying attention to the year of publication and with full text. Furthermore, articles and journals that are considered less relevant are excluded. Literature was obtained from 10 articles relevant to Google Scholar, Indonesia One Search, DOAJ, and Garuda with the keywords Discharge planning, Quality of life and Stroke. Results: After reviewing the selected articles, it was found that discharge planning has a good impact on increasing family readiness in caring for patients, as well as improving the quality of life of stroke patients, namely being able to increase rehabilitation activities, prevent disease complications and adherence to taking medication and routine control. Conclusions: Improving the quality of life of stroke patients, which can improve rehabilitation activities, prevent disease complications and comply with taking medication and routine control. Keywords: discharge planning, patient, stroke Received February 10, 2023; Revised March 12, 2023; Accepted April 3, 2023 DOI: https://doi.org/10.30994/jnp.v6i2.301 The Journal of Nursing Practice, its website, and the articles published there in are licensed under a Creative Commons Attribution-Non Commercial- ShareAlike 4.0 International License. https://thejnp.org/ mailto:indiartinie@gmail.com https://doi.org/10.30994/jnp.v6i2.368 Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.6 No.2. April 2023. Page.130-136 131 BACKGROUND Stroke is a permanent neurological disorder due to disruption of blood circulation to the brain, which occurs for about 24 hours or more. This clinical syndrome occurs suddenly and is progressive, causing acute brain damage with clinical signs that occur in a focal or global manner. Stroke is a loss of brain function caused by the cessation of blood supply to the brain. Stroke can cause neurologic disturbances that depend on the location of the lesion (clogged blood vessel), the size of the area of inadequate perfusion and the amount of collateral blood flow (secondary or accessory) (Carod-Artal & Egido, 2010). Stroke is ranked 2nd in the world as a non-communicable disease that causes death after heart disease. Every year more than 2 million people experience a stroke and an increase of 6.7% annually. Based on WHO (Word Health Organization) data, stroke is the 5th cause of death in America, reaching 129 thousand people per year. Stroke patients in the United States aged between 55-64 years as much as 11% have silent cerebral infarction, the prevalence increases to 40% at the age of 80 years and 43% at the age of 85 years (Mahyuvi & Nursalam, 2020). The prevalence of stroke in Indonesia has increased from 7% in the 2018 Riskesdas to 10.9% in 2020. The prevalence of stroke in East Java Province is ranked 3rd in Indonesia, reaching 302,987 sufferers (Mahyuvi & Nursalam, 2020). Quality of life is a person's assessment of his life. Research results (Abdullah, 2017)said that there is a significant relationship between functional status and quality of life in the acute phase after stroke, patients with poor functional status tend to have a poor quality of life. Individual quality of life is influenced by several factors, namely physiological factors, symptom status, functional status, general health perceptions, individual characteristics and environmental characteristics. Clinical manifestations of stroke include motor loss, loss of communication, reception disturbances, namely the inability to interpret sensations, impaired cognitive function and psychological effects where patients show symptoms of limited attention, difficulty in understanding, forgetfulness and lack of motivation so that patients experience frustration in healing treatment so that adaptations are needed which are arranged in Discharge planning. Providing discharge planning can increase patient knowledge, the effectiveness of hospital care, reduce repeat visits to the hospital and can reduce treatment costs (Sitompul et al., 2020). In the advanced phase or follow-up care, appropriate treatment is needed because it can prevent complications from occurring in stroke patients. Stroke patients when they return from the hospital, post-stroke patients still experience sequelae, for example with the condition; motor loss (hemiplegia/hemiparese) or patients who go home with a state of total bedrest, loss of communication or difficulty speaking (dysatria), impaired perception, impaired cognitive function and psychological effects, so that it will have an impact on activities of daily life in fulfilling basic human needs. Providing good care services at the hospital will speed up the healing process of stroke patients. The minimum standard length of care for stroke patients is an average of 2 to 4 weeks. After that the stroke patient will perform outpatient treatment. The condition of patients who are medically allowed to go home has improved but in fulfilling needs and nursing is still very limited (Kurniati et al., 2022), Improving the quality of life is the main goal expected in the care of post-hospitalized stroke patients. Efforts to improve a good quality of life after a stroke are very dependent on the quality of management and care so that the participation of health workers in the stroke team is needed, in this case the health workers are also involved and the family has an understanding of the disease process, knows how to handle it and the continuity of care in the rehabilitation phase and adaptation arranged in a discharge planning. Discharge planning is an effort made by families and health workers to prepare patients to get continuity of care both in https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.6 No.2. April 2023. Page.130-136 132 the healing process and maintaining their health status until the patient feels ready to return to his environment and must start from the time the patient comes to the health service. Discharge planning can improve health development and help patients achieve optimum quality of life after the patient is discharged, discharge planning can also have a significant effect in reducing disease complications, preventing relapse and reducing mortality (Prick et al., 2022). As the main implementation of discharge planning is the provision of health education to patients and families which aims to increase knowledge and understanding as well as support for the patient's health condition and follow-up that must be carried out after returning home. Discharge planning for stroke patients is very important considering the period of care and recovery to the level of disability and the sequelae that are caused are quite severe and require a long time. Giving Discharge Planning aims to influence patient behavior as an effort to improve quality of life and prevent recurrent stroke attacks (Permata Sari, 2022). METHODS This article is a literature review. A review study includes a summary of previous findings in a review of the research literature on a specific topic. The existence of a lot of information is an opportunity, a systematic review method is needed so that the information can be used as needed by the researcher to complete this research. The literature search was carried out by the researchers themselves. Extracted documents are reviewed by other researchers independently to include documents that are relevant and appropriate in this study. The search took place in the Google Scholar database with the keywords Discharge planning, Quality of life and Stroke. The search for articles started on 10 October 2022 to 17 October 2022 with keywords determined by the researchers, namely, Discharge Planning, quality of life and stroke. Finally, there are 10 journals and articles that the author has obtained which are then reviewed to get the gist of the discussion and some important points in each reference. Lastly is the process of writing articles (Nursalam, 2020). RESULTS Search reviews were identified and filtered according to the variables used. Then the feasibility test was obtained and 10 journals were then selected according to the specified criteria so that 10 journals were obtained. The journal search engines used in this study were Google Scholar, Indonesia One Search, DOAJ, and Garuda. Title, Author and Year Research result Discharge Planning Of Stroke Patient In Regional General Hospital Ungaran Writer:(Eva Rayanti & Yoel, 2020) The conclusion of this study is that nurses have already conducted discharge planning for stroke patients at the hospital, but nurses need to optimize their role in the implementation of discharge planning. The Effect of Discharge Planning Implementation on Stroke Patients in Indonesia Writer :(Adhitya et al., 2020) By carrying out discharge planning, especially for stroke patients, a good influence is obtained for the patient or family in the hope that problems that may occur can be handled so that the patient's health status can improve after a stroke and carrying out discharge planning can improve the quality of nursing care in Indonesia. https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.6 No.2. April 2023. Page.130-136 133 Title, Author and Year Research result The Effect of Discharge Planning on the Quality of Life of Ischemic Stroke Patients Writer : After administering discharge planning to stroke patients, it turns out that they will have a greater chance of life to have a good quality of life compared to those without discharge planning. The Effect of Discharge Planning on Families' Ability in Post-Stroke Care at Home Writer :(Yaslina et al., 2019) There is an effect of providing discharge planning on the family's ability to care for post-stroke at home The Effect of Discharge Planning on the Readiness of Stroke Patients to Face Discharge in the Neurology Inpatient Room Writer :(Permata Sari, 2022) The results showed that the average prior to the discharge planning readiness of respondents was 24.60 with a standard deviation of 3.299. While the average after discharge planning the readiness of respondents was 31.50 with a standard deviation of 0.889. Visible differences between the mean readiness to face the return stroke patients before and after Discharge Planning is 6.90 with an ap value of 0.000. The Effectiveness of Implementing Discharge Planning Using a Structured Method on Family Readiness in Providing Early Mobilization in Cerebro Vascular Attack Patients in Rs. Surabaya Islam Writer :(Damawiyah & Ainiyah, 2017) The results of statistical tests with Mann Whitney obtained a value of p = 0.001 (p <0.05) meaning that there was an effect before and after the application of discharge planning with a structured method was given to family readiness in providing early mobilization in cerebro vascular attack patients in the treatment group. Development of a patient decision aid for discharge planning of hospitalized patients with stroke Writer :(Prick et al., 2022) The developed PTDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness Effect of a Design Discharge Planning Program for Stroke Patients on Their Quality of Life and Activity of Daily Living Writer :(Said Taha & Ali Ibrahim, 2020) Applying a design discharge planning program had statistically significant improvement on knowledge, quality of life and activity of daily living for studied patients The Effect of Discharge Planning on the Quality of Life of Stroke Patients Write(Sitompul et al., 2020) The effect of discharge planning is very good, as well as family support will have an impact, namely improving the quality of life of stroke patients, namely increasing activity, preventing disease complications and patient adherence in taking medication and routinely carrying out disease control. https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.6 No.2. April 2023. Page.130-136 134 Title, Author and Year Research result The Effect Of Discharge Planning Combines Audiovisual With The Family Centered Nursing Preparedness Caring For Acute Post Stroke Patients Writer :(Kurniati et al., 2022) The first phase of the study produced a CADP module for families of stroke patients, the second phase based on the Wilcoxon sign rank test showed that there was an effect after the intervention and the Mann Whitney test showed a significant difference in mean between intervention and control during EH (0.000; 0.000), during treatment (0.000;0.000), before LH (0.000;0.000) DISCUSSION Providing discharge planning affectsfamily readiness to care for stroke patients before leaving the hospital. Families and patients who receive discharge planning after having a stroke are more enthusiastic about undergoing rehabilitation after discharge and families experience fewer psychological disorders in caring for patients (Yaslina et al., 2019). In increasing the readiness of patients and families in the planning process before discharge from the hospital by facilitating discussion and providing education on practical issues relevant to their illness and problems that often arise when care is carried out at home. Giving discharge planning has a positive impact on how patients and families rated their level of self-confidence after discharge from the hospital. So that by providing discharge planning education consistently with material that is gradual and continuous it has an impact on patient and family acceptance and understanding responses to be easier (Kurniati et al., 2022). There are several factors that influence the implementation of discharge planning in hospitals, one of which is the role of the family in carrying out discharge planning. The role of the family cannot be denied as a support system that is very helpful, especially when the patient is at home. Patients will feel motivated to adhere to treatment to speed recovery. The role of nurses in hospitals is to work as health service providers in a professional manner because nurses act as case managers and executors of patient care. Before going home, nurses provide services in the form of care before going home, namely discharge planning stroke by providing information and teaching families about how patients help move from bed to chair, help with dressing, bathing and washing, how to give medicine properly, when giving medicine comes to control at home sick on time and others. Providing discharge planning is able to increase the readiness of families to care for patients because usually nurses are used to giving patient control sheets when they go home and most nurses explain activities that are allowed and activities that are prohibited as well as the nutritional needs of patients after being at hom (Afni Rodearni Purba et al., 2022). Increased family readiness to care for stroke patients can occur due to discharge planning interventions that are provided about complete education regarding preparations that families must know before leaving the hospital, namely when to control, when to take medication, rehabilitation activities and patient nutrition at home. Patient behavior can be changed by providing discharge planning, namely through information given to patients so that it becomes a stimulus that can increase knowledge, influence awareness to behave as expected. Stroke patients have different abilities and responses to the stimulus given, so the behavior and ability of patients to carry out independent care are also different (Permata Sari, 2022). https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.6 No.2. April 2023. Page.130-136 135 CONCLUSION Providing discharge planning to families and stroke patients has a good impact in increasing family readiness in caring for patients, as well as improving the quality of life of stroke patients, which can improve rehabilitation activities, prevent disease complications and comply with taking medication and routine control. REFERENCES Abdullah, E. (2017). Pengaruh Discharge planning terhadap Kualitas Hidup Pasien Stroke Ishkemik. Jurnal Keperawatan, 7(1). Adhitya, S., Basit, M., & Widodo, H. (2020). The Effect of Discharge Planning Implementation on Stroke Patients in Indonesia. Proceeding of Sari Mulia University Nursing National Seminars. Afni Rodearni Purba, S., Susyanti, D., & Yuda Pratama, M. (2022). Discharge Planning Pada Pasien Stroke Iskemik. Jurnal Keperawatan Flora, 15(2). Carod-Artal, F. J., & Egido, J. A. (2010). Quality of Life after Stroke: The Importance of a Good Recovery. Cerebrovasc Disease. https://doi.org/DOI: 10.1159/000200461. 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