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Commentary: Nursing Interventions Within the Mauk Model of Poststroke
Dr. Mauk clearly states the purpose of the article in the abstract: “to use [the Mauk Model for Post Stroke Recovery] to present nursing interventions appropriate to the identified six phases of stroke recovery.” Dr. Mauk is not presenting her grounded theory method and qualitative analysis that led to development of the Mauk Model for Post Stroke Recovery nor is she testing the proposed model in any way. Her point is that “nursing interventions could be more effective if specifically targeted to the needs of the stroke survivor at each point in the journey of recovery.”
The common practice, especially with dissertation research and funded research in general, is to publish several articles from each research endeavor. Qualitative methodologies in particular yield so much data, that multiple publications are required to present all the findings. But the reader needs to remain clear that this article is not for the most part a presentation of findings from the research. Dr. Mauk briefly overviews the study from which the model emerged. Grounded theory is an appropriate method to generate a process model. It is designed to investigate and describe process. The grounded theorist looks for processes that emerge from the data. Dr. Mauk also explains the model to demonstrate how the model can be used by rehabilitation nurses in the rehabilitation setting to better assess patient and family needs, then plan and implement nursing interventions to facilitate recovery. Within the article, she is teaching rehabilitation nurses how to use the model to identify phases of post-stroke recovery.
Dr. Mauk appears to present findings from her research in the description of the essential survivor and nursing tasks for each phase of recovery and she appropriately offers the caveat that “these suggestions/assumptions have yet to be refined and tested through clinical studies with survivors.” Dr. Mauk appears to draw on her own nursing expertise, her experience with stroke survivors and families as well as data from survivors to generate “practical suggestions as to more appropriate interventions for each phase of the post-recovery journey.” Examining, refining, and finally testing these interventions empirically for effectiveness and efficacy is an appropriate next step and acknowledged by Dr. Mauk.
Dr. Mauk’s assertions that nursing interventions are often not targeted to the needs of survivors and families, and that discharge teaching is often done at a time in the recovery process when the person and family are not ready to learn are true in most rehabilitation situations. But care must be taken not to generalize Dr. Mauk’s model, tasks or interventions without exercising great caution and care. Again Dr. Mauk appropriately acknowledges and addresses this issue.
An additional factor that may influence applicability of the model for persons with stroke is the cognitive dysfunction that may be present such as comprehension and production of language impairment, declarative episodic and semantic memory impairments, executive attention impairment and recognition impairments (agnosias). Dr. Mauk acknowledges that additional complicating medical problems, such as traumatic brain or severe cognitive deficits, challenge the applicability of the model and necessitate further testing.
Dr. Mauk’s article is important. Her past and current research is needed and makes a real contribution to nursing science. I commend Dr. Mauk and would encourage her to continue to pursue her research agenda as indicated in the article and to publish the research on the model’s development. That publication is overdue.