This approach to rehabilitation has been preferred due to the typical level of complexity of patient care needs, with many patients having medical, social, psychological and economic issues (Haley et al., 1998). To be effective, though, these authors emphasize that such team approaches to healthcare delivery require communication, collaboration, and coordination required in order to avoid fragmented care that does not address the unique needs of the rehabilitation patient: "Rehabilitation professionals must collaborate and coordinate the intensity of rehabilitation care to efficiently and effectively influence and achieve maximum patient and family outcomes" (Haley et al., 1998, p. 29). This is particularly important for stroke victims that still have children at home. According to Dowdy, Kiev, Lathrop and Winkle (1997), "Sudden disability of a parent brought on by stroke or other life-threatening illnesses can have a devastating effect on a child at any age. Families are frequently ill-equipped to deal with the questions and concerns that children have regarding the nature of the illness and course of recovery" (p. 22). In this regard, nurses are in an excellent position to both help coordinate the delivery of rehabilitation services as well as to help educate stroke patients, their caregivers, family members and community at large concerning the ongoing need for timely rehabilitation interventions and what effect the stroke may have on the family unit. According to Dillon and Sternas (1997), "Due to the multifaceted changes occurring within the health care system, it is essential that nurses continue to expand their care beyond that of restoration of health to include that of health promotion and health maintenance through education" (p. 1). These are especially important considerations once stroke victims return to their homes. Because every patient is unique, Fischer (1999) emphasizes that the healthcare implications for stroke patients are varied, and nurses must to remain knowledgeable about changes in Medicare and managed care systems in order to ensure that homebound stroke patients receive the rehabilitation services they require. In this regard, Antai-Otong emphasizes that many stroke patients are at an increased risk of developing depressive symptoms that can adversely affect their rehabilitation progress, but these symptoms are treatable: "Stroke is a risk factor for depression and requires...

167).
Conclusion

The research showed that strokes remain better described in the scholarly literature than they are understood, but the impact on victims and their families has been well documented. A consistent theme that emerged from the literature review was the need for a collaborative approach to the delivery of post-rehabilitation services, the need to ensure that the patient received the follow-up care required in the home or other caregiving setting, and the need to involve the patients' family members in the treatment process. Finally, nurses in particular were shown to be in an excellent position to help facilitate this multidimensional level of care, including educating the patient, family members and the community alike concerning the implications of strokes and the need for timely rehabilitation interventions.