**5.4 Improving the ability to perform activities independently according to patient's ability**

In Orem's theory (self-care deficit theory of nursing), Orem believes that human have the ability to care for themselves and if this ability is distorted, nurses help individuals to regain their abilities by providing direct care [32]. The results of our previous qualitative research showed that the informants' ability to carry out activities of daily living was in accordance with their ability to describe the conditions included in the supportive-educative system [36].

The supportive-educational system in Orem's theory states that individuals can do or can learn to take necessary actions externally or therapeutic self-care but cannot do so without help [28]. For this reason, guidance from nurses and caregivers

are needed. However, in carrying out self-care activities emphasize the active role of patients in their health care rather than a passive role. It is necessary to make efforts to increase the self-care ability of post-stroke UI patients by involving patients in daily activities, but still being given supervision and help from caregivers in stages.

#### **5.5 Improving family support and peer's attention**

Social support can act as moderator of the effect of disability on well-being [35]. Support can be defined as help that a person can use in difficult situations. Support reduces the risk of mental and somatic disorders, modulates approaches to coping with stress, and reduces the likelihood of premature death [50, 51]. Social and emotional support is important for quality of life [51]. High levels of social support are associated with better mental health [52].

Family support and peer attention are often recommended as sources of emotional, instrumental, informational, and affirmative support for people with chronic disease conditions [22]. Family and peer support programs are an effective way to meet patient needs. Orem believes that the lack of social support to reassure patients in complex care situations leads to limitations in self-care behaviors [28].

Families contribute to maintaining the patient's well-being through emotional, instrumental, and practical support. Previous research has shown the effectiveness of treatment by involving the family in patient care [53]. However, in involving families as caregivers in patient care, it is necessary to be equipped with knowledge and skills related to patient care, caregivers must also be able to take care of their own health when caring for patients. The results of our previous qualitative study found that caregivers experience fatigue when caring for patients at home [36]. Fatigue and lack of rest experienced by caregivers are caused by the increased responsibility of caregivers in maintaining patient health [54]. Caregivers recognize that it is important to take care of their personal health so they can continue to care for their sick family members [54].

In addition to caregivers, peer attention is also needed. The results of qualitative study stated that informant felt very happy with the presence of a friend who also experienced the same disease as the informant, they shared their experiences during post-stroke UI [36]. Attention from peer who also experienced the same illness can help reduce feeling of isolation and fear, where peer support can be done by sharing experiences and providing information about the health services they need [22].

## **6. Model implementation guide**

This model is implemented in five activities. The first activity was carried out at the hospital in the form of health education to patients and caregivers about poststroke UI. The second activity is also carried out at the hospital and continued at the patient's home, in the form of skills training that needs to be given in the management of post-stroke UI including bladder retraining, pelvic floor muscle exercises, deep breathing exercises, ROM exercises, positive thinking exercises, and exercises controlling emotions. The third activity is in the form of assistance in implementing the skills that have been taught, this can be done at the patient's home. The fourth activity is in the form of monitoring and evaluation of patient's ability (patient independence), which can be done through home visits and telephone calls. The fifth activity is a follow-up. Follow-up can be done four weeks after all activities have been carried out.
