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Keeves J, Hutchison A, D'Cruz K, Anderson S. Social and community participation following traumatic lower limb amputation: an exploratory qualitative study. Disabil Rehabil 2023; 45:4404-4412. [PMID: 36448299 DOI: 10.1080/09638288.2022.2152114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To explore barriers and facilitators to social and community participation experienced by people following traumatic lower limb amputation (LLA). METHODS An exploratory qualitative study was conducted with nine adults with traumatic LLA in Victoria, Australia. Participants were a minimum of 18 months post amputation. Interview data was analysed using thematic analysis. RESULTS Participants referenced the inaccessibility of the built environment and physical challenges associated with prosthetic mobility as barriers to participation. Chronic and complex health concerns due to their injuries resulted in physical and emotional distress for some, further limiting their social and community engagement. Participants highlighted the benefit of peer-support networks and the value of supportive community groups in assisting the transition to their pre-amputation family, work and social roles. Participants also felt that a strong, positive attitude and being self-motivated were important to aid in their return to social and community participation. CONCLUSION People following traumatic LLA experience a number of physical, psychological and environmental challenges to participation. The role of peer-support networks, community groups and personal attitudes are important facilitators to assist a return to family, work and life roles. The findings of this study have informed the development of recommendations to guide clinical practice.IMPLICATIONS FOR REHABILITATIONPeer-support groups for people following traumatic lower limb amputation (LLA) may assist to improve their long-term adjustment to disability and community participationRetraining skills in an individual's own community should be considered when planning community-based therapy services for people following traumatic LLA.Ongoing psychosocial support including strategies to develop self-efficacy and positive mindset may improve social and community participationRegular medical and allied health reviews can be beneficial to promote early intervention for any complications that arise to minimise time off prosthesis.
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Affiliation(s)
- Jemma Keeves
- Epworth Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Abby Hutchison
- Epworth Hospital, Melbourne, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kate D'Cruz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sarah Anderson
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Chui A, Dainty KN, Kirsh B, Dawson DR, Colquhoun H. Hope for “Continued Vitality”: Qualitative Study of Adults With Traumatic Brain Injury and Low Mood on Their Rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:848575. [PMID: 36189039 PMCID: PMC9397807 DOI: 10.3389/fresc.2022.848575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022]
Abstract
Objective Depression is highly comorbid with traumatic brain injury (TBI) with often complex and interacting symptomology that contributes to the experience of disability. Comorbid depression results in poorer TBI rehabilitation and downstream participation outcomes yet perspectives of this group regarding person-centered care is unknown. Purpose This study aimed to explicate the perspectives of persons with TBI and depression on their values, preferences, and desired outcomes for optimal rehabilitation. Methods A qualitative descriptive approach was taken. Thirteen adults [mean age: 40.5 (standard deviation 9.8)] diagnosed with TBI and with self-reported low mood were recruited through convenience sampling. Participants were predominantly female (n = 12) with concussion/mild TBI and at least 6 months post-injury. One-on-one, semi-structured interviews were conducted by phone with Canadian participants (March-May 2020). Interviews were transcribed; data were analyzed thematically by two researchers and the thematic map refined by the research team. Results Three themes were identified on values, preferences, and desired outcomes in person-centered care. Participants valued “validation” from healthcare providers and the health system to feel seen and believed about their conditions and concerns. They preferred for healthcare providers to “share the burden of managing care” through improved interactions and better access to concussion care. Participants expressed that “meaningful outcomes” were to be symptom free, to resume valued life activities, and to be able to adapt/be resilient. The latter indicated hope for “continued vitality” for life participation despite past and ongoing challenges. Conclusions Many adults with TBI and self-identified low mood expressed rehabilitation experiences that were invalidating. Their identified values, preferences, and desired outcomes provide directions for better person-centered care by healthcare providers and health systems to support participation.
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Affiliation(s)
- Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Toronto, ON, Canada
- *Correspondence: Adora Chui
| | - Katie N. Dainty
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Bonnie Kirsh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Deirdre R. Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Injuries were the most common cause of hospitalization in Sweden in 2017. There is a lack of knowledge about trauma recovery and its relation to health-related quality of life (HRQoL) after hospitalization due to minor trauma. This study aimed to prospectively evaluate recovery and HRQoL at discharge from hospital and 3 and 6 months after the trauma. METHODS This is a secondary analysis of data from a prospective follow-up study. Fifty-seven patients who sustained physical trauma were included. Recovery was measured with postoperative recovery profile and HRQoL 3 and 6 months after discharge. The association between the outcomes was analyzed, as well as the impact of gender, age, Injury Severity Score (ISS), and trauma mechanism using nonparametric statistics. RESULTS There was a significant improvement in recovery and HRQoL between discharge and 3 months after the trauma (p < .001) as well as between 3 and 6 months after the trauma (p < .001) except for EQ-5D VAS scale (p = .222). However, only 14 (25%) patients viewed themselves as fully recovered 6 months after the incident. Correlation between recovery and HRQoL increased after discharge and was at its strongest 6 months after the trauma (rs > .071). CONCLUSION Trauma mechanism has an impact on recovery but not gender, age, or ISS score. Most patients did not consider themselves fully recovered even at 6 months postinjury, indicating that they require additional support to manage their recovery.
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Azami-Aghdash S. Meta-synthesis of qualitative evidence in road traffic injury prevention: a scoping review of qualitative studies (2000 to 2019). Arch Public Health 2020; 78:110. [PMID: 33292547 PMCID: PMC7607842 DOI: 10.1186/s13690-020-00493-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A considerable number of qualitative studies have been published in recent years on the issues that the quantitative studies have limitations on. This study aimed at performing a meta-synthesis on qualitative studies on Road Traffic Injuries (RTIs) with a scoping review approach. METHODS This meta-synthesis study was conducted as a scoping review in 2019. The Arkesy and O'Malley framework was applied which has six steps of identifying the research question, identifying the relevant studies, selecting the studies, charting the data, data analysis and reporting the results, and consultation exercise. The required data were gathered by searching the relevant keywords in databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex. Extracted data were analyzed by the Content-Analysis method. RESULTS Finally, 30 studies were included. Extracted data summarized in five main themes and 17 sub-themes. The main themes were: consequences (individual, family, social, financial), the needs of survivors (social support and healthcare), risk factors (general risk factors, risk factors for motorcyclists, risk factors for children and adolescents), barriers of prevention (general barriers, pre-hospital barriers, emergency, and hospital barriers), and prevention solutions (increasing safety, rules and regulations, education, increasing equipment, scientific solutions) of RTIs. CONCLUSION This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs, with this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified.
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Affiliation(s)
- Saber Azami-Aghdash
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Keeves J, Braaf SC, Ekegren CL, Beck B, Gabbe BJ. Caring for people with serious injuries in urban and regional communities: a qualitative investigation of healthcare providers' perceptions. Disabil Rehabil 2020; 43:3052-3060. [PMID: 32109168 DOI: 10.1080/09638288.2020.1728787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: To understand the factors that affect the management of people after serious injury in urban and regional settings, beyond hospital discharge from the perspectives of allied health professionals (AHPs).Materials and methods: An exploratory qualitative study of AHPs caring for people with serious injuries post-hospital discharge in urban and regional areas of Victoria, Australia was completed. Twenty-five semi-structured interviews were undertaken with AHPs and thematically analysed.Results: Allied health professionals in urban and regional settings reported the benefits of a multi-disciplinary team to deliver high-quality care. However, a number of barriers to service delivery were identified that impacted on their ability to meet the needs of patients. These included insufficient psychological services, a shortage of available carers and an unmet need for external clinical support in regional areas. Communication between AHPs and other services, and care co-ordination of post-discharge services, was also highlighted as key areas to improve for optimal patient care.Conclusions: Factors that influenced optimal patient management included the availability of psychological and carer services, communication between health professionals and coordination of post-discharge care. The experiences of AHPs can offer practical suggestions to optimise service delivery and post-discharge care for people with serious injuries.Implications for RehabilitationAllied health professionals (AHPs) face a number of challenges in the provision of optimal care to people with serious injuries.Improving the availability of psychological support and attendant carers is needed in regional areas.A designated care coordinator role may assist people with serious injuries transitioning between hospital and home to engage with necessary services and reduce administrative burden for AHPs.Telehealth may provide facilitate improved communication between health professionals and support regional clinicians caring for people with complex injuries.
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Affiliation(s)
- Jemma Keeves
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Epworth Hospital, Melbourne, Australia
| | - Sandra C Braaf
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Sandström L, Engström Å, Nilsson C, Juuso P. Experiences of suffering multiple trauma: A qualitative study. Intensive Crit Care Nurs 2019; 54:1-6. [PMID: 31351691 DOI: 10.1016/j.iccn.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In an effort to strengthen health care professionals' ability to anticipate and address multiple trauma patients' needs, this study aims to explore the experience of suffering from multiple trauma. DESIGN This is a qualitative descriptive study. Nine interviews were analysed using content analysis. SETTING The study included patients who had been registered in the Swedish Intensive Care registry [SIR] due to suffering multiple trauma. FINDINGS The analysis revealed one theme, A detour in life, based on three sub-themes: (a) Feeling lost and not knowing what to expect, (b) Striving to get life back on track and (c) Dealing with 'dead ends' during rehabilitation. The theme showed that those who suffered multiple trauma did not know what to expect of their recovery and they expressed experiencing a lack of understanding and guidance from healthcare professionals. As it was important to focus on the present and find ways to move on in life, they sought for other ways to find direction in matters of rehabilitation and care. CONCLUSIONS A shared understanding is essential in order to define a person's needs. By setting short-term goals and improving documentation, healthcare professionals across the trauma recovery continuum could more easily gain insight of their patients' needs and address them with supportive guidance.
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Affiliation(s)
- Linda Sandström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
| | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Carina Nilsson
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Päivi Juuso
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Kaufman EJ, Richmond TS, Wiebe DJ, Jacoby SF, Holena DN. Patient Experiences of Trauma Resuscitation. JAMA Surg 2017; 152:843-850. [PMID: 28564706 DOI: 10.1001/jamasurg.2017.1088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patient satisfaction is an increasingly common feature of quality measurement, and patient-centered care is a key aspect of high-quality clinical care. Incorporating patient preferences in an acute context, such as trauma resuscitation, presents distinct challenges; however, to our knowledge, patients' experiences of trauma resuscitation have not been explored. Objectives To describe patient experiences of trauma resuscitation and to identify opportunities to improve patient experience without compromising speed or thoroughness. Design, Setting, and Participants This qualitative, descriptive study was conducted at an urban, academic, level I trauma center. Semistructured interviews and video observations were conducted from May to December 2015. Interview participants were adult English-speaking patients who had experienced trauma resuscitation and were clinically stable with no alteration in consciousness. We recruited interview participants and conducted video observations until thematic saturation was reached, resulting in 30 interviews and 20 observations. Video observation patients did not overlap with interview participants. The purposive sample included equal numbers of violently and nonviolently injured patients. Data were analyzed for thematic content from June 2015 to April 2016. Main Outcomes and Measures The main outcomes reported are themes of patient experience. Results Of 30 interview participants, 25 were men (83.3%), and 21 were black (70.0%). Of 20 video observation patients, 16 were men (80.0%), and 17 were black (85.0%). Salient aspects of patient experience of trauma resuscitation included emotional responses, physical experience, nonclinical concerns, treatment and procedures, trauma team members' interactions, communication, and comfort. Participants drew satisfaction from trauma team members' demeanor, expertise, and efficiency and valued clear clinical communication, as well as words of reassurance. Dissatisfaction stemmed from the perceived absence of these attributes and from participants' emotional or physical discomfort. Observation data added insight into the components of care that may have contributed to participants' responses and those aspects of care that were not salient to participants. Conclusions and Relevance Although the urgency of trauma care limits explicit discussion and consideration of patient priorities, we found that patient concerns corresponded well with trauma team goals. Patients perceived trauma team members as competent, efficient, and caring. Focusing on patient communication could further improve patient-centeredness in this setting.
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Affiliation(s)
- Elinore J Kaufman
- Department of Surgery, NewYork-Presbyterian Weill Cornell Medical Center, New York
| | | | - Douglas J Wiebe
- Epidemiology in Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sara F Jacoby
- Center for Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel N Holena
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Saei A, Rahimi A. Collaboration of Patients With Mobility Disabilities in Caring: Conceptual Analysis. HEALTH IN EMERGENCIES & DISASTERS QUARTERLY 2017. [DOI: 10.29252/nrip.hdq.2.4.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Claydon J, Maniatopoulos G, Robinson L, Fearon P. Challenges experienced during rehabilitation after traumatic multiple rib fractures: a qualitative study. Disabil Rehabil 2017; 40:2780-2789. [DOI: 10.1080/09638288.2017.1358771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jacqueline Claydon
- Major Trauma Rehabilitation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Lisa Robinson
- Major Trauma Rehabilitation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Fearon
- Department of Trauma and Orthopaedics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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10
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Sandström L, Nilsson C, Juuso P, Engström Å. The helicopter as a caring context: Experiences of people suffering trauma. Int Emerg Nurs 2017; 32:34-38. [DOI: 10.1016/j.ienj.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 11/25/2022]
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Pashaei Sabet F, Norouzi Tabrizi K, Khankeh HR, Saadat S, Abedi HA, Bastami A. Road Traffic Accident Victims' Experiences of Return to Normal Life: A Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e29548. [PMID: 27275399 PMCID: PMC4893411 DOI: 10.5812/ircmj.29548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/23/2015] [Accepted: 06/23/2015] [Indexed: 11/16/2022]
Abstract
Background Road traffic accident (RTA) victims also suffer from different types of injuries and disabilities, which can affect their quality of life. They usually face with various physical, mental, and social problems. Most traffic accident victims had difficulty to return to normal life. Objectives This study aimed to understand the experiences of return to normal life in RTA victims. Patients and Methods This qualitative study with content analysis approach was conducted on 18 Iranian patients with disability in the upper or lower limbs caused by traffic accidents, who had passed a time between 3 months till 2 years. A purposeful sampling method was applied until reaching data saturation. Data were collected using semi-structured interviews. Afterwards, the gathered data were analyzed through conventional content analysis. Results By analyzing 498 primary codes, four main categories, including supportive needs, adaptation to the new situation, seeking information, and transition from functional limitation, were extracted from traffic accident victims’ experiences of reintegration to normal life. Conclusions The results of this study may help policy-makers to take steps toward health promotion and recovery of RTA victims. Considering the results of this study, it is a need for further research to investigate RTAs victims’ needs for reintegration to home and community. Access to training and supportive facilities like strong therapeutic, nursing and social support, and the possibility to participate in self-care activities is essential for reintegration to community in RTA victims.
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Affiliation(s)
- Fatemeh Pashaei Sabet
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Kian Norouzi Tabrizi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
- Corresponding Author: Kian Norouzi Tabrizi, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel/Fax: +98-2122180036, E-mail:
| | - Hamid Reza Khankeh
- Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, Sweden
| | | | | | - Alireza Bastami
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
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12
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Lundälv J, Lindqvist R. Between ‘Lifeworld’ and ‘System’: Caseworker Role Conflict in the Provision of Disability Services to People Injured by Traffic Accidents in Sweden. THE AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2015. [DOI: 10.1375/jrc.15.2.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractThe aim of this study was to describe and analyze how caseworkers in the Swedish disability services deal with people disabled by road accidents. Data were collected by means of a web-based survey of 259 caseworkers, and a direct content analysis of open-ended questions was used to interpret and analyse the data. The conceptual toolbox consisted of Habermas' lifeworld-system dichotomy, social recognition, and concepts from human service organisation research. Dilemmas within the following areas were identified: interaction with the service users, experiences of communication, assessment of needs, and inter-organisational cooperation between health care and disability services. These difficulties occurred because of tensions between ‘lifeworld’ and ‘system’, and because social recognition and mutual communicative action were not easy to achieve when cognitive impairments distorted and prevented the development of an ‘ideal speech situation’. Inter-organisational cooperation was difficult because of different regulations and professional perspectives.
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13
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Kellezi B, Beckett K, Earthy S, Barnes J, Sleney J, Clarkson J, Regel S, Jones T, Kendrick D. Understanding and meeting information needs following unintentional injury: comparing the accounts of patients, carers and service providers. Injury 2015; 46:564-71. [PMID: 25533126 DOI: 10.1016/j.injury.2014.11.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/21/2014] [Accepted: 11/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore information needs of unintentional injury patients and their carers over time, across services, and how such needs are met from the perspectives of patients, carers and service providers. METHODS Qualitative nested study within a multi-centre longitudinal study quantifying psycho-social, physical, occupational outcomes and service use and costs following a range of unintentional injuries. Semi-structured interviews conducted with 45 patients during the first year post injury, 18 of their carers and 40 providers of services. RESULTS Patients and carers needed information about the nature and severity of injury, prognosis, self-management and further services. Information needs changed over time with the biggest difficulties being during transfer from primary to secondary care. Barriers to information provision included service providers' time limitations and uncertainty around information provision, and patients' reluctance to ask for information or inability to process it. Suggested improvements included provision of reassurance as well as factual information, information about further services, earlier follow-up, increased appointment times and greater involvement of families where appropriate. CONCLUSIONS The information needs of patients and carers post injury change with time and there are a number of ways to remove gaps and barriers in current provision to meet such needs. PRACTICE IMPLICATIONS Providing information on injury management, prognosis and available services and reassurance at each stage of the recovery process in secondary care and when transferring to primary care would be helpful for patients and carers. A follow-up contact soon after discharge and the opportunity to ask questions could be beneficial. Better information about the patient's needs and ways they can help could help carers fulfil their caring role.
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Affiliation(s)
- Blerina Kellezi
- Division of Primary Care, School of Medicine, Nottingham University, University Park, Nottingham, UK.
| | - Kate Beckett
- University of the West of England, Research and Innovation, University Hospitals Bristol NHS Foundation Trust, Education Centre, Bristol, UK
| | - Sarah Earthy
- Department of Sociology, Faculty of Arts and Human Sciences, University of Surrey, Guildford, Surrey, UK
| | - Jo Barnes
- Loughborough Design School, Loughborough, UK
| | - Jude Sleney
- Department of Sociology, Faculty of Arts and Human Sciences, University of Surrey, Guildford, Surrey, UK
| | | | - Stephen Regel
- Centre for Trauma, Resilience and Growth, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Trevor Jones
- Patient Representative, Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, Nottingham University, University Park, Nottingham, UK
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Elmqvist C, Frank C. Patients' strategies to deal with their situation at an emergency department. Scand J Caring Sci 2014; 29:145-51. [PMID: 24750520 DOI: 10.1111/scs.12143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 03/21/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The care in the emergency department (ED) is often characterised by high standards of efficiency and rapid treatment and the encounter between patient and staff can be described as both short and fragmented. Research within this field has mostly been performed with quantitative measurements and patients are both satisfied and vulnerable in their care at an ED. There is a lack of qualitative studies about patient's strategies to deal with their situation. AIM The aim was to describe patient's strategies for dealing with their situation at an ED. METHODS Secondary analysis has been made of 13 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis. RESULTS The results showed that patients' strategies to deal with the situation at the ED are passive or active. The passive strategy is being patient and the active strategies varied in terms of having hidden tactics, using visible tactics and using families as support. CONCLUSION These findings increase the importance of gaining knowledge about these strategies so that the staff at the ED can support the patients so they do not have to use them.
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Affiliation(s)
- Carina Elmqvist
- Centre for Acute & Critical Care, Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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15
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Abstract
Recovery following trauma depends on many factors and is not related to only the physical severity of injury. Different people respond differently to the stress of injury and, therefore, recover differently. Support networks are important. Expectation and hope, which can be greatly influenced by responsible health care professionals, can hugely influence recovery.
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Kendrick D, O'Brien C, Christie N, Coupland C, Quinn C, Avis M, Barker M, Barnes J, Coffey F, Joseph S, Morris A, Morriss R, Rowley E, Sleney J, Towner E. The impact of injuries study. multicentre study assessing physical, psychological, social and occupational functioning post injury--a protocol. BMC Public Health 2011; 11:963. [PMID: 22208707 PMCID: PMC3332304 DOI: 10.1186/1471-2458-11-963] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 12/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury. METHODS/DESIGN A longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design. DISCUSSION This study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.
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Affiliation(s)
- Denise Kendrick
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Claire O'Brien
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Nicola Christie
- Centre for Transport Studies, Dept of Civil, Environmental and Geomatic Engineering, UCL, Gower Street, London WC1E 6BT, UK
| | - Carol Coupland
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Casey Quinn
- Division of Primary Care, Tower Building, University Park, NG7 2RD Nottingham, UK
| | - Mark Avis
- Nursing, Midwifery & Physiotherapy Department, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Marcus Barker
- Division of Psychiatry, Institute of Mental Health, B Floor, Sir Colin Campbell Building, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, UK
| | - Jo Barnes
- Transport Safety Research Centre, Loughborough Design School, Loughborough University, Ashby Road, Loughborough LE11 3UZ, UK
| | - Frank Coffey
- Emergency Department, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Stephen Joseph
- Sociology & Social Policy Department, University Park, Nottingham NG7 2RD, UK
| | - Andrew Morris
- Transport Safety Research Centre, Loughborough Design School, Loughborough University, Ashby Road, Loughborough LE11 3UZ, UK
| | - Richard Morriss
- Division of Psychiatry, Institute of Mental Health, B Floor, Sir Colin Campbell Building, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, UK
| | - Emma Rowley
- CLAHRC NDL, Sir Colin Campbell Building, University of Nottingham Innovation Park, Nottingham NG7 2TU, UK
| | - Jude Sleney
- Department of Sociology Faculty of Arts and Human Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Elizabeth Towner
- Centre for Child & Adolescent Health, University of the West of England, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, UK
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Elmqvist C, Fridlund B, Ekebergh M. On a hidden game board: the patient's first encounter with emergency care at the emergency department. J Clin Nurs 2011; 21:2609-16. [PMID: 22192405 DOI: 10.1111/j.1365-2702.2011.03929.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES Describe and understand the patient's first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions. BACKGROUND The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown. DESIGN A lifeworld research perspective was used in four different situations at the emergency department. METHODS The data consisted of 14 open-ended interviews with patients, next of kin and first providers. RESULTS The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, 'courtesy encounters', isolated in a timeless encounter, striving for meaning in the encounter. DISCUSSION Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter. RELEVANCE TO CLINICAL PRACTICE The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurse's role as the patients' advocate and for strengthening the effort for an emergency department to become more of a learning organisation.
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Affiliation(s)
- Carina Elmqvist
- Centre for Acute & Critical Care, School of Health and Caring Sciences, Linneaus University, Växjö, Sweden.
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18
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Khorasani-Zavareh D, Mohammadi R, Khankeh HR, Laflamme L, Bikmoradi A, Haglund BJA. The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study. BMC Public Health 2009; 9:486. [PMID: 20030826 PMCID: PMC2811114 DOI: 10.1186/1471-2458-9-486] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 12/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic injuries (RTIs) are a major public health problem, especially in low- and middle-income countries. Among middle-income countries, Iran has one of the highest mortality rates from RTIs. Action is critical to combat this major public health problem. Stakeholders involved in RTI control are of key importance and their perceptions of barriers and facilitators are a vital source of knowledge. The aim of this study was to explore barriers to the prevention of RTIs and provide appropriate suggestions for prevention, based on the perceptions of stakeholders, victims and road-users as regards RTIs. METHODS Thirty-eight semi-structured interviews were conducted with informants in the field of RTI prevention including: police officers; public health professionals; experts from the road administrators; representatives from the General Governor, the car industry, firefighters; experts from Emergency Medical Service and the Red Crescent; and some motorcyclists and car drivers as well as victims of RTIs. A qualitative approach using grounded theory method was employed to analyze the material gathered. RESULTS The core variable was identified as "The lack of a system approach to road-user safety". The following barriers in relation to RTI prevention were identified as: human factors; transportation system; and organizational coordination. Suggestions for improvement included education (for the general public and targeted group training), more effective legislation, more rigorous law enforcement, improved engineering in road infrastructure, and an integrated organization to supervise and coordinate preventive activities. CONCLUSION The major barriers identified in this study were human factors and efforts to change human behaviour were suggested by means of public education campaigns and stricter law enforcement. However, the lack of a system approach to RTI prevention was also an important concern. There is an urgent need for both an integrated system to coordinate RTI activities and prevention and a major change in stakeholders' attitudes towards RTI prevention. The focus of all activities should take place on road users' safety.
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Affiliation(s)
- Davoud Khorasani-Zavareh
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Norrbacka, SE-171 76, Stockholm, Sweden
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19
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Franzén C, Björnstig U, Brulin C, Lindholm L. A cost-utility analysis of nursing intervention via telephone follow-up for injured road users. BMC Health Serv Res 2009; 9:98. [PMID: 19515265 PMCID: PMC2705356 DOI: 10.1186/1472-6963-9-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 06/11/2009] [Indexed: 11/24/2022] Open
Abstract
Background Traffic injuries can cause physical, psychological, and economical impairment, and affected individuals may also experience shortcomings in their post-accident care and treatment. In an earlier randomised controlled study of nursing intervention via telephone follow-up, self-ratings of health-related quality of life were generally higher in the intervention group than in the control group. Objective To evaluate the cost-effectiveness of nursing intervention via telephone follow-up by examining costs and quality-adjusted life years (QALYs). Methods A randomised controlled study was conducted between April 2003 and April 2005. Car occupants, cyclists, and pedestrians aged between 18 and 70 years and attending the Emergency Department of Umeå University Hospital in Sweden after an injury event in the traffic environment were randomly assigned to an intervention (n = 288) or control group (n = 280). The intervention group received routine care supplemented by nursing via telephone follow-up during half a year, while the control group received routine care only. Data were collected from a mail survey using the non-disease-specific health-related quality of life instrument EQ5D, and a cost-effectiveness analysis was performed including the costs of the intervention and the QALYs gained. Results Overall, the intervention group gained 2.60 QALYs (260 individuals with an average gain of 0.01 QALYs). The car occupants gained 1.54 QALYs (76 individuals, average of 0.02). Thus, the cost per QALY gained was 16 000 Swedish Crown (SEK) overall and 8 500 SEK for car occupants. Conclusion Nursing intervention by telephone follow-up after an injury event, is a cost effective method giving improved QALY to a very low cost, especially for those with minor injuries. Trial registration This trial registration number is: ISRCTN11746866.
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Affiliation(s)
- Carin Franzén
- Department of Nursing, Division of Surgery, Umeå University, Umeå, Sweden.
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20
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Khorasani-Zavareh D, Khankeh HR, Mohammadi R, Laflamme L, Bikmoradi A, Haglund BJA. Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC Emerg Med 2009; 9:8. [PMID: 19435521 PMCID: PMC2692975 DOI: 10.1186/1471-227x-9-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 05/12/2009] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Road traffic injuries are a major public health problem, especially in low- and middle-income countries. Post-crash management can play a significant role in minimizing crash consequences and saving lives. Iran has one of the highest mortality rates from road traffic injuries in the world. The present study attempts to fill the knowledge gap and explores stakeholders' perceptions of barriers to - and facilitators of - effective post-crash management in Iranian regions. METHODS Thirty-six semi-structured interviews were conducted with medical services personnel, police officers, members of Red Crescent, firefighters, public-health professionals, road administrators; some road users and traffic injury victims. A qualitative approach using grounded theory method was employed to analyze the material gathered. RESULTS The core variable was identified as "poor quality of post crash management". Barriers to effective post-crash management were identified as: involvement of laypeople; lack of coordination; inadequate pre-hospital services; shortcomings in infrastructure. Suggestions for laypeople included: 1) a public education campaign in first aid, the role of the emergency services, cooperation of the public at the crash site, and 2) target-group training for professional drivers, police officers and volunteers involved at the crash scene. An integrated trauma system and infrastructure improvement also is crucial to be considered for effective post-crash management. CONCLUSION To sum up, it seems that the involvement of laypeople could be a key factor in making post-crash management more effective. But system improvements are also crucial, including the integration of the trauma system and its development in terms of human resources (staffing and training) and physical resources as well as the infrastructure development.
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Affiliation(s)
- Davoud Khorasani-Zavareh
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Norrbacka,SE-171 76 Stockholm, Sweden.
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21
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Memories following physical trauma in patients treated in the ICU: Does gender and head injury make a difference? Int Emerg Nurs 2008; 16:241-9. [DOI: 10.1016/j.ienj.2008.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 05/05/2008] [Accepted: 05/06/2008] [Indexed: 11/18/2022]
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Franzén C, Björnstig U, Jansson L, Stenlund H, Brulin C. Injured road users’ experience of care in the emergency department. J Clin Nurs 2008; 17:726-34. [PMID: 17419790 DOI: 10.1111/j.1365-2702.2006.01873.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe the patients' perceptions of quality of care (QoC) in an emergency department (ED) and to analyse associations between patients' background characteristics and estimated QoC. BACKGROUND Each year 1.4 out of every 100 inhabitants are injured in the traffic environment and receive care at the ED. No study has yet analysed different injured road users' perceived QoC, or how important they rate different caring dimensions. DESIGN Cross-sectional study at the ED, in the University Hospital in Umeå, Sweden. METHOD A stratified consecutive sample of 166 car occupants, 200 cyclists and 199 pedestrians, aged 18-70 years, all injured in the traffic environment. Data were collected from medical records and from a mail survey using a short form of the Quality from the Patient's Perspective questionnaire, modified for ED use. The statistical methods used included Mann-Whitney's U-test, the Kruskal-Wallis test and multiple logistic regression. RESULTS The perceived QoC and the subjective importance of the corresponding QoC dimensions were rated at the 'better' half of the rating scale, with no differences between the different road user categories. The most prominent factors associated with a positive perceived QoC rating were a short waiting time, moderate or serious injuries and high age as well as high educational level of the injury victim. For the subjective importance, a short waiting time was rated as the most important but slight differences were seen, related to education and sex. CONCLUSION The association patterns between the areas of perceived reality and subjective importance indicated that expectations were higher than perceived QoC, suggesting that patients expected somewhat higher QoC than they received. RELEVANCE TO CLINICAL PRACTICE Information on factors causing long waiting times, adapted to patients' age, sex and educational level, may reduce dissatisfaction among long waiting patients, especially among those with minor injuries.
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Affiliation(s)
- Carin Franzén
- Department of Nursing, Umeå University, Umeå, Sweden.
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