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Shirozhan S, Arsalani N, Seyed Bagher Maddah S, Mohammadi-Shahboulaghi F. Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study. Front Public Health 2022; 10:931287. [PMID: 36033757 PMCID: PMC9402936 DOI: 10.3389/fpubh.2022.931287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Nurses play a key role in providing rehabilitation care. In this regard, identifying the factors that affect their practice can be useful in planning to improve the quality of rehabilitation nursing care. This study aims to explore the experience of nurses and members of the rehabilitation team about barriers and facilitators of rehabilitation nursing care of patients with disability in the rehabilitation hospital. This qualitative study was conducted in the main public rehabilitation hospital in Tehran, Iran. Eighteen persons including 12 nurses in clinical and managerial positions, an occupational therapist, a physical medicine specialist, a patient, and an informal caregiver participated in this study. Participants were selected based on purposeful sampling. Data were collected through 18 in-depth semi-structured interviews and analyzed based on qualitative content analysis principles. Three themes were derived from the data analysis, which represented Barriers and facilitators related to nurses (specialized knowledge and skills, psychological status, mentoring, professional communication), barriers and facilitators related to the work environment (nurses' performance evaluation, nursing workforce, comprehensive care facilities, workplace design, specialized unit), barriers and facilitators related to patients and caregivers (patient's participation in nursing care, patient adaptation, efficiency of formal caregivers). The experiences of the rehabilitation team shows that not only nurses, but also the environment, patients, and caregivers can affect the provision of care and change the quality of care. Identifying these factors can help managers, researchers, and clinical nurses to facilitate and improve rehabilitation nursing care by modifying the influencing factors.
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Affiliation(s)
- Shima Shirozhan
- Nursing Department, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Narges Arsalani
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,*Correspondence: Narges Arsalani ;
| | | | - Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Assessing the risk for falls among Portuguese community-dwelling stroke survivors. Are we using the better tools? Observational study. Porto Biomed J 2022; 7:e160. [PMID: 35801217 PMCID: PMC9257293 DOI: 10.1097/j.pbj.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/09/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk.
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Farr B, Olver J, Fedele B, McKenzie D. Co-Located or Freestanding Multi-Trauma Orthopedic Rehabilitation. PM R 2020; 13:153-158. [PMID: 32306518 DOI: 10.1002/pmrj.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Multi-trauma rehabilitation is delivered in a variety of hospital settings. However, it is unclear whether the proximity of rehabilitation to acute services has an effect on rehabilitation outcomes. OBJECTIVE To evaluate whether the primary outcomes of an inpatient multi-trauma rehabilitation program (functional outcome and length of rehabilitation stay) are impacted when rehabilitation is delivered in a unit co-located in an acute hospital compared with a unit located in a freestanding hospital. To also compare these outcomes at a national level using data provided by the Australasian Rehabilitation Outcomes Centre (AROC). DESIGN Observational, retrospective audit study. SETTING An inpatient, orthopedic, multi-trauma rehabilitation unit that re-located from an acute co-located facility to a freestanding facility. PATIENTS Patients following multi-trauma injury admitted to the co-located rehabilitation unit (n = 216) or after its relocation to the freestanding rehabilitation unit (n = 186). METHODS Data were audited from the patients' hospital medical records including demographics, injury characteristics, and rehabilitation outcome measures (Functional Independence Measure [FIM] and length of rehabilitation stay). OUTCOME MEASURES The primary outcome variables were motor FIM change (change in function between admission and discharge), FIM efficiency (functional gain per inpatient day), and length of rehabilitation stay. RESULTS There were no statistically significant differences between the two settings in terms of motor FIM change (adjusted for admission motor FIM score) and motor FIM efficiency. In general, there was no statistically significant difference in length of rehabilitation stay between settings (median: 26 vs 27 days). At a national level, the majority of facilities offering inpatient multi-trauma rehabilitation are co-located. Nationally, freestanding units resulted in a slightly greater motor FIM change (difference between median changes adjusted for baseline = -.5, 95% confidence interval [CI] = -2.5, -0.6, P = .0012). CONCLUSIONS There were no differences observed in outcomes between multidisciplinary rehabilitation programs in either setting. Optimizing the individual components of a rehabilitation program and improving staff skill sets should be a focus going forward.
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Affiliation(s)
- Babak Farr
- Epworth HealthCare, Melbourne, Australia.,Chronic Pain Service, Austin Health, Melbourne, Australia.,Department of Anaestheisa and Pain management, Western Health, Melbourne, Australia
| | - John Olver
- Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bianca Fedele
- Epworth HealthCare, Melbourne, Australia.,Department of Rehabilitation, Epworth Monash Rehabilitation Medicine Unit (EMReM), Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Dean McKenzie
- Epworth HealthCare, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Lipson-Smith R, Churilov L, Newton C, Zeeman H, Bernhardt J. A Framework for Designing Inpatient Stroke Rehabilitation Facilities: A New Approach Using Interdisciplinary Value-Focused Thinking. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:142-158. [PMID: 30799632 PMCID: PMC6745610 DOI: 10.1177/1937586719831450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aim: To use Value-Focused Thinking to investigate what is important in the design
of inpatient stroke rehabilitation facility buildings. Background: Many stroke patients require inpatient rehabilitation in a dedicated
facility. Rehabilitation facilities are healthcare spaces, but they are also
learning spaces where patients practice targeted tasks to acquire new skills
and to reacquire skills and abilities that were compromised as a result of
their stroke. There is currently no consensus regarding how the design of
inpatient rehabilitation facilities could be optimized for patients’
learning. Method: We used Value-Focused Thinking to develop a framework of what
interdisciplinary experts consider important for inpatient stroke
rehabilitation facility design. Two workshops were conducted. The following
experts were invited to participate: past patients with experience of stroke
rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation
academics; healthcare environments academics; learning environments
academics; architects, designers, and wayfinders with experience designing
healthcare or learning environments; and healthcare design policy
makers. Results: Thirty experts participated. The experts’ final framework included 16
criteria that were considered fundamentally important for inpatient stroke
rehabilitation facility design, and 14 criteria that were considered
instrumentally important. Inpatient stroke rehabilitation facility design
should maximize efficiency, maximize effectiveness (i.e., patients’ clinical
and functional outcomes), foster emotional well-being, and maximize safety.
Opportunities to practice physical, cognitive, and social activity were
considered important for patients’ outcomes. Conclusions: Value-Focused Thinking was an effective and equitable means of engaging
experts from multiple disciplines. Designers, planners, and developers of
inpatient stroke rehabilitation facilities should consider the
rehabilitation-specific framework developed in this study alongside evidence
from other healthcare settings.
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Affiliation(s)
- Ruby Lipson-Smith
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Newton
- Faculty of Architecture, Building and Planning, University of Melbourne, Melbourne, Victoria, Australia
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,The Hopkins Centre Research for Rehabilitation and Resilience, Brisbane, Queensland, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria, Australia
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Sabari JS, Woodbury M, Velozo CA. Rasch analysis of a new hierarchical scoring system for evaluating hand function on the motor assessment scale for stroke. Stroke Res Treat 2014; 2014:730298. [PMID: 25177513 PMCID: PMC4142312 DOI: 10.1155/2014/730298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/22/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives. (1) To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS), an existing instrument used for clinical assessment of motor performance in stroke survivors; (2) To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients (N = 332) receiving stroke rehabilitation following left (52%) or right (48%) cerebrovascular accident; mean age 64.2 years (sd 15); median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results. The new scales assessing hand movements and hand activities met Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS. The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy.
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Affiliation(s)
- Joyce S. Sabari
- College of Health Related Professions, Occupational Therapy Program, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Michelle Woodbury
- Ralph H Johnson VA Medical Center, Charleston, SC 29425, USA
- Department of Health Sciences and Research, Medical University of SC, Charleston, SC 29425, USA
| | - Craig A. Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC 29425, USA
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New PW, Andrianopoulos N, Cameron PA, Olver JH, Stoelwinder JU. Reducing the length of stay for acute hospital patients needing admission into inpatient rehabilitation: a multicentre study of process barriers. Intern Med J 2014; 43:1005-11. [PMID: 23800164 DOI: 10.1111/imj.12227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient flow is a major problem in hospitals. Delays in accessing inpatient rehabilitation have not been well studied. AIMS Measure the time taken for key processes in the patient journey from acute hospital admission through to inpatient rehabilitation admission in order to identify opportunities for improvement. METHODS Retrospective open cohort study. All patients admitted over 8- and 10-month periods during 2008 into two inpatient rehabilitation units in Melbourne, Australia. Main outcome measures were the duration of the following key processes: acute hospital admission until referral for rehabilitation, referral until assessment by the rehabilitation service, assessment until deemed ready for transfer to rehabilitation, ready for transfer until rehabilitation admission. RESULTS Three hundred and sixty patients were in the study sample (females = 186; 51.7%); mean age = 58.4 (standard deviation = 15.0) years. There was a median of 7 (interquartile range [IQR] 4-13) days from acute hospital admission till referral for rehabilitation, a median of 1 (IQR 0-1) day from referral till assessment, a median of 0 (IQR 0-2) days from assessment till deemed ready for transfer and a median of 1 (IQR 0-3) day from ready till admission into rehabilitation. Overall, patients spent 12.0% (804/6682) of their acute hospital admission waiting for a rehabilitation bed. CONCLUSIONS There are opportunities to improve the efficiency of key processes in the acute hospital journey for patients subsequently admitted to inpatient rehabilitation; in particular, reducing the time from acute hospital admission till referral for rehabilitation and from being deemed ready for transfer to rehabilitation till admission.
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Affiliation(s)
- P W New
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Yang SN, Park SW, Jung HY, Rah UW, Kim YH, Chun MH, Paik NJ, Yoo SD, Pyun SB, Kim MW, Lee SG, Park BK, Shin H, Shin YI, Lee H, Han TR. Korean Brain Rehabilitation Registry for rehabilitation of persons with brain disorders: annual report in 2009. J Korean Med Sci 2012; 27:691-6. [PMID: 22690103 PMCID: PMC3369458 DOI: 10.3346/jkms.2012.27.6.691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 03/13/2012] [Indexed: 11/20/2022] Open
Abstract
This first annual report provides a description of patients discharged from rehabilitation facilities in Korea based on secondary data analysis of Korean Brain Rehabilitation Registry V1.0 subscribed in 2009. The analysis included 1,697 records of patients with brain disorders including stroke, traumatic brain injury, brain tumor and other disorders from 24 rehabilitation facilities across Korea. The data comprised 1,380 cases of stroke, 104 cases of brain injury, 55 cases of brain tumor, and 58 cases of other brain diseases. The functional status of each patient was measured using the Korean version of the Modified Barthel Index (KMBI). The average change in the KMBI score was 15.9 for all patients in the inpatient rehabilitation facility. The average length of stay for inpatient rehabilitation was 36.9 days. The transfer rates to other hospitals were high, being 62.4% when all patients were considered. Patients with brain disorders of Korea in 2009 and measurable functional improvement was observed in patients. However, relatively high percentages of patients were not discharged to the community after inpatient rehabilitation. Based on the results of this study, consecutive reports of the status of rehabilitation need to be conducted in order to provide useful information to many practitioners.
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Affiliation(s)
- Seung Nam Yang
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
- Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
- Department of Rehabilitation Medicine, Myongji Choonhey Rehabilitation Hospital, Seoul, Korea
| | - Han Young Jung
- Department of Rehabilitation Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ueon Woo Rah
- Department of Rehabilitation Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yun-Hee Kim
- Department of Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University, College of Medicine, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Wook Kim
- Department of Rehabilitation Medicine, The Catholic University of Korea Medical School, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Byung Kyu Park
- Department of Rehabilitation Medicine, Korea University College of Medicine, Seoul, Korea
| | - Heesuk Shin
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Korea
- Department of Rehabilitation Medicine, Wonkwang University College of Medicine, Iksan, Korea
| | - Heeyeon Lee
- Department of Rehabilitation Standard and Policy, National Rehabilitation Center Research Institute, Seoul, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University, College of Medicine, Seoul, Korea
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