Multidisciplinary perceptions of the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care

My job impacts my sleep: signs and symptoms of insomnia among healthcare workers

Potential insomnia in healthcare workers is a public health concern as it may degrade the quality of patient care. We examined the prevalence of insomnia symptoms in healthcare workers and their perceived need for a sleep intervention. Participants were 62 nurses working full-time at a U.S. hospital. These nurses were asked about background characteristics, perceived stress, sleep concerns, and need for a sleep intervention. They also participated in 14-d ecological momentary assessment (EMA) and actigraphy sleep study. A qualitative analysis showed that the majority (92%) of participants reported at least one sleep concern with insomnia-related concerns being most prevalent (68%). Quantitative analyses indicated that those with insomnia-related concerns had higher perceived stress overall and lower EMA sleep sufficiency and sleep quality. Moreover, participants with insomnia concerns had shorter actigraphy-measured nap duration prior to non-workdays than those without. Nearly all (95%) expressed interest in participating in a sleep intervention; an online format and mindfulness contents were most preferred. Our results suggest a high prevalence of insomnia symptoms and a high interest in a sleep intervention in nurses. Information obtained from this study could be used to deliver a tailored sleep intervention for nurses whose role in public health is essential.

The Role of Engagement in Teleneurorehabilitation: A Systematic Review

The growing understanding of the importance of involving patients with neurological diseases in their healthcare routine either for at-home management of their chronic conditions or after the hospitalization period has opened the research for new rehabilitation strategies to enhance patient engagement in neurorehabilitation. In addition, the use of new digital technologies in the neurorehabilitation field enables the implementation of telerehabilitation systems such as virtual reality interventions, video games, web-based interventions, mobile applications, web-based or telephonic telecoach programs, in order to facilitate the relationship between clinicians and patients, and to motivate and activate patients to continue with the rehabilitation process at home. Here we present a systematic review that aims at reviewing the effectiveness of different engagement strategies and the different engagement assessments while using telerehabilitation systems in patients with neurological disorders. We used PICO's format to define the question of the review, and the systematic review protocol was designed following the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographical data was collected by using the following bibliographic databases: PubMed, EMBASE, Scopus, and Web of Science. Eighteen studies were included in this systematic review for full-text analyses. Overall, the reviewed studies using engagement strategies through telerehabilitation systems in patients with neurological disorders were mainly focused on patient self-management and self-awareness, patient motivation, and patient adherence subcomponents of engagement, that are involved in by the behavioral, cognitive, and emotional dimensions of engagement. Conclusion: The studies commented throughout this systematic review pave the way for the design of new telerehabilitation protocols, not only focusing on measuring quantitative or qualitative measures but measuring both of them through a mixed model intervention design (1). The future clinical studies with a mixed model design will provide more abundant data regarding the role of engagement in telerehabilitation, leading to a possibly greater understanding of its underlying components.

Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal

BACKGROUND

Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.

AIM

The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children.

SETTING

The study was conducted in a local district hospital in Ugu, KwaZulu-Natal.

METHODS

An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis.

RESULTS

Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.

CONCLUSION

In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.

Awareness and Knowledge about Occupational Therapy in Jordan

Knowledge and awareness about occupational therapy (OT) are essential for the delivery of quality care to all clients and for occupational therapists' (OTRs) job satisfaction. OT has been a poorly understood profession in Jordan. The current study reports on the assessment of Jordanians' awareness and knowledge of occupational therapy. Convenience sampling was used. There were 829 participants (474 males, 355 females), with mean age of 32 ± 11.6 yrs. They were recruited from the three main geographical areas of Jordan (northern, central, and southern) and from all educational levels. The sample included 222 (26.8%) healthcare personnel, 146 (17.6%) clients, and 461 (55.6%) lay persons. Participants completed questionnaires, and the results revealed that 48% of the sample had poor or no knowledge about OT, while 28.3% were unaware of it. Also, OT was commonly (50%) perceived to be exclusively targeting people with disabilities (PWDs) and neurological and physical conditions (58% and 53%, resp.) in addition to exclusively providing services for the rehabilitation of the upper extremity (48%). Common misconceptions associated with OT were that OTRs prescribe medication (43%) and OTRs are physiotherapists (44%). These preliminary findings suggest that efforts need to be directed by OTRs, the Jordanian Society of Occupational Therapy (JSOT), and the Ministry of Health to preserve the OT identity and value and promote knowledge about OT in the public and among members of interdisciplinary teams. More interprofessional learning needs to be incorporated within the curricula and placements of all healthcare personnels.

Nurse's perceptions of physiotherapists in critical care team: Report of a qualitative study

Background:

Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses’ perceptions of the role of physiotherapists in the critical care team.

Methods:

Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question.

Results:

Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship.

Conclusion:

Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.

[Activating therapeutic care in geriatrics : Evaluation of a practice concept]

BACKGROUND

The special feature of the concept of activating therapeutic care in geriatrics (ATP-G) is based on the focus of nursing and therapeutic elements specifically related to the elderly. Further significance lies in the bottom-up development of this concept, which shows a close proximity to the nursing practice.

OBJECTIVES

The research project targeted the characteristics of ATP-G from a nursing point of view. Furthermore, the resulting elements of professional nursing care understanding for inpatient geriatric rehabilitation were used to build a scientific and theoretical foundation of the ATP-G concept.

MATERIAL AND METHODS

In this study 12 semi-structured interviews with professional caregivers were realized. The data collection was undertaken in three different facilities of inpatient geriatric (early) rehabilitation, chosen by lot. The data analysis was based on the methodology of qualitative content analysis according to Mayring.

RESULTS AND CONCLUSION

The research project showed that the basic elements described in the ATP-G concept are consistent with the view of nursing practitioners and therefore reflect the characteristic features of routine daily practice; nonetheless, some new aspects were found, primarily the importance of interdisciplinary teamwork in geriatric settings. There were also difficulties related to the ATP-G concept which were experienced as restraints by the questioned professionals. Further research should therefore investigate the structures for optimal implementation of the ATP-G concept into standard practice.

Improving neuro-oncological patients care: basic and practical concepts for nurse specialist in neuro-rehabilitation

Background

Neuro-oncological population well expresses the complexity of neurological disability due to the multiple neurological deficits that affect these patients. Moreover, due to the therapeutical opportunities survival times for patients with brain tumor have increased and more of these patients require rehabilitation care. The figure of nurse in the interdisciplinary specialty of neurorehabilitation is not clearly defined, even if their role in this setting is recognized as being critical and is expanding.

The purpose of the study is to identify the standard competencies for neurorehabilitation nurses that could be taught by means of a specialization course.

Methods

A literature review was conducted with preference given to works published between January 2000 and December 2008 in English. The search strategy identified 523 non-duplicated references of which 271 titles were considered relevant. After reviewing the abstracts, 147 papers were selected and made available to a group of healthcare professionals who were requested to classify them in few conceptual main areas defining the relative topics.

Results

The following five main areas were identified: clinical aspects of nursing; nursing techniques; nursing methodology; relational and organisational models; legal aspects of nursing. The relative topics were included within each area. As educational method a structured course based on lectures and practical sessions was designed. Also multi-choices questions were developed in order to evaluate the participants’ level of knowledge, while a semi-structured interview was prepared to investigate students’ satisfaction.

Conclusions

Literature shows that the development of rehabilitation depends on the improvement of scientific and practical knowledge of health care professionals. This structured training course could be incorporated into undergraduate nursing education programmes and also be inserted into continuing education programmes for graduate nurses. Developing expertise in neuro-rehabilitation for nurses, will be critical to improve overall care and care management of patients with highly complex disabilities as patients affected by brain tumors. The next step will be to start discussing, at the level of scientific societies linked to the field of neurorehabilitation and oncology, the development of a specialisation course in neurorehabilitation nursing.

The role of the occupational therapist in Jordan: a survey of the members of the healthcare team exploring their knowledge about occupational therapy in rehabilitation hospitals

PURPOSE

Occupational therapy (OT) is a developing profession that has only been introduced to Jordanian hospitals 18 years ago. The main objective of this study was to explore the level of knowledge the healthcare team members in Jordanian rehabilitation hospitals have about OT.

METHOD

Two hundred and fifty questionnaires were distributed to different members in the healthcare team in three major hospitals in Jordan. One hundred fifty-three questionnaires were returned and used for analysis.

RESULTS

Collectively, the results revealed a fair knowledge level about OT among the healthcare team members in rehabilitation, who stated that the main responsibilities of this profession were rehabilitation for activities of daily living, hand therapy and increasing the quality of life for disabled people. Furthermore, the majority of the respondents agreed that OT is a vital profession that plays an important role in rehabilitation teams, and expressed their expectations of developing standards and regulations for this profession.

CONCLUSION

Actions should be channelled towards educating members of the team about OT through university curriculum. It is critical that the Jordanian Ministry of Health establishes specific statements and regulations which clarify the role of the OT within different settings of the healthcare system.

Shifting roles in nursing--does role extension require role abdication?

AIMS AND OBJECTIVES

To discuss findings relating to role extension and loss of nursing care to auxiliary nurses.

BACKGROUND

There is ongoing discussion in the literature about what nurses' roles may be and how the extension of role affects patient care. Various models have been devised to measure outcomes and the value of nursing to patients. However, there are limited data on the views of nurses themselves in terms of what they perceive their role to be and what they feel about role change.

DESIGN

A qualitative approach was used with the help of the elements of grounded theory.

METHODS

Data were analysed using a constant comparative method with core categories identified. The study described in this paper was the final of three. The first two studies involved student nurses and through theoretical sampling, the third sample was chosen to expand the data gained from the students.

RESULTS

The findings from the student studies indicated concern that the nursing role was being undertaken by auxiliary nurses. The results of the final study, as discussed in this paper, confirmed this. However, one main difference was that qualified nurses were not necessarily unhappy about auxiliary nurses' role expansion but were concerned that the role of the nurse was moving away from the bedside.

CONCLUSIONS

The data suggest that nurses' roles may be hard to define. An abdication of role, as opposed to delegation of role, seems to be occurring. Critical thinking is needed to ensure this is a decision advocated by clinical nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be explicit about what their clinical roles are. This study provides data expressing the views of clinical nurses about role expansion and role abdication and corresponding feelings about it.