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Angel S, Steensgaard R, Kolbaek R, Frimann S. Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1267401. [PMID: 38149111 PMCID: PMC10749968 DOI: 10.3389/fresc.2023.1267401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
Introduction The power of action research to create change by anchoring research results in practice was challenged in an action research project at a specialized rehabilitation unit for persons with acquired spinal cord injury. Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for the practicing of nursing. We aimed to raise awareness of the mechanisms that govern barriers by exploring these barriers as experienced by nurses in their effort to change their practice to improve patient participation. Method We used Fairclough's critical discourse analysis drawing on Foucault's practical systems; ethics (identity, relation to oneself), power (action, relation to others), and knowledge (representation, aspects of the world), which he combines with discourse-analytical concepts. Results Our discourse analysis of the empirical data at micro-level uncovers the nature of barriers to change in practice. In addition, our analysis at macro-level unveils how these practices are embedded in larger historical, societal, and institutional discourses. This identified two current discourses: a biomedical discourse and a biopsychosocial discourse. In the light of these two discourses, the nurses at micro-level saw themselves as strong agents for the best rehabilitation by acting in accordance with the biopsychosocial discourse. But they were unable to find the time and space to do so due to tasks, structures, and practices specified by an organization dominated by the biomedical discourse.
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Affiliation(s)
- Sanne Angel
- Research Unit of Nursing and Healthcare, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Randi Steensgaard
- Specialized Hospital for Polio and Accident Victims, Aarhus, Denmark
| | - Raymond Kolbaek
- Research Unit of Nursing and Healthcare, Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Søren Frimann
- Department of Culture and Learning, Aalborg University, Aalborg, Denmark
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Wasilewski MB, Szigeti Z, Sheppard CL, Minezes J, Hitzig SL, Mayo AL, Robinson LR, Lung M, Simpson R. Patients, Caregivers, and Healthcare Providers' Experiences with COVID Care and Recovery across the Care Continuum: A Qualitative Study. Int J Integr Care 2023; 23:27. [PMID: 37333775 PMCID: PMC10275165 DOI: 10.5334/ijic.6952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/01/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction During the COVID-19 pandemic, discharge timelines were accelerated and patients were moved across the continuum of care, from acute to post-acute care, to relieve the strain in health system capacity. This study aimed to investigate the COVID-19 care pathway from the perspective of patients, caregivers, and healthcare providers to understand their experiences with care and recovery within and across care settings. Methods A qualitative descriptive study. Patients and their families from an inpatient COVID-19 unit and healthcare providers from an acute or rehabilitation COVID-19 unit were interviewed. Results A total of 27 participants were interviewed. Three major themes were identified: 1) The perceived quality and pace of COVID-19 care improved from acute care to inpatient rehabilitation; 2) Care transitions were especially distressing; and 3) Recovery from COVID-19 stagnated in the community. Conclusion Inpatient rehabilitation was viewed as higher quality due to the slower paced care. Care transitions were distressing for stakeholders and enhanced integration between acute and rehabilitation care were suggested to improve patient handover. A lack of rehabilitation access led to recovery stagnating for patients discharged to the community. Telerehab may improve the transition to home and ensure access to adequate rehabilitation and support in the community.
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Affiliation(s)
- Marina B. Wasilewski
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, CA
| | - Zara Szigeti
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, CA
| | | | - Jacqueline Minezes
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John’s Rehab, Sunnybrook Health Sciences Centre, CA
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, CA
| | - Amanda L. Mayo
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, CA
| | - Lawrence R. Robinson
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, CA
| | - Maria Lung
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John’s Rehab, Sunnybrook Health Sciences Centre, CA
| | - Robert Simpson
- Department of Physical Medicine and Rehabilitation & Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, CA
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Vaalburg AM, Wattel E, Boersma P, Hertogh C, Gobbens R. Goal-setting in geriatric rehabilitation: Can the nursing profession meet patients' needs? A narrative review. Nurs Forum 2021; 56:648-659. [PMID: 33625738 PMCID: PMC8451803 DOI: 10.1111/nuf.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To provide an overview of patients' needs concerning goal-setting, and indications of how those needs can be met by nurses. METHODS A narrative review. Pubmed and Cinahl were searched through March 1, 2020 for: patients' experiences concerning goal-setting and the role of nursing in rehabilitation. Additional articles were found through snowballing. A total of 22 articles were reviewed on patients' experiences, and 12 on the nursing role. RESULTS Patients need to be prepared for collaborating in goal-setting and to receive an explanation about their part in that process. The multiplicity of disciplines may cloud patients' understanding of the process. The nurse's planning of the rehabilitation process should be aimed at resolving this issue. Goals need to be meaningful, and patients need support in attaining them. The interpretive, integrative, and consoling functions of Kirkevold's nursing role are suitable to meet these needs. CONCLUSIONS Both the literature about patients' needs regarding goal-setting and the nursing role make clear that the way nurses work in rehabilitation can gain in clarity. Strengthening the role of nurses will improve the goal-setting process for patients. Interprofessional collaboration, clear work procedures, continuity of care, time and trust, and the physical environment all are important to reinforce this role.
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Affiliation(s)
- Anne Marie Vaalburg
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Elizabeth Wattel
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
| | - Cees Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research InstituteAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social WorkInholland University of Applied SciencesAmsterdamThe Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
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Cummins C, Payne D, Kayes NM. Governing neurorehabilitation. Disabil Rehabil 2021; 44:4921-4928. [PMID: 33989096 DOI: 10.1080/09638288.2021.1918771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Person centred approaches to rehabilitation are promoted as an ethical means of addressing paternalistic power relations in clinician dominated medical encounters and improving outcomes. However, they fail to account for the complex nature of power. We sought alternative ways to explain the use of power in health service provision. METHODS A poststructural discourse analysis using the view of power offered by Michel Foucault was undertaken. Foucault's concept of governmentality is useful to explain the way health services deploy technologies of power to achieve objectives of the state. Governmentality refers to not just political structures but all the strategies and procedures for directing human behaviour. RESULTS Our investigation uncovered a web of strategic relationships operating that were both potentially productive and problematic and illuminate how client centred approaches in neurorehabilitation intertwines its subjects in strategic power relationships that involve webs of obligations and responsibilities. CONCLUSION The client-professional relationship promoted in neurorehabilitation as a moral way to practice can be a tool for mastery of one over the other, and assist the client to achieve their desired ends, but also has the potential to marginalise others who are unable to shape themselves into the desired ideal client.Implications for rehabilitationThis analysis shows how power is subtle and productive in that it produces knowledge and roles for both clients and practitioners.It demonstrates how neurorehabilitation's disciplinary practices assist the client to achieve their recovery goals.It reveals how certain clients might be marginalised when they cannot shape themselves into the ideal rehabilitation client.As a final point we hope that by being aware of how power works in neurorehabilitation, practitioners can become aware of opportunities for challenging disciplinary practices that do not serve the best interest of the client.
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Affiliation(s)
- Christine Cummins
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Payne
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.,Centre for Midwifery and Women's Health Research, Auckland University of Technology, Auckland, New Zealand
| | - Nicola M Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Loft MI, Poulsen I, Esbensen BA, Iversen HK, Mathiesen LL, Martinsen B. Nurses’ and nurse assistants’ beliefs, attitudes and actions related to role and function in an inpatient stroke rehabilitation unit-A qualitative study. J Clin Nurs 2017; 26:4905-4914. [DOI: 10.1111/jocn.13972] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mia I Loft
- Department of Neurology; Rigshospitalet; Glostrup Denmark
- Department of Nursing Science; Institute of Public Health; Aarhus University; Aarhus C Denmark
| | - Ingrid Poulsen
- Department of Nursing Science; Institute of Public Health; Aarhus University; Aarhus C Denmark
- Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC); Clinic of Neurorehabilitation; TBI unit Rigshospitalet; Hvidovre Denmark
| | - Bente A Esbensen
- Copenhagen Centre for Arthritis Research (COPECARE); Centre for Rheumatology and Spine Diseases VRR; Head and Orthopaedics Centre; Rigshospitalet - Glostrup; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Helle K Iversen
- Department of Neurology; Rigshospitalet; Glostrup Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Bente Martinsen
- Department of Public Health; Section of Nursing; Faculty of Health; Aarhus University; Copenhagen NV Denmark
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Pryor J. Compensatory care: The elephant in the in-patient rehabilitation room. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.4.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julie Pryor
- Rehabilitation Nursing Research and Development Unit, Royal Rehabilitation Centre Sydney, Associate Professor, School of Medicine, Flinders University
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Staniford LJ, Breckon JD, Copeland RJ, Hutchison A. Key stakeholders' perspectives towards childhood obesity treatment: a qualitative study. J Child Health Care 2011; 15:230-44. [PMID: 21917596 DOI: 10.1177/1367493511404722] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Over the past three decades, there has been a dramatic global increase in childhood obesity. A better understanding of stakeholders' perceptions of intervention requirements could contribute to developing more effective interventions for childhood obesity. This study provides a qualitative, in-depth, analysis of stakeholders' (children, parents and health professionals) perspectives toward the efficacy of childhood obesity treatment interventions. Twenty-six stakeholders were recruited using purposive sampling; semi-structured interviews were adopted to explore stakeholders' perceptions with data analysed using a framework approach. Stakeholders concurred that treatment should be family-based incorporating physical activity, nutrition and psychological components, and be delivered in familiar environments to recipients. However, incongruence existed between stakeholders towards the sustainability of obesity treatment interventions. Parents and children reported needing ongoing support to sustain behavioural changes made during treatment, while health professionals suggested interventions should aim to create autonomous individuals who exit treatment and independently sustain behaviour change. This study provides an insight into issues of stakeholder involvement in the obesity intervention design and delivery process. To promote long-term behaviour change, there needs to be increased congruence between the delivery and receipt of childhood obesity treatment interventions. Interventions need to incorporate strategies that promote autonomous and self-regulated motivation, to enhance families' confidence in sustaining behaviour change independent of health professional support.
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Aadal L, Kirkevold M. Integrating situated learning theory and neuropsychological research to facilitate patient participation and learning in traumatic brain injury rehabilitation patients. Brain Inj 2011; 25:717-28. [PMID: 21604928 DOI: 10.3109/02699052.2011.580314] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) constitutes a major health problem throughout the world. Despite interdisciplinary efforts, patients reach varying outcomes in terms of every-day life functioning and quality-of-life. This paper suggests that a situated learning perspective supplemented with evidence from neurophysiologic and neuropsychological research provides a perspective to get a grasp of problems typically encountered in rehabilitation. Applying such a perspective may help to facilitate patient participation and learning during the rehabilitation process by taking their altered abilities into consideration. METHOD Qualitative study. Theoretical analysis and synthesis of 'situated learning theory', neuropsychological theory and empirical studies of cognitive and emotional functioning following a TBI collected through interviews with 11 interdisciplinary rehabilitation experts and a field study of two patients at a rehabilitation hospital. The data were analysed from a hermeneutic perspective using N-VIVO 8. RESULTS/CONCLUSION Patients with severe TBI pose challenges in terms of being participants in the 'rehabilitation practice community'. Two levels of pedagogical challenges seem to exist: Helping the patient regain or compensate for changed learning abilities and supporting the patient in learning or compensating for lost abilities. This study highlighted six main categories of changed abilities that need to be considered in developing a practice which fosters re-learning: perception, attention, memory, language, physical competencies and emotion/model of behaviour.
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Affiliation(s)
- L Aadal
- Hammel Neurorehabilitation and Research Centre, Voldbyvej 15, Hammel, Denmark.
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A model for neurorehabilitation after severe traumatic brain injury: facilitating patient participation and learning. ANS Adv Nurs Sci 2011; 34:E1-E17. [PMID: 21304277 DOI: 10.1097/ans.0b013e318209b01a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During intensive neurorehabilitation, it is a professional challenge that patients with severe traumatic brain injury may have changed abilities to learn. PURPOSE To develop, initially test, and evaluate a model for neurorehabilitation aimed at systematizing and facilitating professionals' efforts of promoting patients' participation and learning. METHODS Qualitative study inspired by action research. Empirical data were analyzed by a theoretical framework of "didactic relation model," "situated learning theory," and neurophysiologic/neuropsychological categories of learning premises. FINDINGS Our findings indicate that the model for neurorehabilitation expands and systematizes the professional's reflections and interventions aimed at facilitating learning among patients with traumatic brain injury.
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Pryor J, Walker A, O'Connell B, Worrall-Carter L. Opting in and opting out: a grounded theory of nursing’s contribution to inpatient rehabilitation. Clin Rehabil 2009; 23:1124-35. [DOI: 10.1177/0269215509343233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation. Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory. Setting: Five inpatient rehabilitation units in Australia. Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice. Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable. Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.
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Affiliation(s)
- Julie Pryor
- Rehabilitation Nursing Research and Development Unit, Royal Rehabilitation Centre Sydney, Flinders University, , Charles Sturt University
| | | | | | - Linda Worrall-Carter
- St Vincent's Hospital & Australian Catholic University National, Centre for Nursing Research, Australia
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