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Steensgaard R, Kolbaek R, Angel S. Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation. Health Expect 2022; 25:2525-2533. [PMID: 36004714 PMCID: PMC9615065 DOI: 10.1111/hex.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Persons with spinal cord injury have experienced a life‐changing event, and they need to engage in the rehabilitation process to adjust to their current situation and future living conditions. Due to the highly contextual and varying psychological and physical ability to participate from patient to patient during rehabilitation, this is difficult for the injured person and for health professionals to support. Therefore, the aim of the study was to develop and facilitate patient participation by engaging nursing staff and from this engagement in the process, disclose methods to support participation. Methods The processes conducted were based on an action research approach, from problem identification to the development, test and evaluation of four new nursing initiatives. The initiatives were developed by eight nursing staff members who participated actively as co‐researchers in a 2‐year study conducted at a Spinal Cord Injury Centre in Denmark from 2016 to 2018. Data evolved from workshops, transcriptions of meetings and written evaluations and was further analysed using Ricoeur's phenomenological‐hermeneutic approach. Results Action research processes facilitated the development of four communicative initiatives and a shift in the nursing staff's support of the patient. In a collaborative process, the nursing staff acted as participants in the patient's rehabilitation. Awareness of the patient's perspective facilitated a caring, attentive and engaged approach from the nursing staff, which promoted rehabilitation tailored to the individual. Conclusion Patient participation was enhanced when nursing staff actively participated in the development of initiatives and a culture supporting a person‐to‐person approach involving the patient and themselves as equal participants in the collaborative rehabilitation process. Patient or Public Contribution Eight nursing staff members from the rehabilitation centre participated throughout the study as co‐researchers. Patients participated in observations and as informants in interviews during the first phase to identify challenges to patient participation. Patients also participated in testing the nursing initiatives during the action phase (Phase 3). Furthermore, a former patient was a member of the advisory board.
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Affiliation(s)
- Randi Steensgaard
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Central Region Hospital, Viborg, Denmark.,Centre for Research in Clinical Nursing, Central Region Hospital, Viborg, Denmark
| | - Raymond Kolbaek
- Centre for Research in Clinical Nursing, Central Region Hospital, Viborg, Denmark.,Department of Nursing, Campus Viborg-VIA University College, Viborg, Denmark
| | - Sanne Angel
- Research Unit for Nursing and Healthcare, Institute of Public Health, Aarhus University, Aarhus, Denmark
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Hitzig SL, Jeyathevan G, Farahani F, Noonan VK, Linassi G, Routhier F, Jetha A, McCauley D, Alavinia SM, Omidvar M, Craven BC. Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S79-S93. [PMID: 34779731 PMCID: PMC8604477 DOI: 10.1080/10790268.2021.1955204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Community participation following spinal cord injury/disease (SCI/D) can be challenging due to associated primary impairments and secondary health conditions as well as difficulties navigating both the built and social-emotional environment. To improve the quality of SCI/D rehabilitation care to optimize community participation, the SCI-High Project developed a set of structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. A pan-Canadian Working Group of diverse stakeholders: (1) defined the community participation construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with community participation; and (4) prepared a process map. Facilitated meetings allowed selection and review of a set of structure, process and outcome indicators. The structure indicator is the proportion of SCI/D rehabilitation programs with availability of transition living setting/independent living unit. The process indicators are the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend. The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index. The proposed indicators have the potential to inform whether inpatient rehabilitation for persons with SCI/D can improve self-efficacy and lead to high levels of community participation post-rehabilitation discharge.
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Affiliation(s)
- Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gaya Jeyathevan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | | | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - François Routhier
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Québec, Canada
| | - Arif Jetha
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
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Maribo T, Jensen CM, Madsen LS, Handberg C. Experiences with and perspectives on goal setting in spinal cord injury rehabilitation: a systematic review of qualitative studies. Spinal Cord 2020; 58:949-958. [PMID: 32424174 DOI: 10.1038/s41393-020-0485-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review of qualitative studies. OBJECTIVE To synthesise qualitative research exploring the experiences and perspectives of persons with spinal cord injury (SCI), relatives and health professionals concerning goal setting in SCI rehabilitation. METHODS Five electronic databases were searched. A search strategy was constructed with key concepts identified using PICo (Population, phenomena of Interest and Context). Peer reviewed studies complying with the inclusion criteria were selected. Interpretive Description methodology guided analysis and synthesis of the findings. RESULTS The search yielded 427 records. Of 12 full text studies assessed for eligibility, four were included describing goal setting in SCI rehabilitation from the perspective of persons with SCI and health professionals. Persons with SCI described a need for goal setting to be related to their everyday life, whereas the health professionals tended to use the hospital setting as their point of reference. Persons with SCI emphasised the importance of being self-directed and taking an active role in goal setting and rehabilitation. No studies presented the perspective of relatives. CONCLUSIONS This review illuminates the divergence in the understanding of goal setting between persons with SCI and health professionals. Goal setting in SCI rehabilitation often directly reflects physical functioning goals set by the health professionals, which does not prepare persons with SCI for everyday life and emotional issues. There is lack of focus on goals addressing psychosocial components such as family issues and change of roles. A shared process with goal setting relevant to persons with SCI and their everyday life is needed.
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Affiliation(s)
- Thomas Maribo
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark. .,DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - Charlotte Maria Jensen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,The Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | - Louise Sofia Madsen
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
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Angel S, Kroll T. Sex Life During the First 10 Years After Spinal Cord Injury: A Qualitative Exploration. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09620-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Melin J, Persson LO, Taft C, Kreuter M. Patient participation from the perspective of staff members working in spinal cord injury rehabilitation. Spinal Cord 2018; 56:614-620. [DOI: 10.1038/s41393-018-0061-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 11/09/2022]
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Unger J, Singh H, Mansfield A, Hitzig SL, Lenton E, Musselman KE. The experiences of physical rehabilitation in individuals with spinal cord injuries: a qualitative thematic synthesis. Disabil Rehabil 2018; 41:1367-1383. [PMID: 29334811 DOI: 10.1080/09638288.2018.1425745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this thematic synthesis review was to identify and synthesise published qualitative research on the perspectives of individuals with spinal cord injuries with respect to physical rehabilitation interventions. MATERIALS AND METHODS The peer-reviewed literature was searched across seven databases and identified abstracts were independently screened by two reviewers. A thematic synthesis methodology was used to code and synthesise the results from the included studies. RESULTS In total, 7233 abstracts were identified; 31 articles were selected for inclusion, representing 26 physical rehabilitation interventions. The methodological quality of studies was moderate (Standards for Reporting Qualitative Research mean ± standard deviation = 14.39 ± 3.61). The four main themes developed were: (1) Benefits of physical rehabilitation, (2) Challenges of physical rehabilitation, (3) Need for support, and (4) Issue of control. CONCLUSIONS This qualitative thematic synthesis provides key insights into the experiences of individuals with spinal cord injuries who received physical rehabilitation. Recommendations for practice, based on the findings, include creating a diverse, encouraging, and educational physical rehabilitation experience with supportive staff who focus on communication and person-centred care. Implications for Rehabilitation Physical rehabilitation provides psychological as well as physical benefits to people with spinal cord injuries, including motivation, hope, improved self-confidence, and acceptance. Challenges identified during physical rehabilitation for people with spinal cord injuries, such as comparisons, negative emotions, recovery expectations, and slow progress, should be addressed by healthcare professionals to ensure person-centred care. People with spinal cord injuries identified a need for support from health care professionals, family, and friends, as well other people with spinal cord injuries. There is an issue of control in physical rehabilitation for people with spinal cord injuries, which can result in a fight with oneself or with healthcare professionals to regain the control that has been lost.
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Affiliation(s)
- Janelle Unger
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Canada
| | - Hardeep Singh
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Canada
| | - Avril Mansfield
- b Toronto Rehabilitation Institute , University Health Network , Toronto , Canada.,c Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute , Sunnybrook Health Sciences Centre , Toronto , Canada.,d Department of Physical Therapy, Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Sander L Hitzig
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Canada.,c Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute , Sunnybrook Health Sciences Centre , Toronto , Canada.,e Department of Occupational Science & Occupational Therapy , University of Toronto , Toronto , Canada
| | - Erica Lenton
- f Gerstein Science Information Centre , University of Toronto , Toronto , Canada
| | - Kristin E Musselman
- a Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada.,b Toronto Rehabilitation Institute , University Health Network , Toronto , Canada.,d Department of Physical Therapy, Faculty of Medicine , University of Toronto , Toronto , Canada
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Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Call for human contact and support: an interview study exploring patients’ experiences with inpatient stroke rehabilitation and their perception of nurses’ and nurse assistants’ roles and functions. Disabil Rehabil 2017; 41:396-404. [DOI: 10.1080/09638288.2017.1393698] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mia Ingerslev Loft
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Bente Appel Esbensen
- Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
- Clinic of Neurorehabilitation, TBI unit, Rigshospitalet, Hvidovre, Denmark
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Narratives of life with long-term low back pain: A follow up interview study. Scand J Pain 2017; 17:382-389. [DOI: 10.1016/j.sjpain.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 11/21/2022]
Abstract
Abstract
Background
Long-term low back pain is associated with multiple challenges to a person’s identity and social position. Despite efforts to understand the challenges of low back pain, recovery remains a major problem both personally and socially. This indicate a need for a different approach. Although personal stories have been used to extend knowledge of issues that relate to low back pain, they also make i possible to learn about how people understand themselves and their lives. As such, analysis of narrative: may provide further insights into people’s coping processes and novel insights about how best to support them.
Objective
The aim of the study was to analyse personal recovery narratives to gain an insight into how people understand themselves and cope with long-term low back pain 2-4 years after a bio-psycho-social counselling intervention.
Study design
Using a Ricoeurian phenomenological-hermeneutic perspective, qualitative in-depth interviews were undertaken and interpreted to explore people’s narratives of long-term recovery after an intervention.
Methods
We interviewed 25 informants 2-4 years after participating in a counselling intervention for low back pain where they were advised to exercise regularly; they were part of the intervention group in a randomised clinical trial. The sample included both informants who had benefited from the intervention and some who had not. Analysis was informed by Ricoeur’s interpretation theory.
Findings
The informants’ stories revealed two main narratives regarding themselves and their lives: (1) getting on with life without pain, (2) life with continual pain and variations of the emplotment. The first included Recovering from low back pain and returning to prior lifestyle if possible, Keeping low back pain in check by strict regimes, or Developing strategies when low back pain recurs. The second related to Finding a way to a functioning everyday life with continual pain while narratives of being stuck with low back pain and finding no way out highlight the significance of being able to configure a narrative that can support an understanding of the pain and how to deal with it to have a functioning life. Furthermore, the health professional has a significant role to play in the configuration of narratives.
Conclusions
The challenge for people with low back pain was to find ways of getting on with life, and this included their ability to configure an understandable narrative that opened up for a future, implying new understandings of the self and how life could be lived. When healthcare professionals offered personal and realistic suggestions to the informants’ configuration of narratives of life with low back pain, they supported a positive change in the informants’ ways of coping with their situation.
Implications
Health professionals can play an important role in low back pain sufferers’ configuration of meaningful narratives that help in coping with pain and learning about the relationship between pain and everyday life.
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Angel S, Vatne S. Vulnerability in patients and nurses and the mutual vulnerability in the patient-nurse relationship. J Clin Nurs 2017; 26:1428-1437. [PMID: 27626897 DOI: 10.1111/jocn.13583] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the mutual vulnerability of patients and nurses, anticipating that an enhanced understanding of the phenomenon may help reduce vulnerability. BACKGROUND Patient vulnerability is a key issue in nursing, aimed at protecting the patient from harm. In the literature, vulnerability is described both from a risk perspective and a subjective perspective. This implies that the objective dimension of patient vulnerability does not necessarily reflect the patient's own perception of being vulnerable. However, external judgment may influence internal perception. Adding to this complexity, attention has also been drawn to the vulnerability of the nurse. DESIGN A definition deduced from central literature on vulnerability captures the complexity of objective versus subjective vulnerability. Based on the perspective of vulnerability in general, vulnerability in healthcare services shows how dependency may increase patient vulnerability. Further, despite education, training and supportive settings, patients may increase nurse vulnerability. The core of this mutuality is explored in the light of Martin Heidegger's philosophy of being. CONCLUSION The patient's need for help from the nurse opens the patient to engage in supportive and/or harmful encounters. Thus, dependency adds to the vulnerability related to health issues. The nurse's vulnerability lies in her engagement in caring for the patient. If failing to provide proper care, the nurse's existence as 'a good nurse' is threatened. This is exacerbated if the patient turns against the nurse. Therefore, the core of vulnerability seems to lie in the fact that the patient and the nurse are both striving to be the persons they want to be, and the persons they have not yet become. RELEVANCE TO CLINICAL PRACTICE Recognition of the mutual vulnerability in the patient-nurse relationship calls for collective acknowledgement of the demanding nature of caring relationships, for support and for a strengthening of professional skills.
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Affiliation(s)
- Sanne Angel
- Section of Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark.,Department for Health and Social Care, Molde University College, Molde, Norway
| | - Solfrid Vatne
- Department for Health and Social Care, Molde University College, Molde, Norway
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Martin D, Hoy L, N Hoy K. Service user and carer participation in an endoscopy nursing programme. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:1051-5. [PMID: 24121848 DOI: 10.12968/bjon.2013.22.18.1051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports an initiative to improve students' insight into service user and carer experience of endoscopy, particularly those with severe disability, such as spinal cord injury. This insight has the potential to improve the information provided and level of person-centred care in an endoscopy service. It was evident in the feedback from the classroom encounter that the teaching and learning strategy had a positive outcome, which will allow us to integrate the approach into future curriculum development and delivery, bringing the lived experience from the service user and carer perspective into the classroom. Students engaged in discussion and used their reflective skills to develop sensitivity to those with physical disability and complex needs requiring endoscopy procedures.
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Affiliation(s)
- Daphne Martin
- Nurse Lecturer, Course Coordinator, Endoscopy and Related Procedures, Nursing/Pathway Leader Specialist Practice in Anaesthetic Nursing, School of Nursing and Midwifery, Queens University Belfast
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Lindberg J, Kreuter M, Person LO, Taft C. Patient Participation in Rehabilitation Questionnaire (PPRQ)-development and psychometric evaluation. Spinal Cord 2013; 51:838-42. [PMID: 24042990 DOI: 10.1038/sc.2013.98] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A cross-sectional postal questionnaire study. OBJECTIVES The aim of the study was to evaluate selected psychometric properties of a draft version of the Patient Participation in Rehabilitation Questionnaire (PPRQ) measuring patients' experiences of participation in care and rehabilitation. SETTING Sweden. METHODS On the basis of previous qualitative analyses of patient interview data, a 32-item questionnaire covering five domains of participation was developed and sent to 268 persons with spinal cord injury, aged 18-80 years and injured 1-12 years previously. In total, 141 (51%) evaluable questionnaires were returned. Multi-trait analysis was used to assess scaling assumptions by testing item convergent and discriminant validity and internal consistency reliability (Cronbach's α) associated with the hypothesized item-scale structure of the questionnaire. RESULT Nine items failed to meet scaling assumptions and were omitted. Scaling assumptions were thereafter substantiated for the scales: 'respect and integrity' (6 items); 'planning and decision-making' (4 items); 'information and knowledge' (4 items); 'motivation and encouragement' (5 items); and 'involvement of family' (4 items). Item-scale correlations ranged from 0.67 to 0.85 and most items correlated higher or significantly higher with their hypothesized scale than with other scales. Cronbach's α was 0.89 for all scales. CONCLUSION The PPRQ appears to adequately assess central aspects of participation in care and rehabilitation from the perspective of patients with spinal cord injury. Further studies using larger samples will be undertaken to confirm the scale structure as well as the sensitivity and responsiveness of the questionnaire.
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Affiliation(s)
- J Lindberg
- 1] Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden [2] Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Lindberg J, Kreuter M, Taft C, Person LO. Patient participation in care and rehabilitation from the perspective of patients with spinal cord injury. Spinal Cord 2013; 51:834-7. [PMID: 23999110 DOI: 10.1038/sc.2013.97] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/09/2013] [Accepted: 07/09/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Qualitative method, semi-structured interviews. OBJECTIVES The aim of the study was to explore the meaning of patient participation in care and rehabilitation from the perspective of patients with spinal cord injury (SCI). SETTING Post discharge community setting. METHODS Semi-structured interviews were performed with 10 persons with SCI representing different ages, gender and levels of injury. All interviews were conducted individually and lasted 40-120 min. The interviews were verbally transcribed and the data were analyzed by means of content analysis. RESULTS All informants stressed the importance of patient participation as a necessary prerequisite for successful care and rehabilitation, but emphasized that participation must be tailored to each patient's own preferences, capacities and needs. They also underscored that the staff should be sensitive and responsive to the fact that desired levels and kinds of participation may vary from patient to patient, as well as for the same patient during the course of the rehabilitation. Five themes reflecting central aspects of participation emerged: respect and integrity, planning and decision-making, information and knowledge, motivation and encouragement, and involvement of family. CONCLUSIONS Patient participation is a critical component of successful SCI rehabilitation and must be facilitated, promoted and tailored to each patient by the staff. Based on the finding from this study a questionnaire has been developed for assessing patient experiences of five domains of participation in rehabilitation to serve as a tool to help in evaluating provided care and in identifying patients' preferences for participation.
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Affiliation(s)
- J Lindberg
- 1] Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden [2] Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Pallesen H. Body, coping and self-identity. A qualitative 5-year follow-up study of stroke. Disabil Rehabil 2013; 36:232-41. [PMID: 23631656 DOI: 10.3109/09638288.2013.788217] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this article is to identify, from a long-term perspective, stroke survivors' self-identity, their views of any associated disabilities and how they manage their lives after stroke. METHODS The interviews and analyses were conducted using a phenomenological qualitative method. A total of 10 men and 5 women, aged 42-84, participated. All had suffered first-time stroke 5 years earlier. RESULTS After 5 years, participants had greater acceptance of their situation compared with immediately after participating in the rehabilitation programme. However, they described how they still had to deal with the consequences of stroke. They had suffered further illnesses and additions to side effects of the stroke. In dealing with their disabilities and changes to self-identity and life patterns, they seemed to be in a continuous process of change that never truly stabilised. They coped with this continuous process in at least two different ways, including resignation or personal growth. CONCLUSION Stroke survivors suffered considerable ongoing and changing difficulties in relation to disability, self-perception and to coping with a new life. This continuous process of change could be seen to drain their energy. The study shows that many survivors live a more home-centred life with fewer social relations and less active participation in their community. This can entail the risk of depression and loneliness. The study also shows, however, that adopting an optimistic approach to life can lead to continued learning about abilities and limitations, to the development of new skills and to the fashioning of a new self-identity.
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Affiliation(s)
- Hanne Pallesen
- Vejlefjord Neurocenter, University College Lillebaelt and
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Angel S. Vulnerable, but strong: The spinal cord-injured patient during rehabilitation. Int J Qual Stud Health Well-being 2010; 5. [PMID: 20927203 PMCID: PMC2950800 DOI: 10.3402/qhw.v5i3.5145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2010] [Indexed: 11/30/2022] Open
Abstract
A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation. The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit and after discharge. A phenomenological–hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury. The patient's strength during the rehabilitation was portrayed by their endurance and from their narratives of how they handled difficult situations. The patient's perception of vulnerability varied, and strength was mobilised as a response to the vulnerability to overcome the imbalance between demands and resources. Vulnerability should therefore refer to a person's experience of the situation rather than the person, as it may hinder the professionals' open, explorative approach towards the person.
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Affiliation(s)
- Sanne Angel
- Department of Nursing Science, School of Public Health, Aarhus University, Aarhus C, Denmark
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