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Kuven BM, Giske T. Hope that provides strength in illness-patients' perspectives: Nursing students' narratives after conversation with patients. Scand J Caring Sci 2023; 37:909-916. [PMID: 35037714 DOI: 10.1111/scs.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/25/2021] [Accepted: 12/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this article is to explore sources of hope for patients by using patients' narratives and perspectives on how they find hope when facing illness. Hope enables people to endure suffering and can be critical to how people cope with illness. Hope is not a singular phenomenon, so nurses need to understand how to support the patients' sources of hope. METHODS We used a qualitatively descriptive design with qualitative content analysis. We examined reflective notes from 385 first-year nursing students after they had had a conversation with patients with disease experiences following Graneheim and Lundman's description of analysis. The conversation with the patients/persons was related to sources of hope and strength, who they turned to when they needed help, and if they were available. After the conversation, the students had to write a reflective log with a summary of the conversation. RESULTS We found four categories that explained how patients found hope: (1) relational hope, (2) spiritual hope, (3) hope in nature and (4) hope in oneself. Most of the patients found hope in more than one of these categories. CONCLUSION It is important for nursing to have knowledge about patients' narratives about how they build and sustain hope during times of illness. Nursing can contribute to promoting hope and thus alleviating patients' suffering. The four categories in this study can serve as a guide for nurses to assess and support patients' hope and encourage them to find their strength through different sources.
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Affiliation(s)
- Britt Moene Kuven
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tove Giske
- Faculty of Health Studies, Bergen VID Specialized University, Bergen, Norway
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Heredia-Callejón A, García-Pérez P, Armenta-Peinado JA, Infantes-Rosales MÁ, Rodríguez-Martínez MC. Influence of the Therapeutic Alliance on the Rehabilitation of Stroke: A Systematic Review of Qualitative Studies. J Clin Med 2023; 12:4266. [PMID: 37445301 DOI: 10.3390/jcm12134266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The therapeutic alliance is a fundamental component of rehabilitation in order to achieve effective outcomes. However, what develops, maintains or hinders this relationship has not been sufficiently explored. The aim of this systematic review is to recognize the role of the therapeutic alliance in the neurological rehabilitation process. A search for articles was carried out in the databases PubMed, Web of Science, SCOPUS, CINAHL, APA PsycInfo, OTseeker and Dialnet. They were selected according to the eligibility criteria. Internal quality assessment of the articles was measured with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The systematic review was registered in PROSPERO (ID 346523). The search in the databases identified 1596 articles, from which 9 different studies were finally included in the systematic review, reflecting the limitations of studies in this field. All studies are qualitative, from the point of view of the patients themselves, their relatives and healthcare professionals. The total sample of the included studies is 182 participants (96 health professionals, 76 users and 10 relatives). Semi-structured interviews, focus group discussions and written reflections were mainly used to collect the data. In conclusion, the therapeutic alliance can be an active component in the post-stroke rehabilitation process. Being recognized as a person, collaboration with the therapeutic team, empathy, empowerment, confidence, professional skills, maintenance of hope and the role of the family have been identified as aspects that can have an influence on the therapeutic alliance.
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Affiliation(s)
| | - Patricia García-Pérez
- Occupational Therapy Department, Hospital Marítimo, Servicio Andaluz de Salud (SAS), 29620 Malaga, Spain
| | - Juan Antonio Armenta-Peinado
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - Miguel Ángel Infantes-Rosales
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - María Carmen Rodríguez-Martínez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
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Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Developing tailored theoretically informed goal-setting interventions for rehabilitation services: a co-design approach. BMC Health Serv Res 2022; 22:811. [PMID: 35733190 PMCID: PMC9214993 DOI: 10.1186/s12913-022-08047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Several active ingredients contribute to the purposes and mechanisms of goal-setting in rehabilitation. Active ingredients in the goal-setting process include, interdisciplinary teamworking, shared decision-making, having meaningful and specific goals, and including action planning, coping planning, feedback, and review. Clinicians have expressed barriers and enablers to implementing these active ingredients in rehabilitation teams. Interventions designed to improve goal-setting practices need to be tailored to address context specific barriers and enablers. Attempts to understand and enhance goal-setting practices in rehabilitation settings should be supported using theory, process models and determinant frameworks. Few studies have been undertaken to enhance goal-setting practices in varied case-mix rehabilitation settings. Methods This study is part of a larger program of research guided by the Knowledge to Action (KTA) framework. A multisite, participatory, codesign approach was used in five sites to address three stages of the KTA. (1) Focus groups were conducted to understand barriers and enablers to implementing goal-setting at each site. Following the focus groups three staff co-design workshops and one consumer workshop were run at each site to (2) adapt knowledge to local context, and to (3) select and tailor interventions to improve goal-setting practices. Focus groups were analysed using the Theoretical Domains Framework (TDF) and informed the selection of behaviour change techniques incorporated into the implementation plan. Results Barriers and enablers identified in this study were consistent with previous research. Clinicians lacked knowledge and understanding of the differences between a goal and an action plan often confusing both terms. Clinicians were unable to demonstrate an understanding of the importance of comprehensive action planning and review processes that extended beyond initial goal-setting. Interventions developed across the sites included staff training modules, a client held workbook, educational rehabilitation service flyers, interdisciplinary goal-based case conference templates, communication goal boards and a key worker model. Implementation plans were specifically established for each site. Conclusions Rehabilitation teams continue to struggle to incorporate a truly client-centred, interdisciplinary model of goal-setting in rehabilitation. Whilst clinicians continue to lack understanding of how they can use aspects of goal-setting to enhance client outcomes and autonomy in rehabilitation settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08047-6.
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Affiliation(s)
- Amanda Baker
- School of Allied Health Sciences, Griffith University, Brisbane, Australia. .,Clinical Excellence Division, Statewide Rehabilitation Clinical Network, Queensland Health, Brisbane, Australia. .,Physiotherapy Department, Sunshine Coast University Hospital, Allied Health, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia.
| | - Petrea Cornwell
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Claire Stewart
- Physiotherapy Department, Sunshine Coast University Hospital, Allied Health, Sunshine Coast Hospital and Health Service, Sunshine Coast, QLD, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Baker A, Cornwell P, Gustafsson L, Lannin NA. An exploration of goal-setting practices in Queensland rehabilitation services. Disabil Rehabil 2021; 44:4368-4378. [PMID: 33961530 DOI: 10.1080/09638288.2021.1906957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Goals are vital in rehabilitation; however, how goal-setting occurs varies widely in clinical practice. This study aims to review goal-setting practices across the rehabilitation continuum within varied case mix services in Queensland, Australia. METHOD A descriptive multisite qualitative case study with medical record audits and interviews of adult rehabilitation clients was used to evaluate four propositions across three inpatient and two community rehabilitation services. The propositions evaluated the process in which goal-setting occurs, action planning and review of goals, as well as the type, specificity and client-centeredness of goals set. RESULTS Goals (n = 1120) were often poorly defined, focussed on short term physical functioning and were predominantly set by individual disciplines with the client rather than using an interdisciplinary approach. Clients were not consistently given action plans to pursue goals (n = 59, 18%) and the review of goal progress (n = 60, 18%) was limited. Few clients reported receiving copies of their rehabilitation goals (n = 16, 25%). CONCLUSION Goal-setting in rehabilitation should be specific, meaningful and include the client in action planning, feedback and review. However, goal-setting in rehabilitation is often multidisciplinary and unstructured.Implications for rehabilitationBest-practice rehabilitation team goal-negotiation and goal-setting should include a common goal focus and incorporate components of staff and client action planning, coping planning, feedback and review.Rehabilitation clients prefer shared-decision making approaches to setting meaningful and personalised goals, however, require time and support to engage in the goal-setting and negotiation process.Rehabilitation clinicians need training and support to improve their goal negotiation and goal writing skills to create specific, understandable and meaningful goals with rehabilitation clients.
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Affiliation(s)
- Amanda Baker
- School of Allied Health Sciences, Griffith University, Brisbane, Australia.,Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane, Australia.,Allied Health, Department of Physiotherapy, Sunshine Coast Hospital and Health Service, Queensland Health, Nambour, Australia
| | - Petrea Cornwell
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Budge C, Taylor M, Curtis C. Support for living well with long-term conditions: How people manage. J Clin Nurs 2020; 30:475-487. [PMID: 33171001 DOI: 10.1111/jocn.15560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore how people self-manage their long-term conditions and the support enabling them to do so. BACKGROUND People with long-term conditions are required to engage in daily self-management with the support of health practitioners, family and friends. DESIGN A qualitative interview study. METHODS Thirty-two New Zealand European and Pacific people with long-term conditions were interviewed about how they manage their condition/s at home with support from family, neighbours, agencies and general practice doctors and nurses. Interviews were recorded, transcribed, checked and analysed for thematic content. The COREQ checklist was used. RESULTS Three themes emerging from the data were as follows: 'acceptance' of conditions, limitations, support and advice; 'making it work' regarding life with long-term conditions; and the need for health practitioners to 'work alongside me'. CONCLUSIONS People with long-term conditions struggle with acceptance of a diagnosis and symptoms, and acceptance of help which conflicts with their need to maintain independence and personal control. They self-manage every day, learning to plan, choose what and what not to do and negotiate with others to get tasks done and maintain quality of life. They manage better with support from understanding health practitioners, especially advanced nurses, with whom they have established a positive, sustained relationship. RELEVANCE TO CLINICAL PRACTICE Active support for people to self-manage has been shown to assist people to achieve their goals and improve overall health and well-being. Nurses are well positioned to provide self-management support for people with long-term conditions but require allocated time and system changes to enable this. Practitioners need to acknowledge that it is difficult for people to accept diagnoses and symptoms and provide individualised support for this process. The desire to remain independent may limit acceptance of help, making it harder for people to maintain life quality. A change in length and content of consultations is required in order for practitioners to really get to know people and provide the self-management support they need to meet their goals.
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Affiliation(s)
| | | | - Chrystal Curtis
- Te Tihi o Ruahine Whānau Ora Alliance, Palmerston North, New Zealand
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Amati M, Grignoli N, Rubinelli S, Amann J, Zanini C. The role of hope for health professionals in rehabilitation: A qualitative study on unfavorable prognosis communication. PLoS One 2019; 14:e0224394. [PMID: 31661529 PMCID: PMC6818780 DOI: 10.1371/journal.pone.0224394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients. METHODS Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis. RESULTS The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery. CONCLUSIONS The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.
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Affiliation(s)
- Mirjam Amati
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
| | - Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
- Rehabilitation Clinic, Ente Ospedaliero Cantonale, Novaggio, Switzerland
- Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Julia Amann
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Lawton M, Sage K, Haddock G, Conroy P, Serrant L. Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:550-563. [PMID: 29349881 PMCID: PMC5969294 DOI: 10.1111/1460-6984.12368] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/15/2017] [Accepted: 11/20/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Therapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change. AIMS To explore speech and language therapists' perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post-stroke. METHODS & PROCEDURES Twenty-two, in-depth, semi-structured interviews were conducted with speech and language therapists working with people with aphasia post-stroke. Qualitative data were analysed using inductive thematic analysis. OUTCOMES & RESULTS Analysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists' responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers. CONCLUSIONS & IMPLICATIONS The findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non-verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in goal setting, relational strategies; and motivational enhancement techniques. The conceptualization of therapeutic alliance, however, is only provisional. Further research is essential to elucidate the experiences and perceptions of alliance development for people with aphasia undergoing rehabilitation.
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Affiliation(s)
- Michelle Lawton
- Department of Psychological SciencesUniversity of ManchesterManchesterUK
| | - Karen Sage
- Faculty of Health and WellbeingSheffield Hallam UniversitySheffieldUK
| | - Gillian Haddock
- Department of Psychological SciencesUniversity of ManchesterManchesterUK
| | - Paul Conroy
- Department of Psychological SciencesUniversity of ManchesterManchesterUK
| | - Laura Serrant
- Faculty of Health and WellbeingSheffield Hallam UniversitySheffieldUK
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Soundy A, Rosenbaum S, Elder T, Kyte D, Stubbs B, Hemmings L, Roskell C, Collett J, Dawes H. The Hope and Adaptation Scale (HAS): Establishing Face and Content Validity. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojtr.2016.42007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Soundy A, Roskell C, Elder T, Collett J, Dawes H. The Psychological Processes of Adaptation and Hope in Patients with Multiple Sclerosis: A Thematic Synthesis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojtr.2016.41003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Soundy A, Condon N. Patients experiences of maintaining mental well-being and hope within motor neuron disease: a thematic synthesis. Front Psychol 2015; 6:606. [PMID: 26029142 PMCID: PMC4428059 DOI: 10.3389/fpsyg.2015.00606] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/23/2015] [Indexed: 12/12/2022] Open
Abstract
Research is required that can synthesize the experiences of patients with Motor Neuron Disease (MND). One value of being able to do this is to understand the psychological experiences and processes involved in maintaining mental well-being and hope. A qualitative thematic synthesis of studies was undertaken. Studies were electronically searched from inception until June 2014. Twenty-nine studies with 342 (175 male) unique individuals with MND were identified. Five themes were identified: (1)The effects of the disease on interactions, relationships, roles and meaningful activities, (2) Responses that relate to the expression of hope, (3) Factors which disable hope, (4) Factors which enable hope, and (5) Cognitive and Practical adaptation that enabled hope, control and coping. Finally, a model of hope enablement was identified that considers the psychological pathways undertaken by a patient which influence mental well-being and hope. Within this review article evidence is provided which illustrates the central importance of relationships and social support for individuals with MND. Further, it has been identified that periods of coping are possible and are likely associated with greater mental well-being for patients with MND.
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Affiliation(s)
- Andrew Soundy
- Department of Physiotherapy, School of Sport, Exercise and Rehabilitation Sciences, University of BirminghamBirmingham, UK
| | - Nicola Condon
- University Hospitals Birmingham, NHS Foundation TrustBirmingham, UK
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