Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study

Barriers and facilitators to providing rehabilitation for long-term care residents with dementia: a qualitative study

BACKGROUND

Rehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them.

METHODS

Using a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators.

RESULTS

Barriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents.

CONCLUSION

Enhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings.

Subjective Well-Being, Positive Affect, Life Satisfaction, and Happiness With Multiple Sclerosis: A Scoping Review of the Literature

PURPOSE

People with multiple sclerosis (MS) may face challenges maintaining their subjective well-being, life satisfaction, happiness, and positive emotions. This scoping review's purpose was to summarize studies on these positive psychological constructs among people with MS.

METHODS

Observational and interventional studies that included measures of subjective well-being, life satisfaction, happiness, or positive affect were identified. Variables associated with these constructs were classified using the International Classification of Functioning, Disability and Health (ICF).

RESULTS

The review included 22 observational and 10 interventional studies. Variables were categorized into each of the ICF domains. Cognitive behavior therapy was the most common intervention, with content and dosing varying widely.

CLINICAL RELEVANCE

Subjective well-being, life satisfaction, happiness, and positive affect are crucial components of community and individual health. The findings of this scoping review highlight the complex interplay between function, personal factors, and environmental conditions in influencing positive psychological constructs. Given the limited evidence, rehabilitation nurses should leverage their skills in delivering holistic care and adopt data-driven approaches to integrate positive psychological strategies into care plans.

CONCLUSION

Further research is needed to measure and compare interventions aimed at improving these constructs and to examine the influence of personal and environmental factors among diverse MS populations.

Home-based telerehabilitation in multiple sclerosis: a scoping review

BACKGROUND

Introducing home-based telerehabilitation (TR) approaches helps clinical experts to choose appropriate and effective interventions and researchers identify knowledge gaps to design clinical trial studies and systematic reviews.

PURPOSE

This study aimed to review the knowledge of home-based TR in multiple sclerosis.

METHOD

This scoping review study was conducted based on Arksey and O'Malley's five-step approach. The Embase, PubMed, Cochrane, Web of Sciences, Scopus and ProQuest databases were searched in 2017-2024 to find full-text English-language articles.

FINDINGS

In 25 studies reviewed, various and extensive home-based interventions have been used in physical and cognitive aspects.

CONCLUSION

Home-based rehabilitation is applicable, useful, safe and affordable, maintains the continuity of the rehabilitation process and increases patients' adherence to the rehabilitation programme. However, there are challenges such as patients' lack of familiarity with technology and limitations of outcome measurement tools that should be addressed in future studies.

The clarification of the concept of colostomy nursing care in ostomy care centers: A concept analysis through Walker and Avant's method

BACKGROUND

Specialist nurses need to have an accurate understanding of colostomy care-related concepts to provide care. Although patients with different types of ostomy have different types of needs, terms such as ostomy care, colostomy care, and ileostomy nursing are interchangeably used. Moreover, there are limited concept analysis studies into the concept of colostomy nursing care (CNC) in ostomy care centers (OCCs). The aim of this study was to analyze and clarify the concept of CNC in outpatient OCCs.

METHODS AND MATERIAL

This was a concept analysis study. This concept analysis was conducted using Walker and Avant's eight-step method. The online databases were searched until 2022 to retrieve documents on CNC. Finally, 35 articles and four books were included in the analysis, the defining attributes, antecedents, and consequences of the concepts were determined, and model and additional cases as well as empirical referents were presented.

RESULTS

The defining attributes of CNC in OCCs are the development of professional role, participatory practice and interdisciplinary care, selection of the best clinical procedures, care based on patient education, and patient rehabilitation. The antecedents of the concept are nurse-related antecedents, patient- and family-related antecedents, environmental antecedents, and professional rules and regulations. Its consequences are patients' and families' greater care-related knowledge, improvement of nurses' care quality, patient autonomy, and self-efficacy.

CONCLUSION

The concept of CNC in OCCs can be defined as "a continuous and coherent care based on knowledge, skill, expertise, experience, and colostomy type which uses interdisciplinary collaboration and the best available evidence in order to select and provide the best services according to patients' and families' culture and background, fulfill patients' physical, mental, sexual, social, and spiritual needs, and timely refer patients to specialists, with the ultimate goal of improving patient autonomy and facilitating their return to normal life."

The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers: A qualitative study

BACKGROUND

Ostomy care nurses are responsible for the management of patients with colostomy from the time of diagnosis. Currently, most ostomy care services are provided in outpatient ostomy care centers in order to reduce patients' hospital stay and reduce hospitalization-related costs. Many different factors can affect colostomy nursing care provision in these centers. Identification of these factors can facilitate quality care provision.

MATERIALS AND METHODS

This descriptive qualitative study was conducted in 2020-2021 to explore the barriers and facilitators to nursing care for patients with permanent colostomy in Tehran and Qom ostomy centers. Participants were twelve nurses with ostomy care licenses, two adult patients with permanent colostomy for at least two years, and one family caregiver of a patient with permanent colostomy purposefully selected from outpatient ostomy care centers in Iran.

RESULT

Data were collected via fifteen in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's conventional content analysis. The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers came into three main categories, namely specialized capabilities of colostomy care, care continuity, and caring status in the family.

CONCLUSION

These findings imply that not only nurses, but also patients, family caregivers, and referral systems can influence nursing care provision to permanent colostomy. Effective management of these factors can improve the quality of ostomy nursing care.

Artificial intelligence-driven virtual rehabilitation for people living in the community: A scoping review

Virtual Rehabilitation (VRehab) is a promising approach to improving the physical and mental functioning of patients living in the community. The use of VRehab technology results in the generation of multi-modal datasets collected through various devices. This presents opportunities for the development of Artificial Intelligence (AI) techniques in VRehab, namely the measurement, detection, and prediction of various patients' health outcomes. The objective of this scoping review was to explore the applications and effectiveness of incorporating AI into home-based VRehab programs. PubMed/MEDLINE, Embase, IEEE Xplore, Web of Science databases, and Google Scholar were searched from inception until June 2023 for studies that applied AI for the delivery of VRehab programs to the homes of adult patients. After screening 2172 unique titles and abstracts and 51 full-text studies, 13 studies were included in the review. A variety of AI algorithms were applied to analyze data collected from various sensors and make inferences about patients' health outcomes, most involving evaluating patients' exercise quality and providing feedback to patients. The AI algorithms used in the studies were mostly fuzzy rule-based methods, template matching, and deep neural networks. Despite the growing body of literature on the use of AI in VRehab, very few studies have examined its use in patients' homes. Current research suggests that integrating AI with home-based VRehab can lead to improved rehabilitation outcomes for patients. However, further research is required to fully assess the effectiveness of various forms of AI-driven home-based VRehab, taking into account its unique challenges and using standardized metrics.

Rehabilitation nursing care in the acute phase of diseases with physical disabilities: A concept analysis study

BACKGROUND

Despite the importance of rehabilitation nursing care in improving patient outcomes, the provision of this care in the early stages of diseases and injuries is limited. In this situation, analyzing the concept of rehabilitation nursing care can increase nurses' understanding of this concept and improve the provision of rehabilitation nursing care in the acute phase. This study aimed to analyze the concept of rehabilitation nursing care in acute phase of diseases with physical disability.

METHOD

Walker and Avant's approach to concept analysis was performed in eight stages, including choosing a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline and contrary cases, identifying antecedents and consequences, and defining empirical referents.

RESULTS

The important characteristics of rehabilitation nursing are comprehensive, education-based, specialized, client and family centered, interprofessional, and need-based. The antecedents of rehabilitation nursing care are related to nurses, the care settings and the nursing profession. The most important consequence of rehabilitation nursing care is improving the quality of life of patients. Rehabilitation nursing care also has positive outcomes for nurses and the healthcare systems.

CONCLUSION

The findings indicate that rehabilitation nursing care has several attributes that require antecedents such as knowledge and specialized skills such as teamwork skills, effective communication skills, cultural sensitivity, holistic perspective, intuitive thinking, and reasoning. The most important consequence of rehabilitation nursing care is improving the quality of life of patients.

The effects of dynamic motion instability system training on motor function and balance after stroke: A randomized trial

BACKGROUND

The balance and postural control of humans is related to the coordination of dynamic perception and movement. Multiple senses, such as vision, vestibular sense, proprioception, and/or a single sensory disorder, would lead to its integration disorder and induce imbalance and abnormal gait.

OBJECTIVE

The present study aimed to determine the effects of dynamic motion instability system training (DMIST) on the balance and motor function of hemiplegic patients after stroke.

METHODS

In this assessor-blinded, randomized controlled trial, the participants allocated to the intervention group (n = 20) received 30 minutes of conventional treatment and 20 minutes of DMIST training. Participants randomized to the control group (n = 20) received the same dose of conventional therapy and 20 minutes of general balance training. Rehabilitation was performed 5 times per week for 8 weeks. The primary outcome was the Fugl-Meyer assessment for the lower extremity (FMA-LE), and the secondary outcomes were the Berg balance scale (BBS) and gait function. Data were collected at baseline and immediately after the intervention.

RESULTS

After 8 weeks (t1), both groups showed significant post-intervention improvements in BBS, FMA-LE, gait speed and stride length (P < 0.05); there were significant positive correlations between the increase in FMA-LE and gait speed and stride length. Compared with the control group, the DMIST group showed significant post-intervention improvements in FMA-LE, gait speed and stride length (P < 0.05). However, no significant differences between the groups were found over time with respect to BBS (P > 0.05). The experiences of patients with DMIST were positive, and no serious adverse events were related to the interventions.

CONCLUSION

Supervised DMIST could be highly effective in treating lower-limb motor function in patients with stroke. Frequent (weekly) and medium-term (8 weeks) dynamic motion instability-guided interventions might be highly effective in enhancing motor function, and subsequently improving gait in stroke patients.