Purpose: There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels.
Aim: To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation.
Materials and methods: A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach.
Results: Patients reported (1) Time to diagnose: “Finally I’m in the right place;” (2) Awareness: “They gave me a mirror;” (3) Partnership: “There was real contact with the therapists; we made decisions together;” (4) Close collaboration: “Overlapping scopes of practice; doing the same from a different perspective;” and finally (5) Self-management: “Now I can do it myself.” Therapists reported (1) “Patients knowledge and understanding is critical to success;” (2) “Activate problem solving and decision making;” (3) “Personalize your therapy; it’s more than just giving exercises and information;” (4) “Constant consultation within the team; consistency in messages and approach;” and (5)” Ultimately the patient is in charge.”
Conclusions: The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme.
Implications for rehabilitation
Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries.
A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions.
Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient–therapist and within the team; patient activation and self-reflection; and personalised care.
Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.
BackgroundA shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery.MethodsAn institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship. Telephone interviews were conducted on a portion of these surgeons.ResultsFifty-seven students (3.6%) completing the rural-focused longitudinal integrated clerkship became general surgeons. Of those participating in phone interviews, most (90%) decided to become surgeons during their experience while all stated that preclinical years did not influence their specialty decision.ConclusionsA substantial portion of these surgeons went on to practice in rural communities. Pre-existing rural and primary care-focused education could help to address the future projected shortage of rural general surgeons. 相似文献
Early identification and anaesthetic assessment of high-risk patients in pregnancy is important and best delivered through a formal assessment clinic. It provides the opportunity to provide information, agree management plans, and carry out necessary investigations and referrals to other specialists prior to labour and delivery. Clear referral criteria and lines of communication are necessary for an effective service. 相似文献
Despite health care reform, our nation continues to struggle containing health care costs while meeting the needs of persons with behavioral health disorders and comorbid chronic care conditions. The purpose of this article is to propose that dually certified primary care and psychiatric mental health nurse practitioners may be the disruptive innovation that becomes the solution for improving the coordination and care for high-need patients while containing costs. The concepts of disruptive innovation, integrated care, and whole person care are discussed followed by an introduction to the innovative primary care and psychiatric mental health nurse practitioner’s role and its potential for health care system disruption. Finally, a call to nursing is proffered to seize current opportunities to meet the Triple Aim challenge by providing whole person care that is high-quality, cost-effective, and satisfactory to patients because it is truly patient centered and meets their needs. 相似文献
