Neurological rehabilitation nursing: a review of the research

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988-1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in-patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.     

An evaluation of nurse-led team care within a rehabilitation ward for elderly people

• ? This small exploratory study evaluated the effects of introducing a system of nurse-led team care on a ward providing intensive nursing and rehabilitation to elderly people.
• ? A quasi-experimental design compared three variables between the study ward and two similar wards within the unit. These were:

• — quality of care,
• — job satisfaction,
• — length of patient stay. Quantitative data were complemented by semi-structured interviews with team members and by observation of team meetings.

• ? Quality of care scores showed an improvement on the study ward, but no difference on the main comparison ward. There were no differences between nurse job satisfaction between the study and comparison wards or in length of patient stay throughout the period of evaluation.
• ? Observation of team meetings suggested that communication was more structured and focused on the study ward and that patient goals were more clearly specified. Interviews suggested three main factors in successful implementation of the change to nurse-led team care:

• — commitment of the team,
• — open communication about difficulties,
• — the support of managers and medical staff. The main effects noted were:

• — partnership with patients,
• — equality between team members,
• — improved decision making and quality of care.

• ? Further studies of nurse-led team care are required, and the stress and anxiety for staff consequent on developing the nurse's role in this way should be considered.

     

Meeting the needs of families and carers on acute psychiatric wards: a nurse-led service

ACCESSIBLE SUMMARY: ? Families and carers of inpatients often have little contact with ward staff. ? A nurse-led service was set up to address this issue. ? Families were highly satisfied with the service they received. ABSTRACT: The needs of families and carers are often not met by the busy staff on inpatient units. A nurse-led family and carers service was set up on three adult acute psychiatric wards. A four-session protocol was developed for structuring sessions with families and carers. Methods of engaging reluctant carers were developed. Satisfaction rates are high. Families and carers value the emotional support, improved communication, help and advice. About one quarter are referred on for further input after discharge. A nurse-run service for the families and carers can make a significant difference to those who use it, providing support, creating a working alliance and improving the two-way exchange of information.     

Evaluation of the research agenda for rehabilitation nursing.

From 1993 to 1995, under the direction of the board of directors of the Association of Rehabilitation Nurses (ARN), the Rehabilitation Nursing Foundation (RNF) created a research agenda for the field, which was published in 1996. The goal of the agenda was to identify a broad range of issues in rehabilitation practice that could be examined to advance the scientific knowledge base. Ten years later, the board of directors of ARN directed RNF to evaluate and update the agenda. A committee of three ARN members was formed to undertake this task. This article reports the committee's evaluation of the 1996 Rehabilitation Nursing Research Agenda. A separate article reports on the process of revising the agenda.     

Chronic illness: reflections on a community-based action research programme

AIM: The purpose of this paper is to describe the birth of a research culture in a community nursing service, and the development and implementation of an action research programme that focuses on understanding the experiences of living with chronic illness. BACKGROUND: Approximately 70% of the clients of our community nursing practice in South Australia live with chronic illness. Our research interest has focused on how community nurses can assist people living with chronic conditions to live 'well'. In this paper we describe the way in which we have applied the principles of participatory action research (PAR) when working with women who live with multiple sclerosis (MS) and urinary incontinence. We then draw on elements of PAR research with men who live with MS and men and women who live with type 2 diabetes. In total, we have convened eight PAR groups researching with people who live in the community with chronic illness and this work constitutes our chronic illness research programme. DESIGN: The PAR philosophy is based on the principles of democratic, equitable, liberating and life enhancing relations within a research process, and is operationalized in cycles of: look, think and act. In these collaborative inquiries the researchers have facilitated participants to reflect on how illness affects their lives, to tell their own story, make connections, plan action and help them negotiate the rites of passage. We select two areas for discussion: methodological issues in the application of PAR principles and our tentative findings from the chronic illness research programme. FINDINGS: We assert that the facilitator's skill in managing group dynamics is crucial to the life and outcome of the project. Change can occur as a result of action at an individual level, with improved self-management of chronic illness, or at a collective level where the PAR group instigates larger reform strategies. In terms of tentative findings, men and women living with a chronic illness appear to be involved in an ongoing process of transition toward incorporating the illness into their lives. Although we have not yet identified specific events, we have noted that there are critical turning points in the illness transition experience. Participants feel validated in telling their story of living with a chronic illness. Story telling may be the turning point that enhances the lives of all those who participate. CONCLUSION: If health care professionals can understand the process that facilitates people to move toward incorporating chronic illness into their lives, we can make a substantial contribution to enhance their chronic disease self care management.     

Effects of a stroke rehabilitation education programme for nurses

AIMS: This paper reports a study which aimed to explore the effects of education on the practice of nurses working in stroke rehabilitation units. BACKGROUND: It has been suggested that a key component of the success of stroke units in reducing mortality and disability is the contribution made by nurses, but debate continues around their specific role. Literature has concentrated on nurses' perceptions of their role rather than their actual activities with patients. In studying the effects of education on nurses' practice with stroke patients there is a need to identify what nurses actually do, rather than what they say they do. METHODS: A quasi-experimental, non-equivalent control group design was used to study two stroke rehabilitation units. Non-participant observation was conducted during morning care sessions, focusing on styles of physical interaction. Base-line observations were recorded in each unit, after which the staff in the intervention unit received 7 hours' education, specifically focused on therapeutic handling in relation to morning care activities. Following this, postintervention observations were conducted and comparisons of interaction styles made between units. RESULTS: Twenty-six staff and 37 patients took part in the study. Following the education, staff in the intervention unit showed a change in physical interaction style more in line with therapeutic practice, with the proportion of 'doing for' interventions reducing (45.4% vs. 33.2%; P < 0.05). The proportion of facilitatory interventions increased (3.9% vs. 6.1%) however, this difference was not statistically significant (P = 0.098). The change in styles of practice was achieved with no increased demand on nurses' time. CONCLUSION: Education for nurses which aims to change styles of interaction with stroke patients can be effective. However, further research is required to identify the effect of nursing interventions on patient outcomes following stroke.     

The use of ICF codes for information retrieval in rehabilitation research: An empirical study

Purpose. Rehabilitation research information can be obtained from various bibliographic sources. Nevertheless, search strategies and terminologies differ from one database to another making it challenging for the novice user or users of multiple databases. This paper discusses a novel approach of using the International Classification of Functioning, Disability and Health (ICF) codes to retrieve rehabilitation research information.

Method. A crosswalk was created by mapping the Center for International Rehabilitation Research and Information Exchange's (CIRRIE) subject headings to the two-level ICF codes and a search interface was developed (available at: http://cirrie.buffalo.edu/icf/crosswalk.php) so that users can input ICF codes instead of conventional subject headings.

Results. About 62% of all CIRRIE subject headings were mapped to equivalent ICF codes. Among the CIRRIE subject heading that were mapped, 43% were mapped to the Environmental Factors, followed by 34% mapped to the Activities and Participation component of the ICF.

Conclusion. Although the ICF was not conceived or developed as a system of formal terminology, it can be used effectively for information retrieval in conjunction with an existing vocabulary. This paper describes the first attempt in implementing the use of ICF for information retrieval.     

森田疗法对社交恐怖症的康复效果评价

目的:研究森田疗法对社交恐怖症的社会康复作用。方法:将41例社交恐怖症患者随机分为两组,森田疗法组22例,健康教育组19例,均于干预前、干预后、治疗结束半年后做社交回避及苦恼量表(SAD)和效果评定。结果:干预后及半年后随访,森田疗法组SAD总分与健康教育组相比,均呈显著性下降(P<0.01);明尼苏达多项人格测查表(MMPI)显示干预后森田疗法组临床量表(神经症量表)减分率显著高于健康教育组。结论:社区护理中采用森田疗法干预社交恐怖症,疗效好,能促进患者社会康复。     

Action research as a catalyst for change: Empowered nurses facilitating patient participation in rehabilitation

Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.     

A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China

Aim. The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu, China. Background. Epidemiological studies indicate a dose‐, level‐ and duration‐dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality. Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes. Design methods. A randomized controlled trial was conducted. Coronary heart disease patients (n = 167) who met the sampling criteria in two tertiary medical centres in Chengdu, south‐west China, were randomly assigned to either an intervention group (the cardiac rehabilitation programme) or control group (the routine care). The change of health behaviours (walking performance, step II diet adherence, medication adherence, smoking cessation) and physiological risk parameters (serum lipids, blood pressure, body weight) were assessed to evaluate the programme effect. Results. Patients in the intervention group demonstrated a significantly better performance in walking, step II diet adherence, medication adherence; a significantly greater reduction in serum lipids including triglyceride, total cholesterol, low‐density lipoprotein; and significantly better control of systolic and diastolic blood pressure at three months. The majority of these positive impacts were maintained at six months. The effect of the programme on smoking cessation, body weight, serum high‐density lipoprotein, was not confirmed. Conclusions. A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients. Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease. Relevance to clinical practice. This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients. Furthermore, the hospital–home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care.     

“吞咽评估及吞咽仪康复干预护理流程表”设定的行动学研究

目的:评价行动研究法在吞咽障碍早期判断及康复护理流程中的效果。方法:根据"洼田饮水试验",按照提出问题、设计合理流程、行动、观察、反思、再设计、再实施、再观察和反思的螺旋循环方式,制订、修订"吞咽评估及吞咽仪康复干预护理流程表"并有效应用于临床。结果:应用"洼田饮水试验"于临床,及时评估、判定、对应宣教/请示医生给予鼻饲,及时提示康复师给予吞咽治疗仪治疗,能达到吞咽安全、吞咽功能改善的临床效果。结论:行动研究法应用于临床护理,对脑卒中患者进行吞咽功能评估与干预的护理流程,实现早评估、早宣教、早期康复干预、早恢复。     

Development of a family-based pulmonary rehabilitation programme: an exploratory study

Abstract

Purpose: This study explored the expectations of patients with chronic obstructive pulmonary disease (COPD) and family members about a family-based pulmonary rehabilitation (PR) programme; developed and implemented a family-based PR programme and explored the impacts of the intervention on patients and family members. Method: Patients with COPD and family members were interviewed. A family-based PR programme was designed. Patients' breathlessness, muscle strength, exercise tolerance, functional balance and health-related quality of life were collected pre/post-programme. Family coping and adjustment to illness were measured in patients and family members. Focus groups were conducted after the programme. Results: Patients (n?=?35; 69?±?10 years; FEV₁ 62?±?15% predicted) and family members (n?=?35; 57?±?12 years) had similar expectations/needs about a PR programme. Nine dyads participated. Patients' quadriceps strength, exercise tolerance and functional balance improved significantly (all p values?<?0.023). Patients and family members seem to use more positive coping behaviours (p?=?0.026; p?=?0.011). Patients (n?=?7; 78%) and family members (n?=?8; 89%) considered having more knowledge about COPD and its management. Patients felt more functional (n?=?9; 100%) and reported their family members to be more active (n?=?3; 38%). In family members' perspective, their relationship with the care receiver was enhanced (n?=?2; 22%). Conclusions: PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

• Implications for Rehabilitation

• Patients with chronic obstructive pulmonary disease (COPD) and their family members have similar expectations and needs about a family-based pulmonary rehabilitation (PR) programme.

• A family-based PR programme is feasible to implement within primary care.

• PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

     

COPD病人肺康复运动训练的质性研究

目的:探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病人肺康复运动训练的影响因素,为更好地开展肺康复运动提供指导,从而进一步提高慢性阻塞性肺疾病病人的运动耐量和生活质量。方法:采用质性研究中现象学方法,以半结构式深入访谈了12例慢性阻塞性肺疾病病人,包括有意愿、已参与和拒绝或中途退出肺康复运动项目的病人。结果:运用Colaizzi分析程序进行分析,得到影响病人肺康复运动训练的因素,并归纳为4个主题:慢性阻塞性肺疾病病人的个人因素;客观因素;家庭成员的态度及锻炼环境因素;住院期间医护人员因素。结论:加强对慢性阻塞性肺疾病病人肺康复运动的宣教,提高病人的依从性和积极性,在临床护理中,发挥医务人员的主导作用,鼓励病人家属的支持并合理的利用社区资源,促使病人形成健康的行为习惯,以促进康复、提高生活质量。