Variables related to job satisfaction among professional care providers working in brain injury rehabilitation

Purpose : To examine variables that contribute to work satisfaction among rehabilitation professionals involved in brain injury rehabilitation.

Method : One hundred and thirty-three respondents completed a job satisfaction questionnaire and qualitative questions regarding sources of stress and satisfaction in working with individuals with acquired brain injury (ABI).

Results : Factor analysis yielded four factors relating to intrinsic satisfaction, perceived importance to the organization, organizational support and training support. Although intrinsic satisfaction was significantly related to the three other factors, it was best predicted by training support, particularly training that addressed the management of intrusive and/or aggressive behaviours. Qualitative correlates of both work stress and satisfaction were also identified with respect to personal issues, client-related issues, and organizationally-related issues.

Conclusions : Satisfaction with work in ABI rehabilitation is derived from multiple sources, but it appears to be largely dependent on feeling important to, and valued by, the organization and on the level of support and training provided in the workplace.     

Training in brain injury rehabilitation

Purpose: To evaluate our current training programme for professionals involved in brain injury rehabilitation, which involves disability simulation, and to consider the ethics and consequences of such programmes. Method: Seventy-two professionals took part in a brain injury disability simulation exercise and completed questionnaires pre and post the workshop. Results: Results suggest that participants have increased insight into the challenges faced by people with brain injuries. Conclusions: We believe that brain injury simulation exercises help professionals increase their understanding of the impairments and disabilities that may follow brain injury and can therefore form an important part of a training programme for rehabilitation staff.     

护理人员医疗器械相关压力性损伤认知现状及其影响因素研究

目的:调查护理人员医疗器械相关压力性损伤(MDRPI)认知现状,并分析其影响因素。方法:采用分层抽样法选取2020年5月—2020年7月清远市10所医院的1 074名护理人员为调查对象,采用自行设计的问卷对其进行问卷调查,采用多重逐步回归分析研究护理人员MDRPI认知的影响因素。结果:42.3%的护理人员知晓压力性损伤的最新分期,MDRPI知晓率为86.8%。绝大部分护理人员在为病人护理时选择合适的器械,固定适宜。48.0%的护理人员不会直接将器械放置在病人身上,大部分护理人员使用纱布/棉垫保护器械接触部位皮肤。约43%的护理人员每天2次或3次评估医疗器械接触部位皮肤,52.4%的护理人员每天2次清洁使用器械部位皮肤;气管插管被认为是最容易引起MDRPI的原因。多重线性回归分析结果显示,职称、医院级别、培训次数为护理人员MDRPI知识得分的影响因素(P<0.05)。结论:护理人员MDRPI知识和行为水平有待提高,需加强护理人员MDRPI相关知识的规范化培训,提高护理人员对MDRPI的认知和护理行为水平,以降低病人的MDRPI发生率。     

Brain injury rehabilitation settings: a gold mine for student and staff learning

This article explores cognitive, psychomotor, and affective learning relative to the professional development of senior nursing students and staff in a long-term brain injury rehabilitation setting. Valuable opportunities for learning exist in this environment. Nursing students acquire a much different perspective toward caring for patients in rehabilitation settings than in acute care; they also gain tremendous opportunities to strengthen the clinical judgement and psychomotor skills applicable to most clinical work environments following graduation. In addition, they assume professional attitudes toward and interest in caring for long-term brain-injured patients as they work closely with expert rehabilitation nurses. When staff nurses interact with students, they receive reciprocal benefits. Staff nurses profit by refining and broadening the scope of their own practice; they also develop a positive self-image and a feeling of pride in their work. More importantly, staff nurses in a long-term brain injury rehabilitation setting regain the feeling that their daily efforts are really worthwhile.     

Oculomotor rehabilitation in acquired brain injury: a case series

OBJECTIVE: To investigate the effects of systematic, oculomotor rehabilitation on basic versional ocular motility, as well as reading eye movements, in subjects with acquired brain injury, using objective eye movement recording and subjective rating of reading ability. DESIGN: Case series. SETTING: Clinical research laboratory. PARTICIPANTS: Two men with acquired brain injury: one with traumatic brain injury and one with stroke. INTERVENTIONS: Versional oculomotor training was performed for 1 hour, twice weekly for 8 weeks. There were 2 feedback modes of training: normal internal oculomotor visual feedback alone (4wk), or that feedback in conjunction with external oculomotor auditory feedback (4wk). Testing was conducted before and after training.Main outcome measures Objective outcome measures included both basic eye movement parameters (fixational accuracy, saccadic gain and latency, pursuit gain, mean saccade frequency ratio for simulated reading), and reading eye movement parameters (words per minute, grade level equivalent, fixations per 100 words, regressions per 100 words, percentage of reading comprehension, duration of fixation in seconds). Subjective outcome measures included the subject's ability to read based on the responses to the reading rating-scale questionnaire. RESULTS: Both subjects improved objectively in terms of basic versional oculomotor accuracy and reading ability. These findings concurred with their subjective impressions. CONCLUSIONS: This case series provides objective documentation of the positive effects of oculomotor rehabilitation on basic ocular motility and reading ability in selected cases with acquired brain injury, thus suggesting the need for a larger clinical trial in this area.     

Locomotor training within an inpatient rehabilitation program after pediatric incomplete spinal cord injury

BACKGROUND AND PURPOSE: The outcomes of intense locomotor training after incomplete spinal cord injury (SCI) have been described in adults with acute and chronic injuries and with various levels of ambulatory function. This case report describes a comprehensive inpatient rehabilitation program with a locomotor training component in a child with a severe incomplete SCI. CASE DESCRIPTION: A 5-year-old girl injured at C4 participated in locomotor training for 5 months during inpatient rehabilitation. OUTCOMES: The patient's Functional Independence Measure for Children II (WeeFIM II) mobility score increased from 5/35 to 21/35. Her Walking Index for Spinal Cord Injury II (WISCI II) score improved from 0 to 12. The patient returned to walking in the community with assistive devices. DISCUSSION: It is feasible to include an intense locomotor training program in the clinical rehabilitation setting for a child with a severe SCI, and the outcomes were consistent with results in adults. Further investigation with experimental designs and more participants will determine the extent to which this intervention benefits the pediatric population with SCI.     

Boredom in patients with acquired brain injuries during inpatient rehabilitation: a scoping review

Abstract

Purpose: Boredom may impede engagement in inpatient rehabilitation following an acquired brain injury. This review aimed to: (1) describe the experience and (2) quantify the incidence of boredom; (3) identify measurement tools used to quantify boredom; (4) summarize factors contributing to boredom, and (5) outline evidence-based interventions shown to reduce boredom during inpatient rehabilitation.

Methods: Two researchers independently screened publications retrieved from electronic database searches. Publications presenting patient, carer or staff data relating to boredom in inpatients with acquired brain injuries were included.

Results: Two thousand four hundred and ninety-nine references were retrieved, 88 full texts were reviewed, with 24 studies included. The majority of studies reported qualitative data indicating boredom to be a common experience of patients with acquired brain injuries (n?=?14 studies +1 review). The incidence of boredom post acquired brain injury is unknown. Personal and organizational factors and the physical environment may contribute to boredom (n?=?11 studies +2 reviews). Qualitative work (n?=?9 studies) indicates that use of the creative-arts or exposure to environmental enrichment may help alleviate boredom in patients with acquired brain injuries during inpatient rehabilitation.

Conclusion: Further mixed-methods research is required to establish the incidence of and contributing factors to boredom in patients with acquired brain injuries undergoing rehabilitation. Understanding this will help inform future research aimed at improving patient engagement in inpatient rehabilitation.

• Implications for rehabilitation

• Boredom is commonly reported by hospitalised patients with ABI to negatively affect their rehabilitation yet the scope of the problem has not been measured.

• Boredom is a complex phenomenon, likely influenced by a number of personal and environmental factors that are not fully understood in this population.

• Through a better understanding of boredom, interventions may be developed to improve patient engagement in inpatient rehabilitation programs.

     

Healthcare personnel's attitudes towards patients with urinary incontinence

The aim of the study was to understand the variability of Norwegian staff's attitudes towards patients with urinary incontinence across years and place of work, age and education levels. The Incontinence Stress Questionnaire-Staff Reaction (Norwegian version) (ISQ-SR-N) was used to measure staff's reactions and feelings towards patients with urinary incontinence. A cross-sectional survey design was used to gather self-reported data. The research sites were five nursing homes, three home care districts and medical and surgical wards at a university hospital. Of the 745 staff invited, 535 (72%) returned the questionnaire. Staff members working in long-term care units were older than staff members working in acute care units. Most of the registered nurses worked in acute care, whilst most of the nursing assistants worked in long-term care. Stepwise regression analysis identified education, working in a medical/surgical units, and the interaction of education and working in a medical unit to be most predictive of attitudes. Nursing assistants had more positive attitudes than registered nurses. Working in medical/surgical units predicted the most negative attitudes. Only 15.2% of the variability of attitudes can be explained by the predictive variables.     

Staff burnout in dementia care--relations to empathy and attitudes.

Sixty nursing staff in geriatric and psychogeriatric care (RNs, LPNs and nurse's aides) were selected to be studied on two occasions with an interval of one year regarding the relationships between their experience of burnout, empathy and attitudes towards demented patients. A semistructured interview was performed on the second occasion to learn more about their work experience and to relate the ratings of burnout, empathy and attitudes to their experience at work. The staff's experience of burnout changed from a mean score of 2.7 in 1987 to 2.5 in 1988. Their empathic ability was moderately high and increased from 398 (m) in (1987) to 450 (m) in 1988. The attitudes of staff remained unchanged from 1987 to 1988 and no differences were found regarding the staff's age, place of work or time at present place of work. As for the staff's empathy, there was no difference with respect to sex, category of staff or place of work. RN's showed the most positive attitudes towards demented patients both in 1987 and 1988 and differed compared to the nurse's aides and LPN's. Burnout correlated with lower empathy and less positive attitudes in the staff. Regression analysis showed that 'experience of feed-back at work' and 'time spent at present place of work' were the most important factors when explaining burnout among the staff. Staff with high empathy experienced "a close contact with the patient" as the most stimulating factor at work while staff with low empathy experienced "improvement of the patient's health" and "contact with colleagues" as the most stimulating factors. The importance of counteracting burnout in the care of demented patients is stressed.     

Selection of clients for vocational rehabilitation at six local social insurance offices: a combined register and questionnaire study on rehabilitation measures and attitudes among social insurance officers

OBJECTIVE: The aim of this study was to evaluate possible differences between local social insurance offices with regard to their selection of clients for vocational rehabilitation. A further aim was to determine whether social insurance officers from different local insurance offices have uniform attitudes regarding professional practice in their application of the insurance system. METHODS: A register-based investigation of 815 vocational rehabilitees served by 6 local social insurance offices in a Swedish county. The study was supplemented with a questionnaire to 30 officers about attitudes to social insurance. RESULTS: The office with the lowest rate of sick-listing periods exceeding one year, and a high frequency of employment training, showed the highest degree of work resumption and the lowest pension rate after vocational rehabilitation. There were wide differences in attitude among the local social insurance officers regarding professional practice in their application of the system. CONCLUSION: Intra-county differences occur in handling people on sick-leave who undergo vocational rehabilitation. The local social insurance offices with the highest and lowest outcome rates of work resumption and disability pension, respectively, select clients for vocational rehabilitation from different categories of cases. Social insurance officers from different local offices differ in their attitudes towards the social insurance system and its clients.     

认知康复训练治疗脑损伤后认知功能障碍的Meta分析

目的:系统评价认知康复训练治疗脑损伤后认知障碍的疗效。方法:计算机检索CNKI、VIP、CBM、万方及PubMed数据库,查找关于认知康复训练治疗脑损伤后认知障碍的临床随机对照试验。对纳入的研究逐个进行质量评价,并进一步对治疗后认知训练组和对照组的有效率、简易智力状况检查法(MMSE)、日常生活活动能力(ADL)、洛文斯顿认知功能评定测验(LOTCA)评分进行Meta分析。结果:16个研究共1281例患者符合纳入标准。结果显示,认知训练组的总有效率、MMSE、ADL及LOTCA评分均明显优于对照组(P0.05,0.01)。结论:认知康复训练治疗脑损伤后认知障碍患者可一定程度上减轻认知障碍的程度,提高患者的自我生活能力。     

关于医护人员对新型冠状病毒肺炎康复知信行的调查研究

目的 了解医护人员对新型冠状病毒肺炎(COVID-19)康复的知识、信念态度及行为（即知信行）情况,为针对性地向医护人员进行COVID-19康复培训提供参考依据。 方法 2020年3月1日至2日,对296名参与抗疫的医护人员进行COVID-19康复的知信行问卷调查,以知信行得分评价医护人员对COVID-19康复的认识。 结果 医护人员COVID-19康复知信行总分、知识、态度、行为得分分别为（69.41±15.06）、（21.23±6.52）、（30.84±4.45）和（17.32±5.63）分,得分占满分的百分比分别为57.8%、53.1%、77.1%和43.3%。不同年龄、工龄、科室、职称以及康复学习经历的医护人员知信行总分差异有统计学意义（P＜0.05）。 Pearson相关性分析显示,医护人员COVID-19康复知识与态度（r=0.693,P＜0.01）、知识与行为（r=0.790,P<0.01）、态度与行为（r=0.697,P<0.01）之间均存在正性相关。 结论 医护人员对COVID-19康复的态度较为积极,但相关的理论知识及实践欠缺,需加强培训。     

Experience of social support in rehabilitation: a phenomenological study

The progressive muscular weakness brought on by muscular dystrophy causes the sufferer many problems in everyday life. Earlier studies in Sweden have shown that adults with hereditary muscular dystrophy often have difficulty in gaining access to rehabilitation. For this reason a special rehabilitation programme was drawn up and carried out, extending over a period of 18 months. The purpose of the study is to describe the participants' experience of social support in connection with the programme. Thirty-seven participants (21 women and 16 men) were interviewed. The analytical method was phenomenological, incorporating validation by independent judges. Nine overall themes emerged from the interviews: psychosocial support, meeting other people with muscular dystrophy, knowledge and learning, adjustment in daily life, coping with illness-related problems, adjustment at work, management of physical disability, medical examination and treatment, and involvement of relatives. The results indicate that the participants encountered staff with a sense of commitment and felt themselves to be 'seen and confirmed'. From the discussions and the contact with others in the same situation there arises a sense of affinity and a better understanding of one's own situation. There was appreciation of the education about the disease, its hereditary aspect, technical aids, grants and physical training. Hardly any of the participants spoke of knowing such things before. In conclusion there was approval of the received support, and recognition that persons with muscular dystrophy should be given access to recurrent rehabilitation.     

记忆障碍康复训练的疗效研究

目的 研究记忆障碍康复训练的疗效,比较不同训练模式的疗效及优缺点,对可能影响疗效的因素进行分析.方法 将全国12家综合医院和专业康复机构144例记忆障碍患者分为仪器训练组、人工训练组和对照组.仪器和人工训练组患者进行以记忆为主的认知康复训练,1次/d,30min次,分别治疗6周和12周;对照组不参加训练.对训练前后的瞬时、短时和长时记忆进 行评定;比较仪器训练组、人工训练组及对照组训练前后组内及组间成绩;并对性别、年龄、受教育年限、病程、损伤部位及昏迷时间对疗效的影响进行分析.结果 仪器训练组及人工训练组6周、12周成绩均较初评显著提高(P＜0.001),并均明显高于对照组(P＜0.01);仪器训练组成绩明显高于人工训练组(P＜0.01);年龄与疗效呈负相关.结论 记忆障碍康复的疗效显著;12周的康复训练可使患者的记忆功能显著提高;采用认知康复专业仪器进行认知训练模式的疗效明显优于人工训练模式,应予以普及推广.     

Direct care staff's need for support in their perceived work role in day activities units

AIMS: This study sets out to investigate direct care staff's views of their need for support, supervision, and training in their practice in day care settings when supporting daily occupations among developmentally disabled persons. BACKGROUND: The first line staff are considered as having a prominent role in the successful delivery of service. METHODS: Three municipalities, one urban and two rural areas in southern Sweden, were chosen for the study. The studied population n = 81 consisted of 94.1% of all staff employed in day activities units supporting the clients' daily occupations or community-integrated, sheltered work employment. The data were collected by means of a questionnaire. FINDINGS: This material identified the staff's perceived work role, and their needs for support, supervision, and training in the areas of communication, environment adaptation, individual activation and training methods, with regard to learning disabilities and special needs. CONCLUSIONS: Care managers should focus upon preparation of staff support programmes to improve the quality and efficiency in this area of care.     

The Family Conference as an example of involving the patient's relatives in neurological early rehabilitation

For the patient the social support plays a crucial role when trying to cope with critical life events. Therefore the "Saarland-Heilst?tten" hospitals in Saarbrücken usually integrate the relatives of patients in a minimally conscious state ("apallisches Syndrom") or having a severe brain injury into the therapies during the neurological early rehabilitation. All members of the interdisciplinary working team attend to the relatives of those patients: there are one-to-one meetings with therapists, weekly meetings with groups of relatives, and Family Conferences. This article explains why generally the qualified work with patients' relatives is absolutely necessary, and it illustrates that concept by describing the approach of the Family Conference. Finally the therapeutic possibilities and limitations of Family Conferences in the rehabilitation process are discussed as seen after several years of experience.     

Process and outcome during early inpatient rehabilitation after brain injury

Purpose: To describe aspects of process and outcome during early inpatient rehabilitation of younger adults after single incident brain injury.

Method: Analysis of a database of 290 patients discharged from an inner-city hospital based inpatient unit for younger adults after single incident neurological events, over a 5-year period.

Results: Analysis showed a stable case-mix of patients over the 5 years surveyed with a preponderance of young male patients after traumatic brain injury. Improvements in patients' disability and dependency, measured by the Barthel Index and Functional Independence Measure, were recorded in the majority of patients. The ethnic diversity of the patients, reflecting the multi-cultural nature of the catchment population, did not appear to affect rehabilitation outcome. Failure to record improvement in 15% of patients was related to the floor and ceiling effects of the instruments. A useful regression equation was produced relating length of stay to Barthel score on admission.

Conclusions: These data demonstrate the changes that occur during early inpatient rehabilitation after single incident brain injury. They explore clinical indicators of dependency and outcome, and aspects of resource utilization that characterize our service. Publication of data of this sort, from this and other units, should encourage the development and improvement of current rehabilitation service delivery after brain injury.     

Substance abuse policies in rehabilitation medicine departments

A 27-item substance abuse questionnaire covering attitudes, beliefs, and policies was sent to the directors or other representatives of the 68 physical medicine and rehabilitation training programs in the United States. Anonymity of the respondents was guaranteed. Respondents representing 52 programs (76%) from 20 states participated. Almost all respondents were physicians; most were rehabilitation unit directors, directors of residency training, or department chairpersons. The average size of the rehabilitation units was 46 beds. Four important findings are emphasized. First, 73% of respondents were concerned about alcohol or drug (A/D) problems in their patients, but only 52% supported routine A/D screening for all patients. Importantly, only 25% routinely screened all patients. Second, 90% supported guidelines prohibiting A/D use in the rehabilitation unit, but only 65% had a prohibition policy and only 45% had written guidelines. More than 50% of the respondents stated that there were appropriate reasons for ordering alcohol for an inpatient. Third, 92% supported immediate intervention for inpatients found to have A/D problems, but only 55% routinely provided access to drug counselors. Fourth, 75% were in favor of drug abuse education for patients and staff, but only 29% provided education to patients and 22% to staff. The results suggest that the problems of A/D abuse in the physically disabled have yet to be adequately recognized and addressed by workers in rehabilitation medicine.     

Post-traumatic rehabilitation of the knee joint

Early rehabilitation was administered to 44 patients (ranging in age from 5 to 19) with post-traumatic and post-operational damage to the knee joint. A positive outcome for the treatment of injuries in the vicinity of the knee joint proved to be dependent on rehabilitation treatment, among other factors. Early commencement of movement and joint mobilization after injury and surgical treatment produces a number of positive physiological changes. The overall plan for rehabilitation is conditioned by the patient's psychological condition, and by the anatomical and functional condition of the joint. A methodology based on muscle strength training using isotonic or isometric work causes specific and non-specific changes in the muscular system. On the basis of the isometric and isotonic training used here in the rehabilitation process after trauma and surgery to the knee joint, it was determined that training based on isometric work is more effective in assisting the convalescence of these patients.