Evaluation of a nurse-led social rehabilitation programme for neurological patients and carers: An action research study

Background

Very few neurological rehabilitation programmes have successfully dealt with patients’ and relatives’ social needs. Furthermore, the nurses’ contribution in those programmes is poor or unclear.

Objectives

To determine the rationale, effectiveness and adequacy of a nurse-led social rehabilitation programme implemented with neurological patients and their carers.

Design

In this action research study Hart and Bond's experimental and professionalizing typologies were applied through Lewinian cycles. A social rehabilitation programme was planned, based on the results of an in-depth baseline assessment of the context and individual needs. The programme focused on increasing the level of acceptance/adaptation of the disease through verbal and written education, easing the discharge planning, and offering social choices based on the social assessment of individual needs and possibilities at home.

Settings

Two neurological wards of a hospital in Spain.

Participants

The programme evaluation included 27 nurses, and two groups of patients and relatives (control group = 18 patients and 19 relatives, intervention group = 17 patients and 16 relatives).

Methods

The two groups of patients and relatives were compared before and after discharge to determine the effectiveness of the programme. Socio-demographic forms, semi-structured interviews, participant observations, and validated scales to measure activities of daily living and social life were used, and data were analysed using content (QSR Nudist Vivo, v.2.0) and statistical (SPSS v. 13.0) analyses.

Results

The new programme resulted in social care being integrated in daily practice and developed knowledge about social rehabilitation. This had a positive impact on nurses’ attitudes. Patients and relatives had more realistic expectations and positive attitudes towards social life, and developed a wider variety of choices for social changes. Better adaptation, and more coping skills and satisfaction were achieved.

Conclusions

This rehabilitation programme was feasible and effective. Patients and relatives benefited from better understanding of the socialisation process, as a result of advancing nurses’ knowledge, experience and role in psychosocial care.     

Evaluation of doctoral nursing education in Japan by students, graduates, and faculty: a comparative study based on a cross-sectional questionnaire survey

Evaluation of doctoral education in nursing is needed with the rapid increase in doctoral nursing programs in Japan. This study aimed to compare the evaluations of doctoral nursing education by students, graduates, and faculty. All 46 doctoral nursing programs in Japan were target settings. 127 students who had been in the doctoral program, 24 graduates and 87 faculty members had responded to the survey. A questionnaire with 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, and 3 for overall evaluations was distributed in November and December 2008. Responses to 1 program evaluation item, 2 faculty evaluation items and 4 resource evaluation items indicated significant differences among evaluators. While 79.2% of graduates responded positively that the number of faculty members was sufficient to facilitate learning, only 36.1% of faculty members and 49.6% of students responded affirmatively. Graduates' ratings were the most positive and faculty members were the least positive, especially for infrastructure or equipment such as libraries, computers, and the number of technical and support staff. The significant differences among the evaluators suggested that having evaluators in various roles is important to evaluate the quality of doctoral nursing education.     

Velocity tracking, a new and user independent method for detecting regional function of the left ventricle

Background: The use of two‐dimensional echocardiography (2D echo) for detection of ischaemia is limited due to high user dependency. Longitudinal motion is sensitive for ischaemia and usable for quantitative measurement of longitudinal myocardial function but time consuming. Velocity tracking (VeT) is a new method that gives an easy three‐dimensional understanding of both systolic and diastolic regional motion, using colour coded bull’s eye presentation of longitudinal velocity, derived from colour coded tissue Doppler. The aim of this study was to test the accuracy of VeT in detecting ischaemia in non‐ST‐segment elevation myocardial infarction (NSTEMI) patients bedside. Methods: Twenty patients with NSTEMI and 10 controls were included. Echocardiography was performed within 24 h of symptoms and prior to coronary angiography. Bull’s eye plots presenting the peak systolic velocity (PSV) and the sum of PSV and the E‐wave‐velocity (PSV+E) were created using our developed software. VeT was compared to expert wall motion scoring (WMS) and bedside echo. We used the clinical conclusion based on ECG, angiography and clinical picture as ‘gold standard’. Results: Sensitivity for ischaemia with VeT (PSV+E) was 85% and specificity 60%. The corresponding sensitivities for expert WMS were 75% (specificity 40%). For regional analysis VeT and WMS showed comparable results with correct regional outcome in 11/20 of patients both superior to bedside echo. Conclusion: Velocity tracking is a promising technique that provides an easily understandable three‐dimensional bull’s eye plot for assessment of regional left ventricular longitudinal velocity with great potential for detection of regional dysfunction and myocardial ischaemia.     

Use of the program explication method to explore the benefits of a service for homeless and marginalized young people

Maintaining the alignment between the dynamic development of health and social services and the rapidly advancing scientific evaluation literature is a central challenge facing service administrators. We describe "program explication," a consulting method designed to assist services to identify and review implicit program logic assumptions against the evaluation literature. Program explication initially facilitates agency staff to identify and document service components and activities considered critical for improving client outcomes. Program assumptions regarding the relationship between service activities and client outcomes are then examined against available scientific evidence. We demonstrate the application of this method using an example of its use in reviewing a service for homeless young people operating in Melbourne, Australia, known as the Young People's Health Service (YPHS). The YPHS involved 21 activities organized within 4 components. The intended benefits of each of the activities were coherently articulated and logically consistent. Our literature search revealed moderate to strong evidence for around 1 quarter of the activities. The program explication method proved feasible for describing and appraising the YPHS service assumptions, thereby enhancing service evaluability.     

Learning together, working together: an evaluation of experiences of a pilot programme for partnership between unions and management in the health service

This article describes an innovative initiative to support partnership working between trade unions and management in three National Health Service Trusts, by means of shared participation in a series of learning and development days. Although there is existing evidence, within the literature on partnership, of the benefits of partnership working for employees and employers, there is little discussion of processes by which effective partnership is developed. More specifically, there is no current academic literature on the role of education in enabling improved partnership working between trade unions and managers. The findings of the evaluation suggest that the pilot provided a successful learning experience as well as a number of pointers for improving future developments of this nature. The recommendations include embedding of partnership work within existing staff development processes.     

Of ethics committees, protocols, and behaving ethically in the field: a case study of research with elderly residents in a nursing home

In this paper we discuss differing discourses of research ethics committees and the clinical research field. Reflections on our experience of conducting research in a nursing home are used to highlight the tensions and inconsistencies that arise from these discourses and the need to behave ethically in the field. While accepting the need for adherence to guiding principles of duty based ethics, we have found that practical moral decisions in the field required that, as individual researchers, we needed to exercise discretionary judgement, informed by the ethic of care and the concern for the well-being of research participants.     

Long-term community reintegration: concepts,outcomes and dilemmas in the case of a military service member with a spinal cord injury

Abstract

Purpose: Despite growing knowledge about medical and functional recovery in clinical settings, the long-term issue of community reintegration with a spinal cord injury (SCI) in the military context remains virtually unexamined. Thus, the U.S. Department of Defense created the SCI Qualitative Research Program to advance knowledge about service members’ reintegration into civilian life. The purpose of this paper is to better characterize the long-term outcomes related to the community participation experienced and desired vis-à-vis a case study of a military veteran who suffered a service-related traumatic SCI. Methods: An in-depth anthropological interview was used with Jake, a 28-year old marine with a service-related C5/C6 SCI. Data were analyzed using content analysis. Findings: Three significant themes were identified: opportunities for better engaging socially meaningful others may not be adequately included in so-called “client-centered” interventions; how management of the social self in inter-personal interactions and public spaces is critical to gaining broader societal acceptance; and how meaningful age normative relationships and activities are essential to establish lasting inclusive social connections. Conclusions: Jake’s case challenges existing models of rehabilitation predominantly focused on physical capacity building. Study findings point to the need for rehabilitation to invest more resources in efforts to address the existential and social elements of long-term social reintegration.

• Implications for Rehabilitation

• Both the veteran with SCI and their meaningful support network face challenges socially reintegrating after injury and rehabilitation.

• Empowering clients to envision future possibilities in terms of family, intimate relationships, and meaningful work are important to successful long-term social reintegration.

• Addressing the existential desires and social capacities of the individual may be as important as addressing physical functioning skills after SCI.

     

The order and priority of research and design method application within an assistive technology new product development process: a summative content analysis of 20 case studies

Summative content analysis was used to define methods and heuristics from each case study. The review process was in two parts: (1) A literature review to identify conventional research methods and (2) a summative content analysis of published case studies, based on the identified methods and heuristics to suggest an order and priority of where and when were used. Over 200 research and design methods and design heuristics were identified. From the review of the 20 case studies 42 were identified as being applied. The majority of methods and heuristics were applied in phase two, market choice. There appeared a disparity between the limited numbers of methods frequently used, under 10 within the 20 case studies, when hundreds were available.

• Implications for Rehabilitation

• The communication highlights a number of issues that have implication for those involved in assistive technology new product development:

• ?The study defined over 200 well-established research and design methods and design heuristics that are available for use by those who specify and design assistive technology products, which provide a comprehensive reference list for practitioners in the field;

• ?The review within the study suggests only a limited number of research and design methods are regularly used by industrial design focused assistive technology new product developers; and,

• ?Debate is required within the practitioners working in this field to reflect on how a wider range of potentially more effective methods and heuristics may be incorporated into daily working practice.

     

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness,social cost,and user satisfaction

There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3–17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.