Providing psychosocial and physical rehabilitation advice for patients with burns

Title.  Providing psychosocial and physical rehabilitation advice for patients with burns.
Aim.  This paper is a report of a study evaluating the perceived skills of nursing and allied healthcare professionals in providing psychosocial and physical rehabilitation advice, including the effect of years of burn injury experience.
Background.  Recovery from burn injuries is a complex mix of physical and psychosocial rehabilitation, yet research in the UK has demonstrated that healthcare professionals feel more competent at giving advice to patients on issues of physical rehabilitation than psychosocial rehabilitation.
Methods.  This was a replication study with a cross-sectional design. A questionnaire survey was conducted with a convenience sample of healthcare professionals in a large urban hospital with specialist burn and plastic services in New Zealand. The data were collected in 2005.
Results.  Consistent with the UK results, New Zealand healthcare professionals rated their skills in advising patients about physical items of burn rehabilitation higher than their skills for psychosocial items. Years of experience working with burns was related to greater perceived skill in advising patients on physical rehabilitation. In contrast, no relationship between years of experience and perceived skill in the provision of psychosocial rehabilitation advice was found.
Conclusion.  Strategies to enhance effective staff/patient communication should form an integral part of staff education. The psychosocial needs of patients must be incorporated as an essential part of such strategies.     

头颈肿瘤外科护士专科知识的培训需求与相关对策

目的调查头颈肿瘤外科护士专科知识的培训需求,探讨培训对策。方珐采用自行设计问卷调查34位头颈肿瘤外科护士专科护理知识技能的培训需求。结果头颈肿瘤外科护士在心理、社会康复知识技能方面得分低,与生理康复知识技能相比较有统计学意义（P〈0．05）。结论对头颈肿瘤外科护士进行心理、社会康复等方面知识技能培训是必要的且可行的。     

District and practice nurses' public health practice and training needs

In 2000, the UK government set out its plan to tackle poor health in 'Saving Lives: Our Healthier Nation'. Practice and district nurses were recognized as key health professionals in achieving the integration of health improvement into the local delivery of health care. In order to respond to these changes, North Tyneside PCT undertook a training needs and skills analysis of local practice and district nurses. Thirty practice nurses and 39 district nurses returned completed questionnaires. Practice and district nurses rated their competence as lower in public health skills than in clinical skills and also rated them of less importance. Senior practice and district nurses indicated that they perceived low value in skills required to move forward public health practice within community nursing. The findings of this study have been used to develop a 5-day training programme. The approach has relevance to those concerned with making public health a reality within community services.     

How nurses in a stroke rehabilitation unit attempt to meet the psychological needs of patients who become depressed following a stroke

Fourteen qualified nurses working in a stroke rehabilitation unit were interviewed in order to ascertain their understanding of post-stroke depression, what they do to help a patient who becomes depressed and what they feel unable to do They were also asked what would improve the situation The nurses were able to describe the characteristics of depression following a stroke and recognize its effect on the subject's rehabilitation They were able to identify patients who were becoming depressed and tried to help them to the best of their abilities They felt constrained, however, mainly by lack of time, limited skills and lack of appropriate training They themselves wanted to be able to meet the needs of depressed patients and thought that this could be achieved through better staff education and access to other health professionals experienced in providing psychological care It is recommended that nurses have access to expert personnel both as a source of referral for patients and as a resource for support and guidance to staff In addition, an education programme combining theoretical and practical aspects of psychological care would be useful     

Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.

• Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.

• Nurses can routinely incorporate rehabilitation principles in their care.

• Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

     

The Thorn Course: rhetoric and reality

The Thorn Course that provides psychosocial interventions and family work training for UK mental health professionals was founded in 1992. Since this time policy, service provision and needs have changed. The aim of this study was to examine the Thorn Course through relevant literature, in order to establish whether research and policy have been integrated into practice within training and services. A search of professional journal databases was conducted. Keywords used were 'Thorn Course' and 'psychosocial intervention training'. The resulting body of literature was reviewed. Five main themes emerged which were examined: needs identified, delivering the Thorn Course, training outcomes, implementing interventions and user and carer involvement. There is a distinct lack of research studies evaluating any aspect of the Thorn Course. There is little evidence that user and carer involvement has moved beyond rhetoric and community mental health nurses continue to lack opportunities and support to implement psychosocial skills acquired in training.     

Nursing personnel in inpatient rehabilitation--work satisfaction,motivation for interdisciplinary cooperation and for achieving psychosocial competence

106 nurses from eleven rehabilitation clinics were questioned by means of an anonymous clinical questionnaire on the issues of job satisfaction, interdisciplinary cooperation, and expectations towards future psychosocial staff training (main fields of the participants: orthopaedics, cardiology, dermatology and neurology). Two thirds were altogether satisfied with their jobs, primarily with regard to their relationships with the patients and the colleague nurses (76%), to some extent less so, however, with the doctors (63%). More than 90% expected psychosocial service to deliver feedback for the team and close interdisciplinary communication. Main expectations of psychosocial staff focused on the improvement of communication skills with strained patients, on improved psychological and especially psychodiagnostic knowledge as well as more functional coping with conflicts with patients and team-members (60% expressed marked expectations with regard to each issue). More than half of the staff indicated that they would prefer regular training sessions of one to two hours' duration, and more than 20% favoured each one-day- or weekend-workshops. The most popular ways of working in staff training were "discussion of team conflicts", "exchange of experience", "seeking emotional release", "discussing cases" and "training of communication skills" (approx. 60% each). Nearly 90% found "coping with aggressive patients" as well as "depression and suicide" to be the most important issues, followed by "ways of self-protection", "dealing with anxious patients", "coping with illness", "improvement of team-atmosphere" and "coping with death and dying". The findings of the study recommend an integration of psychosocial issues into education--and training--curricula for the various professions in rehabilitation.     

Emergency Department Mental Health Triage and Consultancy Service: an advanced practice role for mental health nurses

This paper describes a four-month preparatory training program for mental health nurses to provide an Emergency Mental Health Triage and Consultancy Service in the emergency department. The emergency department is an important gateway for patients presenting with psychiatric/psychosocial problems and mental health professionals need to provide prompt and effective care to this group of patients. Prior to the implementation of the service, it was acknowledged that occupational stress and burnout could affect the turnover of mental health nurses in the department. Therefore, a training program was employed to prepare a number of experienced mental health nurses to work at an advanced practitioner level. The four-month training program developed at Fremantle Hospital in Western Australia provided support, guidance and clinical supervision. In the first 12 months of the service, five mental health nurses completed the program, thus creating a pool of nurses who were able to provide the service. The results demonstrated that providing mental health nurses with a structured program was instrumental in facilitating their movement to an advanced practitioner level. The nurses were able to apply advanced knowledge and skills to assess and manage clients with complex mental health /psychosocial problems. Furthermore, on leaving the emergency department these nurses were able to utilise the advanced skills in other areas of mental health nursing practice.     

Determining the content for an interactive training programme and interpretive guidelines for the Assistive Technology Device Predisposition Assessment

PURPOSE: Develop the content for interpretive guidelines and an interactive training programme for professionals administering the Assistive Technology Device Predisposition Assessment (ATD PA) consumer form, a self-report assessment tool for consumers to identify their perceived functional capabilities and limitations, satisfaction with and priorities for quality of life achievement, psychosocial characteristics and device preferences. METHOD: Twenty-two professionals (with 1-2 consumers each) completed surveys on their use of the ATD PA and recommendations for interpretive guidelines and an interactive training programme. Participants represent eight US states and the country of Italy. Fourteen women and eight men (professionals) participated, and 20% of the sample was comprised of US consumers from Hispanic or African-American ethnic groups. Professionals represented the following disciplines: occupational therapy (n=1); physical therapy (n=1); rehabilitation engineering (n=4); and vocational rehabilitation counselling (n=16). Additionally, an advisory committee of 14 persons was formed, comprising consumers as well as international AT experts. The committee members prioritized content areas for the training programme and interpretive guidelines. RESULTS/CONCLUSIONS: Responses strongly support the need for and the continued development of the training programme and interpretive guidelines. Content areas have been identified and prioritized.     

Counselling and mental health nursing: a qualitative study

The author draws upon his experience of training, practising and teaching both counselling and mental health nursing in order to examine the relevance of counselling skills training to mental health nurses. The qualitative study reported in this paper elicits the feelings and thoughts of five mental health nurses about their attitude towards individual counselling work with mental health clients. It is asserted that newly qualified mental health nurses may feel inadequately prepared for this aspect of their work and they may also feel inadequately supported. Additional counselling training may help equip mental health nurses for the skills they need to work within the therapeutic relationship. By not providing adequate counselling skills training, mental health nurse educators may contribute to a cycle of incompetence. Training methods are identified that may enhance nurse training and help promote competence and confidence for the newly qualified nurse.     

Perceptions of the role of the hospital palliative care team

AIM: The aim of this study was to understand staff perceptions of the role of the hospital palliative care team and to identify knowledge and confidence levels of general staff caring for patients with palliative care needs. METHOD: A survey questionnaire tool was used with a response rate of 51 per cent. Participants included nurses, health care assistants and doctors. RESULTS: The study highlighted several misconceptions about the role of the palliative care team, but demonstrated that the clinical staff surveyed were confident in their palliative care skills, with the exception of discharge planning, despite the fact that only 26 per cent of nurses reported having undergone training in palliative care. It identified that HCAs felt confident in caring for dying patients yet had little confidence in dealing with distressed relatives or speaking to patients and families about death. It was also interesting to note that trained nurses felt confident in their symptom control skills, and they rated training in this area as one of the top priorities. CONCLUSION: The findings have considerable implications for palliative care services. Professional education should continue to focus primarily on symptom control and communication skills training, but stress management training should be considered. Staff need to be clear about how to obtain advice and what support is available for cancer patients. Further research is required to understand the needs of HCAs and potential models for education and support.     

Assistive technology education: an online model for rehabilitation professionals

PURPOSE: A model for delivering Assistive Technology (AT) education is described in the context of an online masters degree in rehabilitation counselling, demonstrating the integration of content and process in an interactive format. METHOD: Data collected from course activities and assignments were examined to identify ways in which 120 students from 18 US states responded to and interacted with the information and how they applied the course content to their jobs as rehabilitation professionals. A qualitative research design was used to identify themes to add to the understanding of issues associated with learning about AT in an online format. RESULTS: Critical components of the course identified from the data analysis included: increased awareness, skills, confidence, and immediate application to own job responsibilities; interaction with instructors and peers; access to resources and expertise; value-based practices; and participation on interdisciplinary teams. These themes were consistent across all six groups of students enrolled in the participating three rehabilitation regions. CONCLUSIONS: Online education can be an effective medium for teaching practicing rehabilitation professionals how to provide person-centred AT services to people with disabilities. The content must drive the technology; the process must be student-driven; and the interaction must address individual learning styles and promote lifelong learning.     

Stereotypes of emotional caregivers and their capacity to absorb information: the views of nurses, stroke carers and the general public

This study examines the phenomenon of stereotyping informal caregivers' capacity to learn about the condition of stroke victims. Forty-nine nurses, 55 carers and 39 members of the general public gave their opinions on how emotional they considered six hypothetical wives of stroke patients to be and how much information they thought each wife would be able to absorb. Results indicated that nurses were more pessimistic than caregivers in their assessment of how much information could be absorbed, even though these two groups did not differ in their assessment of the emotionality of the wives. Nurses and the general public responded in accordance with the expected stereotype: those rated as being high in emotionality were less likely to absorb information. No such association emerged from the ratings of caregivers. The existence of the stereotype, particularly among health professionals, has serious implications for rehabilitation programmes and caregiver well-being, and provides an explanation for why caregivers sometimes feel neglected in medical settings.     

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong

AIM OF THE STUDY: The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong's Community Rehabilitation Centres (CRNs). DESIGN/METHODS: Using a two-phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients' perceptions of the psychosocial interventions provided by the nurses and face-to-face interviews with clients and their caregivers. FINDINGS: These findings revealed that the nurses' interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes. CONCLUSION: Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.     

Community Health and Pediatric Nurses' Knowledge, Attitudes, and Behaviors Regarding Child Sexual Abuse

Abstract Community health and other child care nurses can play a major role in the prevention, early detection, referral, treatment, and rehabilitation of victims of child sexual abuse (CSA) and their families. It is not known, however, whether these health care professionals are well prepared or feel sufficiently confident to address these challenges. The present study provides some information on this matter by examining their knowledge, attitudes, practices, and degree of confidence concerning CSA. The total population of community health and pediatric nurses of a Canadian province were surveyed using a mail out questionnaire. The results revealed that these nurses need and want to improve their knowledge and skills regarding the identification, referral, and treatment of victims of CSA. Small but significant differences were noted between the nurses and other professional and non-professional workers who had been surveyed in a previous study regarding their applied knowledge of CSA, attitudes toward victim credibility and culpability, and punishment for offenders.     

Health care professionals report positive experience with a breastfeeding training program based on the Baby-Friendly Hospital Initiative for Neonatal Intensive Care

Support from health care professionals (HCPs) with good knowledge and positive attitudes toward breastfeeding has been associated with better breastfeeding outcomes in the mothers of preterm infants. The aim of the study was to describe HCPs' experiences of a breastfeeding training program. A total of 48 specialist registered nurses, registered nurses, assistant nurses and physicians working at a neonatal intensive care unit attended a breastfeeding training program and answered a questionnaire including Likert scales and open-ended questions. The participants reported that their interest in breastfeeding had increased as a median (range) of 10 (8–10) on a 10-point scale and rated to what extent they had received new tools for breastfeeding support as a median of 10 (8–10) after training. There were no differences in the median between different professions' ratings. Qualitative content analysis of the open-ended questions resulted in two categories: Discussions of the case scenarios in the group and Knowledge regarding breastfeeding. The results showed that discussions based on breastfeeding scenarios were perceived as valuable; the health care professionals reported receiving new knowledge and useful practical skills. This program was shown to increase health care professionals’ interest in breastfeeding and is useful for different health care professions.     

Are ward sisters and charge nurses able to fulfil their role?

AIM: To investigate the self-reported duties carried out by sisters and charge nurses working on the wards and to assess the attitudes of these health care professionals towards their management role. METHOD: Questionnaire. RESULTS: Sisters/charge nurses were allocated patients in addition to being in charge of their ward for, on average, half of their shifts each week. Most of them did not have time to complete their managerial duties, which included supporting and supervising other staff on patient care issues. More than 50 per cent of the sisters/charge nurses did not have the time to attend clinical supervision. CONCLUSION: Sisters/charge nurses treat clinical care--both delivering it directly themselves and advising other staff on its delivery--as a higher priority than their managerial and administrative duties; lack of time is a barrier to the successful fulfilment of their role.     

Bridging the distance: educating nurses for telehealth practice

BACKGROUND: The aim of this research project was to explore the impact of telehealth technology on health assessments performed by nurses delivering health services to isolated populations. METHOD: Nurses performing preoperative and oncology assessments for clients in remote communities via telehealth received training. Education workshops were delivered to nurses (N = 37) in 13 communities across Northwestern Ontario. RESULTS/CONCLUSION: Presurveys and postsurveys indicated that the nurses were receptive to the mode of delivery and the content was relevant to their telehealth practice.     

Self-responsibility and coping with pain: disparate attitudes toward psychosocial issues in recovery from work place injury

Purpose : To compare injured worker and health professional ratings of psychosocial variables as they relate to recovery.

Method : Seventy patients and 70 health care staff at an injured worker rehabilitation centre completed a 17-item checklist. Each subject selected five psychosocial variables believed to be most important to recovery. Group ratings were compared using chi-square with a Bonferroni adjustment.

Results : In general, patients and health professionals agreed on the relative importance of 15 of 17 variables. However, the groups did differ significantly on two items - staff rated 'self-responsibility' higher than patients, while patients rated 'coping with pain' higher than staff.

Conclusions : The ratings reflect the occasionally divergent goals and expectations of the rehabilitation staff and patient groups. Consequently, some patients may be moved into inappropriate treatment modalities, resulting in non-compliance. Being aware of patient beliefs and expectations should assist health care professionals in generating improved rehabilitation outcomes by promoting better co-operation through shared perceptions and goals.