Rehabilitees perspective on goal setting in rehabilitation – a phenomenological approach

Purpose: Setting meaningful goals for the rehabilitation process after acute illness is essential for rehabilitees recovery. The aim of this study was to understand the meanings of the goal setting situation with professionals from rehabilitees point of view.

Method: We included 20 acute stroke and back pain rehabilitees (mean age 66?y) who set goals with a multidisciplinary rehabilitation team. Data was collected by interviewing the rehabilitees after the goal setting situations. A qualitative analysis from a phenomenological perspective using Spiegelberg’s seven-phase meaning analysis was performed to reveal meanings.

Results: The five meanings were identified as: (i) “trust in the rehabilitation situation, professionals, oneself, and relatives;” (ii) “respectful presence;” (iii) “confusing awareness;” (iv) “disturbing pain;” and (v) “fear of unpredictability.” When professionals committed to working in a patient-centred manner, the rehabilitees felt respected and they trusted professionals and thus their self-efficacy was empowered. Moreover, relatives were an important support in the situation. However, disturbing pain and fear of the future limited patients level of participation in the situation.

Conclusion: Rehabilitee commitment to rehabilitation can be supported with equality in communication and presence of relatives, while pain and uncertainty because of changed health limit participation in a goal setting situation.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation professionals should be recommended to support the active role of a patient in the goal setting situation.

• Relatives are recommended to participate in goal setting situation as they are an important support for rehabilitees.

• Professionals should be recommended to remove obstacles that restrain patient’s participation in the goal setting situation.

• Professionals should be recommended to recognize patients with changed health and offer psychosocial support for those in need to improve their participation in rehabilitation process.

     

Goal setting in palliative care: A structured review

Abstract

Background

Palliative care and rehabilitation both aim to support patients to live as actively as possible. Goal setting has been identified in health policy and clinical guidelines as a mechanism to achieve this. While goal setting is well established in traditional rehabilitation, it is unclear how it should be implemented within palliative care where people are faced with diminishing abilities.

Aim

To identify and synthesize published literature regarding goal setting in palliative care.

Method

Electronic searches were carried out on MEDLINE, PSYCHINFO, EMBASE, CINAHL, ASSIA, and Google Scholar databases between November 2010 and January 2011. Papers were included if they focused on patient-centred goal setting in palliative care. No restrictions were placed on study design or type of paper. Papers were classified according to the type and design and research papers were quality appraised. Papers were read and analysed using framework analysis.

Findings

Sixteen papers met the inclusion criteria. Three themes were identified: 1. Definitions, process, and functions of goal setting;

2. The challenges of delivering goal setting;

3. Theories underpinning goal setting.

Conclusions

Goal setting is recognized as an important component of patient-centred palliative care, but there is no agreement regarding ‘best practice’ and clinicians face particular challenges when trying to set goals with patients in this context. Little attention has been paid to developing a robust, theory-based approach to goal setting in this setting. Hope theory and theories of how people adapt to life-threatening illness could inform the process of goal setting in palliative care.     

An organizational perspective on goal setting in community-based brain injury rehabilitation

Purpose.?To use a taxonomy of goal content, developed in community-based brain injury rehabilitation to examine and compare the content of goals set within two different service settings; and to further examine the potential of the taxonomy to be a reliable and comprehensive framework for classifying goals.

Method.?Qualitative analysis and categorization of 1492 goal statements extracted from a community-based brain injury rehabilitation service over two time periods (1996?–?97, 1998?–?99), and cross-organizational comparison of ratings of goal classifications using a random sample of 100 goal statements drawn from this data set and the original 1765 goal statements used in developing the taxonomy.

Results.?Application of the taxonomy beyond the original service setting in which it was developed indicated a strong inter-rater reliability, with a high test-retest agreement reported over time. For both services, a small number of categories accounted for a substantial proportion of goals set within the two time periods, while considerable change was evident in goals between the two periods for one service. Further, both placed emphasis on individually focused goals rather than relationship or family-related goals.

Conclusion.?The taxonomy provides a reliable means for classifying goals and is a useful tool for exploration of the multiple influences on goal setting. Further application of the taxonomy to examine the relative influence on goal setting of client factors versus a range of organizational factors would be beneficial.     

Patients' experiences of health transitions in pulmonary rehabilitation

HLDING A-G and HEGGDAL K. Nursing Inquiry 2012; 19: 345-356 Patients' experiences of health transitions in pulmonary rehabilitation People who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after PR. The research was inspired by interpretive phenomenology. Thirty-three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well-being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time-limited PR and support the current trends towards patient-centred rehabilitation efforts that incorporate user involvement and self-management education.     

Participants' perspectives of a multi-component, group-based weight loss programme supplement for cardiac rehabilitation: a qualitative study

Addressing overweight and obesity in people with cardiovascular risk factors is an important aspect of cardiac rehabilitation, but minimal implementation of targeted strategies has occurred. The aim of this study was to describe participants' perspectives of a multi-component, group-based weight loss supplement to cardiac rehabilitation programmes. Four focus groups of participants completing the intervention (n = 16) and maintenance phases (n = 19) of the Healthy Eating and Exercise Lifestyle Program (HEELP) were conducted. Interviews were transcribed and thematically analyzed using an inductive process. The overall theme of participants' responses was that HEELP helped them reprogramme their lifestyle behaviours to achieve weight loss. The programme was unique compared with other weight loss programmes because it was delivered and developed by familiar and expert health professionals who tailored the programme to participants' health status. Themes included the process of recognizing and deciding to make a commitment to managing their weight problem and feeling supported by the group and the staff to do this. Participants valued the group-based structure and the specific tools used in the programme. The programme content and structure provides a framework for the development of supplemental programmes for overweight and obese people at high cardiovascular risk.     

The development of a patient-specific method for physiotherapy goal setting: a user-centered design

Purpose: To deliver client-centered care, physiotherapists need to identify the patients’ individual treatment goals. However, practical tools for involving patients in goal setting are lacking. The purpose of this study was to improve the frequently used Patient-Specific Complaints instrument in Dutch physiotherapy, and to develop it into a feasible method to improve physiotherapy goal setting.

Methods: An iterative user-centered design was conducted in co-creation with the physiotherapists and patients, in three phases. Their needs and preferences were identified by means of group meetings and questionnaires. The new method was tested in several field tests in physiotherapy practices.

Results: Four main objectives for improvement were formulated: clear instructions for the administration procedure, targeted use across the physiotherapy process, client-activating communication skills, and a client-centered attitude of the physiotherapist. A theoretical goal-setting framework and elements of shared decision making were integrated into the new-called, Patient-Specific Goal-setting method, together with a practical training course.

Conclusions: The user-centered approach resulted in a goal-setting method that is fully integrated in the physiotherapy process. The new goal-setting method contributes to a more structured approach to goal setting and enables patient participation and goal-oriented physiotherapy. Before large-scale implementation, its feasibility in physiotherapy practice needs to be investigated.

• Implications for rehabilitation

• Involving patients and physiotherapists in the development and testing of a goal-setting method, increases the likelihood of its feasibility in practice.

• The integration of a goal-setting method into the physiotherapy process offers the opportunity to focus more fully on the patient’s goals.

• Patients should be informed about the aim of every step of the goal-setting process in order to increase their awareness and involvement.

• Training physiotherapists to use a patient-specific method for goal setting is crucial for a correct application.

     

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey

Abstract

Purpose: We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. Methods: We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Results: Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n?=?335/407) and provided input to a mixed diagnostic group of patients (71%; n?=?312/437). Ninety one percent of services (n?=?358/395) reported setting goals with “all” or “most” stroke survivors. Seventeen percent (n?=?65/380) reported that no methods were used to guide goal setting practice; 47% (n?=?148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n?=?362/369) reported routinely asking patients about goal priorities; 39% (n?=?141/360) reported routinely providing patients with a copy of their goals. Conclusions: Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist.

• Implications for Rehabilitation

• Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients.

• Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal.

• Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

     

目标设置理论在膝关节韧带损伤术后早期系统康复训练中的应用观察

目的观察目标设置理论在膝关节韧带损伤后早期系统康复训练中的应用效果。方法选取2018年1月至2019年1月某院收治的102例膝关节韧带损伤术后患者作为分析对象,按照随机数表法将其分为观察组与对照组各51例。对照组患者实行术后常规康复训练,观察组患者在对照组基础上应用目标设置理论进行指导。比较干预前、干预3个月后两组患者膝关节功能(Lyshom评分标准)、步行功能[功能性步行量表(FAC)]、运动功能(Fugl-Meyer运动功能量表)评分及关节活动度(ROM)差异。结果干预3个月后,两组患者Lyshom评分、FAC评分、ROM及运动功能各项目评分均高于治疗前,且观察组高于对照组(P均<0.05)。结论对膝关节韧带损伤后患者早期康复训练中应用目标设置理论进行干预,能有效改善患者膝关节功能及步行、运动功能。     

Nursing contribution to the rehabilitation of older patients: patient and family perspectives

tyrrell e.f., levack w.m., ritchie l.h. & keeling s.m. (2012)?Nursing contribution to the rehabilitation of older patients: patient and family perspectives. Journal of Advanced Nursing68(11), 2466-2476. ABSTRACT: Aims. This article reports a study of the perspective of older patients and their family members on the role of nurses in inpatient rehabilitation. Background. Rehabilitation services are used increasingly by older patients as life expectancy increases. The role of rehabilitation nurses in the multidisciplinary team has, however, yet to be clearly articulated. Previous research has focussed on the views of health professionals about nursing involvement in rehabilitation, but none has sought family members' perspectives. With the expectation of patient-centred care, it is important to consider what older patients and their families expect and require from nurses. Design. Grounded theory was used to collect and analyse data from interviews in an inpatient rehabilitation unit in New Zealand with seven patients, aged 72-89?years, and six family members, during 2009-2010. Findings. A substantive theory was developed which recognizes that the older patient values the relationship they build with nurses more than any specific role nurses perform. Participants acknowledged that rehabilitation nurses' roles included 'looking after', 'stepping in' and 'coaching independence' but 'best fit' nurses were identified by patients based on their 'nature', 'being available' and 'being attuned' to the patient's individual needs. If a 'connection' was formed, then this 'best fit relationship' maximized the older person's motivation to participate in his or her rehabilitation therapy. Conclusion. Patients and family members appreciate 'best fit relationships' where nurses seek to enter into the older person's world of disability to form a partnership which enhances their motivation to achieve independence.     

The effect of goal setting in asthma self-management education: A systematic review

BackgroundAsthma self-management education combining with behavior therapy is considered to be more effective. Goal setting is a common behavior change technique used to help patients self-manage their symptoms. However, empirical evidence around its effectiveness on asthma management lacks clarity.AimsTo systematically integrate and appraise the evidence for effectiveness of goal setting interventions on asthma outcomes.MethodsDatabases included CENTRAL, PubMed, EMBASE, CINAHL and Proquest Psychology Database were systematically searched for relevant intervention studies employing goal setting technique as a method in asthma education program for self-management. Characteristic of studies and outcomes in clinical, psychosocial and healthcare utilization outcome were extracted.ResultsFrom a total of 2641 citations, 45 full-text articles were assessed for eligibility and 9 studies met the inclusion criteria. Eight studies were randomized controlled trial and one was before-after study. None studies have a high methodological quality. Goal-setting based intervention appeared to improve symptom control, quality of life and self-efficacy in adult patients with asthma.ConclusionThis systematic review highlighted the potential of a goal setting technique in the asthma self-management education. However, due to the limitations of the quality and quantity of the included literature, more rigorous studies are needed. In the future, better effective study protocol combining with goal setting approach and other behavior technique is needed to further investigate.     

Patients' perspectives on information received in outpatient psychiatry

The purpose of this study is to develop a scale in order to determine the informational needs deemed most important by psychiatric outpatients, and to determine their level of satisfaction with information received. The 'Patients' Perspective on Information Questionnaire' (PPIQ) scale was created and given to a volunteer sample of 86 psychiatric outpatients. The Client satisfaction questionnaire (CSQ-8), assessing global satisfaction, was also completed to assess the convergent validity of the PPIQ-Satisfaction subscale. Internal consistency for the two PPIQ subscales (Information and Satisfaction) is excellent (alpha = 0.90 and 0.91). Convergent validity between the Satisfaction subscale and the CSQ is adequate (r = 0.5). The PPIQ reveals high importance ratings given to items such as 'side effects of medication' and 'confidentiality and access to chart'. Elevated satisfaction ratings are given to items from the conceptual category 'treatment information'. Dissatisfaction on the PPIQ is highest for components of 'information on service modality and organization'. The PPIQ appears to distinguish between information that is important to clients and their level of satisfaction with that information. Satisfaction on multiple components of information, such as treatment, service modality and organization, and clinical difficulties should be assessed to generate feedback to improve services.     

How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions

Purpose: We investigated stroke rehabilitation clinician’s perceptions of the patient as an active partner in setting goals within stroke rehabilitation and factors that influence patient engagement.

Methods: Semi-structured interviews, subject to general inductive analysis with 20 Clinicians’ working in three UK based stroke rehabilitation teams (one in-patient ward and two community based rehabilitation teams).

Results: There were three key themes that impacted on the patients active involvement in setting goals for rehabilitation after stroke: Patient barriers to goal setting (knowledge of the patient and family, who is the patient and the stroke’s impact); How we work as a team (the role of the patient in setting goals, the effect of clinician attributes on goal setting); and How systems impact goal setting (goal-setting practice, home versus hospital, and professional/funder expectations of clinicians’).

Conclusions: Goal setting served a range of different, sometimes conflicting, functions within rehabilitation. Clinicians’ identified the integral nature of goals to engage and motivate patients and to provide direction and purpose for rehabilitation. Further, there was an identified need to consider the impact of prioritizing clinician-derived goals at the expense of patient-identified goals. Lastly the reliance on the SMART goal format requires further consideration, both in terms of the proposed benefits and whether they disempower the patient during rehabilitation.

• Implications for rehabilitation

• Goal setting is often promoted as a relatively simple, straightforward way to structure interactions with patients

• Patient-related factors together with resourcing constraints are significant barriers to patient-centered goal setting, particularly during inpatient rehabilitation

• Clinicians need to have pragmatic tools that can be integrated into practice to ensure that goal-setting practice can be maximized for patients with different intrinsic characteristics

     

Patients' experience of home and hospital based cardiac rehabilitation: A focus group study

Background

New cardiac rehabilitation (CR) programmes, such as home programmes using the Heart Manual, are being introduced but little is known about patients' experiences of these.

Aims

To compare the views of patients who had completed a home or hospital-based CR programme and explore the benefits and problems of each programme.

Methods

16 patients from 4 hospital programmes attended one of 3 focus groups; 10 home programme patients attended one of 2 focus groups.

Results

Some themes were common to all focus groups: loss of confidence; continuing to exercise and lifestyle changes; understanding of heart disease. Hospital programme patients particularly enjoyed exercising in a group and mixing with other people, and gained motivation and support from others. Home programme patients spoke very highly of the Heart Manual and valued the one-to-one support of the nurse facilitators. They described the home programme as a lifestyle change compared to the hospital programme which they suggested was more like a treatment.

Conclusions

Patients in the hospital programme enjoyed the camaraderie of group exercise and patients in the home programme valued the wealth of information and advice in the Heart Manual and this gave them a feeling of being in control of their health.     

Bedside nursing handover: Patients' opinions

Within the context of contemporary nursing practice, bedside handover has been advocated as a potentially more suitable mode for achieving patient‐centred care. Given that patients can play an important role in the process, better understanding of patients' perspectives of bedside handover could be a critical determinate for successful implementation of the practice. Using a phenomenological approach, this study attempted to explore patients' perceptions of bedside nursing handover. Four key themes emerged from the patient interviews: ‘a more effective and personalised approach’, ‘being empowered and contributing to error minimization’, ‘privacy, confidentiality and sensitive topics’, and ‘training need and avoidance of using technical jargon’. Patients welcome bedside handover as they can be empowered through participation in the process. Nevertheless, attention is needed to ensure that adequate training is provided to nurses and to minimize the use of technical jargon so that handover is delivered with a professional and consistent approach.