[Applicability of the Therapeutic Nursing Theory in Neurological (Early-) Rehabilitation into Nursing Practice - A Case Study]. / Übertragbarkeit der Theorie "Therapeutische Pflege in der neurologischen (Früh-)Rehabilitation" in die pflegerische Versorgungspraxis ­ Eine Fallstudie.

PURPOSE: The objective of the study is to describe how the theory of therapeutic nursing in neurological (early) rehabilitation can be transferred into nursing practice. MATERIALS AND METHODS: The theory was developed using the method of grounded theory by Glaser and Strauss. Open participatory observations (n=92) and episodic interviews (n=10) with nursing professionals and nursing auxiliaries were conducted in 5 inpatient rehabilitation clinics. Data analysis was performed using the constant comparative method by Glaser and Strauss. RESULTS: By means of a case study, the applicability of the theory into nursing practice with regard to the following care situations is described: (1) training for personal care, (2) therapeutic positioning, (3) oral hygiene, (4) training of sensory-motor perception and (5) counseling relatives. Consequently, the categories of the theory: (1) nursing care, (2) observation/perception, (3) communication, (4) autonomy and individual needs of patients and their relatives, (5) multi-professional team and (6) prerequisites are transferred into the case scenario. CONCLUSIONS: The case study demonstrates how the therapeutic nursing theory in neurological (early-) rehabilitation can be transferred into nursing practice and reveals the complexity of nursing interventions.

[In-patient (early) rehabilitation]. / Frührehabilitation und Rehabilitation im Krankenhaus.

It is difficult to develop the financing and hospital provision of interventions for early rehabilitation within the diagnosis-related group (DRG) system. In addition to a range of partially rehabilitative complex interventions, the system recognizes three main forms of early rehabilitative interventions: geriatric, neurological/neurosurgical, and interdisciplinary and others. In this article, the appropriate definitions and cost-effectiveness of these procedures are analyzed and compared. The early rehabilitative interventions are characterized by constant cooperation in the therapeutic team, especially neurological early rehabilitation through the incorporation of nursing as a therapeutic profession. Whereas geriatric and neurological early rehabilitation are reflected in the DRG system, the former provided in many general hospitals and the latter mainly in specialized institutions, interdisciplinary early rehabilitation has only occasionally been represented in the DRG system so far. If all acute in-patients who require early rehabilitation should receive such an intervention, an additional fee must be implemented for this this interdisciplinary service.

Development of a lifestyle-integrated physical exercise training and home modification intervention for older people living in a community with a risk of falling (Part 1): the FIT-at-Home fall prevention program.

PURPOSE: In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework. METHODS: The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components. RESULTS: The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people. CONCLUSIONS: We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home.IMPLICATIONS FOR REHABILITATIONFalls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community.Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety.This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best.

A feasibility study of a home-based lifestyle-integrated physical exercise training and home modification for community-living older people (Part 2): the FIT-at-Home fall prevention program.

PURPOSE: This study was conducted in a home-based context where trained occupational therapists delivered progressive physical exercise training and home modification intervention for preventing falls, namely the FIT-at-Home intervention. We assessed the feasibility of the intervention's content and mode of delivery from the occupational therapists' perspective as well as the feasibility of study procedures. METHODS: We used a mixed-methods approach, which generated qualitative data from 14 OTs' after delivering the intervention via interviews and quantitative data of the study procedures via questionnaires and documentation sheets. RESULTS: In total, 16 of the 17 older people completed the intervention. Of 9 recorded falls, no serious physical problems occurred. Qualitative data suggested that the intervention content and mode was feasible. Only minor adaptations to the program are needed based on the users' feedback. The main benefit was seen in the fact that simple exercises can be integrated into everyday life for older people with restricted mobility. CONCLUSION: The FIT-at-Home intervention comprising lifestyle-integrated balance and strength exercises and home safety is feasible for occupational therapists to deliver. The findings will help to further refine the intervention and study procedures.Implications for rehabilitationFalling is a frequent and serious health problem for many community-living older people, and the incidence of injurious falls increases with advancing age.Home visiting programs comprising physical exercise training and home modification appear to be beneficial for older people with poor health, functional limitations, and limited mobility.This study indicates that it is feasible to introduce lifestyle-integrated balance and strength exercises, performed as part of daily routine for older people at risk of falling.Behavioural self-management strategies have the potential to improve the implementation of exercises during the course of rehabilitation treatment and afterward.

Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review.

BACKGROUND: During the transition of people with dementia from home to nursing home family caregivers often feel burdened. OBJECTIVES: We aimed to 1) identify interventions which support people with dementia and their caregivers in the transition from home care to nursing home care, 2) synthesize the evidence for efficacy of these interventions, and 3) examine whether the identified interventions have been systematically developed, evaluated and implemented according to the Medical Research Council guidance on complex interventions. DESIGN: A systematic review of randomised controlled trials was conducted according to the recommendations specified in the Cochrane Handbook for Intervention Reviews. The review protocol was registered in PROSPERO (2015: CRD42015019839). Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. DATA SOURCES: MEDLINE, CENTRAL, PsycINFO, CINAHL, OTseeker, and PEDro, were searched. Other sources included Google Scholar, and ALOIS. REVIEW METHODS: Two reviewers independently assessed the eligibility of the articles. Data extraction was performed by one reviewer and verified independently by another. The Cochrane Risk of Bias tool was used for critical appraisal. Development and evaluation of the identified interventions were assessed, taking the Medical Research Council guidance into account. Review findings were synthesized narratively. RESULTS: The search yielded 1278 records. Five studies were included, all conducted in the United States (4 RCTs and 1 cRCT with a total of 695 participants). The psychosocial interventions were individual and family counseling via telephone or ad hoc all of which addressed only informal caregivers. The intervention components, content and mode of delivery differed widely with inconsistent results. Significant intervention effects were found for the reduction of caregivers' depressive symptoms, burden, feeling of guilt, emotional distress, overload, and interactions with staff. Other outcomes, i.e. stress, placement adaptation, role overload, and role captivity, were not statistically significantly affected. The assessment for bias risk across studies varied from moderate to low. Only two studies tested the feasibility of the intervention before full scale evaluation, none evaluated the implementation process according to the Medical Research Council framework. CONCLUSIONS: We identified only a few studies with heterogeneous outcomes; evidence regarding the effectiveness of psychosocial interventions is thus insufficient. Further research is needed focusing on the development and evaluation of complex psychosocial interventions and more well-designed RCTs with larger sample sizes based on a rigorous methodology. Reporting on feasibility and implementation processes of interventions should be guaranteed, since it is crucial to evaluate transferability across care settings.