Examining subacute nurses' roles in a changing healthcare context.

AIMS AND OBJECTIVES: To explore and describe nurses' role in the rehabilitation and care of patients in one subacute care facility in Melbourne, Australia. BACKGROUND: The role of nurses in subacute care and within the rehabilitation team is evolving and remains unclear. DESIGN: Mixed methods. METHODS: Fourteen nurses from seven rehabilitation and geriatric evaluation and management wards in one subacute facility in Melbourne, Australia, were observed in practice for two hours and then interviewed. Activities were recorded electronically. Interviews were audio-recorded and transcribed. Data were analysed using content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Three main themes are as follows: (a) Nurses as rehabilitators; (b) Teamwork in rehabilitation; and (c) The changing context of subacute care. Nurses prioritised patient personal and clinical care above other responsibilities. They were largely excluded from team decision-making because clinical responsibilities precluded them from attending team meetings. Unsuitable buildings, increased patient acuity and time constraints were further challenges. CONCLUSIONS: Nurses have a multifaceted role in patient rehabilitation that is poorly understood. An evaluation of the nursing role within the interdisciplinary team, skills and processes of care may increase understanding, and improve communication and relationships between disciplines potentially benefiting patients. Role clarity and differentiation in nursing skills are required within the nursing workforce. RELEVANCE TO CLINICAL PRACTICE: Nurses have a unique role in both clinical care and rehabilitation of patients, and as part of the interdisciplinary team. Respectful professional relationships need fostering within the interdisciplinary team to achieve optimal patient outcomes. The way that team meetings and decision-making occur in the subacute wards requires adjustment to ensure that the valuable contribution of nurses, both to the interdisciplinary team and to the rehabilitation of patients, is used and acknowledged to improve patient care.

Mapping nursing practices in rehabilitation units in Spain and the United Kingdom: A multiple case study.

Because of the crisis in the health sector with few employment opportunities, many Spanish nurses are looking for professional development abroad. No studies have mapped nursing practices across Europe. The aim of this research was to provide a comprehensive approach to understand nursing practices and features of the context in Spain and the United Kingdom within the rehabilitation unit and to discuss those practices from a patient safety point of view. Multiple case study design with thematic analysis was applied in this study. The methods for data collection were in-depth interviews, nonparticipant observations, and document analysis. Results were classified into six categories: resources, techniques and nursing procedures, patients' personal care, health education, documentation task, and attitudes and communication skills. This study concludes that differences exist between nursing practices despite both countries having similar nursing competences. In addition, the UK unit has a positive safety culture, recognizes that mistakes happen, and applies more barriers to avoid them. The study provides valuable information to help the decision-making process for Spanish nurses considering working in the UK.

Stroke survivors' and carers' experiences of a systematic voiding programme to treat urinary incontinence after stroke.

AIMS AND OBJECTIVES: To explore the views and experiences of stroke survivors and carers about a systematic voiding programme for poststroke incontinence. BACKGROUND: Urinary incontinence after stroke is common and associated with poorer functional outcome. Structured assessment and management are potentially effective interventions, but it is important that there is a good understanding of stroke survivors' and carers' views of their acceptability and implementation. DESIGN: A qualitative study within a feasibility trial. METHODS: Sixteen participants (12 stroke survivors and four carers) were interviewed using a structured schedule shortly before discharge from one of six inpatient stroke units across six hospitals. Interviews were audio-recorded and transcribed verbatim, and thematic analysis was conducted. FINDINGS: Participants included seven male and five female stroke survivors (mean age 76 years) and four female carers (two wives and two daughters). Themes relating to the preliminary (assessment) phase of the programme were as follows: physical impact, psychological impact, beliefs about incontinence, and the assessment process itself. Main themes relating to the implementation of the programme included the following: timed voiding decisions, adapting the programme or the timed voiding schedule, and urinary incontinence management techniques. Participants felt that the programme helped them to re-establish a regular pattern of micturition and to regain autonomy. CONCLUSIONS: The effectiveness of a systematic voiding programme may partly lie in its educational component, challenging patients' and carers' assumptions that poststroke incontinence is inevitable. Individual adaptation of the programme and the ability to incorporate it alongside other aspects of care are likely to be key factors influencing implementation. RELEVANCE TO CLINICAL PRACTICE: Urinary incontinence is common after stroke. To maximise benefits from a systematic voiding programme, nurses should support stroke survivors to overturn erroneous beliefs, to participate in tailoring of the programme, and in self-management where appropriate.

A Nurse-Led Mobility Program on an Acute Rehabilitation Unit.

Rehabilitation assists patients with return to baseline activities of daily living after catastrophic events or long hospitalizations. In an effort to increase mobility episodes in the rehabilitation patient, a nurse-led mobility program was suggested. This allows the rehabilitation nurse to participate in the improvement of mobility for rehabilitation patients by mobilizing the patients safely during hours in which physical therapy is not available. The purpose of this project was twofold: (1) Can additional mobility episodes improve outcomes in the rehabilitation patient? (2) How can safe patient handling principles be applied to the rehabilitation patient?

Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement.

RATIONALE: In the last decades, length of stay of in-hospital rehabilitation of patients with stroke has been significantly reduced. Health authorities expect relatives to be at disposal to convey the knowledge of everyday life and to provide emotional as well as practical support in relation to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity between the relatives' expectations and the actual contribution from nurses. AIM: This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. METHODOLOGICAL DESIGN: A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus group, interviews of 19 randomly selected nurses from three different hospital settings were interpreted in three levels. The study was conducted in accordance with the ethical guidelines for nursing research in the Nordic countries. FINDINGS: The nurses expressed that they address the patient and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. CONCLUSION: Nurses experience their roles and functions addressing relatives after stroke as crucial, challenging and multifaceted. They acknowledged care needs of the relatives in their own right by addressing the relatives' vulnerability during in-hospital rehabilitation characterised by an existential threat to the physical as well as the shared life. The focus on the needs of relatives considering their expected future role was experienced as conflicting with restricting time frames and a healthcare system focusing on the individual patient.

Effect of terbutaline combined with budesonide in treatment of bronchial asthma and rehabilitation nursing.

Terbutaline aerosol and budesonide suspension are commonly used in the treatment of bronchial asthma, and budesonide suspension has local high efficiency and anti-inflammatory effects. In this paper, we selected 240 patients with bronchial asthma and randomly divided them into two groups. The experimental group was treated with atomization inhalation of terbutaline, after 5 minutes interval, nebulized inhalation of budesonide was performed. The control group was treated with atomized inhalation of mixed liquid as terbutaline and budesonide. After treatment, the cough scores of the two groups decreased, and the dyspnea score improved significantly compared with that before treatment (P<0.05).After treatment, the levels of IL-6, BNP and CRP were decreased in the two groups. There was a significant difference between the two groups after treatment (P<0.05). The incidence of adverse drug reactions was low. There were 2 cases of panic disorder and 8 cases of pharyngeal discomfort in the experimental group. The results show that the interval medication of terbutaline and budesonide in the treatment of bronchial asthma can achieve better clinical efficacy and can provide reference for clinical treatment. In addition, this method can effectively reduce the level of inflammatory factors in acute asthma patients, thereby reducing the damage of inflammatory factors to the body.

Analysis of specialized nursing on respiratory functions in thoracotomy patients.

To analyze the nursing effect on the respiratory function of thoracotomy patients, sixty thoracotomy hospitalized patients were studied. The subjects were divided into a normal group (A) and an observation group (B). The patients in group A received routine nursing only, while those in group B received chest physiotherapy as well as routine nursing. Afterwards, the respiratory function indicators of the two groups were compared and a data analysis was performed. The results showed that the partial pressure of oxygen (PO2) value of the patients in group B was greater than that of the patients in group A while the partial pressure of carbon dioxide (PCO2) value in group B was smaller than that in group A, and there was a significant difference between the two groups (p less than 0.05). The vital capacity under normal circumstances and forced breathing of group B were greater than that of group A and the difference was statistically significant (p less than 0.05). The incidence of complications (atelectasis, respiratory infections, pleural effusion) was statistically significant between the two groups (p less than 0.05). The degree of autonomic respiratory dysfunction in group B was lower than that in group A, and there was a significant difference (p less than 0.05), suggesting that the respiratory function in patients receiving chest physiotherapy improved significantly.

Quick rehabilitation nursing improves the recovery of colon cancer patients after laparoscopy.

Colon cancer is a common malignant tumor with particularly high morbidity and mortality. The aim of this study was to compare the effect of quick rehabilitation nursing and routine nursing in postoperative recovery of patients with colon cancer after laparoscopic surgery. Two hundred forty patients with colon cancer were classified into four random groups (A, B, C and D, with 60 patients in each group). All patients underwent surgery to remove the colon tumor by laparoscopy under general anesthesia. Patients in groups A and B received quick rehabilitation nursing for post-surgery recovery. In group C patients, local anesthesia associated with quick rehabilitation nursing for post-surgery recovery was used. Group D was used as control group and the patients were treated based on routine nursing. Time to get out of bed, first bowel movement time and the average time of hospitalisation in group A was lower than group D (p less than 0.05), postoperative leukocyte level as well as the occurrence rate of nausea and vomiting, ankylenteron and pelvic adhesion was decreased in group A compared to group D (p less than 0.05), but the postoperative albumin and total protein level was higher than group D (p less than 0.05). The serum level of C-Reactive Protein (CRP) and interleukin 6 (IL-6) in group A was decreased compared to group D several days after surgery (p less than 0.05); group B had 4 cases of intestinal obstruction after surgery that could be cured through conservative treatment, while group D had 10 cases of intestinal obstruction, 8 of which could be cured through conservative treatment and two needed surgery (p less than 0.05); VAS for pain degree of group C in active state was clearly lower at 1h, 5h, 7h, 15h, 30h and 42h after surgery, and side effects of postoperative analgesia were clearly reduced. Time to get out of bed was obviously decreased, while there was no evident effect on postoperative dosage, chronic pain and complications. Adopting quick rehabilitation nursing can effectively reduce occurrence of complications and postoperative pain, speed up the recovery of gastrointestinal function, shorten the length of stay, and improve patients’ satisfaction.

The longitudinal course of depression symptomatology following a palliative rehabilitation program.

PURPOSE: Patients with advanced cancer have increased life expectancy but suffer from ongoing burden. Depressive symptomatology is their most common mental health concern. The Ottawa Palliative Rehabilitation Program (PRP) offers rehabilitation for this population. It offers 8 weeks of individualized interdisciplinary rehabilitation, post cancer treatment. Interventions include medical (physician and nurse), physiotherapy, occupational therapy, dietary, and social work using a general self-efficacy framework. Pilot data suggest benefits in a range of domains, including ratings of feeling "depressed." We examined whether reduced symptomatology was maintained 3 months after PRP completion. METHODS: Participants with advanced heterogeneous cancers who completed the PRP were mailed the Hospital Anxiety and Depression Scale (among others) 3-month post-PRP (n = 44). Demographic and medical information were obtained from patient files. RESULTS: There was a significant linear trend (mean T1: 6.79 ± 2.29; T2: 5.23 ± 3.06; T3: 4.59 ± 3.34; p = 0.007) with statistically and clinically significant decreases in reported depressive symptomatology between T1 and T2 (p = 0.042) and T1 and T3 (p = 0.007). There was a significant decreases in number of cases reporting symptomatology scores in the clinical range from T1 to T3 (p = 0.038). CONCLUSION: Patients who undergo a palliative rehabilitation program may experience relief of mild depressive symptomatology, maintainable 3-month post-PRP. The sample was exhibiting mild symptomatology and these results may not be generalizable to those with higher scores; a lack of specialized psychosocial clinician may have affected the acquired sample. Experimental designs are needed to more thoroughly compare these findings to independent rehabilitation interventions.

Integrated oral health care for stroke patients - a scoping review.

AIMS AND OBJECTIVES: To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes and practices and the potential benefits of an integrated oral care programme. BACKGROUND: Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia. DESIGN: Scoping review. METHOD: A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed. RESULTS: The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing-driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes. CONCLUSION: Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia. RELEVANCE TO CLINICAL PRACTICE: Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia.

The impact of multidisciplinary rehabilitation on the quality of life of hemodialysis patients in Iran.

BACKGROUND/PURPOSE: Hemodialysis contributes to changes in lifestyle and the health status of patients. The aim of this study was to evaluate the impact of participatory rehabilitation on the quality of life of patients. METHODS: This quasi-experimental before and after study was conducted on 30 patients in the hemodialysis center at Hazrat-e-Rasoul Hospital in Javanrood during 2013. The rehabilitation program was executed with participation of experts in the fields of nursing, physiotherapy, and clinical psychology for 8 weeks. The instrument used for data collection was the hemodialysis version of Ferrans and Powers Quality of Life Index (QLI) which was completed by the research assistant by interview before and after the rehabilitation program. RESULTS: The mean age of patients was 55.8 ± 14.3 years, 60% were male, and 93.3% were married. The average duration of hemodialysis was 3 ± 2.4 years. The quality of life score of all patients before the intervention was between 10 and 19 (moderate level), which after intervention, improved to a good level in half of the patients (p < 0.001). CONCLUSION: Rehabilitation programs improve the quality of life of hemodialysis patients. By this finding, implementation of rehabilitation programs is recommended in hemodialysis centers with participation of experts from different fields including nurses, physiotherapists, and clinical psychologists.

Information Needs of Family Caregivers of People With Dementia.

PURPOSE: Understanding caregiver needs is essential when caring for people with dementia. The aim of this study was to identify family caregivers' information needs as perceived by home care workers and the caregivers themselves. DESIGN: This study used a descriptive survey design and convenience sampling. METHODS: The two groups of care providers were given a list of 48 items and asked to choose caregivers' top 10 information needs. FINDINGS: Group 1 (n = 33 unpaid family caregivers) identified dealing with behavior changes and group 2 (n = 59 paid home care workers) identified providing personal care as most important. CONCLUSION: While differences between these groups emerged, both care providers chose more items related to needing help for the care recipient, than items related to needing help for the caregivers themselves, e.g., support group. CLINICAL RELEVANCE: These information needs can be used by rehabilitation nurses and other healthcare professionals to develop educational materials and supportive interventions.

Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older.

BACKGROUND: Falls are the leading cause of mortality and morbidity in older and represents one of the major and most costly public health problems worldwide. PURPOSE: Evaluate the influences of lower limb muscle performance, static balance, functional independence and quality of life on fall risk as assessed with the timed up and go (TUG) test. DESIGN: Cross-sectional study. METHODS: Fifty-two residents aged 80 or older were assessed and distributed in one of the two study groups (no risk of falls; risk of falls) according to the time to complete the TUG test. A Kistler force platform and linear transducer was used to determinate lower limb muscle performance. Postural Stability (static balance) was measured by recording the center of pressure. The EuroQol-5 dimension was used to assess Health-related quality of life and the Barthel index was used to examine functional status. Student's t-test was performed to evaluate the differences between groups. Correlations between variables were analyzed using Spearman or Pearson coefficient. ROC (receiver operating charasteristic) analysis was used to determine the cut-off points related to a decrease in the risk of a fall. FINDINGS: Participants of no-fall risk group showed better lower limb performance, quality of life, and functional status. Cut-off points were determined for each outcome. CONCLUSIONS: Risk of falls in nursing home residents over the age of 80 is associated with lower limb muscle performance, functional status, and quality of Life. CLINICAL RELEVANCE: Cut-off points can be used by clinicians when working toward fall prevention and could help in determining the optimal lower limb muscle performance level for preventing falls.

Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices.

PROBLEM: Rehabilitation nurses know the impact of injury on function, independence, and quality of life, complicated by age-related changes associated with decreased strength, endurance, reserve, frailty, and social and financial resources. Multidisciplinary teams are essential to provide expert, age specific health care delivery to this vulnerable population across settings of care. PURPOSE: The purpose of this article is to apply level of evidence rating scales to identify the best practice interventions to prevent falls on rehabilitation units. KEY FINDINGS AND CLINICAL RELEVANCE: The evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units.

Meanings of Falls and Prevention of Falls According to Rehabilitation Nurses: A Qualitative Descriptive Study.

PURPOSE: Guided by Friedemann's theoretical framework, this survey explored the meaning of a fall of an institutionalized older adult or fall prevention to rehabilitation registered nurses and whether the experience changed the nurse's practice. DESIGN: Qualitative, descriptive survey. METHODS: A convenience sample of 742 rehabilitation nurses was asked to describe these experiences and the impact on their practice. FINDINGS: Themes discovered related to the meaning of a fall include negative feelings (incongruence) and positive feelings (congruence). Themes related to the meaning of preventing a fall include positive feelings (congruence). Practice change themes emerged from both the experience of a fall and fall prevention. Practice change themes were drawn to Friedemann's (1995) process dimensions. CONCLUSIONS AND CLINICAL RELEVANCE: Nurses' experiences and meanings of falls uncovered negative and positive feelings about these falls. New findings of this study were the positive feelings expressed by nurses, when there was no injury or when a fall was prevented.

Examining Functioning and Contextual Factors in Individuals with Joint Contractures from the Health Professional Perspective Using the ICF: An International Internet-Based Qualitative Expert Survey.

PURPOSE: The aim of this study was to identify disease-related aspects of functioning and disability in people with joint contractures from a health professionals' perspective and to describe the findings, using categories of the International Classification of Functioning, Disability, and Health (ICF). DESIGN: An Internet-based expert survey. METHODS: We asked international health professionals for typical problems in functioning and important contextual factors of individuals with joint contractures using an Internet-based open-ended questionnaire. All answers were linked to the ICF according to established rules. Absolute and relative frequencies of the linked ICF categories were reported. FINDINGS: Eighty experts named 1785 meaning units which could be linked to 256 ICF categories. Among the categories, 24.2% belonged to the component Body Functions, 20.7% to Body Structures, 36.3% to Activities and Participation, and 18.8% to Environmental Factors. CONCLUSION: Health professionals addressed a large variety of functional problems and multifaceted aspects due to the symptom joint contractures. CLINICAL RELEVANCE: International health professionals reported a large variety of aspects of functioning and health, which are related to joint contractures.

The Application of Tensegrity Massage in a Professionally Active Musician - Case Report.

PURPOSE: The purpose of our study was to present options for the application of tensegrity massage to manage pain caused by the overload of soft tissues in musicians. DESIGN: Tensegrity massage was applied to a 34-year-old male violinist. METHODS: The methodology included a correct positioning and tensegrity massage with individually designed procedure. FINDINGS: After therapy, the patient achieved complete pain relief, and relaxation of muscles in the shoulder girdle and free part of the upper arm. The analgesic effect lasted for 6 months after the end of therapy. CONCLUSIONS: Massage is an effective method in eliminating pain caused by the overload of soft tissues. If used regularly before physical effort, it can prevent muscle overload. CLINICAL RELEVANCE: The presented massage procedure is an effective therapy in pain caused by the overload of soft tissues in musicians and it can be one of the elements of complex physiotherapy in active musicians.

Self-perceived Burden in the Young and Middle-aged Inpatients with Stroke: A Cross-sectional Survey.

PURPOSE: The aims of this study are to explore the prevalence and the features of self-perceived burden (SPB) in the young and middle-aged inpatients with stroke and to identify predictors of SPB. DESIGN: A cross-sectional survey. METHODS: One hundred fifty-five patients were recruited from the Neural Medical and Neural Comprehensive wards of a comprehensive hospital in Chengdu city from January to April 2013. Data consisted of survey interviews, medical records, and a series of questionnaires a week after the patients' hospitalization. Relevant statistical analyses were conducted using SPSS 16.0. FINDINGS: We found SPB was a prevalent experience among young and middle-aged inpatients with stroke. The exploratory analyses (independent samples t tests or one-way ANOVAs) indicated that significant influencing factors of SPB were marital status, self-care ability, caregivers' health, knowledge of the illness, and monthly income. Moreover, patients' SPB scores were positively and significantly correlated with anxiety and depression, but they were negatively and significantly associated with social support and quality of life. A multiple stepwise regression analysis revealed that social support score and knowledge of the illness significantly predicted SPB. CONCLUSIONS: The present study indicates that SPB is a prevalent inner feeling among young and middle-aged inpatients with stroke in China and that it is associated with an array of variables, including social support, quality of life, distressful mood, and several demographic characteristics. CLINICAL RELEVANCE: The findings of this study may help rehabilitation nurses plan and implement health education, effectively and efficiently use healthcare resources, so as to better care the young and middle-aged stroke patients as well as promote their rehabilitation.

Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility.

PURPOSE: The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). DESIGN: The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (±8.2). METHOD: The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. FINDINGS: Mean GDS was 7.60 (±2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p = .043). A negative correlations between GDS and MMSE (p = .029), GDS and BI (p = .049), and GDS and AIS (p < .0001) were found. CONCLUSION: The occurrence of depressive symptoms in older adults after stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. CLINICAL RELEVANCE: Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects.