[Inter-Professional Communication Between Nursing Therapists and other Therapeutic Professions (Physio-, Occupation and Speech Therapy) in Neurological Early Rehabilitation]. / Interprofessionelle Kommunikation zwischen therapeutisch Pflegenden und anderen therapeutischen Berufsangehörigen (Physiotherapie, Ergotherapie und Logopädie) in der neurologischen Frührehabilitation.

PURPOSE: A comparison of inter-professional communication within the core therapeutic teams including nurses in 5 neurological early rehabilitation hospitals of one non-profit organization was supposed to indicate factors facilitating and impairing cooperation. METHODS: Data collection was conducted through analysis of architecture plans, passive participating observation in 10 wards and through partly standardized interviews (N=39). Participants were nurses, physio-, occupational and speech therapists. Data analysis used the method of Thick Description [1]. RESULTS: A permanent team, daily team conferences, treatments in cooperation, ward based training and informal talks influence interprofessional communication. Organizational and structural preconditions have effects on the quality of communication. CONCLUSION: Daily inter-professional briefings and the organization of training sessions within the team improve inter-professional communication, a confrontation nurses vs. therapists impairs it.

[Acute Care Rehabilitation is the First Link in a Chain of Rehabilitation Interventions]. / Frührehabilitation ist erstes Glied einer nahtlosen Rehabilitationskette.

An early, intensive rehabilitative therapy accelerates the recovery of the functions of patients. It contributes to a reduction in the complication rate as well as an improvement in physical and social functioning/participation in the long-term follow-up. Early rehabilitation must be strengthened on the basis of the existing structures: the creation and maintenance of adequately qualified early-stage rehabilitation facilities, at least in hospitals with priority and maximum supply contracts. Patients with long-term intensive care and polytrauma must be rehabilitated as soon as possible (intensive medical rehabilitation).Specialists in physical and rehabilitative medicine, rehabilitative geriatrists, neurologists, orthopaedists and accident surgeons and other regional physicians must cooperate in a targeted manner. Exclusion criteria using corresponding OPS codes must be canceled. Additional specialist physician groups (anesthetists and intensive care physicians, general practitioners, accident and thoracic surgeons, internists) must be sensitized to the importance of early rehabilitation.In the case of more than 500,000 hospital beds, 25,000 beds should be identified as age- and diagnosis-independent early-care beds in the country-specific bed-care plans. A cost-covering financing of the different, personal and cost-intensive early rehabilitation must be ensured. A phase model similar to the BAR guidelines for neurological-neurosurgical early rehabilitation is to be considered for other disease entities.In order to make the rehabilitation process as successful as possible, medical (acute) treatment, medical rehabilitation, occupational integration and social integration have to be understood as a holistic event and are effectively interrelated, as a continuous process which accompanies the entire disease phase-wise. For this purpose, a continuous case management or a rehabilitation guidance has to be established.

The Impact of Technology-Based Interventions on Informal Caregivers of Stroke Survivors: A Systematic Review.

OBJECTIVE: This article is a systematic review of the impact of technology-based intervention on outcomes related to care providers for those who survived a stroke. MATERIALS AND METHODS: Literature was identified in the PubMed, PsycINFO, Scopus, and Cochrane databases for evidence on technology-based interventions for stroke survivors' caregivers. The search was restricted for all English-language articles from 1970 to February 2015 that implied technology-based interventions. This review included studies that measured the impact of these types of approaches on one or more of the following: depression and any of the following-problem-solving ability, burden, health status, social support, preparedness, and healthcare utilization by care recipient-as secondary outcomes. Telephone or face-to-face counseling sessions were not of interest for this review. The search strategy yielded five studies that met inclusion criteria: two randomized clinical trials and three pilot/preliminary studies, with diverse approaches and designs. RESULTS: Four studies have assessed the primary outcome, two of which reported significant decreases in caregivers' depressive symptoms. Two studies had measured each of the following outcomes-burden, problem-solving ability, health status, and social support-and they revealed no significant differences following the intervention. Only one study assessed caregivers' preparedness and showed improved posttest scores. Healthcare services use by the care recipient was assessed by one study, and the results indicated significant reduction in emergency department visits and hospital re-admissions. CONCLUSIONS: Despite various study designs and small sample sizes, available data suggest that an intervention that incorporates a theoretical-based model and is designed to target caregivers as early as possible is a promising strategy. Furthermore, there is a need to incorporate a cost-benefit analysis in future studies.

[Activating therapeutic care in geriatrics : Evaluation of a practice concept]. / Aktivierend-Therapeutische Pflege in der Geriatrie : Evaluation eines Praxiskonzepts.

BACKGROUND: The special feature of the concept of activating therapeutic care in geriatrics (ATP-G) is based on the focus of nursing and therapeutic elements specifically related to the elderly. Further significance lies in the bottom-up development of this concept, which shows a close proximity to the nursing practice. OBJECTIVES: The research project targeted the characteristics of ATP-G from a nursing point of view. Furthermore, the resulting elements of professional nursing care understanding for inpatient geriatric rehabilitation were used to build a scientific and theoretical foundation of the ATP-G concept. MATERIAL AND METHODS: In this study 12 semi-structured interviews with professional caregivers were realized. The data collection was undertaken in three different facilities of inpatient geriatric (early) rehabilitation, chosen by lot. The data analysis was based on the methodology of qualitative content analysis according to Mayring. RESULTS AND CONCLUSION: The research project showed that the basic elements described in the ATP-G concept are consistent with the view of nursing practitioners and therefore reflect the characteristic features of routine daily practice; nonetheless, some new aspects were found, primarily the importance of interdisciplinary teamwork in geriatric settings. There were also difficulties related to the ATP-G concept which were experienced as restraints by the questioned professionals. Further research should therefore investigate the structures for optimal implementation of the ATP-G concept into standard practice.

Understanding Work-related Musculoskeletal Injuries in Rehabilitation from a Nursing Perspective.

PURPOSE: The incidence and prevalence of work-related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context-specific patterns of nursing injuries. DESIGN: Using a cross-sectional descriptive research design, 58 rehabilitation nurses participated in this study. METHODS: Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit. FINDINGS: Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication. CONCLUSIONS: Nursing input is critical in understanding and reducing context-specific work-related musculoskeletal injuries. Further research that includes nursing voices is advocated. CLINICAL RELEVANCE: Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.

Cardiac rehabilitation in Canada and Arab countries: comparing availability and program characteristics.

BACKGROUND: Despite the high burden of cardiovascular diseases in Arab countries, little is known about cardiac rehabilitation (CR) delivery. This study assessed availability, and CR program characteristics in the Arab World, compared to Canada. METHODS: A questionnaire incorporating items from 4 national / regional published CR program surveys was created for this cross-sectional study. The survey was emailed to all Arab CR program contacts that were identified through published studies, conference abstracts, a snowball sampling strategy, and other key informants from the 22 Arab countries. An online survey link was also emailed to all contacts in the Canadian Association of Cardiovascular Prevention and Rehabilitation directory. Descriptive statistics were used to describe all closed-ended items in the survey. All open-ended responses were coded using an interpretive-descriptive approach. RESULTS: Eight programs were identified in Arab countries, of which 5 (62.5 %) participated; 128 programs were identified in Canada, of which 39 (30.5%) participated. There was consistency in core components delivered in Arab countries and Canada; however, Arab programs more often delivered women-only classes. Lack of human resources was perceived as the greatest barrier to CR provision in all settings, with space also a barrier in Arab settings, and financial resources in Canada. The median number of patients served per program was 300 for Canada vs. 200 for Arab countries. CONCLUSION: Availability of CR programs in Arab countries is incredibly limited, despite the fact that most responses stemmed from high-income countries. Where available, CR programs in Arab countries appear to be delivered in a manner consistent with Canada.

A family involvement and patient-tailored health management program in elderly Korean stroke patients' day care centers.

PURPOSE: This study aimed to examine the effects of a family involvement and functional rehabilitation program in an adult day care center on elderly Korean stroke patients' perceived health, activities of daily living, instrumental activities of daily living, and cost of health services, and on family caregivers' satisfaction. DESIGN: Using one-group pre- and posttest design, dyads consisting of 19 elderly stroke patients and family caregivers participated in 12-week intervention, including involvement of family caregivers in day care services and patient-tailored health management. FINDINGS: Outcomes of patients and caregivers were significantly improved (all p < .001). However, the cost of health services did not decrease significantly. CONCLUSIONS: This program improved functional levels and health perception of elderly stroke patients and caregivers' satisfaction. However, results must be interpreted with caution, because this was only a small, single-group pilot study. CLINICAL RELEVANCE: This program may be effective for elderly stroke patients and their caregivers.

Nursing care of the super bariatric patient: challenges and lessons learned.

PURPOSE: The purpose of this article is to describe the care of a "super bariatric" patient. DESIGN AND METHODS: We used a case study approach to describe the complex interdisciplinary care challenges posed in the care of a super bariatric patient at a Veterans Administration Hospital in the Midwest. FINDINGS: Nurses and other healthcare providers discovered ways to provide high-quality patient-centered care under challenging conditions and also ensure the safety and well-being of nursing staff and other providers. CONCLUSIONS/CLINICAL RELEVANCE: An interdisciplinary, patient-centered approach with advance planning and coordination is necessary to ensure the delivery of safe, high-quality nursing care to veterans with complex health problems who are "super bariatric."

Transition from hospital to daily life: a pilot study.

PURPOSE: To assess the effect of nurse-led systematic rehabilitation counseling performed before discharge to prevent concerns in the hospital-to-home gap in rehabilitation of lung cancer patients after surgery. DESIGN AND METHOD: A quasi-experimental intervention study. One hundred twenty patients with operable non-small cell lung cancer admitted for surgery participated. Outcome was assessed by a validated self-rating questionnaire. The intervention was performed at the Department of Thoracic Surgery, University Hospital of Copenhagen, Denmark. RESULTS: Following nurse-led rehabilitation counseling, results showed that significantly more patients were offered physical rehabilitation, were aware of where to seek help after discharge, and experienced support to get back to daily life. CONCLUSIONS: A systematic rehabilitation counseling obliges some of the concerns lung cancer patients might have in the transition from hospital to daily life. CLINICAL RELEVANCE: Despite promising results, there is still a need to improve support for patients with lung cancer requiring rehabilitation.

Perceptions of practice guidelines for people with spinal cord injury.

PURPOSE: The Consortium for Spinal Cord Medicine published clinical practice guidelines (CPG) related to upper limb (UL) preservation in people with spinal cord injury (SCI) in 2005. The purpose of this qualitative research was to identify stakeholder agreement with recommendations, performance gaps, and barriers and facilitators to CPG implementation. DESIGN: This 6-month study focused on the perspectives of healthcare providers, veterans, and key informants. The Promoting Action on Research Implementation in Health Services (PARiHS) was used to frame the interview questions, analyze data from focus groups and interviews, and develop conclusions and recommendations. METHOD: SCI Centers at the Tampa, Seattle, and Hines Veterans' hospitals participated. The purposeful sample for the focus groups included 32 healthcare providers, 21 veterans with SCI, and 3 key informants. Analysis of qualitative data netted the percent of agreement with recommendations, performance gaps, and strategies for CPG implementation. FINDINGS: Content analysis of focus group data revealed that healthcare providers agreed or partially agreed with 20 (57%) of the 35 CSCM CPG on UL preservation of function. Agreement ranged from 100% for assessment to 28% for equipment use. Barriers for implementation related to administrative and system issues. CONCLUSION: Consideration of gaps, barriers, and facilitators to implementation will assist clinicians to target interventions to preserve UL function.

Assessment of Patient Participation in Physical Rehabilitation Activities: An Integrative Review.

PURPOSE: In addition to the amount and intensity of rehabilitation interventions and the number of therapies, the degree of patient participation in physical rehabilitation activities is key. For this reason, adequate information regarding participation is necessary to evaluate patient performance. This article reviews instruments designed to assess participation in physical rehabilitation activities. DESIGN: Integrative review. METHODS: Pubmed, CINAHL, PsycInfo, Embase, and Cochrane Library database were searched for publications between January 1976 and July 2012. Secondary searches were also conducted and reference lists scanned for relevant publications. FINDINGS: Fourteen articles reporting on three instruments were found. They differ with regard to their underlying theoretical concepts. Each instrument was tested in medical inpatient rehabilitation settings. CONCLUSIONS/CLINICAL RELEVANCE: Each instrument appears to be useful for assessing specific aspects of patient participation in rehabilitation activities. More theoretical work is needed to clarify the underlying concepts as these instruments are not yet ready for clinical application.

Sub acute gastric residuals elimination change project.

PURPOSE: The practice of checking gastric residual volumes (GRV) for patients receiving enteral tube feedings has long been a tradition in nursing based on the concern that large residuals would increase the risk of aspiration and pneumonia. However, a review of the literature suggests that the practice of checking GRV is not a reliable method for assessing risk for aspiration. We conducted a study in our adult Sub Acute Unit to determine whether it was necessary to continue routine monitoring of GRV. METHOD: A retrospective chart review was conducted that included 15 patients who had received G-tube enteral feedings as their primary source of nutrition for a period of 1 year. FINDINGS: Over 10,000 GRV were reviewed, with no instance of aspiration or pneumonia found. CONCLUSIONS AND CLINICAL RELEVANCE: This resulted in the decision to change our facility's policy, eliminating routine GRV checks, saving over 3 hours of nursing time per patient, per week with no deleterious effects.

The evaluation of daily living activities, pressure sores and risk factors.

PURPOSE: This study was conducted to assess daily living activities, pressure sores and risk factors. DESIGN: This was a descriptive study. METHODS: The study was conducted at a rehabilitation center with 188 individuals participating in the study. Data were collected with a questionnaire form, Activities of Daily Living Scale (ADLS), Instrumental Activities of Daily Living Scale (IADLS) and Braden Risk Assessment Scale (BRAS). FINDINGS: Among the participants, 48.9% were dependent according to activities of daily living and 71.8% were dependent on instrumental activities of daily living. It was noted that 4.8% had pressure sores and 38.8% were at high risk. A strong and positive correlation was found among ADLS, IADLS, and BRAS scores (p < .001). Participants who had a low body mass index, had lived at the rehabilitation center for a long time, and were fed on regime 1 or 2, had a higher risk of developing pressure sores (p < .001). CONCLUSION: Individuals who were dependent according to ADLS and IADLS were at increased risk for the development of pressure sores. Individuals who are treated at rehabilitation centers should be periodically assessed in terms of risk. Pressure sore development can be prevented with appropriate nursing interventions. CLINICAL RELEVANCE: To reduce the risk of developing pressure sores, nurses should describe the individual's degree of dependency according to ADLS and IADLS and initiate preventive nursing care.

Recruitment and Retention Challenges in a Technology-Based Study with Older Adults Discharged from a Geriatric Rehabilitation Unit.

PURPOSE: Technology has the potential to offer support to older adults after being discharged from geriatric rehabilitation. This article highlights recruitment and retention challenges in a study examining an interactive voice response telephone system designed to monitor and support older adults and their informal caregivers following discharge from a geriatric rehabilitation unit. METHODS: A prospective longitudinal study was planned to examine the feasibility of an interactive voice telephone system in facilitating the transition from rehabilitation to home for older adults and their family caregivers. Patient participants were required to make daily calls into the system. Using standardized instruments, data was to be collected at baseline and during home visits. FINDINGS: Older adults and their caregivers may not be willing to learn how to use new technology at the time of hospital discharge. Poor recruitment and retention rates prevented analysis of findings. CONCLUSIONS AND CLINICAL RELEVANCY: The importance of recruitment and retention in any study should never be underestimated. Target users of any intervention need to be included in both the design of the intervention and the study examining its benefit. Identifying the issues associated with introducing technology with a group of older rehabilitation patients should assist others who are interested in exploring the role of technology in facilitating hospital discharge.

Effects of a 6-month nurse-led self-management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy.

PURPOSE: This study was to examine the effectiveness of a nurse-led 6-month comprehensive pulmonary rehabilitation program for stage IV chronic obstructive pulmonary disease patients receiving home oxygen therapy. DESIGN: A controlled clinical study was performed. METHODS: Face-to-face and telephone interviews were conducted with the intervention group, whereas conventional education was given to the control group. FINDINGS: Fifteen participants were analyzed in each group. There were no improvements in physiological outcomes; however, the severity of dyspnea, social activity, and walking distance significantly improved in the intervention group, and consequently quality of life was improved. Three patients in the intervention group received treatment for cold-like-symptoms but did not require hospitalization. However, five patients in the control group received treatment for cold-like-symptoms and two required hospitalization. CONCLUSIONS: The findings demonstrate that our program contributes to patients' learning of self-management skills and significantly improves dyspnea, social activity level, walking distance, and overall quality of life.

Transitioning adolescents and young adults with spina bifida to adult healthcare: initial findings from a model program.

PURPOSE: The Spina Bifida Transition Project (SBTP) was developed by partners from pediatric and adult health care settings using existing best practice information in an effort to transition adolescents to adult health care providers. The purpose of this manuscript is to present the results of an initial evaluation of the SBTP from the adolescent/young adult (AYA) and family perspective. DESIGN AND METHODS: Qualitative evaluation data were obtained from telephone interviews with 40 individuals (24 AYA and 16 parents representing 28 families) two-three weeks after initial adult clinic visits using a semi-structured interview guide. FINDINGS: Interview analysis yielded six overall themes: Positive experience, Developing Trust, Unexpected Benefits, Communication, Potential Worries, and Suggestions for Improvement. The study supported both the effectiveness of the SBTP as well as patient desire for earlier initiation of transition activities CONCLUSION AND CLINICAL RELEVANCE: SBTP is well-received by participants and their parents and may be useful model for other chronic health conditions.

Shared governance: a way to improve the care in an inpatient rehabilitation facility.

BACKGROUND: Rehabilitation care is specialized and individualized requiring effective and efficient communication to achieve optimal patient outcomes. PURPOSE: To examine how effective implementation of shared governance could improve care delivery, promote patient-centered care, and improve patient outcomes. DESIGN: The shared governance approach included all members of the rehabilitation team (i.e., physical therapist, occupational therapist, speech therapist, registered nurse and nurse aide) and was implemented over 6 months. FINDINGS/CONCLUSIONS: The major end products of this shared governance effort were improved staff communication, problem solving, patient outcomes, and staff satisfaction on our stroke and brain injury unit. CLINICAL RELEVANCE: When effectively implemented and sustained, shared governance between all rehabilitation team stakeholders can increase the effectiveness of communication along with more positive patient and staff outcomes.

Reducing the rate of rehospitalization from postacute care: a quality improvement project.

PURPOSE: To evaluate rehospitalizations and develop a strategy to reduce the number of individuals sent back to the hospital within 30 days of admission from postacute care services including skilled care, long-term care, and home care. DESIGN: Using the Plan, Do, Study, Act (PDSA) format outlined by the Institute for Healthcare Improvement, we implemented and evaluated a quality improvement project. METHODS: The number of rehospitalizations was calculated and chart audit was used to determine the reasons. Interventions were designed to decrease the number of reasons individuals had to return to the hospital. FINDINGS: Five rehospitalizations were deemed preventable. Interventions were designed to improve staff knowledge. CONCLUSIONS: The effectiveness of interventions and rehospitalization rates continue to be monitored. The rehospitalization rates from these agencies are low. Low rehospitalization rates are good for clients and improve desirability as a source for care posthospitalization. CLINICAL RELEVANCE: Understanding causes for rehospitalization, providing skills and knowledge aimed at the root causes of hospitalization, and reducing the rate of rehospitalization improves nursing practice and reimbursement.

He Looks Normal But Challenges of Family Caregivers of Veterans Diagnosed with a Traumatic Brain Injury.

PURPOSE: To describe the experience of family caregivers providing care to veterans with traumatic brain injury (TBI). DESIGN/METHODS: Using a qualitative design, interviews were conducted with a purposeful sample of women caregivers. Data were analyzed using content analysis procedures. FINDINGS: Findings resulted in the key concept phrased by participants as "He looks normal but." This phrase conceptualizes the participants' description of their experience caring for a brain injured veteran who could appear normal to others but the caregiver's description revealed substantial cognitive, social, and emotional deficits. Concepts include (a) Becoming aware of his disabilities, (b) Observing his troubling symptoms, (c) Dealing with his memory loss, (d) Being fearful of his anger, (e) Sensing his loneliness, (f) Acknowledging the effects on the children, and (g) Managing the best I can. CONCLUSIONS/CLINICAL RELEVANCE: A better understanding of the needs of caregivers of veterans with TBI may allow clinicians to better support caregivers.

Nurses' knowledge of pain management for patients with combat-related traumatic brain injuries on rehabilitation units.

PURPOSE: The purpose of this project was to survey nurses' knowledge of pain management for patients with combat-related traumatic brain injuries (TBI). DESIGN/METHODS: A survey was used to collect data regarding nurses' knowledge of pain assessment and management for patients with combat-related TBI. Nurses were invited to participate in the study via email and provided with a link to the electronic survey. FINDINGS: Twenty-five surveys were returned (52% response rate). A total of 76% of nurse respondents perceived that TBI patients over report pain intensity. Only 40% of nurses were able to correctly identify the appropriate medication to treat migraine-type headache pain in TBI patients. CONCLUSION: This study identified gaps in knowledge regarding pain management for patients with combat related TBIs. CLINICAL RELEVANCE: Nurses need additional education regarding common pain syndromes, available treatments, and a better understanding of addiction in order to provide optimal care to these patients.