Application Progress of the Case Teaching Method in Standardized Training for Rehabilitation Nurses.

Context: In China, the dearth of adept rehabilitation nurses has escalated into a pressing concern. Conventional nursing education has stymied nurses' autonomous scholarly pursuits. The case-teaching methodology can augment students' competencies and zeal, culminating in the enrichment of educational excellence. Objective: The study intended to elucidate the principles, taxonomy, and enactment of the case-teaching methodology and examine its salutary impacts on nursing practitioners and educators. Design: The research team performed a narrative review by searching BMJ Best Practice, OVID EBM, NGC et al databases. The search used the keywords 'Rehabilitation nursing', 'nursing', 'case teaching method'. Setting: The study took place at the Rehabilitation Medicine Center at West China Hospital of Sichuan University in Chengdu, China. Results: The current study scrutinizes the assimilation of the case-teaching methodology within the realm of nursing, dissects emerging paradigms in the standardized training of rehabilitation nursing staff, and furnishes precedents for the evolution of training frameworks in the field of rehabilitative care. Conclusions: The case-teaching methodology not only serves as an instructional tool but also embodies a fundamental transformation in the modernization of nursing education, embodying the aspiration for excellence, the desire for continuous improvement, and a dedication to the highest standards of patient care.

Produção de conhecimento em enfermagem de reabilitação portuguesa - scoping review / Knowledge production in portuguese rehabilitation nursing ­ scoping review / Producción de conocimiento en enfermería dgués - scoping reviewe rehabilitación portugués - scoping review

Objetivo: mapear a produção de conhecimento em enfermagem de reabilitação em periódicos nacionais e internacionais. Método: revisão do tipo scoping, com base nos princípios preconizados pelo "Joanna Briggs Institute". Os estudos foram extraídos com base nos critérios de inclusão e exclusão. Foram considerados como critérios de inclusão as publicações em periódicos nacionais e internacionais de autoria ou coautoria de enfermeiros portugueses, sem limites temporais. Foram excluídos os documentos cujo foco de intervenção não fosse a enfermagem de reabilitação. Resultados: foram considerados 29 estudos publicados entre 1979 e 2018, sendo possível identificar três áreas temáticas relevantes: Transições Saúde-doença, Promoção Saúde e Qualidade em Enfermagem de Reabilitação. Os resultados fundamentam a área de intervenção do enfermeiro de reabilitação mais evidente no âmbito das transições saúde-doença. Conclusão: apesar do aumento da publicação científica nos últimos três anos sobre essa temática envolvendo a enfermagem de reabilitação, é necessário continuar desenvolvendo estudo nesse campo, a fim de fortalecer as evidências sobre esse cuidado de saúde.(AU)

Objective: to map knowledge production in rehabilitation nursing in national and international journals. Method: scoping-type review, based on the principles advocated by the "Joanna Briggs Institute". The studies were extracted based on the inclusion and exclusion criteria. Inclusion criteria were publications in national and international journals authored or coauthored by Portuguese nurses, with no time limits. The documents in which focus was not rehabilitation nursing were excluded. Results: 29 studies published between 1979 and 2018 were considered, and it was possible to identify three relevant thematic areas: Health-disease transitions, Health Promotion and Quality in Rehabilitation Nursing. The results support the area of intervention of the rehabilitation nurse, being more evident in the scope of health-disease transitions. Conclusions: despite the increase in scientific publication in the last three years on this theme, involving rehabilitation nursing, it is necessary to continue developing studies in this field in order to strengthen the evidence on this health care.(AU)

Objetivo: mapear la producción de conocimiento en enfermería de rehabilitación en periódicos nacionales e internacionales. Método: revisión del tipo scoping, con base en los principios preconizados por el "Joanna Briggs Institute". Los estudios se extrajeron de acuerdo con los criterios de inclusión y exclusión. Se considerarán criterios de inclusión publicaciones en revistas nacionales e internacionales de autoría o co-autoría de enfermeros portugueses sin límites de tiempo. Se excluyeron los documentos cuyo foco de intervención no fuera la enfermería de rehabilitación. Resultados: fueron considerados 29 estudios publicados entre 1979 y 2018, siendo posible identificar tres áreas temáticas relevantes: Transiciones Salud-enfermedad, Promoción Salud y Calidad en Enfermería de Rehabilitación. Los resultados fundamentan el área de intervención del enfermero de rehabilitación más evidente en el ámbito de las transiciones salud-enfermedad. Conclusión: a pesar del aumento de la publicación científica en los últimos tres años sobre esa temática, involucrando a la enfermería de rehabilitación es necesario continuar desarrollando estudio en ese campo, a fin de fortalecer las evidencias sobre ese cuidado de salud.(AU)

"Theory Does Not Get You From Bed to Wheelchair": A Qualitative Study on Patients' Views of an Education Program in Spinal Cord Injury Rehabilitation.

PURPOSE: The aim of this study was to evaluate a new nurse-guided patient education program in spinal cord injury rehabilitation with particular focus on the patients' perspectives and experiences. DESIGN: Longitudinal qualitative study. METHODS: We conducted face-to-face interviews with 10 rehabilitation patients and used the content analysis method to analyze the data. FINDINGS: Patients emphasized the importance of the practical training of the education program. This impacted their well-being as well as their autonomy. They rated discussions with primary nurses and peers about physical or psychological concerns. However, after discharge, the learning process was ongoing, and patients experienced the transition to living at home as a major challenge. CONCLUSIONS AND CLINICAL RELEVANCE: This research provides valuable information from the patients' perspective for enhancing spinal cord injury patient education. Situational learning, based on the practical parts of patient education and working with peers, is highlighted.

Call for human contact and support: an interview study exploring patients' experiences with inpatient stroke rehabilitation and their perception of nurses' and nurse assistants' roles and functions.

PURPOSE: To describe patients' experiences with inpatient stroke rehabilitation and their perception of nurses' and nurse assistants' roles and functions during hospitalisation. MATERIALS AND METHODS: In a qualitative study, 10 interviews with stroke patients were conducted, transcribed, and analysed using qualitative content analysis. RESULTS: The patients' experiences with inpatient stroke rehabilitation and their perception of nurses' and nurse assistants' roles and functions during hospitalisation were found to be related to one overall theme derived from 10 categories. As a recurring motif in the patients' interviews, they experienced existential thoughts, and these thoughts unquestionably affected their experiences within the rehabilitation unit. These thoughts enhanced their need for human contact, thereby affecting their relationships with and perceptions of the nursing staff. CONCLUSION: The findings deepen our understanding of how patients experience inpatient rehabilitation. The patients struggled with existential thoughts and concerns about the future and therefore called for human contact and support from the nursing staff. They perceived the nursing staff as mostly polite and helpful, but were unclear about the nursing staff's function in rehabilitation which, in the patients' perspective, equals physical training. Implications for Rehabilitation Nursing staff need to pay attention to the patients' needs, existential thoughts and concerns during inpatient rehabilitation. Meaningful goals for the rehabilitation of stroke patients are crucial, and it is vital that the patients commit to the goals. Patients expected polite and helpful nurses, but did not see them as therapeutic and active stakeholders, thus it is important that nursing staff present themselves as part of the interdisciplinary rehabilitation. There is a need for training and education of nursing staff, both pre and post graduate.

Nursing students contribution to rehabilitation for home-dwelling patients.

Home-dwelling rehabilitation has expanded in the last years in Norway. The goal is to strengthen self-care for those who have suffered acute impairment or has due to chronic diseases. The purpose of this study was to explore whether nursing students in home-based nursing care (HBNC) can contribute to patients' rehabilitation and mastery work during clinical placement. The study considered 121 undergraduate nursing students' HBNC clinical placements where they, in collaboration with patients, have designed and applied a rehabilitation plan. The duration of the clinical placements were 8 weeks and took place in the municipality of Oslo. Prior to the clinic placement, the students have followed an introductory course rehabilitation plan development. During the initial phase of the placement, the students an eight-step model for mapping the patient's values: 1) home, 2) close relatives, 3) physical activities, 4) friends, 5) job, 6) leisure activities, 7) body and appearance, and 8) spiritual and philosophical values. The students scaled the intensity of each value on a scale from 1 to 10. Through their clinical training a teacher and clinical supervisors have coached the students. The clinical placements have been followed by a written exam. Based on patients' values and resources, the students coached patients in self-care activities that brought the patients closer to their targets, whether it was on an activation or a participation level. The principal finding of this study was that the students in HBNC were adequately prepared to plan and carry out rehabilitation activities with patients.

Educating Chinese Nurses About Rehabilitation Nursing: Findings From a Single Cohort Quantitative Pilot Project.

PURPOSE: The purpose of this study was to present results of a pilot program to educate nurses in China about rehabilitation nursing. DESIGN: A single cohort, pre- and posttest design with an educational intervention. METHODS: A 3-day basic rehabilitation nursing education program was conducted in Shanghai and Hangzhou by a certified rehabilitation nurse specialist from the United States. The effect of the educational intervention was measured using pre- and posttests for six topic areas. Data were analyzed using descriptive statistics, correlations, and paired samples t tests. FINDINGS: Paired samples t tests showed a significant improvement (p < .01) as a result of the educational intervention on all three tests covering the six basic topics. CONCLUSIONS: The knowledge of the nurses on topics of basic rehabilitation nursing significantly increased as a result of the educational program. CLINICAL RELEVANCE: Rehabilitation nurses interested in international travel and developing professional relationships with nurses in China can provide education to promote our specialty practice overseas.

Technical Standards for Nursing Education Programs in the 21st Century.

PURPOSE: The Institute of Medicine (2000, 2002) exposed serious safety problems in the health system and called for total qualitative system change. The Institute of Medicine (2011, 2015) also calls for improving the education of nurses to provide leadership for a redesigned health system. Intertwined with improving education is the need to recruit and retain diverse highly qualified students. Disability is part of diversity inclusion, but current technical standards (nonacademic requirements) for admission to many nursing programs are a barrier to the entry of persons with disabilities. Rehabilitation nurse leaders are in a unique position to improve disability diversity in nursing. The purpose of this paper is to discuss the importance of disability diversity in nursing. DESIGN: The history of existing technical standards used in many nursing programs is reviewed along with examples. METHODS: On the basis of the concept that disability inclusion is a part of diversity inclusion, we propose a new model of technical standards for nursing education. CONCLUSION AND CLINICAL RELEVANCE: Rehabilitation nurse leaders can lead in eliminating barriers to persons with disabilities entering nursing.

Nurses' competence in kinaesthetics : A concept development.

AIM: This study was carried out to systematically describe nurses' competence in kinaesthetics. BACKGROUND: In elderly care the kinaesthetics program for nurses has been taught for over 25 years; however, the competence that nurses should gain through kinaesthetics training from a theoretical perspective has not yet been systematically described. MATERIAL AND METHODS: The method was modelled after the three phases of the hybrid model of concept development by Schwartz-Barcott and Kim (2000). In the theoretical phase a working definition was established and a literature review conducted. We searched the online databases PubMed and CINAHL and the reference lists up to February 2016. In the empirical phase experts defined the attributes during a workshop in October 2013. In the analytical phase the results from the theoretical and empirical phase were combined in order to define antecedents, attributes and consequences of the concept. RESULTS: The concept of nurses' competence in kinaesthetics includes two antecedents: (1) nurses' kinaesthetics training and (2) care recipients' need for mobility support in activities of daily living. This concept includes a set of attributes in the areas of knowledge, skills, attitudes and dynamic state. It contributes towards (1) movement competence and (2) physical and psychological well-being of both care recipients and nurses. CONCLUSION: The concept of nurses' competence in kinaesthetics might support awareness and communication about mobility-enhancing gerontological care. Based on the attributes of nurse' competence in kinaesthetics an assessment instrument will be developed that can be used to evaluate nurses' competence in kinaesthetics in clinical practice. Further research is needed to evaluate the consequences of the developed concept.

Sex and Intimacy after Stroke.

PROBLEM: The sequelae of a stroke can negatively affect sex and intimacy for survivors and their partners. PURPOSE: This clinical article offers practical evidence-based recommendations for nurses to use in advising couples who may be experiencing sexual problems due to decreased desire, erectile dysfunction, vaginal dryness, paraparesis, pain, spasticity, fatigue, aphasia, concrete thinking, emotional lability, shame, embarrassment, fear, depression, or neurogenic bladder. KEY FINDINGS AND CLINICAL RELEVANCE: Recent research and clinical articles show that intimacy and sexual concerns are often ignored by the rehabilitation team, yet research shows that couples want information to assist them to maintain their sexual relationships. Using the PLISSIT model to address sexual concerns, nurses can facilitate discussions to aid couples toward improved sexual function and quality of life.

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.

Novel Active Learning Experiences for Students to Identify Barriers to Independent Living for People with Disabilities.

PURPOSE: This article describes interactive learning about independent living for people with disabilities and features the partnership of the College of Nursing and a Center for Independent Living (CIL). DESIGN: Using qualitative descriptive approach, students' written reflections were analyzed. METHODS: Through "Xtreme Challenge," 82 undergraduate nursing students participated in aspects of independent living as well as identifying barriers. FINDINGS: Students were engaged and learned to consider the person before the disability. Moreover, students valued the activity leaders' openness, which facilitated understanding the point of view of a person with disability. CONCLUSIONS: The value of partnership was evident as it allowed students to participate in active learning, which led to growth in the affective domain. Students became aware of potential education resources through the CIL. CLINICAL RELEVANCE: This article will guide educators in designing experiences that teach nursing care at the individual, family, and community level for people living with disabilities.

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.

Clinical Implications of Family-Centered Care in Stroke Rehabilitation.

PURPOSE: Most stroke survivors will be cared for at home by family caregivers with limited training. Families actively involved in rehabilitation feel more prepared for the new responsibilities of caring for the stroke survivor. The focus of this article is to highlight the relevant concepts of a family-centered model of care and provide general guidance on how integrating a family-centered mindset may be clinically applicable. DESIGN: Concept Analysis. METHODS: Synthesis of literature on family-centered care and its application in for rehabilitation nurses. FINDINGS: Family-centered care is a model of collaborative healthcare that encourages collaboration and partnership among patients, families, and providers with respect to the planning, delivery, and evaluation of health care. Care provided within such a model can expand providers' knowledge of the impact of illness and any issues that may affect eventual transition back home. CONCLUSION: Rehabilitation nurses should view stroke patients and family caregivers as a unit. Using family-centered strategies can help nurses provide appropriate, individualized care during rehabilitation.

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

PURPOSE: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses' practice in stroke rehabilitation. METHOD: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. RESULTS: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. CONCLUSIONS: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills. Implications for Rehabilitation Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care. Views of stroke unit team members on nurses' involvement in rehabilitation have not been reported previously. Nurses can routinely incorporate rehabilitation principles in their care. Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

SAFE Medication Management for Patients with Physical Impairments of Stroke, Part One.

PURPOSE: This article focuses on the extensive impairments of stroke and their influence on medication management. The impairments of motor skills due to paralysis-loss of mobility and balance, lack of hand-to-mouth coordination, and difficulty swallowing-are discussed. A future article will discuss sensory impairments of vision, hearing, cognition, comprehension, communication, and emotional disorders and how these impairments influence medication management. DESIGN: Each of the impairments are presented and discussed, and possible interventions are proposed. Every patient is an individual and requires variable care plans. METHOD: Intervention strategies that include tools for patient assessment, practice tips, and devices available to assist the patient and family in safe medication management are presented. FINDINGS: Patient outcomes and successes vary, but the strategies outlined will return the patient to as close to previous capabilities as possible. CONCLUSION AND CLINICAL RELEVANCE: Teaching SAFE (Systematic, Accurate, Functional, Effective) medication management to the patient, family, and caregivers will increase medication safety and decrease the number of adverse effects. The rehabilitation nurse is charged with evaluating the patients' needs and developing strategies to assist them to manage their medications.

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.