http://informahealthcare.com/doi/abs/10.3109/09638288.2014.991454
Christopher R. Burton, Maria Horne, Kate Woodward-Nutt, Audrey Bowen, and Pippa Tyrrell
1School of Healthcare Sciences, Bangor University,
Bangor, Gwynedd
, UK,
2Faculty of Health Studies, School of Nursing, Bradford University,
Bradford
, UK,
3Stroke & Vascular Research, School of Nursing, Midwifery and Social Work, University of Manchester MAHSC,
Manchester
, UK, and
4Stroke & Vascular Research, University of Manchester MAHSC, Salford Royal NHS Foundation Trust,
Salford
, UKAbstract
Introduction:
Multi-disciplinary team members predict each patient’s rehabilitation
potential to maximise best use of resources. A lack of underpinning
theory about rehabilitation potential makes it difficult to apply this
concept in clinical practice. This study theorises about rehabilitation
potential drawing on everyday decision-making by Health Care
Professionals (HCPs) working in stroke rehabilitation services. Methods:
A clinical scenario, checked for face validity, was used in two focus
groups to explore meaning and practice around rehabilitation potential.
Participants were 12 HCPs working across the stroke pathway. Groups were
co-facilitated, audio-recorded and fully transcribed. Analysis paid
attention to data grounded in first-hand experience, convergence within
and across groups and constructed a conceptual overview of HCPs’
judgements about rehabilitation potential. Results:
Rehabilitation potential is predicted by observations of “carry-over”
and functional gain and managed differently across recovery
trajectories. HCPs’ responses to rehabilitation potential judgements
include prioritising workload, working around the system and balancing
optimism and realism. Impacts for patients are streaming of
rehabilitation intensity, rationing access to rehabilitation and a
shifting emphasis between management and active rehabilitation. For
staff, the emotional burden of judging rehabilitation potential is
significant. Current service organisation restricts opportunities for
feedback on the accuracy of previous judgements. Conclusion:
Patients should have the opportunity to demonstrate rehabilitation
potential by participation in therapy. As therapy resources are limited
and responses to therapy may be context-dependent, early decisions about
a lack of potential should not limit longer-term opportunities for
rehabilitation. Services should develop strategies to enhance the
quality of judgements through feedback to HCPs of longer-term patient
outcomes.Implications for Rehabilitation
- Rehabilitation potential is judged at the level of individual patients (rather than population-based predictive models of rehabilitation outcome), draws on different sources of often experiential knowledge, and may be less than reliable.
- Decisions about rehabilitation potential may have far reaching consequences for individual patients, including the withdrawal of active rehabilitation in hospital or in the community and eventual care placement.
- A better understanding of what people mean by rehabilitation potential by all team members, and by patients and carers, may improve the quality of joint decision making and communication.
Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2014.991454
No comments:
Post a Comment