Co-constructing engagement in stroke rehabilitation: a qualitative study exploring how practitioner engagement can influence patient engagement

How can practitioners be engaged in their patients stroke recovery when they know damn well that only 10% get to full recovery and they don't have any protocols with efficacy ratings to give their patients?
http://journals.sagepub.com/doi/full/10.1177/0269215517694678

Felicity AS Bright, Nicola M Kayes, Christine Cummins, Linda M Worrall, Kathryn M McPherson

First Published February 1, 2017 research-article

Abstract

Objective:

To explore how practitioner engagement and disengagement occurred, and how these may influence patient care and engagement.

Design:

A qualitative study using the Voice Centred Relational Methodology. Data included interviews, focus groups and observations.

Setting:

Inpatient and community stroke rehabilitation services.

Subjects:

Eleven people experiencing communication disability after stroke and 42 rehabilitation practitioners.

Interventions:

Not applicable.

Results:

The practitioner’s engagement was important in patient engagement and service delivery. When patients considered practitioners were engaged, this helped engagement. When they considered practitioners were not engaged, their engagement was negatively affected. Practitioners considered their engagement was important but complex. It influenced how they worked and how they perceived the patient. Disengagement was taboo. It arose when not feeling confident, when not positively impacting outcomes, or when having an emotional response to a patient or interaction. Each party’s engagement influenced the other, suggesting it was co-constructed.

Conclusions:

Practitioner engagement influenced patient engagement in stroke rehabilitation. Practitioner disengagement was reported by most practitioners but was often a source of shame.