Exploring staff experience of an “enriched environment” within stroke rehabilitation: a qualitative sub-study

This was written about by Dale Corbett back in Feb. 2011

What the hell is it going to take to get this into a stroke protocol rolled out to all hospitals? Are we going to need a scenario like Denzel Washington had in the movie

John Q in 2002 before anything gets done?

Exploring staff experience of an “enriched environment” within stroke rehabilitation: a qualitative sub-study

Jennifer H. White¹, Katherine Alborough¹, Heidi Janssen¹, Neil Spratt², Louise Jordan¹, and Michael Pollack³

¹Hunter Stroke Service, John Hunter Campus,

New Lambton, New South Wales

, Australia,

²Department of Medical Sciences, The University of Newcastle,

Callaghan, New South Wales

, Australia, and

³Rankin Park Unit,

New Lambton, New South Wales

, Australia

Address for correspondence:

Jennifer H. White, MMSc (Occupational Therapy), Hunter Stroke Service, Level 2, The Lodge

, John Hunter Campus,

Lookout Rd, New Lambton, New South Wales 2301

, Australia. E-mail: jennifer.white@hnehealth.nsw.gov.au

Abstract

Background: Environmental Enrichment (EE) is shown to facilitate recovery of motor and cognitive function in animal models of stroke. The efficacy of EE in the clinical setting with stroke survivors remains unknown. Successful implementation of EE in a busy rehabilitation unit requires identification of barriers and enablers which are best informed by staff feedback. Aim: To qualitatively explore the experiences of nursing staff involved in a pilot study investigating the feasibility of EE in a rehabilitation ward. Methods: This was a qualitative study consisting of analysis of semi-structured interviews with nine nursing staff who were asked to reflect on “routine care” and their own “experience of the EE study”. An inductive thematic approach was used to collect and analyse data using a process of constant comparison. Results: Male and female staff with varying years of experience working in stroke rehabilitation participated in focus group and individual interviews. Three key themes were identified concerning the implementation of EE including: (i) “Nurses are so busy” – perceptions on routine work practice; (ii) “A better outlook” – perceptions of the benefit of EE; (iii) “They’re just not going to participate” – perceptions of barriers to EE. Indeed, the challenges identified in this study align with practice change literature, which indicates that staff workload, routine and attitudes can influence the implementation of a new practice. Discussion: Staff perceived the use of an EE in their rehabilitation unit promoted activity/participation and increased patient moral. The barriers and enablers experienced by staff in this study may be used to inform the design and conduct of future studies investigating the efficacy of EE during inpatient stroke rehabilitation after stroke.