Staff experiences of a reablement approach to care for older people in a regional Australian community: A qualitative study

Staff-reported barriers and facilitators to the implementation of healthcare interventions within regional and rural areas: a rapid review

BACKGROUND

Individuals in rural areas consistently demonstrate higher mortality and morbidity rates, and poorer access to healthcare, compared to their metropolitan counterparts. Optimizing the implementation of evidence-based interventions can reduce these inequities. Existing literature outlines numerous barriers and facilitators to the implementation of healthcare interventions, but these are generally not specific to rural areas. This rapid review aims to synthesize barriers and facilitators to the implementation of healthcare interventions in regional and rural healthcare services as reported by healthcare staff, including clinicians, managers, and administrators.

METHODS

A systematic search for peer-reviewed publications was conducted using CINAHL, PsycINFO, Medline, and Embase databases (1/1/2000-29/08/2023). Eligible publications were primary research articles published in English, assessing staff-reported barriers and facilitators to implementing healthcare interventions within regional and rural areas of high-income countries. Qualitative, quantitative, and mixed-methods designs were included. Eligible healthcare settings encompassed acute, sub-acute, primary care, community health, and aged care. Barrier and facilitator data were coded and grouped into sub-themes and broader themes, with results presented narratively.

RESULTS

Thirty-nine publications met the inclusion criteria. Most studies were conducted in Australia or the USA (both n = 18, 46%), within primary care (n = 13, 33%) or hospital settings (n = 12, 31%) in rural (n = 22, 56%) or regional (n = 9, 23%) locations. Implementation barriers and facilitators were grouped into four overarching themes: intervention-level (intervention feasibility and fit; complexity; privacy and confidentiality); staff-level (staff attitudes and beliefs; knowledge, skills, and confidence; staff roles and professional identity), patient-level (patient characteristics; attitudes), and system-level (leadership support; environmental resources and context; geographic vastness; networks and communication).

CONCLUSIONS

These findings provide essential guidance for policymakers, healthcare leaders, and researchers in planning and designing future implementation efforts in regional and rural healthcare settings. By considering factors across intervention, staff, patient, and system levels, stakeholders can address challenges and leverage local strengths to enhance implementation success and reduce health disparities.

TRIAL REGISTRATION

PROSPERO registration number: CRD42023470736. Registered 19/10/2023.

Senior staff experiences of implementing a reablement model in community care

Background In 2018, a community care organisation in Northwest Tasmania collaborated with University of Tasmania researchers to develop and implement a strategy for incorporating a reablement-based model of care into their service delivery model as a core organisational approach to care. This study aimed to investigate the long-term outcomes from the initial reablement education to improve our understanding of the needs of staff and clients of community care organisations. Methods The research explored the impact of reablement on client outcomes and how reablement can be translated across organisations. A qualitative research method was utilised to explore experiences of senior staff 2years after the first reablement education sessions. Two focus groups were held 4weeks apart. Nine senior staff participated in focus group one and seven in focus group two. Results Three key themes emerged; reablement needs an appropriate governance and organisational strategy; reablement is a beneficial practice; and strong organisational culture supports reablement. Achieving long-term outcomes involves integrating reablement into working practices and this remains challenging due to organisational constraints. Conclusions This study contributes to the growing body of evidence that shifting underlying practices in community care from 'doing for' to 'doing with' involves a major change of behaviour and practice for individuals and organisations.

What Do Nurses Think of Their Role in the Hospital's Restorative Care and Rehabilitation Services for Older Patients?: A Qualitative Systematic Review

AIMS

To examine rehabilitation nurses' perspectives on their roles in caring for older patients in hospitals, emphasising how they fulfil these roles and their significance in geriatric rehabilitation (GR).

BACKGROUND

The need for rehabilitation services was rising with an aging population. Rehabilitation nurses provided evidence-based care to older patients and encouraged them to participate in their rehabilitation goals. Rehabilitation nurses were vital to recovery; their contributions needed to be appreciated and valued.

DESIGN

A qualitative systematic review.

METHODS

A systematic review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative evidence and a PROSPERO protocol CRD42023435728 published beforehand. From inception to 9 October, 2023, a comprehensive database search was developed using Medline and translated into five databases, including CINAHL, Web of Science, Scopus, ProQuest and Ageline.

RESULTS

Thirty-three studies were reviewed, identifying six key themes, including decision-making, nursing role gaps, care coordination, communication, nursing skills and gender preference.

CONCLUSION

This review examined rehabilitation nurses' experiences working with older patients in rehabilitation services. It highlighted gaps in their recognition and decision-making involvement despite being care coordinators, caregivers and advocates who were undervalued as rehabilitation team members.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The review highlighted the importance of valuing nurses' contributions and re-evaluating the rehabilitation model.

FURTHER IMPLICATIONS OF THIS STUDY

Interviewing rehabilitation nurses can validate the findings, potentially improving rehabilitation nursing practices for older patients.

REPORTING METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

NO PATIENT OR PUBLIC CONTRIBUTION

Not applied since it was a systematic review.

Conceptualizing the Facilitators and Barriers of Successful Multidisciplinary Teamwork Within the Reablement Process: A Scoping Review

Background

As the global population ages, there is increasing pressure on health systems to provide high-quality and cost-effective care for this growing segment of the population. Reablement, primarily a strategic home-based rehabilitation approach, has been demonstrated to be a cost-effective, multidisciplinary, holistic, and person-centred approach to maintaining functional independence as one ages. Given that care delivery in the home setting for older persons is complex, a key feature of effective implementation of reablement is the integration of a multidisciplinary team.

Objective

The primary objective of this study was to identify the facilitators and barriers that lead to successful teamwork in a multidisciplinary reablement team setting.

Methods

Scoping review approach was used in this study to determine trends, and mapping themes prevalent in the peer-reviewed literature. Eligible articles were sourced from four electronic databases, and data were extracted, coded, analyzed and chartered in February 2024.

Results

Twenty studies were included in this study. Six main themes were identified: (1) multidisciplinary teamwork for quality service development, (2) dynamics of multidisciplinary collaboration, (3) professional autonomy and reflective practice, (4) towards a flat organizational structure and shared goals, (5) openness and flexibility of developing new cultures, and (6) open and frequent communication for success. Each of the themes can exert a facilitating or/and inhibiting effect depending on the context.

Conclusion

The findings indicate that multidisciplinary teamwork in reablement settings is diverse, complex, and situational. In this paper, we propose a conceptual model that integrates each theme as a way to understand the complexity and interconnectedness of the themes along the quest for greater multidisciplinary teamwork in reablement. Given the positive outcomes of both service consumers and providers, amplification of multidisciplinary teamwork within reablement holds the promise of effective care for older persons in a time of growing service demands.

A qualitative exploration of professionals' perspectives on the implementation of reablement intervention programs in community care

Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults' active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals' experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual's goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.

How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review

AIM

To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older.

DATA SOURCES

Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature.

METHODS

A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full-text articles.

RESULTS

Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment.

CONCLUSION

The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions.

IMPACT

The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care.

PATIENT OR PUBLIC CONTRIBUTION

During the development phase, the study was presented to a consumer group from the researcher's workplace.

PROSPERO REGISTRATION

CRD42022299336.

Publication Trends in Reablement - A Scoping Review

Background

Reablement is a holistic and multidisciplinary intervention that can facilitate achievement of service users' goals related to their independence in everyday activities. Reablement has been the subject of increasing scientific activity in recent years. Currently, no review has provided a broad overview of the extent and breadth of international publications in reablement.

Objective

The objectives were 1) to map the volume of reablement publications, how the publications had increased over time, and their geographical distribution, 2) to identify the publication types and designs, 3) to identify publication trends, and 4) to identify knowledge gaps in the current peer-reviewed literature.

Methods

The scoping review approach designed by Arksey and O'Malley was used to identify peer-reviewed articles on reablement. Information was obtained on scientific activity on reablement over a period of more than two decades from five electronic databases and without language restrictions. Data was extracted from the eligible articles and both descriptive analysis and thematic analysis of the data was performed.

Results

A total of 198 articles published from 1999 to August 2022 from 14 countries were identified. There is a continuous interest in the field from countries where reablement has been implemented. An international and historical overview among countries with peer-reviewed publications on reablement is presented, which also partly reflects the countries that have implemented reablement. Most of the research derives from Western countries, in particular from Norway. Varied approaches to publications in reablement were noted with the majority being empirical and quantitative in nature.

Conclusion

The scoping review confirms the continued expansion of the breadth of reablement-focused publications in terms of originating countries, target populations, and research designs. In addition, the scoping review contributes to the knowledge base regarding reablement's research front.

Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study

Background

There is a need for structural change in municipal homecare to shift power to older persons and to center the individuals in need. To make this change, the individual older persons should have enough self-determination to formulate their own individual homecare goals. Our aim was to explore how stakeholders reason about individual goal-setting in homecare.

Design and methods

We theoretically and methodologically used a participatory appreciative action and reflection (PAAR) design. The stakeholders, that is, the older persons, the older persons' relatives, and the multi-professional team, were seen as co-researchers. Data were collected between 2019 and 2020 through in depth-interviews, focus group discussions, and reference groups. The data were analyzed using thematic analysis.

Results

We learned from the stakeholders that it was a struggle to sustain the individual's goal to continue life as usual, that is, being an ordinary human being with an ordinary everyday life and maintaining individual roles. The individual wants to improve health, be active, and enjoying life. The individuals were struggling against the homecare organization, which tended to overshadow the individual's goals. The individual's goals fall under several legal jurisdictions and come to be overshadowed by the professionals' dominant goal. The organization is rigid, with finances and resources creating the framework.

Conclusion

We learned that older persons receiving homecare must have the same rights as other citizens in society, which is in line with public health goals.

Promotion of physical activity in older adults: facilitators and barriers experienced by healthcare personnel in the context of reablement

BACKGROUND

Being physically active is important for maintaining function and independence in older age. However, there is insufficient knowledge about how to successfully promote physical activity (PA) among home-dwelling older adults with functional challenges in real-life healthcare settings. Reablement is an interdisciplinary, person-centered approach to restoring function and independence among older adults receiving home care services; it also may be an opportunity to promote PA. However, reablement occurs in many different contexts that influence how PA can be integrated within reablement. This study aimed to identify facilitators and barriers experienced by healthcare professionals (HCPs) that influence the promotion of PA within the context of reablement.

METHODS

This exploratory qualitative study is guided by a realist perspective and analyzed through inductive content analysis. Sixteen HCPs, including occupational therapists, physical therapists, registered nurses, and home care workers, participated in semi-structured interviews. The HCPs were recruited from four Norwegian municipalities with diverse sizes and different organizational models of reablement.

RESULTS

The HCPs experienced several facilitators and barriers at the participant, professional, organizational, and system levels that influenced how they promoted PA through reablement. Factors related to the individual person and their goals were considered key to how the HCPs promoted PA. However, there were substantial differences among reablement settings regarding the degree to which facilitators and barriers at other levels influenced how HCPs targeted individual factors. These facilitators and barriers influenced how the HCPs reached out to people who could benefit from being more physically active; targeted individual needs, desires and progression; and promoted continued PA habits after reablement.

CONCLUSIONS

These findings exemplify the complexity of facilitators and barriers that influence the promotion of PA within the reablement context. These factors are important to identify and consider to develop and organize healthcare services that facilitate older adults to be active. We recommend that future practice and research in reablement acknowledge the variations between settings and consider mechanisms on a participant and professional level and within an integrated care perspective.

A scoping review exploring reablement models of training and client assessment for older people in primary health care

AIM

The aim of this scoping review is to explore the evidence by which community service providers have integrated reablement models of staff training and client assessment into practice.

BACKGROUND

The concept of reablement, which has emerged during the last two decades globally, has recently been defined by health experts from 11 countries through a Delphi study. Reablement is seen as a way to support integrated frameworks that achieve person-centred, long-term care and assistance across community settings. International research indicates there is some evidence of developing models of reablement that include staff training and individual components of client assessment. However, evidence of integrating reablement into interdisciplinary practice continues to be sparse.

METHODS

The review adopted the preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach. Inclusion criteria for the review related to community care, primary care, long-term care, and residential care. Populations of interest included service providers, interdisciplinary staff, trainers, and assessors.

RESULTS

A total of 11 papers were reviewed. The studies varied in their approach to reablement training and client assessment frameworks. Three studies included assessment of staff well-being. All included evidence-based, person-centred components that can be integrated across health care settings. Single disciplinary approaches were used in all studies and some included training evaluation.

CONCLUSION

This review has identified that currently reablement models are not yet embedded as frameworks for practice by community service providers in primary health care settings. Different programmes of training and assessment are being designed based on single disciplinary approaches and the context in which they are delivered. Further developmental work is required to integrate the components of discipline-specific training programmes within interdisciplinary frameworks. This will achieve not only an integrated framework for delivery across settings but also further the success of 'ageing in place' policy.