Performance of the measures of processes of care for adults and service providers in rehabilitation settings

An evaluation of the structure and process of stroke rehabilitation in primary, secondary and tertiary hospitals in Ghana

Background

Evidence shows that quality indicators such as the structure and process of stroke rehabilitation can influence patient outcomes. However, not much attention has been paid to the study of these issues in low- and middle-income countries such as Ghana.

Objectives

Our study evaluated the structure and process of stroke rehabilitation in primary, secondary and tertiary hospitals in the Greater Accra Region of Ghana.

Method

A cross-sectional survey was conducted involving 111 healthcare professionals. The World Health Organization (WHO) situational analysis and Measure of Processes of Care for Service Providers for Adults (MPOC-SP[A]) questionnaires were administered to gather information on the structure and process of stroke rehabilitation. Descriptive statistics were used to summarise data, and chi-square and Kruskal–Wallis tests were used to establish associations and comparisons, respectively.

Results

A stroke unit was only available in the tertiary hospital. Although all three hospitals had a multidisciplinary team approach to care, the constituents differed. Length of hospital-stay, duration of treatment and basis for discharge from acute care were not associated with the hospitals. Therapy sessions, access to computed tomography (CT) and magnetic resonance imaging (MRI) scanning were dependent on the hospitals.

Conclusion

The structure and process of stroke rehabilitation across the three hospitals were similar in some constructs and different in others.

Clinical implications

Data gathered will help to provide information on the available structure and processes of stroke rehabilitation, which could help assess the quality of care provided.

Factors Associated With Primary Family Caregivers' Perceptions on Quality of Family-Centered Care in Mental Health Practice

PURPOSE

This study aimed to examine the quality of family-centered care perceived by primary family caregivers and its influencing factors in mental healthcare practice.

DESIGN

A cross-sectional, correlational study.

METHODS

A convenience sample of 121 mental health nurses and 164 primary family caregivers of patients with schizophrenia was recruited from acute psychiatric wards and chronic psychiatric rehabilitation wards in three psychiatric hospitals in Taiwan. Structured questionnaires for mental health nurses were designed to examine nurses' attitudes toward schizophrenia and the importance of families in nursing care. Primary family caregivers were assessed to determine their perceptions of quality of family-centered care. At least one primary family caregiver of patients was matched to a nurse who took major responsibility for the patient during the hospitalization. Data were analyzed with descriptive statistics, Pearson's product-moment correlations, independent t-test, one-way analysis of variance, and stepwise regression analyses.

RESULTS

Quality of family-centered care perceived by primary family caregivers regarding the provision of general and specific information, as compared to enabling and partnership, coordinated and comprehensive care, and respectful and supportive care, was relatively inadequate. Younger and more educated primary family caregivers, having relatives with schizophrenia in acute wards, less supportive nurses' attitudes toward schizophrenia, and the importance of family in nursing care were correlated with poor primary family caregivers' perceptions of quality of family-centered care. Nurses' supportive attitudes toward schizophrenia and chronic psychiatric rehabilitation wards where patients received care were key factors in determining better quality of family-centered care.

CONCLUSIONS

Findings provide a platform for the development of effective continuing education and training programs to equip mental health nurses with supportive attitudes toward mental illness and an integration of the family in nursing care, which will ultimately improve mental health care for families experiencing mental health problems.

CLINICAL RELEVANCE

Efforts in professional training to address stigma and encourage a family-centered approach into recovery-oriented practice for practicing mental healthcare providers, including mental health nurses, are recommended.

Feasibility and psychometric properties of the Finnish version of the measure of processes of care for adults

OBJECTIVE:

To assess the psychometric properties and feasibility of the Finnish translation of the measure of processes of care for adults (MPOC-A) when used in an inpatient rehabilitation setting.

DESIGN:

A feasibility study.

SETTINGS:

Inpatient rehabilitation settings.

SUBJECTS:

A total of 858 people with severe neurological disabilities, musculoskeletal problems, and mental disorders were recruited to the study.

METHODS:

The MPOC-A questionnaire is a self-administered questionnaire consisting of 34 items in five-factorial domains. The construct validity of the translated questionnaire was evaluated using confirmatory factor analysis. To compare the fit of the model to the fit of the independent null-model Comparative Fit Index was used. Internal consistency for the total scale and subscales was calculated using Cronbach's alpha reliability coefficient.

RESULTS:

A total of 554 people, mean age 52 years (SD = 9), participated in the study. Most of the responders had musculoskeletal problems ( n = 328, 57%). The respondents rated the client-centeredness in rehabilitation service as moderate ( m = 5.40, SD = 0.81). The five-factor and the one-factor model fitted the data well according to all three indices. Internal consistency showed high reliability between the one-factor and five-factor models for all except one domain (0.49-0.93). The mean for Person Infit for the people with neurological disabilities was higher than for the other two groups ( m = 1.77, SD = 1.32) indicating less predictable response patterns in this group.

CONCLUSION:

The results confirm the appropriate psychometric properties of the Finnish version of the MPOC-A, especially for people with musculoskeletal problems and those with mental health disorders.

Living with schizophrenia: Health-related quality of life among primary family caregivers

AIMS AND OBJECTIVES

To examine influencing factors of health-related quality of life in primary family caregivers of people with schizophrenia receiving inpatient psychiatric rehabilitation services.

BACKGROUND

Families, particularly primary family caregivers, have become more important than ever in mental health care. Yet, research on health-related quality of life among primarily family caregivers is limited.

DESIGN

A correlational study design was used.

METHODS

A convenience sample of 122 primary family caregivers participated in the study. Data were analysed with descriptive statistics, Pearson's product-moment correlation, t test, one-way analysis of variance and a hierarchical multiple regression analysis.

RESULTS

Primary family caregivers who were parents, older, less educated, and had a lower monthly household income, increased affiliate stigma and decreased quality of family-centred care experienced poor health-related quality of life. Particularly, monthly household income, affiliate stigma and quality of family-centred care appeared to be the most critical determinants of health-related quality of life.

CONCLUSIONS

Efforts to enhance satisfaction of life should focus on reducing affiliate stigma as well as increasing monthly household income and strengthening the quality of family-centred care.

RELEVANCE TO CLINICAL PRACTICE

Findings may assist in the development of culturally integrated rehabilitation programmes to decrease affiliate stigma and increase family engagement as a means of promoting quality of life for primary family caregivers living with people who have schizophrenia.