Rehabilitation Workforce Challenges to Implement Person-Centered Care

Exploring the Associations of Cultural Sensitivity, Technology, and Patient Empowerment with Patient-Centered Care: A Mixed-Methods Study in UAE Rehabilitation Healthcare Centers

BACKGROUND

Patient-centered care is a healthcare priority, particularly in diverse settings like the United Arab Emirates. Understanding the factors influencing its delivery is essential for effective care.

OBJECTIVE

This study examines the association between cultural sensitivity, technology, and patient empowerment with patient-centered care in UAE rehabilitation healthcare centers.

DESIGN

A mixed-methods approach was employed, integrating quantitative and qualitative data collection. Quantitative data was analyzed using correlation and regression analyses, while qualitative data was explored through thematic analysis to identify key patterns.

PARTICIPANTS

The study involved 100 healthcare providers (internists, nurses, rehabilitation therapists) working in licensed rehabilitation healthcare centers in the UAE. Additionally, 200 patients recruited through purposive sampling from both inpatient and outpatient settings. Patients, aged 18-54, represented diverse socio-economic backgrounds and health conditions, including musculoskeletal, neurological, and chronic illnesses.

APPROACH

Quantitative data was collected using a structured questionnaire comprising 12 items measured on a 5-point Likert scale, focusing on healthcare providers' and patients' perceptions of cultural sensitivity, technology integration, and patient empowerment. Qualitative data from semi-structured interviews was transcribed, coded, and analyzed to explore detailed perspectives on how cultural practices, technological tools, and empowerment strategies influence care delivery.

KEY RESULTS

Cultural sensitivity demonstrated a strong positive correlation with patient-centered care (PCC) (r = 0.938, p < 0.001), as did patient empowerment (r = 0.965, p < 0.001). Regression analysis revealed that patient empowerment was the most influential factor (B = 0.800, p < 0.001), followed by cultural sensitivity (B = 0.110, p = 0.041). Thematic analysis of qualitative data highlighted the significance of cultural practices, adaptability of technology, and patient-driven strategies in shaping positive care experiences.

CONCLUSION

The findings align with existing research, underscoring the importance of cultural competence, technological integration, and patient empowerment in delivering effective patient-focused care.

Factors influencing person-centred care: Speech-language pathologists and audiologists perspective

Background

Person-centred care (PCC) is a fundamental aspect of healthcare, and its implementation is primarily based on clinicians' initiation and sustained efforts and the availability of resources. Recent PCC literature has primarily focused on high-income settings, raising concerns about the feasibility of PCC implementation in low- and middle-income countries.

Objectives

This study examined speech-language pathologists' (SLPs) and audiologists' (AUDs) perceptions of barriers and facilitators towards implementing PCC in the diverse South African context, particularly how their demographic factors influence these perceptions.

Method

A national cross-sectional e-survey pooled 103 clinicians who were providing speech-language pathology and audiological services in South Africa. The e-survey included questions on participants' demographics, working environment and a seven-point Likert scale rating 10 components that influence PCC.

Results

Clinicians scored personal factors (64.7%), followed by their relationships with different professionals (54.9%) as the most facilitating factors for achieving PCC. The most significant perceived barrier was resources, including time and finances (59.8%), followed by the client perspectives (53.9%). Significant associations were found between the components influencing PCC and clinicians' qualifications, work sectors and populations served.

Conclusion

The collective findings of this study highlighted the multifaceted nature of PCC implementation within a diverse healthcare context. Client perspectives need to be considered while leveraging clinician attributes and fostering supportive workplace environments for the successful adoption of PCC.

Contribution

This study contributes to literature of PCC implementation and has captured how the perceptions of speech-language therapists (SLPs) and AUDs call for tailored approaches in diverse healthcare contexts.

General Hospital Nurses' Experience and Perception of Person-Centered Care: A Phenomenological Study

This study explored the general hospital nurses' experiences and perceptions of providing person-centered care using a Giorgi's phenomenological approach. Through purposive sampling, 10 nurses were selected from five general hospitals in Korea. We identified 83 codes, which were integrated into 17 subconstituents and further into four constituents: "A comprehensive approach based on love for humanity," "Providing customized nursing care through an individual approach," "Building the expertise required as a nurse," and "Challenges to actual nursing practice." These findings are valuable for understanding general hospital nurses' in-depth experiences providing person-centered care and their perceptions. Despite numerous challenges, nurses in general hospitals are attempting to deliver person-centered care comprehensively and tailored based on their expertise. Current challenges can be overcome by raising awareness about providing person-centered care in general hospitals and enhancing systems to minimize workloads. The results of this will be a crucial foundation for developing educational programs to increase nurses' understanding of person-centered care and encourage their practice. Furthermore, it will be useful in suggesting future directions for altering the nursing workforce or scope of work.

Supporting resident-centred decision-making about transitions from long-term care homes to hospital: a qualitative study protocol

INTRODUCTION

Burdensome care transitions may occur despite clinicians' engagement in care planning discussions with residents and their family/friend care partners. Conversations about potential hospital transfers can better prepare long-term care (LTC) residents, their families and care providers for future decision-making. Lack of such discussions increases the likelihood of transitions that do not align with residents' values. This study will examine experiences of LTC residents, family/friend care partners and staff surrounding decision-making about LTC to hospital transitions and codesign a tool to assist with transitional decision-making to help prioritise needs and preferences of residents and their care partners.

METHODS AND ANALYSIS

This study will use semi-structured needs assessment interviews (duration: 1 hour), content analysis of existing decision support and discussion tools and a codesign workshop series (for residents and care partners, and for staff) at three participating LTC home research sites. This qualitative work will inform the development of a decision support tool that will subsequently be pilot tested and evaluated at three partnering LTC homes in future phases of the project. The study is guided by the Person-centred Practice in Long-term Care theoretical framework. Interview audio recordings will be transcribed verbatim and analysed using reflexive thematic analysis. Participants will be recruited in partnership with three LTC homes in Ottawa, Ontario. Eligible participants will be English or French speaking residents, family/friend care partners or staff (eg, physicians, nurses and personal support workers) who have experienced or been involved in a transition from LTC to hospital.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Bruyère Health Research Ethics Board (#M16-23-030). Findings will be (1) reported to participating and funding organisations; (2) presented at national and international conferences and (3) disseminated by peer-review publications.

Developing the TIDieR-Rehab checklist: a modified Delphi process to extend the Template for Intervention Description and Replication (TIDieR) for rehabilitation intervention reporting

OBJECTIVES

Rehabilitation is essential for supporting the recovery from, and management of, a range of health conditions. However, interventions are often poorly reported in rehabilitation research, hindering advancement of the field. The Template for Intervention Description and Replication (TIDieR) checklist was developed to enhance the reporting of interventions, but does not specifically address the complexities and multifaceted nature of rehabilitation interventions. This study aimed to develop an extension of the TIDieR checklist to support better reporting of rehabilitation interventions.

DESIGN

A modified Delphi study overseen by a Steering Committee.

SETTING

Online.

PARTICIPANTS

Rehabilitation experts were purposively sampled for diversity in discipline, practice setting, area of expertise and geographical location.

METHODS

Participants (n=35) provided both quantitative and qualitative feedback on drafts of the TIDieR-Rehab through online surveys. Quantitative data was descriptively analysed by percentage of agreement, while qualitative data was analysed using conventional content analysis. Quantitative and qualitative findings were subsequently triangulated to facilitate iterative refinement of the TIDieR-Rehab.

RESULTS

Consensus was achieved after two rounds of the modified Delphi process. The TIDieR-Rehab checklist comprises seven original, three adapted and 12 new reporting items, and is supported by a supplementary manual. Specific enhancements include more detailed descriptions of the study population (Who) and timing of the intervention (When), the planned intervention dosage (How much, How challenging and Regression/Progression), person-centred care (Personalisation) and negative undesired effects (Harms) which were considered critical for the comprehensive reporting of rehabilitation interventions.

CONCLUSION

The TIDieR-Rehab checklist marks a significant advancement in enhancing and standardising the reporting of rehabilitation interventions. By offering a structured format for detailing complex rehabilitation interventions, the TIDieR-Rehab supports improvements in reporting quality to promote research replication and support the translation of research findings into clinical practice. Future research should validate the TIDieR-Rehab checklist across a variety of intervention types and clinical contexts.

Role and promise of health policy and systems research in integrating rehabilitation into the health systems

Despite recognized need and reasonable demand, health systems and rehabilitation communities keep working in silos, independently with minimal recognition to the issues of those who require rehabilitation services. Consolidated effort by health systems and rehabilitation parties, recognizing the value, power and promise of each other, is a need of the hour to address this growing issue of public health importance. In this paper, the importance and the need for integration of rehabilitation into health system is emphasized. The efforts being made to integrate rehabilitation into health systems and the potential challenges in integration of these efforts were discussed. Finally, the strategies and benefits of integrating rehabilitation in health systems worldwide is proposed. Health policy and systems research (HPSR) brings a number of assets that may assist in addressing the obstacles discussed above to universal coverage of rehabilitation. It seeks to understand and improve how societies organize themselves to achieve collective health goals; considers links between health systems and social determinants of health; and how different actors interact in policy and implementation processes. This multidisciplinary lens is essential for evidence and learning that might overcome the obstacles to the provision of rehabilitation services, including integration into health systems. Health systems around the world can no longer afford to ignore rehabilitation needs of their populations and the World Health Assembly (WHA) resolution marked a global call to this effect. Therefore, national governments and global health community must invest in setting a priority research agenda and promote the integration of rehabilitation into health systems. The context-specific, need-based and policy-relevant knowledge about this must be made available globally, especially in low- and middle-income countries. This could help integrate and implement rehabilitation in health systems of countries worldwide and also help achieve the targets of Rehabilitation 2030, universal health coverage and Sustainable Development Goals.

Knowledge, Attitudes, and Practices Regarding Preconception Care Among Women in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Preconception care (PCC) aims to address health risks before conception for better pregnancy outcomes. Effective PCC starts before pregnancy and involves interventions to improve well-being and prevent adverse outcomes. Unintended pregnancies and pre-existing illnesses increase risks. Early provision of care is crucial, as fetal development can be affected early. Improving women's knowledge and access to PCC is essential for optimal maternal and child health in Saudi Arabia.

METHODOLOGY

A descriptive, cross-sectional study was conducted in Saudi Arabia to assess knowledge, attitudes, and practices regarding preconception care among women between the ages of 18 and 45 who live in Saudi Arabia, who matched the inclusion criteria. All women working in or studying in the medical field were excluded from the research. Data was collected using Google Forms (Google, Mountain View, CA) via social media apps. Data was cleaned in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using IBM SPSS, version 29 (IBM Corp., Armonk, NY).

RESULTS

Our study assessed awareness about PCC among 788 women. Age distribution revealed 24.9% (n=196) were 30-35 years old and 23.6% (n=186) were 40-45 years. Most were Saudi nationals (86.9%, n=685) and married (94.4%, n=744). University education was reported by 83.0% (n=654). Among notable findings, 79.1% disagreed or were neutral on PCC's necessity, and 78.6% supported free PCC. Barriers included fear of blood draws (68.7%) and negative family reactions (63.8%). Notably, 44.2% (n=348) demonstrated high knowledge and positive attitude towards PCC. Multivariate analysis indicated that marital status was significantly associated with high PCC knowledge (Exp(B)=1.956, p=0.049), while other sociodemographic factors were not associated with PCC knowledge.

CONCLUSION

Our study showed an adequate level of knowledge about PCC among women. However, there is a need for further improvement in PCC awareness among Saudi women. A significant number of women supported free PCC services. Barriers included fear of procedures and family reactions. Marital status was significantly associated with higher PCC knowledge, emphasizing targeted educational interventions.

Developing a consensus-based motivational care pathway for individuals with lower limb fractures: a Delphi protocol

Older adults with lower limb fractures often harbor concerns about losing their mobility, fearing a loss of independence. It is vital to develop strategies that foster their active engagement in the rehabilitation process. The present protocol aims to create a care pathway tailored to motivate individuals with lower limb fractures to adhere to rehabilitation. We will develop an observational, cross-sectional, and descriptive study using the Delphi data-gathering approach. Purposive sampling will recruit a panel of healthcare professionals and experts who care for patients with lower limb fractures. Aligned with the Delphi method, a series of iterative rounds will be developed to gather consensus around the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We will employ the Qualtrics platform for data collection and analysis, and a consensus target of 75% has been predetermined. For quantitative data analysis, we will use descriptive statistics encompassing a range of measures, including count, mean, standard deviation, median, minimum, maximum, and range. An inductive thematic analysis procedure will be employed to extract meaningful themes and patterns from qualitative data. The study results are expected to significantly impact clinical practice by creating a specialized care pathway to motivate individuals with lower limb fractures to adhere to rehabilitation. Adopting these explicit standards by professionals will ensure uniform and high-quality care.

Exploring the Role of Rehabilitation Medicine within an Inclusion Health Context: Examining a Population at Risk from Homelessness and Brain Injury in Edinburgh

People experiencing homelessness are at risk from a number of comorbidities, including traumatic brain injury, mental health disorders, and various infections. Little is known about the rehabilitation needs of this population. This study took advantage of unique access to a specialist access GP practice for people experiencing homelessness and a local inclusion health initiative to explore the five-year period prevalence of these conditions in a population of people experiencing homelessness through electronic case record searches and to identify barriers and facilitators to healthcare provision for this population in the context of an interdisciplinary and multispecialist inclusion health team through semi-structured interviews with staff working in primary and secondary care who interact with this population. The five-year period prevalence of TBI, infections, and mental health disorders was 9.5%, 4%, and 22.8%, respectively. Of those who had suffered a brain injury, only three had accessed rehabilitation services. Themes from thematic analysis of interviews included the impact of psychological trauma, under-recognition of the needs of people experiencing homelessness, resource scarcity, and the need for collaborative and adaptive approaches. The combination of quantitative and qualitative data suggests a potential role for rehabilitation medicine in inclusion health initiatives.

Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders?

BACKGROUND

Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS).

AIMS

A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed.

RESULTS AND DISCUSSION

Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs.

CONCLUSION

There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.

Current Trends in Balance Rehabilitation for Stroke Survivors: A Scoping Review of Experimental Studies

Balance impairment is a common consequence of a stroke, which can significantly hinder individuals' participation in daily activities, social interactions, and leisure pursuits and their ability to return to work. Rehabilitation is vital for minimizing post-stroke sequelae and facilitating the recovery of patients. This review aims to identify current trends in balance rehabilitation of stroke survivors. This Scoping review followed Arksey and O'Malley's methodological framework. The literature search was conducted in electronic databases, including CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection. The search was performed in March 2023, and the inclusion criteria were articles published in English or Portuguese between 2013 and 2023. A total of 446 articles were identified. After selecting and analyzing the reports, fourteen publications were included in this review. Seven distinct categories of balance rehabilitation interventions were identified, covering various approaches. These categories included conventional rehabilitation exercises, gym-based interventions, vibration therapy, rhythmic auditory stimulation training, boxing therapy, dual-task training, and technology-based rehabilitation interventions. Each of these methods presents unique benefits and can significantly impact the recovery of balance in stroke survivors, enhancing their overall well-being and functional capacity.

Adapted Portuguese folk dance intervention for subacute rehabilitation post-stroke: study protocol

Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk dance as a post stroke rehabilitative activity. We will use a mixed-methods pilot study convenience sampling to recruit 16 stroke survivors with mild-moderate lower limb paresis from a rehabilitation center in Lisbon and Tagus Valley. In addition to usual care, participants will attend 3 days per week 1-h dance exercise for 8 weeks. The dance style used for this intervention will be an adaptation of the Portuguese folk dance. Assessment will be conducted before and immediately after the program intervention. Acceptability will be assessed by four key domains (enrollment, retention, satisfaction, and recommendation to others). Safety will be assessed based on the number and type of adverse events. Feasibility will be assessed based on balance performance and functional mobility. Quantitative data will be analyzed through descriptive statistics for sample characterization, followed by inferential statistics to evaluate differences in the balance recovery and functional mobility scores between the initial and final assessment. Qualitative data will be analyzed using an inductive process of content analysis. The Portuguese folk dance program has the potential to improve balance outcomes and functional mobility. Our results will help validate Portuguese folk dance as a tool for rehabilitation settings for stroke survivors. The potential of our program to enhance balance outcomes and functional mobility among stroke survivors bears implications for aging and public health initiatives. Positive results from this study could pave the way for integrating dance-based rehabilitative activities into standard stroke rehabilitation protocols, catering to older stroke survivors' specific needs and preferences.

Enablers, barriers and strategies to build resilience among cancer survivors: a qualitative study protocol

Cancer is a life-threatening illness affecting all dimensions of a person's health. Cancer survivors must build resilience to face this adversity and continue their life projects. The present study explores the enablers, barriers, and strategies to build resilience among cancer survivors. This qualitative, descriptive exploratory study will use purposive sampling to recruit cancer survivors and healthcare professionals from two hospital centers in Lisbon and Tagus Valley. Interviews will be conducted until data saturation occurs. Data analysis will be performed using an inductive content analysis process with the help of the QDA Miner Lite database. The findings from this study will generate knowledge that may help stakeholders to identify effective strategies to build resilience among cancer survivors. By implementing strategies to foster resilience, healthcare professionals can potentially promote positive adaptations to cancer by strengthening resilience enablers and reducing the impact of barriers.

Perspectives on the Person-Centered Practice of Healthcare Professionals at an Inpatient Hospital Department: A Descriptive Study

The characteristics of health professionals and their understanding of person-centeredness may have important implications for the development of person-centered practice in specific care settings. In this study, we characterized the perceptions of the person-centered practice of a multidisciplinary team of health professionals working in the internal medicine inpatient unit of a Portuguese hospital. Data were collected using a brief sociodemographic and professional questionnaire and the person-centered practice inventory-staff (PCPI-S), and the effect of different sociodemographic and professional variables on each PCPI-S domain was determined using an analysis of variance (ANOVA). The results showed that a person-centered practice was positively perceived in the major constructs of prerequisites (M = 4.12; SD = 0.36), the practice environment (M = 3.50; SD = 0.48), and person-centered process (M = 4.08; SD = 0.62) domains. The highest scored construct was developed interpersonal skills (M = 4.35; SD = 0.47), and the lowest was supportive organization systems (M = 3.08; SD = 0.80). Gender was found to influence the perceptions of knowing self (F(2,75) = 3.67, p = 0.03, partial η2 = 0.089) and the physical environment (F(2,75) = 3.63, p = 0.03, partial η2 = 0.088), as was profession on shared decision-making systems (F(2,75) = 5.38, p < 0.01, partial η2 = 0.125) and commitment to the job (F(2,75) = 5.27, p < 0.01, partial η2 = 0.123), and the educational level on being professionally competent (F(1,75) = 4.99, p = 0.03, partial η2 = 0.062) and having commitment to the job (F(2,75) = 4.49, p = 0.04, partial η2 = 0.056). In addition, the PCPI-S proved to be a reliable instrument for characterizing healthcare professionals' perceptions of the person-centeredness of care in this context. Identifying personal and professional variables that influence these perceptions could provide a starting point for defining strategies to move practice toward person-centeredness and for monitoring changes in healthcare practice.

Nurses’ Motivations, Barriers, and Facilitators to Engage in a Peer Review Process: A Qualitative Study Protocol

Peer review supports the integrity and quality of scientific publishing. However, although it is a fundamental part of the publishing process, peer review can also be challenging for reviewers, editors, and other stakeholders. The present study aims to explore the nurses’ motivations, barriers, and facilitators in engaging in a peer review process. This qualitative, descriptive exploratory study will be developed in partnerships with three research centers. Researchers followed the consolidated criteria for reporting qualitative research (COREQ) checklist to ensure the quality of this study protocol. According to the selection criteria, the purposive sampling will be used to recruit nurse researchers that act as peer reviewers for several scientific journals in various fields of knowledge. Interviews will be conducted until data have been sufficiently consistent with meeting the initial objectives. Researchers will develop a guide comprising a set of open-ended questions to collect participants’ characteristics, descriptive review behavior, and perceptions regarding their motivations, barriers, and facilitators. Researchers will analyze data using an inductive process of content analysis with the help of the QDA Miner Lite database. Findings from this study will generate knowledge that may help stakeholders identify facilitating factors and barriers and guide the development of strategies to remove or minimize these barriers.

Needs and expectations of family caregivers of cancer patients in palliative care: A study protocol

Cancer has an associated burden that continues to grow, affecting patients, family caregivers, and the individual's community. The family caregivers' unmet needs may harmfully jeopardize their well-being and the patient's health outcomes. Therefore, it is essential to understand the needs and expectations of family caregivers of cancer patients to develop and improve care practices. The present study aims to explore the needs and expectations of family caregivers of cancer patients in palliative care. This qualitative, descriptive exploratory study will use purposive sampling to recruit family caregivers and healthcare professionals from the palliative care units of two hospital centers in Lisbon and Tagus Valley. First, the Focus group will be performed until data saturation occurs. Then, a conventional thematic analysis will be applied to analyze data with the help of the coding software QDA Miner Lite database. This study's findings will help identify gaps in care and provide data that can support healthcare professionals in providing evidence-based centered care to family caregivers. It can also generate knowledge that may help stakeholders to develop a comprehensive support system for cancer survivors in palliative care and their family caregivers.

Barriers to Gait Training among Stroke Survivors: An Integrative Review

Gait recovery is vital for stroke survivors' ability to perform their activities associated with daily living. Consequently, a gait impairment is a significant target for stroke survivors' physical rehabilitation. This review aims to identify barriers to gait training among stroke survivors. An integrative review was conducted following Whittemore and Knafl's methodology. The research was carried out on the electronic databases Scopus, PubMed, and B-on, applying a time span of 2006 to 2022. A total of 4189 articles were initially identified. After selecting and analyzing the articles, twelve studies were included in the sample. This review allowed for the identification of several barriers to gait training among stroke survivors, which can be grouped into three categories: individual, environmental, and rehabilitation workforce-related barriers. These findings highlight that participation in gait training is not solely dependent on the stroke survivor. Instead, the uptake of rehabilitation programs may also depend on environmental and rehabilitation workforce-related factors.