Patient readiness for scheduled therapies: nursing's positive contribution

A nursing perspective on the relationship between nursing and allied health in inpatient rehabilitation

PURPOSE

To generate a deeper understanding of contextual factors influencing nursing's contribution to inpatient rehabilitation units in Australia.

METHOD

Grounded theory informed by the theoretical perspective of symbolic interactionism. Data were generated by interviews with nurses and observation of their everyday practice.

RESULTS

Nursing and allied health work in inpatient rehabilitation was segregated by divided and dividing work practices. Several contextual conditions contributed to the segregation. These were 'limited acknowledgment of nursing's complex role', 'divisive work practices' and 'discontinuous teamwork'. Segregation limited the extent to which nurses could contribute to patient rehabilitation.

CONCLUSION

The delivery of multi-professional inpatient rehabilitation is complex. By focusing efforts to ameliorate segregation, progress can be made towards optimizing the contribution of all disciplines to patient rehabilitation.

Perceptions of the nursing role in spinal cord injury rehabilitation

In the UK, over the last 50 years there have been many developments in the rehabilitation of spinal cord-injured people leading to improvements in outcomes. In spinal cord injury rehabilitation nurses work as members of a multiprofessional team but their role is not clearly defined and, unlike other professionals, they have a 24-hour relationship with patients. This article presents some findings from a larger ongoing ethnographic research study. The aim of this section of the study was to identify how nurses and patients perceive the nursing role in spinal cord injury rehabilitation. Semistructured interviews were carried out with 14 spinal cord-injured patients and 14 registered nurses. The findings suggest that patients value the nursing contribution as a means of emotional and physical support but that they do not necessarily see nursing input as rehabilitation. Nurses see their role as multifaceted but identify difficulties in crossing over from an acute care philosophy to a rehabilitation philosophy. The 24-hours close relationship with patients may be a source of imbalanced power relationships between nurses and patients and this causes distress to some patients. It is suggested that nurses need to develop their bedrock role in a way that empowers patients in spinal cord rehabilitation.

Neurological rehabilitation nursing: a review of the research

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988-1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in-patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.