ORCID Profile
0000-0003-4907-8530
Current Organisations
Royal Rehab
,
University of Sydney
,
Flinders University
,
Macquarie University
,
Deakin University
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Publications
Compensatory care: The elephant in the in-patient rehabilitation room
Publisher: Mark Allen Group
Date: 02-04-2013
Is there evidence of the International Classification of Functioning, Disability and Health in undergraduate nursing students' patient assessments?
Publisher: Wiley
Date: 14-05-2004
Role Ambiguity in Rehabilitation Settings: A Professional Concern for Nursing
Publisher: Elsevier BV
Date: 2007
An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation
Publisher: Wiley
Date: 04-08-2020
DOI: 10.1111/JAN.14475
Spirituality and its relationship with positive adjustment following traumatic brain injury: a scoping review
Publisher: Informa UK Limited
Date: 05-09-2018
DOI: 10.1080/02699052.2018.1511066
Abstract: To identify the extent of research which has investigated spirituality or closely related meaning-making constructs after traumatic brain injury (TBI). A scoping review was employed to capture the broadest possible range of studies. Search terms 'spirituality', 'religion', 'beliefs', 'faith', 'hope', 'meaning', 'purpose in life', 'sense of coherence' and 'posttraumatic growth' were combined with search terms related to TBI. Findings were restricted to empirical studies published in English, in peer-reviewed journals and conducted over a 20-year period between 1997 and 2016. Nine studies were identified, conducted in the USA, Canada and the UK. These included eight quantitative studies and one qualitative study. Definitions and measurement of spirituality varied widely among the studies. Findings revealed that spirituality was closely related to a number of positive outcomes following TBI including psychological coping, physical health, mental health, productivity, life satisfaction, functional independence and posttraumatic growth. The limited research conducted into spirituality following TBI suggests it can play an important role in the recovery process. Further research is necessary to identify the particular spiritual needs of this population, and how clinical staff may be supported to address such needs.
The concerns of older women during inpatient rehabilitation after fractured neck of femur
Publisher: Mark Allen Group
Date: 05-2009
DOI: 10.12968/IJTR.2009.16.5.42103
Abstract: There have been many studies conducted on the impact of fractured neck of femur on older women, but they have not focused specifically on the psychosocial impact of this injury on the lives of previously independent older women. This pilot study aimed to explore the impact of fractured neck of femur on the lives of previously independent women, and identify their concerns when participating in inpatient rehabilitation following their fracture. Semi-structured interviews were undertaken with five women hospitalized for rehabilitation following fractured neck of femur. Qualitative description within the constructivist paradigm and using thematic analysis was used to analyse the transcripts. All of the five women experienced loss of control as a distressing consequence of fractured neck of femur. Their primary concerns were about the behaviour of others, what was happening to them, the impact of their injury on others and their other health issues. Loss of control is a major issue for older women who fracture a femur. In addition, during rehabilitation they are concerned about a range of issues, some of which seem to have the potential to be ameliorated by thoughtful staff-initiated interactions. Identification of what concerns patients can help staff know where to focus their input as they guide and support patients on their rehabilitation journeys. Further research is required to guide and refine the development of effective staff-initiated interactions.
The experiences and needs of persons with spinal cord injury who can walk
Publisher: Informa UK Limited
Date: 19-03-2012
DOI: 10.3109/09638288.2012.665126
Abstract: The purpose was to explore the experiences and needs of persons with spinal cord injury (SCI) who can walk. Thematic analysis was undertaken on the transcripts of semistructured interviews with 12 in iduals who could walk following SCI. Experiences shared across the group were related to walking in hospital and community settings, fatigue, frustration and invisible impairments. A need was identified for psychological support whilst in hospital and beyond. Professional and peer support following discharge from hospital were needed to assist with adjusting to their injury. Differences were noted between the experiences and needs of persons who had sustained their injury through a traumatic cause and persons who had sustained their injury through nontraumatic cause and the rehabilitation environment in which participants were hospitalized. The lived experiences of the general cohort in this small-scale study suggest that innovative strategies rograms be developed to address the needs of walkers within inpatient settings and following their discharge into the community. Programs should include self-help mental health strategies. Programs are required to better inform health professionals of the needs of this subset of the spinal cord injured population. Attention should be drawn particularly towards the needs of persons who had sustained their injury through nontraumatic cause.
Young people with brain injury in nursing homes: not the best option!
Publisher: CSIRO Publishing
Date: 2002
DOI: 10.1071/AH020046
Abstract: We discuss the growing needs for appropriate accommodation for young people with acquired brain injury by exploring the accommodation of young people with brain injury in nursing homes. While the actual number is not clear, it is certainly expected to grow. Reviewing the literature and drawing on clinical experience exposes how nursing home becomes an option for these people. We argue that this should not be an option for this typically young male population, and give some suggestions for more appropriate accommodation.
The impact of stroke on female sexuality
Publisher: Informa UK Limited
Date: 09-12-2017
DOI: 10.1080/09638288.2016.1213897
Abstract: The purpose of this study was to explore the impact of stroke on female sexuality from the perspective of women who have had a stroke. A descriptive qualitative study. Nine female stroke survivors living in metropolitan and surrounding districts of Sydney, Australia took part in semi-structured conversational interviews. The mean length of time from stroke onset to interview was around 6 years and 2 months (range 1 year, 2 months to 15 years, 9 months). The interviews were digitally recorded and transcribed. The transcripts were systematically analysed using inductive thematic analysis. The women experienced many and varied bodily alterations as a consequence of stroke which impacted negatively on their sexuality. These bodily alterations impacted on female sexuality in two ways: one was as an assault on the female sense of self and the other was by limiting possibilities for enacting female sexuality. Stroke impacts on female sexuality through bodily alterations and their consequences and because sexuality is important to female stroke survivors, it should be addressed as part of person-centred rehabilitation. Implications for Rehabilitation Sexuality is about much more than just "having sex" and is important to female stroke survivors. Stroke impacts on female sexuality through bodily alterations and their consequences. Understanding the impact of stroke on female sexuality is a step towards more person-centred rehabilitation.
What do nurses do in response to their predictions of aggression?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2006
DOI: 10.1097/01376517-200606000-00007
Abstract: Nurses working with people who have an acquired brain injury report a high incidence of verbal assault and physical aggression directed against them. The aim of the current study was to identify the responses nurses make to such predictions of aggression. Twenty-eight nurses from 10 inpatient brain injury rehabilitation units in Australia participated. Participants were selected because of their expertise in predicting and minimizing aggression. They were interviewed one-on-one using the Critical Decision Method of interviewing. Transcripts were analyzed using thematic analysis. Nurses identified three general responses to predictions of aggression: paying attention, planned nonintervention, and planned intervention. The nurses were able to respond to predictions of aggression in a clinically effective way. Knowledge of the in idual patient and experiences with other brain-injured patients informed their practice.
Incongruence between nurses' and patients' understandings and expectations of rehabilitation
Publisher: Wiley
Date: 15-05-2009
DOI: 10.1111/J.1365-2702.2008.02322.X
Abstract: To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation. Qualitative. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.
Preparing patients to self-manage faecal continence following spinal cord injury
Publisher: Mark Allen Group
Date: 02-2004
DOI: 10.12968/IJTR.2004.11.2.13394
Abstract: Spinal cord injury is catastrophic and there is much to learn for the injured person. During inpatient rehabilitation in Australia, it is the responsibility of the nurse to teach the patient to care for him or herself. One of the components of this self-care is the management of the patient's newly acquired neurogenic bowel. However, readiness and motivation to learn about this may be missing or weak, and non-adjustment to the injury may initially impair the patient's learning. Astute assessment is therefore needed to determine the person's learning ability. As a result, the bowel management programme can be adjusted accordingly to either meet the needs of a self-directed learner or a dependent learner. Whichever the case, well designed education materials will facilitate patient learning and the transfer of education from inpatient to community settings. This article highlights the complexity of preparing patients with spinal cord injury for the self-management of faecal continence.
Examination of the dependency and complexity of patients admitted to in-patient rehabilitation in Australia
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH18073
Abstract: Objective The aim of this study was to determine whether there has been a measurable change in the dependency and complexity of patients admitted to in-patient rehabilitation in Australia between 2007 and 2016. Methods A retrospective cohort study design was used to examine in-patient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database for the period 2007–16. Epidemiological descriptive analysis was used to examine datasets for difference between four discrete years (2007, 2010, 2013 and 2016). Datasets included patient demographics, length of stay (LOS), comorbidities, complications and the Functional Independence Measure (FIM™). Results Between 2007 and 2016, rehabilitation in-patients as a whole: (1) had a mean decrease in total admission FIM score (2) became more complex, as evidenced by the increased proportion of particular comorbidities impacting on rehabilitation, namely cardiac and respiratory disease, dementia, diabetes and morbid obesity and (3) had a mean decrease in total discharge FIM score. However, there was an increase in the proportion of patients discharged home from rehabilitation (from 86.5% to 92%) and decreases in onset and rehabilitation LOS of 2.2 and 2.5 days respectively. Conclusion The dependency and complexity of patients admitted to in-patient rehabilitation in Australia has increased between 2007 and 2016. What is known about the topic? Anecdotal reports suggest that rehabilitation patients in Australia have become more complex, necessitating increased active management of their presenting health condition and comorbid health conditions. However, to date, no systematic investigation has been undertaken to examine trends in rehabilitation in-patient dependency and complexity over time. What does this paper add? This study provides measurable evidence of increased dependency and complexity in patients admitted to rehabilitation in Australia. Further, compared with 2007, rehabilitation in-patients as a whole had an increased burden of care on discharge from rehabilitation in 2016. What are the implications for practitioners? The changes in patient dependency and complexity reported in this study have implications for rehabilitation service delivery. This is because the increased need for illness or injury and comorbidity management may result in increased potential for acute complications and health deterioration, and compensatory care for patients during rehabilitation. Clinicians may need to widen their skill set to include more acute and chronic illness management.
Return to work following traumatic brain injury: An exploration of using the Brannagan Executive Functions Assessment to increase self-awareness in practice
Publisher: University of South Australia Library
Date: 27-07-2023
Abstract: Aim and Background: The Brannagan Executive Functions Assessment is an occupation-based approach for increasing self-awareness. This study explores the application of the Brannagan Executive Functions Assessment in traumatic brain injury return to work intervention. It describes changes in self-awareness, goal achievement and perspectives of occupational therapy and people with brain injury. Methods: Case study design using a mixed-methods approach: with pre-post evaluation of outcomes and semi-structured interviews. Participants with traumatic brain injury completed the assessment with two occupational tasks related to return to work. Primary outcomes were self-awareness (Self-awareness Deficits Interview and Awareness Questionnaire) and Goal performance/satisfaction using the Canadian Occupational Performance Measure. Mood was a secondary outcome. Analysis was descriptive for quantitative data, thematic for qualitative data. Results: Two participants with brain injury, two support people and one occupational therapist were recruited. One participant with brain injury had an increase in self-awareness scores. Brain injury participants and the occupational therapist identified benefits including an increased awareness of needing to incorporate planning to meet goals. Conclusion: The Brannagan Executive Functions Assessment offers benefits to practice in brain injury rehabilitation, facilitating a structured occupational approach to self-awareness and participation in meaningful return to work tasks.
Opting in and opting out: A grounded theory of nursing?s contribution to inpatient rehabilitation
Publisher: SAGE Publications
Date: 11-11-2009
Abstract: Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation. Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory. Setting: Five inpatient rehabilitation units in Australia. Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice. Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable. Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.
Insights into the nature of female sexuality from the perspective of female stroke survivors
Publisher: Informa UK Limited
Date: 06-09-2018
Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand
Publisher: Hindawi Limited
Date: 06-2010
DOI: 10.1111/J.1365-2524.2009.00865.X
Abstract: In Thailand, the crude death rate from stroke is 10.9/100,000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006 and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001 and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life.
The characteristics of falls in an inpatient traumatic brain injury rehabilitation setting
Publisher: Wiley
Date: 12-2016
DOI: 10.1111/JOCN.13087
Abstract: To describe the nature of falls in an inpatient traumatic brain injury rehabilitation setting. Falls are the most frequently recorded patient safety incident in the inpatient context. However, higher rates of falls are reported in rehabilitation settings compared to acute care settings. In the rehabilitation setting, patients with a traumatic brain injury have been identified as at a high risk of falling. However to date, research into the nature of falls involving this patient population is limited. Five-year retrospective cohort study design. Falls data from an inpatient traumatic brain injury rehabilitation unit were retrieved from the NSW Ministry of Health Incident Information Management System and patient clinical notes nursing shift data were retrieved from the local rostering system. The fall rate was 5·18 per 1000 patient bed days. Over a 24-hour period falls (n = 103) occurred in a trimodal pattern. The median fall free period after admission was 14 days and 22% of traumatic brain injury patients had at least one fall. 53% of falls occurred in the patient's bedroom and 57% were attributed to loss of balance. At time of fall, 93% of fallers had impaired mobility and 85% required assistance for transfers. Falls within inpatient traumatic brain injury rehabilitation are a significant and complex clinical issue. While many patients continued to be at risk of falling several months after admission, a repeat faller's first fall occurred earlier in their admission than a single faller's. Generic falls prevention measures are insufficient for preventing falls in the brain injury rehabilitation population. Falls prevention initiatives should target times of high patient activity and situations where there is decreased nursing capacity to observe patients. Rehabilitation clinicians need to be mindful that a patient's risk of falling is not static and in fact, may increase over time.
The psychometric properties of a modified client-centred rehabilitation questionnaire in an Australian population
Publisher: Informa UK Limited
Date: 28-09-2020
Seeking evidence of rehabilitation in nephrology nursing.
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/S1322-7696(08)60497-7
Abstract: In iduals with renal failure experience many varied and complex alterations in their health status. As a consequence, rehabilitation is an important aspect of their care. However, until recently, rehabilitation has not been explicit in the published nephrology nursing literature. This paper addresses that deficit through an examination of Australian nephrology nursing competency standards for evidence of rehabilitation. Recent Australian research about rehabilitation nursing practice was used as a guiding definition of rehabilitation. A systematic examination of these documents revealed evidence of rehabilitative practices embedded in the nephrology nursing competency standards' domains of empowerment and clinical problem solving. These findings add support for the belief that rehabilitation is a philosophy that all nurses can apply in their practice.
A nursing perspective on the relationship between nursing and allied health in inpatient rehabilitation
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09638280701256900
Abstract: To generate a deeper understanding of contextual factors influencing nursing's contribution to inpatient rehabilitation units in Australia. Grounded theory informed by the theoretical perspective of symbolic interactionism. Data were generated by interviews with nurses and observation of their everyday practice. Nursing and allied health work in inpatient rehabilitation was segregated by ided and iding work practices. Several contextual conditions contributed to the segregation. These were 'limited acknowledgment of nursing's complex role', ' isive work practices' and 'discontinuous teamwork'. Segregation limited the extent to which nurses could contribute to patient rehabilitation. 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.
Nurses create a rehabilitative milieu
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2010
DOI: 10.1002/J.2048-7940.2010.TB00287.X
Abstract: Despite the recognition of milieu therapy as a nursing intervention, nursing's contribution to the creation of inpatient environments that facilitate patient rehabilitation has been underresearched. A large study conducted in five inpatient rehabilitation units in Australia that sought to develop a grounded theory of nursing's contribution to inpatient rehabilitation has begun to address this gap in the literature. Analysis of data collected from 53 nurses during interviews and observations of their everyday practice revealed that nurses act purposefully to create a milieu conducive to rehabilitation. In doing so, they target all patients using a range of strategies that include allowing time, keeping patients'spirits up, protecting patients from embarrassment, and making hospitals more homelike than is typically experienced in acute-care environments. As a consequence, rehabilitative milieu therapy is proposed as a subset of milieu therapy.
“Spirituality is everybody’s business”: an exploration of the impact of spiritual care training upon the perceptions and practice of rehabilitation professionals
Publisher: Informa UK Limited
Date: 25-09-2020
DOI: 10.1080/09638288.2020.1820586
Abstract: This study explored the impact of a brief spiritual care training program upon the perceptions and self-reported practice of rehabilitation professionals working in traumatic injury. A qualitative study. Semi-structured interviews were held with staff from a rehabilitation hospital in Sydney, Australia, between six and eight weeks after participation in spiritual care training. A thematic analysis was conducted. Of the 41 rehabilitation professionals who attended the training (1 h online, 1.5 h face to face), 16 agreed to be interviewed. The majority worked in spinal cord injury and were female. Half reported holding a Christian affiliation. One overarching theme and six sub-themes were identified from the qualitative data. The overarching theme was "spirituality is everybody's business". The six sub-themes were: (i) increased awareness of the nature of spirituality, (ii) realisation of the importance of spirituality to clients, (iii) a desire to keep spirituality on the radar, (iv) identifying barriers to providing spiritual care (v) incorporating spirituality into practice, and, (vi) recognising spirituality as personally meaningful. A brief spiritual care training program can impact positively upon perceptions and practice of rehabilitation professionals. Ongoing training is needed to ensure that staff retain what was learnt.IMPLICATIONS FOR REHABILITATIONBrief spiritual care training can impact positively upon rehabilitation professionals' perceptions of spirituality and lead to practice change in the delivery of spiritual care across many clinical disciplines.The stories of patients and family members are powerful staff education tools in spiritual care training.Client spirituality is an under recognised resource that staff can draw upon in supporting and enhancing the rehabilitation process.
Problems people with spinal cord injury experience accessing help with bowel care when hospitalised outside a specialist spinal injury service
Publisher: Wiley
Date: 08-03-2021
DOI: 10.1111/JOCN.15717
Abstract: To examine the nature of problems experienced by people with spinal cord injury (SCI) when accessing help to maintain recommended bowel regimes while hospitalised outside a specialist spinal injury service. Bowel dysfunction is one particularly undesirable aspect of life with a SCI, with constipation and incontinence common. Descriptive qualitative. Accounts of problems encountered in hospitals in New South Wales Australia collected during interviews with 11 people living with SCI and 12 responses provided by spinal clinicians via an online survey were subjected to thematic analysis. The COREQ guidelines were followed for reporting. There were similarities across data collected from both sources. In iduals with SCI described instances where their bowel care needs did not fit with the pace and processes in acute hospitals. The clinician data pointed to a failure of healthcare professionals to assist people with SCI to maintain bowel care regimes recommended by specialist spinal services. Both groups described times when bowel care received was unreliable and fragmented, along with reports of staff who were unwilling and/or unable to provide the assistance required. Many and varied physical and psychosocial repercussions for in iduals were associated with these system failures. In some instances, rather than restoring health, being admitted to hospital represented a significant health risk. A failure of hospital systems to meet the bowel care needs of people with SCI when hospitalised outside a specialist spinal unit was identified. System and in idual factors contributed to these problems, hence addressing them requires both system and in idual responses. If this problem is left unaddressed, the health and quality of life of people with SCI will continue to be compromised. Nursing scope of practice needs to be clarified and communicated to nurses outside specialist spinal injury units in relation to their role in maintaining bowel care regimes recommended for their patients by spinal specialists, and nurses need to ensure they possess the skills required. To allocate the time needed to provide this care, in idual nurses need the support of the whole nursing team, including managers who are prepared to arrange additional staff when needed.
A case-control study examining the characteristics of patients who fall in an inpatient traumatic brain injury rehabilitation setting
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2016
Development of the Sydney Falls Risk Screening Tool in brain injury rehabilitation: A multisite prospective cohort study
Publisher: Wiley
Date: 15-01-2018
DOI: 10.1111/JOCN.14048
Abstract: To develop a falls risk screening tool (FRST) sensitive to the traumatic brain injury rehabilitation population. Falls are the most frequently recorded patient safety incident within the hospital context. The inpatient traumatic brain injury rehabilitation population is one particular population that has been identified as at high risk of falls. However, no FRST has been developed for this patient population. Consequently in the traumatic brain injury rehabilitation population, there is the real possibility that nurses are using falls risk screening tools that have a poor clinical utility. Multisite prospective cohort study. Univariate and multiple logistic regression modelling techniques (backward elimination, elastic net and hierarchical) were used to examine each variable's association with patients who fell. The resulting FRST's clinical validity was examined. Of the 140 patients in the study, 41 (29%) fell. Through multiple logistic regression modelling, 11 variables were identified as predictors for falls. Using hierarchical logistic regression, five of these were identified for inclusion in the resulting falls risk screening tool: prescribed mobility aid (such as, wheelchair or frame), a fall since admission to hospital, impulsive behaviour, impaired orientation and bladder and/or bowel incontinence. The resulting FRST has good clinical validity (sensitivity = 0.9 specificity = 0.62 area under the curve = 0.87 Youden index = 0.54). The tool was significantly more accurate (p = .037 on DeLong test) in discriminating fallers from nonfallers than the Ontario Modified STRATIFY FRST. A FRST has been developed using a comprehensive statistical framework, and evidence has been provided of this tool's clinical validity. The developed tool, the Sydney Falls Risk Screening Tool, should be considered for use in brain injury rehabilitation populations.
A framework for the role of Registered Nurses in the specialty practice of rehabilitation nursing in Australia
Publisher: Wiley
Date: 08-2002
DOI: 10.1046/J.1365-2648.2002.02271.X
Abstract: This study sought to explore systematically the role of Registered Nurses working in rehabilitation in Australia. Rehabilitation has been identified as an important aspect of health care. However, evidence of a comprehensive investigation of the nurses' role in rehabilitation cannot be found. From Australia, in particular, no research has been published in this area. This study used a qualitative approach by engaging 13 nurses in one-to-one interviews and a further 21 in focus group discussions. Thematic analysis was conducted on the interview and focus group data. Seven domains of practice were identified and are suggested as a framework for the specialty practice of rehabilitation nursing. They capture the 'how' and 'what' of rehabilitation nursing practice. Central to this practice is a rehabilitative approach to patient care, teaching and coaching, and continual assessment. The nurses explained in detail how these aspects of rehabilitation nursing differentiate their practice from that of their acute care colleagues. The rehabilitative approach is one of a variety of approaches to nursing care, but should not be seen as the exclusive domain of rehabilitation nurses. Rehabilitation belongs in every nurse's toolkit.
Falls and fallers in traumatic brain injury (TBI) rehabilitation settings: An integrative review
Publisher: Informa UK Limited
Date: 23-01-2015
DOI: 10.3109/09638288.2014.1002578
Abstract: To critically appraise the research literature on the nature of falls and fallers in traumatic brain injury (TBI) rehabilitation settings. An integrative review of the literature using thematic analysis was undertaken. Papers identified via a systematic search strategy were independently appraised by two reviewers. A data extraction instrument was developed to record results and to aid identification of themes in the literature. Critical Appraisal Skills Programme instruments were utilised to conduct a methodological critique of the papers included. Thirteen studies were identified as having between 4% and 100% TBI patients in their study cohorts. From these papers, up to 71% of falls took place in a patient's bedroom occurring in peaks and troughs over a 24-h period. With some ergent results, nine themes were identified describing faller characteristics including: (1) functional mobility impairments (2) dizziness (3) bladder and bowel dysfunction (4) certain medications and number of medications prescribed (5) executive functioning (6) patient age (7) fear of falling (8) coma length following TBI and (9) Functional Independence Measure (FIM™) total score, subscale scores and particular in idual items. Being a multifactorial phenomenon, falls are a complex clinical issue. Despite the heterogeneity of diagnosis related groups (DRGs) in the included studies, TBI patients were identified as a high falls risk patient population in several studies. Implications for Rehabilitation Due to multisystem impairments, falls in the traumatic brain injury (TBI) rehabilitation context are a multifactorial and significant clinical issue. When interpreting and generalising results from research into falls, clinicians need to be mindful that falls and faller characteristics may be dependent on study setting and patient population. There is need for context specific research into faller characteristics following a TBI particularly in relation to post-traumatic amnesia.
Partners’ experiences of caregiving and perceptions of inpatient rehabilitation following catastrophic injury
Publisher: Mark Allen Group
Date: 02-06-2017
DOI: 10.12968/IJTR.2017.24.6.255
Abstract: The aim of this study is to critically review the research literature investigating the experiences of providing care to a spouse or partner during inpatient rehabilitation following a catastrophic injury (namely, stroke, traumatic brain injury or spinal cord injury) and their perceptions of inpatient rehabilitation service delivery. An integrative review was undertaken to determine the extent to which the topic has been investigated. Quantitative and qualitative research papers were systematically identified in peer-reviewed journals in electronic databases. Five articles published between 1994 and 2016 reported on four studies investigating the experiences of caregiving specifically by a spouse artner to a person receiving rehabilitation following a stroke. No research was found that committed to understanding the experiences of the spouse artner and their perceptions of inpatient rehabilitation service delivery following traumatic brain injury and spinal cord injury exclusively. The erse aspects of caregiving are not an area of inquiry in rehabilitation service delivery following a traumatic brain injury or spinal cord injury. Further research in this area is warranted.
Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review
Publisher: Wiley
Date: 03-07-2019
DOI: 10.1002/PMRJ.12179
Abstract: Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for in iduals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC. LEVEL OF EVIDENCE: IV.
A snapshot of rehabilitation referrals in rural New South Wales
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/AH08713
Abstract: The aim of this paper is to describe patterns of referral to inpatient rehabilitation in rural NSW. Archival records of referrals to one rural speciality medical rehabilitation service during 2004 and 2005 were analysed using descriptive statistics displayed using tables and graphs. Seventy-six referrers referred 922 patients for inpatient rehabilitation. Almost two-thirds (63.6%) came from the local acute hospital. Most referrals (80.4%) were considered appropriate for inpatient rehabilitation. Almost three-quarters (72.5%) of the patients referred were admitted. The demand for inpatient rehabilitation is high in rural NSW, suggesting that many healthcare providers view rehabilitation as a valuable service. Furthermore, this study suggests the important contribution that inpatient rehabilitation makes to the utilisation of acute care beds, but does not confirm it. What is known about the topic?Internationally and nationally there is a growing appreciation of the contribution that clinical rehabilitation services make to quality of life for people with a range of conditions, but little is known about referrals patterns to inpatient rehabilitation in rural NSW. What does the paper add?This paper provides the first focussed study of referrals to inpatient rehabilitation in rural NSW. It reports the number of patients referred, the number of referrers, the appropriateness of those referrals and their outcomes. What are the implications for practitioners?Rehabilitation services are important, widely and largely appropriately used and that further work is needed to assess whether additional services are required to meet this demand.
An examination of patient characteristics that contribute to falls in the inpatient traumatic brain injury rehabilitation setting
Publisher: Informa UK Limited
Date: 14-09-2017
DOI: 10.1080/09638288.2016.1212112
Abstract: To examine patient characteristics that contribute to falls in the inpatient traumatic brain injury (TBI) rehabilitation setting. A three-round modified Delphi technique that engaged a multidisciplinary panel of 11 health experts was used. Group median score and disagreement index were used to measure agreement between participants about patient characteristics that contribute to falls. All panel members participated in each questionnaire round. Several factors (such as, a fall since admission to hospital, cognitive impairment and motor impairment) were interpreted as contributing to falls in the TBI rehabilitation setting but others were not (such as, antecedent falls and medication class). Some salient themes identified in participants' comments include: (1) the need to differentiate between what is an activity (e.g., mobility) and impairment (e.g., ataxic gait)-based falls risk factor (2) over the course of a 24-h day and inpatient rehabilitation stay, a patient's risk of falling is not linear and (3) Functional Independence Measure and predictors of TBI severity have varied sensitivity in predicting falls. In the TBI rehabilitation setting, falls result from a combination of many patient factors. Some factors are believed to be more relevant at different time points over a 24-h day and, at particular times during the course of a patient's rehabilitation. The utility and statistical significance of risk factor of falls are both important concepts when determining their clinical relevance. Implications for Rehabilitation Clinicians should be mindful that the rehabilitation context can present unique falls risk factors, some of which emerge at different times during a patient's rehabilitation. Over the course of a patient's rehabilitation their risk of falling is not linear therefore, rehabilitation clinicians should undertake periodic falls risk screening. The utility value and statistical significance of falls risk factors are both important aspects to consider when determining their clinical utility.
Predictors of unplanned readmission to acute care from inpatient brain injury rehabilitation
Publisher: Wiley
Date: 10-12-2019
DOI: 10.1111/JOCN.15118
Abstract: To identify the predictors of unplanned readmission to acute care (RTAC) from inpatient brain injury rehabilitation and to develop a risk prediction model. RTAC from inpatient rehabilitation is not uncommon. In idual rehabilitation patient populations require their own body of evidence regarding predictors of RTAC. Retrospective cohort study. Adult patients with new onset acquired brain injury admitted to a stand-alone rehabilitation facility between 1 January 2012-31 December 2018 were included in the study. The main measures were RTAC, sensitivity, specificity, the C-statistic and Youden's index. This paper is reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Of 383 patients admitted for rehabilitation, 83 (22%) experienced a RTAC 69 (18%) patients had at least one unplanned RTAC episode. Patients requiring unplanned RTAC were more likely to have lower Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) scores on rehabilitation admission, a higher burden of care on rehabilitation discharge and be discharged to a nonhome residence. Rehabilitation admission GCS and motor FIM were identified as the independent RTAC predictors in multivariate regression modelling. The combined C-statistic was 0.86. A GCS cut-off score of ≤14 and motor FIM cut-off score of ≤40 were identified as optimal, yielding a combined Youden's index of 0.56 (sensitivity = 0.72 specificity = 0.83). Patients requiring an unplanned RTAC had a lower functional status on rehabilitation admission. A prediction model for unplanned RTAC has been developed using validated and readily available clinical measures. The developed RTAC risk prediction model is the first step in preventing unplanned RTAC from inpatient brain injury rehabilitation. Future research should focus on discrete interventions for preventing unplanned RTAC from inpatient brain injury rehabilitation.
Enhancing inpatient rehabilitation through the engagement of patients and nurses
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1365-2648.2009.05237.X
Abstract: This paper is a report of a study conducted to describe nurses' knowledge, experiences and perceptions of a rehabilitation nursing practice development project conducted in their workplace. Several studies over the past two decades have led to increasing clarity about the nursing role in rehabilitation. Practice development is a useful vehicle for using the findings of such studies to enhance person-centred practice in rehabilitation settings. This qualitative study, in which grounded theory informed data collection and analysis, involved interviews with 21 nurses working in an inpatient rehabilitation unit in Australia about their knowledge, experiences and perceptions of a rehabilitation nursing practice development project conducted in their workplace. The three rounds of interviews were conducted as follows: 1) December 2005-January 2006 2) June-July 2006 and 3) October 2006. Practice development was an effective vehicle for developing rehabilitation nursing practice. While collaboration and leadership were critical to the effectiveness of the project, the use of a clinically credible practice development facilitator and a focus on the development of collective nursing practice also seem to have been important. Through the introduction of new activities, both patient and nurse engagement in rehabilitation was enhanced and, as a consequence, the nurses developed a deeper appreciation of their role in rehabilitation. Carefully and collaboratively designed and sensitively implemented work-based practice development initiatives can change the context and culture of inpatient care. The use of a facilitator with relevant clinical nursing expertise to engage staff in idually and collectively with research findings and to reflect on their practice and skill development is worth exploring in similar initiatives.
Rehabilitation and Recovery Processes
Publisher: Wiley
Date: 03-02-2010
Dietary management of neurogenic bowel in adults with spinal cord injury: an integrative review of literature
Publisher: Informa UK Limited
Date: 15-08-2019
DOI: 10.1080/09638288.2019.1652702
Abstract: To examine the literature for current evidence on the dietary management of neurogenic bowel in adults with spinal cord injuries (SCIs). Neurogenic bowel dysfunction presenting as faecal incontinence or constipation is a common occurrence in in iduals with SCI. It poses numerous challenges for the management of bowel function and has a significant impact on quality of life following SCI. Dietary management is a common, early treatment strategy as a conservative approach for neurogenic bowel however, current recommendations rely on expert opinion only. An integrative review of the literature using a systematic search was conducted using Medline, Embase, CINAHL, Proquest, and Google Scholar. The selected articles were critically appraised using Critical Appraisal Skills Programme checklists by two independent reviewers. The risk of bias of studies and the quality of evidence for outcomes were assessed using the risk of bias tool and the grading of recommendations, assessment, development, and evaluation system in the Thirteen studies that met the inclusion criteria were identified exploring a variety of diet-related factors: foods, dietary behaviours, and multiple interventions including a diet plan. However, the dietary management strategies used varied significantly between studies, posing challenges to ascertain its efficacy. Given the low level of evidence and paucity of data on dietary management of neurogenic bowel, the efficacy of dietary strategies (alone or in combination with others) in managing neurogenic bowel cannot be substantiated from the studies identified. Therefore, more robust studies are warranted to bridge this gap.IMPLICATIONS FOR REHABILITATIONConsumption of ∼15 g dietary fibre is shown to be beneficial in managing neurogenic bowel in SCI.Further research is required to strengthen evidence for fibre recommendations and investigating the potential benefits of traditional and non-traditional dietary approaches.
What environmental factors irritate people with acquired brain injury?
Publisher: Informa UK Limited
Date: 19-08-2004
Co-ordination of patient care in inpatient rehabilitation
Publisher: SAGE Publications
Date: 05-2003
DOI: 10.1191/0269215503CR616OA
Abstract: Objective: To evaluate the effectiveness of a new patient care co-coordinator position in an inpatient rehabilitation setting. Design: Pre and post test using a 42-item staff survey. Setting: One inpatient rehabilitation service in rural New South Wales, Australia. Subjects: Members of the multidisciplinary team. Intervention: A new patient care co-coordinator position. Outcome measures: Comparison of trends in staff responses to pre and post test surveys. Findings: The post test survey demonstrated an overall increase in the reported frequency of desirable rehabilitation practices and increased staff satisfaction with those practices. Conclusions: A patient care co-coordinator may contribute to improving the processes and practices of inpatient rehabilitation and staff satisfaction.
Predicting falls: considerations for screening tool selection vs. screening tool development
Publisher: Wiley
Date: 22-04-2016
DOI: 10.1111/JAN.12977
Abstract: This paper discusses considerations for falls risk screening tool selection vs. the need to develop new tools. Inpatient falls are a complex patient safety issue that represent a significant burden for the healthcare system. In the inpatient context, falls risk screening tools are most often used for predicting falls, but in some populations assessment tools are more suited, however in others, a clinician's clinical judgment may be just as effective. Limited external validity is a central issue with falls risk screening tools when used in different populations than the original study. There is clinical need for guidance regarding screening tool selection vs. the need to development new tools and how to effect change in relation to the prediction of falls. Discussion paper. This discussion paper is based on our own experiences and research and is supported by literature. This paper provides clinicians with a better understanding of considerations for falls risk screening tool selection vs. the need to develop new tools. In doing so, it provides clinicians guidance on how to critique the efficacy and utility of their falls risk screening tool. This paper equips clinicians for effecting change in relation to the prediction of falls. Falls risk prediction is a particularly complex patient safety issue. Clinicians need to be aware of the limitations of their tool used to predict falls.
A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia
Publisher: Informa UK Limited
Date: 14-02-2020
The International Classification of Functioning, Disability and Health (ICF) and nursing
Publisher: Wiley
Date: 30-03-2004
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