Benjamin Turner

A qualitative study of the transition from hospital to home for individuals with acquired brain injury and their family caregivers

Primary Objective: To explore the transition experiences from hospital to home of a purposive sample of individuals with acquired brain injury (ABI). Research Design: Phenomenological, qualitative design. Methods and Procedures: Semi-structured interviews were conducted with 13 individuals with ABI (mean time since discharge = 15.2 months) and 11 family caregivers. Each interview was recorded, transcribed verbatim and then inductively analyzed. Results: Through the inductive analysis process, a summary coding framework was developed that included that following eight main categories: the hospital experience; the transition process; the role of family caregivers; post-discharge services; friendship networks and community involvement; meaningful activities and time management; physical and psychological wellbeing; and barriers and facilitators. Conclusions: The results of the study provide valuable insights into the lived experiences of participants and provide evidence to support the existence of a distinct transition phase within the ABI rehabilitation continuum; additional to and closely associated with the acute, post-acute and community integration phases.

The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations.

Purpose. To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. Method. Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. Results/discussion. A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. Conclusion. Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.

Perceived service and support needs during transition from hospital to home following acquired brain injury

Objective. To explore the service and support needs of individuals with acquired brain injury (ABI) and their family caregivers during the transition phase from hospital to home. Methods. The study utilised a qualitative research design. Participants included 20 individuals with ABI and 18 family caregivers recruited from a specialist inpatient brain injury rehabilitation unit. Data collection entailed in-depth semi-structured interviews, which were conducted at three time points: pre-discharge, and 1- and 3- months post-discharge. Thematic analysis of the interview transcripts involved open, axial and selective coding techniques. Results. The following primary themes, each with associated secondary themes, emerged from the analysis: (1) balancing the service and support equation; (2) negotiating the rehabilitation maze; (3) working with or against ‘the system’. The first theme describes the varying types and level of support received by participants during the transition phase, while the second theme highlights the difficulties participants experienced in negotiating the rehabilitation process between hospital and home. The final theme depicts the challenges experienced by participants in accessing and utilising service support. Conclusions. The findings suggest that the scope of existing service models need to be extended to bridge the existing gap between inpatient and community services, thereby easing the impact of transition.

Perceptions of recovery during the early transition phase from hospital to home following acquired brain injury: A journey of discovery

The increasing volume of literature concerning community-based rehabilitation for individuals with acquired brain injury (ABI) has recently brought into focus the importance of the early hospital-to-home transition phase. The present study aimed to explore the perspectives of individuals with ABI and their family caregivers concerning recovery and adjustment during the early transition phase from hospital to home. The study utilised a qualitative phenomenological design and included 20 participants with ABI and 18 family caregivers. Participants completed in-depth semi-structured interviews at the following time points: pre-discharge, and 1 and 3 months post-discharge. Data analysis entailed thematic analysis of the interview transcripts and incorporated open, axial and selective coding techniques. The following four primary themes emerged from the analysis process: (1) adapting to life in the real world; (2) variations in recovery; (3) the emotional adjustment rollercoaster; and (4) discovering the new me. Collectively, the findings highlight that while returning home was typically perceived to facilitate ongoing recovery, the process of adjusting emotionally to life at home posed a significant challenge for many participants during the transition phase. The clinical/service implications of the findings relate to the need for: (1) contextually appropriate rehabilitation options during the transition phase; and (2) the expansion of transition-based models of service delivery to include targeted psychological intervention approaches.

Profiling early outcomes during the transition from hospital to home after brain injury

Primary objective: To profile early outcomes during the transition from hospital to home for individuals with acquired brain injury (ABI) and their family caregivers. Research design: Prospective longitudinal study with data collected at three time points: pre-discharge and 1- and 3-months post-discharge. Methods and procedures: Participants included 26 individuals with ABI and 26 family caregivers, who were assessed on measures of global functioning, psychosocial reintegration, health-related quality-of-life and emotional well-being. Changes in outcomes over time and group comparisons were examined using repeated measures ANOVAs with relevant post-hoc analyses. Results: Participants typically demonstrated improved global functioning and psychosocial reintegration during the transition period, with closer alignment of perspectives (i.e. comparisons between self-ratings of participants with ABI and ratings of family caregivers) at 3-months post-discharge on the occupational activities and living skills domains. Additionally, levels of depression and stress reported by participants with ABI were observed to increase over time. Conclusions: Collectively, the results highlight the critical nature of the transition phase for psychosocial reintegration and emotional adjustment and support the need for holistic approaches to transition-specific interventions.

Supporting the growth of peer-professional workforces in healthcare settings: an evaluation of a targeted training approach for volunteer leaders of the STEPS Program

Abstract Purpose: To examine the effectiveness of a targeted training approach to foster and support a peer-professional workforce in the delivery of a community rehabilitation program for adults with acquired brain injury (ABI) and their families. Method: A prospective longitudinal design was used to evaluate the effectiveness of a targeted two-day training forum for peer (n = 25) and professional (n = 15) leaders of the Skills to Enable People and Communities Program. Leaders completed a set of questionnaires (General Self-Efficacy Scale – GSES, Rosenberg Self-Esteem Scale, Volunteer Motivation Inventory – VMI and Community Involvement Scale – CIS) both prior to and immediately following the forum. Data analysis entailed paired sample t-test to explore changes in scores over time, and independent sample t-tests for comparisons between the two participant groups. Results: The results indicated a significant increase in scores over time for the GSES (p = 0.047). Improvements in leaders’ volunteer motivations and community involvement were also observed between the two time intervals. The between group comparisons highlighted that the peer leader group scored significantly higher than the professional leader group on the CIS and several domains of the VMI at both time intervals. Conclusion: The study provides an enhanced understanding of the utility of innovative workforce solutions for community rehabilitation after ABI; and further highlights the benefits of targeted training approaches to support the development of such workforce configurations. Implications for Rehabilitation Innovative workforce solutions that incorporate peer-professional partnerships should be considered in planning for future health services. Service implementation needs to address the unique training and support needs of such a workforce to ensure high standards of service delivery and to enhance long-term sustainability. Good practice is to include an evaluation of a targeted training approach to foster leader development.