Heidi Muenchberger

Identity transition following traumatic brain injury: A dynamic process of contraction, expansion and tentative balance

Primary objective: The study aimed to understand turning points and processes that define the experience of identity change for individuals with brain injury. Research design: The current study applied an interpretive qualitative research design using a phenomenological approach. Qualitative ‘life-story’ interviewing was undertaken to explore the natural course of identity following TBI and a critical incident technique was applied to systematically examine key milestones. Methods and procedures: A purposive sample of six individuals with brain injury who represented a successive range of post-injury time frames (1–2 years, 2–5 years, 5–10 years, 10–15 years, 15–20 years and 25+ years) participated in the interviews. Main outcomes and results: Qualitative analysis indicated that identity transition was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Conclusions: The influence of subjective processes on the development of identity highlights the inadequacy of fragmented approaches when exploring the individual experience. Findings from this study have important implications for the delivery of person-focused rehabilitation and remind one to consider with caution the usual indicators of adjustment that are often applied to brain injury rehabilitation.

Self-managing versus self-management: reinvigorating the socio-political dimensions of self-management

In Australia, self-management predominantly refers to education programmes that, theoretically, equip people with chronic disease with the necessary information and skills to manage their own healthcare, maintain optimal health, and minimize the consequences of their condition. These programmes are designed, and often delivered, by practitioners. Our research has demonstrated that for consumers, self-management involves navigating and responding to a myriad of information sources and experiences, many of which originate in their own lived bodily experiences and personal knowledge. In contrast to this organic and dynamic version of self-managing that is naturally practised by consumers, common practitioner and policy representations of self-management tend to discount consumer agency and overlook the daily ways in which people manage their own body, experiences and health choices. We argue that if the self-management movement is to tackle health inequalities (rather than creating new ones), health professionals and policy-makers must examine the potentially damaging assumptions that are inherent in contemporary self-management discourse.

Predictors of preventable hospitalization in chronic disease: Priorities for change

AbstractResearch in the area of preventable hospitalization, hospital admissions that could otherwise be avoided, provides little guidance in terms of priority areas for change. This synthesis of multiple electronic databases searched systematically for studies related to preventable hospitalization identifies six priority areas for future action in three broad conceptual areas: person priorities (symptom management and supportive relationships), programme priorities (self-management supports and service delivery), and place priorities (local infrastructure and socio-economic opportunities). Attention to these priorities could help reduce preventable hospitalization while simultaneously improving health access and quality of care.

Coordinated care: what does that really mean?

The healthcare system in Australia is struggling to meet the healthcare needs of the ageing population. The pressure on health systems to solve these complex problems can create a sense of urgency to find a panacea in concepts such as coordinated care. A common understanding of coordinated care is often assumed when, in reality, the concept is neither clearly defined nor completely understood. The purpose of this review was to examine and identify the attributes of coordinated care to facilitate a shared definition of this concept within the primary care context. The study was a conceptual review of the literature relating to coordinated care in chronic disease. Two key electronic databases (MEDLINE and CINAHL) were searched using terms generated by a panel of primary healthcare practitioners and researchers. Following the application of inclusion and exclusion criteria, 20 studies were selected from an initial pool of 128. Several key attributes of coordinated care were identified together with a definitional statement. Coordinated care in the primary healthcare setting can be broadly defined as the delivery of systematic, responsive and supportive care to people with complex chronic care needs. It relies heavily on complicated concepts such as partnerships, networking, collaboration, knowledge transfer, person-centred practice and self-management support. The expression of these concepts in the literature was relatively superficial, with little discussion of the actual practices that might be implemented in order to enact them. This paper provides a framework of coordinated care within the primary care setting that can guide future work around implementation and evaluation.

Idiopathic macrocephaly in the infant: long-term neurological and neuropsychological outcome

RationaleThe long-term outcome of idiopathic macrocephaly is presently unknown.Methods and resultsIn the current study (n=15), MRI conducted at long-term review showed regression of orbito-frontal extradural collections and normal or slightly enlarged ventricular space compared to infant examination. Head circumference had normalised in all but one participant. Neuropsychological assessments of nine participants showed general intellectual ability within the normal range in the majority of participants; however, specific deficits in attention were evident. Clinical interviews conducted with a smaller sub-group revealed anecdotal histories of behavioural difficulties and reading or arithmetic difficulties in half of the total sample.ConclusionsProspective review studies such as this indicate that abnormal radiological findings in infancy are not necessarily predictive of neurodevelopmental problems and may reflect a normal variant. However, while overall intellectual ability may be within average limits in this diagnostic sample, considerable individual variations remain in specific areas of neuropsychological function.

Collaborative capacity building in complex community-based health partnerships: a model for translating knowledge into action.

Partnerships among multiple organizations across a range of sectors that bring together multiple perspectives are a common way of addressing community health and building capacity. To function successfully, partnerships depend on the careful orchestration of a collaborative culture and the facilitation of collective action. Using a systematic method, we developed a synthesis of evidence about collaborative capacity building, integrating this diverse knowledge base into a usable framework. Seventeen published models of collaborative capacity building met the inclusion criteria and were combined to derive a matrix that could guide the actions of those responsible for partnership management. This matrix may make the process of developing partnerships less complicated in future.

Pofessional Practice and Innovation: Geographical Information Systems: An Effective Planning and Decision-Making Platform for Community Health Coalitions in Australia

The development of locally-based healthcare initiatives, such as community health coalitions that focus on capacity building programs and multi-faceted responses to long-term health problems, have become an increasingly important part of the public health landscape. As a result of their complexity and the level of investment, it has become necessary to develop innovative ways to help manage these new healthcare approaches. Geographical Information Systems (GIS) have been suggested as one of the innovative approaches that will allow community health coalitions to better manage and plan their activities. The focus of this paper is to provide a commentary on the use of GIS as a tool for community coalitions and discuss some of the potential benefits and issues surrounding the development of these tools.

The move towards community-based rehabilitation in industrialised countries: Are we equipped for the challenge?

Background. Recent challenges to health systems in industrialised countries (e.g., health trends, workforce shortages, geographical dispersion, changing demographics and the growing demand for hospital beds) have prompted a rise in popularity of services loosely labelled community-based rehabilitation (CBR). The rise of CBR is based on the assumption that these models of service delivery have the potential to address some of these challenges by promoting efficient use of community resources. However, due to the way in which CBR has evolved in industrial countries, there is considerable ambiguity surrounding the concept, and even more uncertainty about the methods by which its implementation can be fostered. Purpose. To explore the CBR in an industrialised country and the implications of its implementation for the health workforce, health systems and service delivery. Method. This article reviews existing literature to explore the concept of CBR as it is applied in industrialised countries. It examines the possible implications of adopting CBR into health systems, including the need for conceptual clarity, a competency frameworks and ongoing professional development. Conclusion. This article has shown that for CBR is to become a viable model for the delivery of health services in industrialised countries, a competency framework is needed, together with strong leadership to facilitate the translation of theory into practice. Further, collaboration is required among practitioners, policy makers, unions, consumers, educators and professional associations to support this transformation.

Living with brain injury in the community: Outcomes from a community-based self-management support (CB-SMS) programme in Australia

Objective: To determine the impact of a community-based self-management support (CB-SMS) programme for people with acquired brain injury delivered across multiple communities in Queensland, Australia. Design: A longitudinal study. Participants: A prospective cohort of 52 individuals with brain injury aged between 21–75 years of age (M = 47.29 years, SD = 15.40) participated in the study. The impact of the programme was measured on three separate occasions using the same questionnaire (at programme commencement—Time 1; 3 months post-programme completion—Time 2; and 6 months post-programme completion—Time 3). Measures: The questionnaire measured demographic details, general health, emotional health, goal commitment, ability to manage illness, information use and perceived social support. Results: Significant effects were found in the ability to manage ones long-term condition, goal commitment and emotional health, however these findings were sensitive to gender differences over time. Conclusions: Results from this study partially support the role of the programme in promoting the development of personal resources following brain injury. However, the findings remind one that without monitoring and maintenance over time, any gains made are unlikely to be sustained. Further, the need for programmes to respond to gender differences is highlighted by this study.

Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators

People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing.