Melissa Kendall

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.

Transfer out of intensive care: A qualitative exploration of patient and family perceptions

OBJECTIVE To examine perceptions of ICU transfer held by patients and their family members, focusing specifically on those aspects of transfer perceived as difficult and those perceived as helpful. DESIGN Descriptive qualitative case study design. SETTING General ICU of a large regional Australian teaching hospital. PATIENTS A total of 7 patients and 6 family members were purposefully recruited at one-month post-discharge from hospital. Participants were selected for their ability to recall ICU transfer, the involvement of family members and their ability to articulate their experiences. MAIN OUTCOME MEASURES Two focus groups (one for patients and one for families) were conducted in the hospital setting, aimed at capturing the individual and collective perceptions of transfer out of intensive care. RESULTS Four themes emerged from the data that reflected the complex and emotional nature of transfer out of intensive care. These themes included (1) a sense of sudden abandonment (2) pervasive feelings of vulnerability and helplessness, (3) a loss of importance and (4) ambivalence about the experience. CONCLUSIONS The need for ICU nurses, ward nurses and affiliated healthcare professionals to provide emotional support throughout ICU transfer is the most significant implication of the study. Strategies to provide this support must be developed, implemented and evaluated.

Error self-regulation following traumatic brain injury: A single case study evaluation of metacognitive skills training and behavioural practice interventions

The objective of the study was to evaluate the effects of metacognitive skills training (MST) and behavioural practice on error self-regulation during a naturalistic task after traumatic brain injury (TBI). A single-case study design was used and three participants (two males, one female) aged 26–43 years with severe TBI were included in the study. In the first study, after a four-session baseline of behavioural practice, two participants received eight MST sessions followed by four maintenance sessions. In the second study, a third participant received 16 sessions of behavioural practice to assess the extent to which error self-regulation improves through long-term task practice and therapist corrections. Participants prepared two different meals with a novel meal introduced later to examine skills generalisation. Behavioural outcomes included error frequency, checking and self-corrections. Data analysis involved a combination of visual analysis and two standard deviation (2-SD) band analysis. In the MST study, the two participants demonstrated a 38% and 76% reduction in error frequency (p < .05), a significant decrease in checks (p < .05), and a significant increase in self-corrections (p < .05) relative to baseline. In the behavioural practice study, the participant demonstrated reduced errors (25%), although this was not statistically significant, and a significant increase in checks (p < .05), but self-corrections did not significantly change (p > .05). This exploratory research suggests that, firstly, by targeting error self-regulation MST can potentially promote independence on complex everyday tasks; and secondly, although behavioural practice alone may facilitate some functional gains, it fails to promote more independent self-regulatory behaviours.

Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties

Primary objective: This study compared the psychometric properties of two community integration measures used with people with acquired brain injury (ABI) in the community. Research design: Questionnaires were mailed-out to people with ABI and nominated proxies. Methods and procedures: Responses were obtained from 96 people with ABI and 121 proxies on the Community Integration Questionnaire (CIQ) and the Sydney Psychosocial Reintegration Scale (SPRS). Main outcomes and results: Matched client-proxy scores were not significantly different. The SPRS had greater internal consistency and more normal distributions than the CIQ. Correlations between the three pairs of theoretically parallel sub-scales were modest (0.41–0.60). Multi-dimensional scaling did not support the theoretical structure of the sub-scales, but found two dimensions underpinning the measurement of community integration. Conclusions: Mail-out administration is associated with poor completion rates. The SPRS has sound psychometric properties when compared to the CIQ. Further research investigating the theoretical structure of community integration in ABI is recommended.

The Development of a Scale to Assess the Training Needs of Professionals in Providing Sexuality Rehabilitation Following Spinal Cord Injury

The training needs of rehabilitation professionals in the area of sexuality and sexual function, particularly following spinal cord injury (SCI) has received little attention in the literature. Specifically, there is negligible theoretical discussion related to staff training needs, as well as a paucity of standardised scales to measure these needs. A conceptual model was developed encompassing staff knowledge, comfort, and attitudes towards sexuality following SCI. Using this model, a scale was developed, evaluated, and refined. Factor analysis supported the construct validity of the scale in measuring the existing conceptual model outlined but highlighted the existence of a separate construct related to personal approaches from clients. The subsequently named Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) demonstrated high levels of internal consistency across the four conceptual domains. The KCAASS has utility for rehabilitation facilities interested in identifying and targeting training initiatives related to addressing client sexuality needs following SCI.

Bridging the gap: Transitional rehabilitation services for people with spinal cord injury

Purpose : To review the current international rehabilitation and healthcare climate and describe a new model of service delivery aimed at enhancing the continuity of care for people with spinal cord injury (SCI). Method : An extensive literature review was undertaken and a new model of service delivery conceptualized and implemented in the Australian context of SCI rehabilitation. Results : This new model of service delivery aims to improve the rehabilitation continuum for people with SCI by reducing the time spent in hospital, increasing consumer control over the rehabilitation environment and enhancing community re-integration. The new model recognizes the changing nature of the healthcare system, the legislative frameworks within which rehabilitation services are provided and the increasing role of the consumer. Conclusions : Models of rehabilitation that address the need for shorter periods of hospitalization and attempt to improve client outcomes are integral to ensure sustainable rehabilitation services in the future.

Investigating Changes in Quality of Life and Function Along the Lifespan for People With Spinal Cord Injury

OBJECTIVE To track changes in quality of life and function for people with spinal cord injury (SCI) along the lifespan. DESIGN A wave panel design in which data were collected annually over 5 years across 6 strata that represented different periods since injury. SETTING Telephone interviews with participants in their home environment. PARTICIPANTS People (n=270) who had sustained a traumatic SCI in Queensland, Australia, over the previous 60 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Quality of life was measured using the World Health Organization Quality of Life-8. Human functioning was measured in 3 components. Body structure/function was measured using the Secondary Conditions Surveillance Instrument. Activity was measured using the motor subscale of the FIM (mFIM) and the Clinical Outcomes Variables Scale. Participation was measured using the Community Integration Measure (CIM) and the Impact on Participation and Autonomy questionnaire. RESULTS Quality of life remained relatively constant across the lifespan. For body structure/function, there was a significant increase in secondary conditions with time since injury. There was a significant decrease in activity as measured by the mFIM for higher functioning individuals. Participation, as measured by the CIM, showed a significant increase with time since injury, but not when adjusted for the American Spinal Injury Association Impairment Scale, income level, and living situation. CONCLUSIONS The findings of this study highlight that people with SCI are able to maintain quality of life and participation along the lifespan; however, increases in secondary conditions and a decline in function over time are likely. Rehabilitation services could work more effectively at addressing secondary prevention through enhanced monitoring over time, while broader societal responses are likely to hold the key to optimizing human functioning.

Towards healthy professional-client relationships: the value of an interprofessional training course.

Boundary violations that threaten professional-client relationships are rarely discussed at the coalface. There is an assumption that healthcare practitioners have the skills necessary to manage professional boundary dilemmas with clients. The issue, if addressed, is usually confined to discipline specific education and training. A one-day Professional Boundaries for Health Professionals (PBHP) training program was developed in response to real life practice dilemmas experienced by health practitioners across the continuum of care. The program was delivered to 109 participants throughout the state of Queensland, Australia, from government and non-government organizations. Participants were doctors, nurses, allied health (physiotherapists, occupational therapists, social workers, psychologists, dietitians, speech therapists), therapy assistants and personal care staff from a diverse range of hospital and community settings. Evaluations of PBHP suggest that the interprofessional learning context was valued with specific advantages identified in the use of adult learning approaches, the teaching of ethical decision making principles, the value of supervision and peer support and the opportunities provided for critical reflection. The effectiveness of training for healthcare practitioners in this area is discussed as a meaningful way of developing skills and engendering collaborative relationships between professional (e.g., occupational therapist, social worker) and paraprofessional (e.g., therapy assistant, personal care worker) groups. A combination of intensive training in professional boundaries and opportunities for ongoing professional development are important for all health practitioners.

Using participatory action research in community-based rehabilitation for people with acquired brain injury: from service provision to partnership with Aboriginal communities

Purpose. Community-based rehabilitation (CBR) developed in response to delivery of rehabilitation services to people with disability in developing countries, and appears appropriate to address rehabilitation needs of rural and remote populations, including Australian Aboriginal People with acquired brain injury (ABI). This article will describe participatory action research (PAR) as a vehicle for exploring and translating the CBR model within a mainstream brain injury rehabilitation service in Queensland, Australia. Method. PAR was conducted with two self-selected remote Aboriginal communities in Far North Queensland. Key components to this project were the employment of a local Aboriginal worker, facilitating community engagement and consultation. PAR elements of planning, action and review were conducted through individual and group meetings and activities within the communities across a 3-year period. Results. The project has facilitated expansion and change within the current brain injury rehabilitation service model in line with CBR philosophical foundations, including community development and partnership as a desirable way of engaging with key stakeholders. Conclusions. The focus on community consultation through PAR and the development of community partnerships has increased the cultural competency of the rehabilitation service, the capacity of participating communities and of the sector to respond in ways that are valued and owned by Aboriginal People with brain injury, their families and communities.

Perceived causes of change in function and quality of life for people with long duration spinal cord injury

Objective: To determine those factors perceived to change or threaten function and quality of life among individuals with long duration spinal cord injury. Design: Retrospective self-report using telephone-administered questionnaire. Setting: Queensland, Australia. Subjects: Eighty-four community-resident persons with spinal cord injury. Main outcome measures: Functional Independence Measure, Delighted-Terrible Scale, Perceived Causes of Change Inventory. Results: Pain and loss of strength were perceived to have caused change in function in 11.9% and 14.3% of participants respectively while these same factors were perceived to have caused change in quality of life in 19.0% and 17.9% of participants respectively. Even when measurable change had not occurred, pain and loss of strength were perceived threats to function in 45.2% and 44.0% of participants respectively, while these same factors were perceived threats to quality of life in 10.7% and 11.9% of individuals respectively. Emotional issues such as stress, depression, family functioning, financial status and employment were also perceived causes of change in quality of life. Conclusions: The ability of participants to identify the perceived causes of change in function and quality of life may have implications for preventative health care if these individuals are encouraged to seek assistance when these factors first become apparent.