gerontological rehabilitation in the nursing system
As a way of exploring the previous researches into gerontological rehabilitation in the nursing system, as well as the available concepts that did emerge from this study,
there was a need to do a review on literature. However, the first approach here was to get proper keywords for the research. As a result, the keywords such as; nurses, stroke, rehabilitation units, among others as well as synonyms to these terms were grouped. The grouping was done in Bolean conjoiner of the term “OR”, as a way of targeting the study. Through this conjoiner, it was easier to get articles related to the study.
As a way of narrowing down to the exact patients, patient terms were used. For instance, elderly, rehabilitation, older stroke, geriatric and elderly impairment was used to search for relevant articles. The activity terms also were included in this category, to help identify articles that studied elderly stroke, but with keywords that were related to activities. Activities such as gait, mobility, muscle, mobilizing, passive exercises, and positioning were used. Some of the nursing terms, which was included here, were assessment, intervention diagnosis, outcomes, nurse-patient relationships were also used. These keywords thus were categorized in the above themes, which were combined with ‘and’ as a Boolean conjoiner.
Even so, limits were applied in the entire research work, as a way of limiting searches. The first limit was that the study was supposed to target English language readers of older people (Aadal Angel, Langhorn, Pedersen & Dreyer, 2018). The search was note done in the wider Google search machines, but was restricted to databases that related to medic-care. For instance, electronic databases that were purposeful was AMED, Medline, CINAHL as well as Cochrane libraries. Besides, the research is time cautious, considering that nursing is one of the field that are highly dynamic. It was not proper to get information from very old websites, because the service delivery mechanisms in medical centers are changing with time. Being cautious of time, the research considered articles that were written not beyond 2016, on rehabilitation and nursing of elderly people in the community. All the articles that were researched were 20 articles, written by different people and in different timeframe. However, since the study needed only 6 articles, things such as date, types of article, whether it was a scholarly or not, and viability of information was noted, so as to ensure the articles under discussion were relevant.
Searches were more specific just to restrict searching criteria. For instance, more searches were done in CINAHL grouped patients, aged over 65 years, family, significant others, and frail elderly, just as way of restricting the research to a specific group. The use of the word ‘OR’ was also used to combine the search with groups including patient attitudes, patient viewpoints, nurse attitudes, nurse-patient relationships as well as interpersonal relations.
Besides, there was needed to read the papers of interest thoroughly. In the course, it gave out essential references, which were retrieved for the sake of helping in the entire research. Besides the above, more advanced attention was also given to the studies that had clear methodological description. This clear description included the articles that used analysis, which primarily focused on the nurses’ roles when it came in the physical rehabilitation setting. The article that did the above on the context and perspective of the patient, nurse and or even the family of the member were as well given the first priority (Bennett, 2016). Besides, the article that had information that did focus on the nursing instead of fully focusing on the rehabilitation generally, were as well included in the restriction inclusion criteria.
Some few sources, which were mentioned by Pryo, mostly on the context of the writer, were as well given the needed attention.
Summary of the articles
The article written by Aadal and colleagues on the roles of the nurses and the functions that address relatives during the in-hospital rehabilitation, agrees that there is a demand vested upon both the relatives nurses when it comes to helping stroke patients (Aadal et al. 2018). The authors mentions that the case of cognitive and neurological changes usually results to complex needs, in time when behavioral and cognitive as well as emotional changes occur. The article explains that majority of patients who undergo stroke, are discharged home. In the event, relatives care for them. Stroke patients undergo life-threatening and unexpected natures, with a combination of a range of emotional, physical, behavioral and social changes, which constitutes to the needs of support, treatment and care. Arguably, this article was the larger empirical research study, done by Dreyer, which did describe the experiences of the nurses in their functions and roles. The article however, specifically did address the relatives of those patients with stroke condition in hospital rehabilitation.
The research was based on the three open focus group. The data obtained this way had strength because of its power to elicit mutual understanding. Out of the 29 nurses who were recruited to take part into this study, gave out conclusive information in this investigation. The nurses’ role as shared in this article, which included talking to the family relatives of the patients, claimed that they shared their feelings in a manner that showed their lives were forever changed. By the helped of the nurses, the article mentions that family in such a situation have burden of care, which occurs due to loss of predictability that occurs as a result of the nature of the stroke, which is known as a life threatening condition. The family relatives thus had a duty and work when it comes to caring for a stroke patient.
Loft and colleagues contributed into this study by doing a research on the functions and roles of nursing staff in rehabilitating of stroke patient. The aim or purpose of the research was to enlighten readers on the poorly defined roles of nurses, when it comes to servicing the stroke stricken patients. That which these writers are acknowledging is that stroke comes second when it comes to causing disability globally. Some of the complications, which those people go through after stroke, are issues such as: cognitive deficits and motor impairment. Even so, the basis of this study was the MRC framework, which is used for evaluating, and developing as well as implementing complex interventions. Through this framework, the study was able to describe evaluation and development of complex interventions that evolves in four phases; including piloting/feasibility, development, implementation and evaluation. The behavioral theory based intervention did act as a stepwise guide, which did map the entire MRC stages.
The aim of this study was to systematically describe a structured development of rehabilitation intervention of the stroke inpatients. This happened by strengthening the functions and roles of nursing staffs. The research however, based its arguments on already done literatures just to analyze the nurses’ interventions in this category. By the use of MRC framework, the article did agree that it was easier to develop an intervention that is complex in understanding the roles of the nurses. Even so, the article reveals that there is a role and function, which nurses play, when it comes to rehabilitating stroke patient.
The article by Poulsen and colleagues majors on the nurse and their assistants when it comes to attitudes, beliefs and actions that relates to functionality and roles of these professionals when it comes to inpatient stroke rehabilitation. The article mentions about unclear and vague roles of nurses in terms of participating in rehabilitation of stroke patients. This forms the basis by which this research was made, as a way of explaining or understanding these professionals’ mandate in the whole picture. Methodologically, this study did target cultural circumstances through which rehabilitation takes place. It also went ahead to mention about the experiences of the nurses and their assistances, by assessing the field from various angles. The interpretation of the study was done through hermeneutic research, which is based on pre-understanding and perspectives. Data collection for this study was at a strike unit. Even so, the research reveals that contrary to O’Connell and Pryo’s (2009), which argues that assistants and nurses have shared understanding when serving the stroke patient; this study reveals that the two groups had varied attitudes and believes. Therapeutic training identifies rehabilitation to these professionals. Despite their believes they understand that they have their role, and believes that relatives, interdisciplinary collaborators and patients did not acknowledge their contribution.
The article by Christiansen and Feiring worked to understand the challenges of these nurses when it comes to the roles of rehabilitation (Christiansen & Feiring, 2016). The purpose was to shed more light on the specific challenges through which nurses’ encounters on their routine with rehabilitation wards. The methodological designs in this case were application of qualitative designs categorized in almost three focus groups, where they were subjected on interviews. The study number was 15 nurses, and the three main themes which was acknowledged were information and tailoring supports, adjusting patients as well as recognizing the patient knowledge.
The article written by Bennet takes care culture caring, in terms of how the nurses are able to promote their emotional wellbeing as well as aid recovery in handling stroke (Bennett, 2016). The author reveals that the aim of this study was to explore the emotional experiences of the patients when they are attacked by the condition. The research also examined the manner in which the nurses were able to inform their interactions with the patients’ families using their knowledge.
The theory, which this author used, was interactionism, which argues that emotions are at times conceptualized by rising within relationships. The article reveals that nurses can easily embed into their interventions, which would focus on the emotions that are positive and thus enhance recovery. With that, it is vital to note that nurses are at the forefront, in supporting the stroke patients to recover.
The final article in this category is the one done by Reeves and friends. The article did research on a Michigan Stroke Transition trial. The study was done in three Michigan hospitals, with the aim of understanding why there is need on the improvement of care, towards the stroke patients. The study was formulated in interventions, with the aim of engaging the stroke patients actively plus their caregivers in the current complex decision making process, that is frustrating the smooth operation of rehabilitation. Even so, the article argues that various case managements that have been recorded so far, did show programs that utilized social workers’ help, when it comes to transiting the patients into their homes. Some of the works of the nurses as explained was that nurse-case led management should be home-based assessments, patient and caregiver education, medical appointments among others. However, the idea is that with the help of social workers, nurses have all that it takes, to help the stroke patients to cope and live a positive life. The nurse management workers did focus primarily on medication, health conditions and lifestyle changes (Poulsen et al. 2017).
In conclusion, it is significant to mention that all the articles agreed that nurses have some work, which they need to do, in ensuring stroke patients recover. In as much as almost all articles argued that the nurses and concerned stakeholders have lamented of a no defined duty of nurses in this category, they play a vital role in helping the patients.
Findings
In one way or another, the articles were studying the roles of nurses, when it comes to caring for the patients affected by stroke. Well, they used unique structural research to reach to their conclusion. For instance, some researcher used cultural aspect to understand the role of the nurses in this regard, others investigated the nurses’ views, and others addressed the roles of nurses and their assistants, to understand the position of these professionals. In the process, they did build on themes, to bring out the all notion, of nurses’ roles when it comes to stroke patients.
Threefold purpose
The threefold theme argues that the nurses should understand that they have a threefold purpose when it comes to taking care of the stroke inpatient in rehabilitation. The threefold involves taking care of the patient, to support the interaction that occurs between relatives and the patients and lastly to take care of the relatives. It is essential to note that relatives either directly or indirectly are affected by the needs of these patients. Even so, there needs in this regard are not prioritized. The priority in this regard is preserving the patients’ integrities. Even so, some more themes evolved in this process. The lives of the relatives are changed forever, life after stroke, having time for the relatives and if the relatives are not corporation.
The lives of the relatives are changed
One of the main roles when serving the stroke patients is acknowledging the important roles, which the family of these paints plays. In this way, they will not consider relatives as attachments to the patient, but people whose lives have been changed forever because of the patient. In this event, the nurses manage the burden of talking to the family, to note their feelings. It is very significant for the nurses to be aware of how the families are reacting to this situation and help them in case of a crisis (Aadal et al 2018). Because the lives of the patient and the relatives are changed forever, the nurses come in to address their shared future life. In this regard, they will emphasize on the essential of sharing the process. Arguably, this involves making the patients and the relatives to be able to share the entire process together. At times, relatives find it hard to corporate as required. In such a situation, it is the role of the nurses to work extra hard to involve them into taking care of the patient. Even so, the nurses also work to understand the perception of the patient. At this time, if the relatives are a valued resource to the patient, and they are not cooperating, they create a crisis. In this event, both the patient and the relatives will require care, and thus the nurses come in to help the family become supportive. Even so, one thing is for sure, such a moment is not easy. One of the nurses interviewed in the article claimed that such a situation was really difficult, because they were to adjust themselves to serve the relatives and the patients.
Nursing staff’s contributions
As explained by Loft et al (2017), nursing contribution in stroke rehabilitation was a theme studied in various literature. The contribution of the nurses is explained through their intervention. For instance, there is need of focusing on the educational intervention for the nursing professional staff, who are working in this environment. The training did strive to ensure the nurses get rehabilitative skills, approaches and professional identities. Some of the interventions, which the nurses need to uphold in this regard, are prevention of emergence of further complications, bladder problems and swallowing issues. They as well are required to intervene in ensuring they can deliver task-oriented problems. To that extend, it is worthy to mention that nurses need to be trained on how to intervene when it comes to helping those stroke patients in a rehabilitation unit. They therefore have a wider role of ensuring that the patients are not battling with other condition that might result from stroke. This assumption, is uniquely stated, because unlike Aadal et al’s (2018) study, the nurses here are not expected to concentrate with both the patients are they relatives. They are only supposed to manage the disease, on the level of the patient.
Theoretic approach
It is significant to as well understand that as much as nurses’ roles are widely defined, and that they take wider responsibility in managing stroke patients, their service delivery schemes are theoretically defined. For instance, nurses first need to understand that which needs to change, if they want to achieve specific behaviors from the patients or even the relatives. COM-B model is important in addressing that which nurses and their assistants need to do.
The C term stands for Capabilities, the O letter stands for opportunities and the M letter stands for motivations. As a result, target behaviors can be analyzed by using the COM-B to understand the target behaviors. This then means that even if the relatives of the patients are not cooperating, they can be lured into their duties by using this model. In the same way, the patient’s position too can be put into reality by using this model, however much the situation can be delicate. Theoretical domains too can be applied in this regard, which also relates to the COM-B model in a way.
The nursing staffs too need to be motivated. That means, the COM-B theory does not only apply to the patients and relatives, but also to the nurses. Due to the nature of their work, nurses also require motivation as well as assistance in managing and taking up their responsibilities as required. Motivations would provoke them to change their behaviors and embrace that which would help them fit into this context. Interventions that would help the nurses get into their gear would include: modeling, education, persuasion, environmental and enablement restructuring and incentivization among other things. To that extent, it is important to note that there is need to strength the roles and functions of the nursing staff, and this works best if they are helped by conforming to certain models.
Importance of structure, professionalism and striving for visibility
Throughout the evaluation of the papers, some of the things that stand out are that nursing professionalisms is very essential. Fortunately, the nursing group seeks this professionalism themselves, that is why, both the nurses and their assistants agree that professionalism is key to managing stroke patients in a rehabilitation unit. Professionalism entails the manner in which the nurses and their assistants understood the rehabilitation concept as well as the manner in which they can manage to get to the desired levels in terms of rehabilitation. It means that for the nurses to be aware of the complexities that come with stroke rehabilitation, they require something special. This something is for them to have and exercise willingness and patients so that they can work with the challenges that patients with brain injuries usually go through (Christiansen & Feiring, 2016).
For the striving and visibility, means that the nurses should not only be present continuously, but also be available from the moment the patient is taken to the stroke unit. Striving means they need to be around and in the process contribute in the various ways in basic nursing and coordination, where both aspects are important foundations when it comes to rehabilitating the patients. The unfortunate part is that at times, nurses usually strove to ensure their contribution when it comes to rehabilitation is visible to the patients, themselves and interdisciplinary collaborators.
For the above to happen, clarity in roles is very essential. For instance, some nurses argued that the nurses and assistants were being referred as one group, yet internally, they are described as two different groups. As a result, the act of putting that which they do in a rehabilitation unit became a complex ordeal, because their job is made to be seen as fluid, where they are required to do little bit everything. In the end, there is a natural feeling that nurses should cover all the functions and they are supposed to be present in all situations. They thus pointed it out that the patients and the interdisciplinary collaborators did find it hard to differentiate their work in a rehabilitation center. To that extend, it is important to mention that defining roles, making good operational structure, and adhering to professionalisms will elaborate what nurses need to do, and what their assistants need to do. In the event, the idea of serving the stroke patient will receive its professionalism as required.
Patients and next of kin adjustments
One of the activities, which take place in rehabilitation unit, is the transfer of patients from the hospital departments that take care of acute medication to a more every day situation. Nurses who shared their views in these articles, revealed that at times, nurses usually have their unique views when it come to understand what rehabilitation entails. As a result, their views will go along with their believes on what they need to get in service. The hospital setting is made in such a way that it values the patients as the recipient of care. That means that even if the nurses would say no, the patients need to make efforts to get that which they want. Most patients would want to be the way they were before, but such a position can be weak, and thus even if the nurses will say yes, the achieving of the previous condition for the patients can be hard. After stroke, many patients will start showing lack of insights, when it comes to medical conditions. The situation can even be more challenging, if the main concern of the patient is to go home. To manage such a situation therefore, it so allow the patient to discover their needs. In this regard, it is essential to observe that one of the main roles of the nurses and even assistants is to let the patients understand their needs and adjust. This will as well affect the next of kin to want to comply with what the patients are demanding. There is always a positive position when the patients are allowed to discover their needs by themselves.
Supporting strengths of the patients
It is not always a good idea to focus on the negative emotional experience of the patients who are suffering from stroke. At times, supporting as well as recognizing personal strength of the patients and their coping strategies is important. Nurses are at liberty of embedding into their purposeful strategies through their interventions by focusing on the enhancing recovery measures and promoting positive emotions. As per the conclusion done by most of these research articles, the idea of supporting the patient is a factor that enables the stroke patients to transcend this damaging condition and in the process maintain their emotional being. Currently, rehabilitation units are strategized in a manner that they confirm to rapidly changing services in terms of delivery and the organization. This in most cases does emphasize on the cost commitments and measuring of the outcomes, which causes a significant risk when it comes to nurses’ contribution to inpatient rehabilitation. In the end, this aspect becomes more focused on the technical care and in the even remains a therapeutic non-specific care. There is therefore a huge need for the nurses to develop a good relationship with the patients as well as sustain a good relationship with the relatives, if they want to achieve an emotional wellbeing as well as recovery measures for the patient. As a result, the above nursing responsibility should fully be adhered to, be it in professionalism or within the multi-professionalism rehabilitation team. To that extend, it is worth mentioning that nurses too have a role in ensuring the patients get well irrespective of the severity of the stroke and their cognitive levels. Instead of putting pressure on the patients to adjust, the nurses too need to embrace the positive aspect of supporting this group.
Re-designing medical care
Recently, delivering care in the United States is on the verge of being re-designed. The country is striving to focus on the episode of care. This will cause various issues, including the demand to improve in care transition, for the stroke patients who opt to return to their home. The care in this regard campaigns for social work principles with proper technological information as well as chronic care models. The primary goal for this strategy is to ensure stroke patients are actively engaged as well as their caregivers to work well to manage complex decision-making as well as self-manage themselves, after they return home. The intervention follows four care of chronic model, which include community resources, self-management, and the use of clinical information systems and delivering of self-management supports.
This system identifies that as much as nurses have a role in managing the stroke patients, the government and the social workers to have a place in the U.S’s medical system. In that regard, it is worth to agree that the reliance of nurses, even though it works to some extent, is becoming an outdated phenomenon. To that extent, it is important to note that one of the main roles of nurses, if they want to succeed in this regard, is to work and liaise with the government. The above will form systems that are nurse-led, when it comes to transitional models. The model includes putting more emphasis on the follow-up in terms of medical appointments, home-based assessments, caregivers and patient education as well as accessing community resources. Nurse case managing strategies would mainly focus on the medication, health conditions as well as lifestyle changes. To help the nurses meet their duties well, the social workers can come in to add value by caregiving and expanding patient issues, and in the process helping the patients with psychosocial issues, which are emotional and tangible support.