Abstract
New Zealand, in common with other developed countries, has an ageing population. Although medical advances and health promotion may improve the health of those aged over 65 years of age, an increase in the demands on the health system from this cohort is predicted. It is proposed that improvements which increase the effectiveness of inpatient rehabilitation services will ensure a greater independence in older patients, promoting their wellbeing and enhancing their likelihood of returning home. Nurses form the largest proportion of the multidisciplinary health professionals within assessment, treatment and rehabilitation (ATR) services, but until the last decade, their specific contribution to the rehabilitation of patients has been poorly understood. Previous studies which have sought to clarify their functions in rehabilitation have been mostly undertaken from the nursing perspective. Research seeking the patient perspective has predominately been undertaken with younger patients.
The aim of this qualitative research was to analyse the experiences and observations of older patients and their family members concerning the involvement of nurses in their rehabilitation at a 20-bedded ATR unit. This grounded theory study, using a constructivist approach, resulted in a substantive theory based on interviews with seven patients, aged 72 to 89 years old and six family members. The researcher is a rehabilitation nurse and the study was undertaken at her place of work. Interviews were carried out by the nurse researcher prior to the older patients’ discharge and family members were interviewed separately. Interview transcriptions were coded and the constant comparative analysis of this methodology was applied to produce a theoretical framework which was mostly consistent with and added to the findings of previous studies.
The current study suggested that patients had difficulty differentiating between the role of nurses and the role of other members of the multidisciplinary team due to an overlap of clinical activities. However, the most valued nursing role noted by patients and family members was to form “best fit relationships” which fostered motivation whilst nurses coached patients to be independent. Such relationships were possible with therapists as well as nurses. All participants noted that rehabilitation nurses were distinguished by how they performed their role rather than the tasks themselves. The most effective rehabilitation nurses provided a positive environment and included input from family members if they were available. The concept of the “best fit” nurse has implications in patient management as well as in the individual care nurses give. It is suggested that relationship-building and motivational skills would be important components of future educational programmes for nurses in rehabilitation.
Overall the study implies that rehabilitation nurses need to respond to the individual personhood as well as physical needs of those in their care. A willingness to listen to the older patient ensures patient participation and a better appreciation of potential barriers to progress. Acknowledgment of family members as sources of knowledge and their inclusion in patient care and therapy when possible also appears to facilitate the older person’s commitment to his/her rehabilitation programme.