Pub Date : 2001-07-08DOI: 10.1002/j.2048-7940.2001.tb01932.x
S. Dean‐Baar
This issue includes two articles that address the issue of access to rehabilitation services by women. The study by MeSweeney and Crane and the one by Missik investigated the participation of women in cardiac rehabilitation. Once again the relationship between access, cost, and quality is demonstrated. The results should cause all of us to pause. In the McSweeney and Crane study 65%, and in the Missik study 75%, of the women were either not offered cardiac rehabilitation or declined it. Many factors probably contributed to these rates of nonparticipation in cardiac rehabilitation. One of the most disturbing examples is that many of the women don't remember ever having cardiac rehabilitation discussed with them or, in one case, a woman reported that her physician would not order it even after she requested it. Recent literature has demonstrated the differences in acute treatment of myocardial infarctions in women and men, with men being treated far more aggressively. These studies suggest that those gender-based differences in treatment continue into the rehabilitation phase. Perhaps in the acute phase some of the differences in how men and women are treated can be explained by the fact that we have only recently realized that men and women may present with different symptoms. But how do we explain the differences after the diagnosis has been made? Another factor to consider is that with ever-shorter hospital stays for acute events, it is not uncommon for patients and families to forget much of what is discussed during the acute hospitalization. Access to rehabilitation services may be limited when patients and families are expected to follow up on information received while hospitalized, and there is no reminder or prompt by healthcare professionals after discharge. Although this is a very real effect of the decrease in lengths of stay, it is a factor that is not related to gender. Patients and families of both genders find themselves overwhelmed by events and the amount of information provided, and at risk for not getting the postdischarge healthcare services that are recommended. The world of insurance coverage has also become an obstacle to being referred to and receiving appropriate postacute healthcare services. It is impossible for any healthcare provider to be knowledgeable about all 'the intricacies of each patient's insurance coverage without contact with the insurance provider. The time and effort that may be needed to ascertain benefits and, when necessary, provide additional rationale for why certain services are needed must be a responsibility that we never shirk-even though we are too busy or the systems are too cumbersome to deal with as easily or efficiently as we would like. But this too is an issue that transcends gender. Nursing, as a profession that is still overwhelmingly female, needs to take a leadership role in protecting against gender discrimination in the care that is provided to women. Recent awareness of gender issues
{"title":"Roadblocks to rehabilitation? A question of gender.","authors":"S. Dean‐Baar","doi":"10.1002/j.2048-7940.2001.tb01932.x","DOIUrl":"https://doi.org/10.1002/j.2048-7940.2001.tb01932.x","url":null,"abstract":"This issue includes two articles that address the issue of access to rehabilitation services by women. The study by MeSweeney and Crane and the one by Missik investigated the participation of women in cardiac rehabilitation. Once again the relationship between access, cost, and quality is demonstrated. The results should cause all of us to pause. In the McSweeney and Crane study 65%, and in the Missik study 75%, of the women were either not offered cardiac rehabilitation or declined it. Many factors probably contributed to these rates of nonparticipation in cardiac rehabilitation. One of the most disturbing examples is that many of the women don't remember ever having cardiac rehabilitation discussed with them or, in one case, a woman reported that her physician would not order it even after she requested it. Recent literature has demonstrated the differences in acute treatment of myocardial infarctions in women and men, with men being treated far more aggressively. These studies suggest that those gender-based differences in treatment continue into the rehabilitation phase. Perhaps in the acute phase some of the differences in how men and women are treated can be explained by the fact that we have only recently realized that men and women may present with different symptoms. But how do we explain the differences after the diagnosis has been made? Another factor to consider is that with ever-shorter hospital stays for acute events, it is not uncommon for patients and families to forget much of what is discussed during the acute hospitalization. Access to rehabilitation services may be limited when patients and families are expected to follow up on information received while hospitalized, and there is no reminder or prompt by healthcare professionals after discharge. Although this is a very real effect of the decrease in lengths of stay, it is a factor that is not related to gender. Patients and families of both genders find themselves overwhelmed by events and the amount of information provided, and at risk for not getting the postdischarge healthcare services that are recommended. The world of insurance coverage has also become an obstacle to being referred to and receiving appropriate postacute healthcare services. It is impossible for any healthcare provider to be knowledgeable about all 'the intricacies of each patient's insurance coverage without contact with the insurance provider. The time and effort that may be needed to ascertain benefits and, when necessary, provide additional rationale for why certain services are needed must be a responsibility that we never shirk-even though we are too busy or the systems are too cumbersome to deal with as easily or efficiently as we would like. But this too is an issue that transcends gender. Nursing, as a profession that is still overwhelmingly female, needs to take a leadership role in protecting against gender discrimination in the care that is provided to women. Recent awareness of gender issues","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"123 1","pages":"126"},"PeriodicalIF":0.0,"publicationDate":"2001-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73130262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-07-08DOI: 10.1002/J.2048-7940.2001.TB01934.X
W. Karper, Regina Hopewell, Michele Hodge
A year-long exercise program, designed by the first author to benefit people with dermatomyositis (DM), was offered to a patient we call "Mrs. Casey." This program was approved by the University of North CarolinaGreensboro Institutional Review Board governing research with human subjects in keeping with federal regulations. We are aware of only one other report published in the 1990s (discussed below) about exercise effects on someone with this disorder. Because maintaining function is of paramount importance for those with progressive muscle disorders, we wanted to find out whether exercise might help this woman to remain physically and psychologically strong, so that her life and activities might be positively affected. Because she still was fully functional at the time of the program, she was a good candidate for meaningful help. It is important for rehabilitation nurses to be aware of such findings for possible use in helping their patients. The rehabilitation nurse is in a good position to educate and train the patient early in the rehabilitation process about initiating actions such as exercise, which can be done at no cost and may be very beneficial. DM is characterized as an inflammatory myopathy involving inflammation and degeneration of skeletal muscle tissue. Muscle weakness is often preceded by a distinctive rash and some people develop calcified nodules beneath the skin. Muscles closest to or involving the trunk are usually the first affected. Swallowing problems occur in at least one third of those with DM. Muscle weakness tends to be a greater problem than muscle pain for most patients.DM is more common in females than males. High dose prednisone and various immunosuppressants have remained the standard pharmacological treatments for DM. Many of these drugs have adverse side effects (Myositis Association of America, Inc., 1998). Mrs. Casey, the patient who participated in our exercise program, was white, married, and 60 years old. She was diagnosed using the accepted classification criteria for DM (Tanimoto et aI., 1995) approximately 4 years before this study. She was 5 ft, 4 in. tall and her weight ranged from 145 to 1461bs over the 3day-per-week, 12-month program. During that time, she attended 57% of the exercise sessions. (She missed sessions on occasions throughout the program, with no specific pattern noted.) In addition to DM, she suffered from osteoarthritis (in the knees and ankles), occasional bursitis (in her right shoulder), occasional headaches, rashes that would itch or bum and make her feel hot over her entire body, photosensitivity (she wore sunscreen every day), fatigue, and total body muscle weakness. She regularly took dapsone (75-100 mg/day), diclofenac sodium (75 mg per day as needed), hormone replacement (Premarin®, .625 mg per day; Provera®, 5 mg/day), a multivitamin (Centrum® Silver) and a calcium supplement (1,200 mg/day). In addition to exercising at the program, she walked approximately 30 minutes, 4 or
{"title":"Exercise program effects on one woman with dermatomyositis.","authors":"W. Karper, Regina Hopewell, Michele Hodge","doi":"10.1002/J.2048-7940.2001.TB01934.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB01934.X","url":null,"abstract":"A year-long exercise program, designed by the first author to benefit people with dermatomyositis (DM), was offered to a patient we call \"Mrs. Casey.\" This program was approved by the University of North CarolinaGreensboro Institutional Review Board governing research with human subjects in keeping with federal regulations. We are aware of only one other report published in the 1990s (discussed below) about exercise effects on someone with this disorder. Because maintaining function is of paramount importance for those with progressive muscle disorders, we wanted to find out whether exercise might help this woman to remain physically and psychologically strong, so that her life and activities might be positively affected. Because she still was fully functional at the time of the program, she was a good candidate for meaningful help. It is important for rehabilitation nurses to be aware of such findings for possible use in helping their patients. The rehabilitation nurse is in a good position to educate and train the patient early in the rehabilitation process about initiating actions such as exercise, which can be done at no cost and may be very beneficial. DM is characterized as an inflammatory myopathy involving inflammation and degeneration of skeletal muscle tissue. Muscle weakness is often preceded by a distinctive rash and some people develop calcified nodules beneath the skin. Muscles closest to or involving the trunk are usually the first affected. Swallowing problems occur in at least one third of those with DM. Muscle weakness tends to be a greater problem than muscle pain for most patients.DM is more common in females than males. High dose prednisone and various immunosuppressants have remained the standard pharmacological treatments for DM. Many of these drugs have adverse side effects (Myositis Association of America, Inc., 1998). Mrs. Casey, the patient who participated in our exercise program, was white, married, and 60 years old. She was diagnosed using the accepted classification criteria for DM (Tanimoto et aI., 1995) approximately 4 years before this study. She was 5 ft, 4 in. tall and her weight ranged from 145 to 1461bs over the 3day-per-week, 12-month program. During that time, she attended 57% of the exercise sessions. (She missed sessions on occasions throughout the program, with no specific pattern noted.) In addition to DM, she suffered from osteoarthritis (in the knees and ankles), occasional bursitis (in her right shoulder), occasional headaches, rashes that would itch or bum and make her feel hot over her entire body, photosensitivity (she wore sunscreen every day), fatigue, and total body muscle weakness. She regularly took dapsone (75-100 mg/day), diclofenac sodium (75 mg per day as needed), hormone replacement (Premarin®, .625 mg per day; Provera®, 5 mg/day), a multivitamin (Centrum® Silver) and a calcium supplement (1,200 mg/day). In addition to exercising at the program, she walked approximately 30 minutes, 4 or ","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"74 1","pages":"129-31, 158-9"},"PeriodicalIF":0.0,"publicationDate":"2001-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86159853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-06DOI: 10.1002/J.2048-7940.2001.TB02211.X
D. Brauer, B. Schmidt, V. Pearson
This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms "stroke," "stress," "coping," "chronic illness," and "transitions and growth" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences.
{"title":"A framework for care during the stroke experience.","authors":"D. Brauer, B. Schmidt, V. Pearson","doi":"10.1002/J.2048-7940.2001.TB02211.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB02211.X","url":null,"abstract":"This article describes a model we developed to guide the selection and design of nursing activities that will facilitate the health of persons with stroke and their families. Care in the context of stroke has been structured by the medical model's focus on functional ability. As a result, nursing is viewed as ancillary to other professions; yet, studies of the stroke experience from the patient's view suggest that distinctive nursing interventions are needed. Current models of illness do not sufficiently address the nature of stroke and thus cannot serve as a framework for nursing care. Our model conceptualizes stroke as a progressive, holistic experience with physiological, psychological, and social dimensions. It was developed from a synthesis of research articles identified through searches of CINAHL, MEDLINE, and PSYCHLIT (1980-1999) indexes using the terms \"stroke,\" \"stress,\" \"coping,\" \"chronic illness,\" and \"transitions and growth\" and from our clinical experiences. Our research established that the stroke experience involves the deterioration of the whole person and the development of a new person through discovery and resynthesis. Each of these processes progressively dominates the experience and together they form a three-phase model. This model of the stroke experience suggests that nursing care should focus initially on limiting deterioration and then concentrate on facilitating growth. Selection of specific interventions requires an understanding of the uniqueness of each stroke experience, as well as the commonalities, among these experiences.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"88 1","pages":"88-93"},"PeriodicalIF":0.0,"publicationDate":"2001-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90500292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-06DOI: 10.1002/J.2048-7940.2001.TB02209.X
K. Michael
Rehabilitationnurseshave a deliberate focus on function, independence, dignity, and the preservation of hope that makes a fittingcontribution to careat theend of life. Even when it is not reasonable to expect cure or reversal of diseaseprocesses, or to restore a previouslevelof functioningand independence, rehabilitationnurses know there is something more to be done. With respect for each unique patient, they address palliative and end-of-life care with concern for preserving hope, human dignity, and autonomy. Theyenlistsocial,spiritual, and functional support systems to reach these goals. They help patients and families make the most out of each day in spite of the disease trajectory.
{"title":"A case for rehabilitation in palliative care.","authors":"K. Michael","doi":"10.1002/J.2048-7940.2001.TB02209.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB02209.X","url":null,"abstract":"Rehabilitationnurseshave a deliberate focus on function, independence, dignity, and the preservation of hope that makes a fittingcontribution to careat theend of life. Even when it is not reasonable to expect cure or reversal of diseaseprocesses, or to restore a previouslevelof functioningand independence, rehabilitationnurses know there is something more to be done. With respect for each unique patient, they address palliative and end-of-life care with concern for preserving hope, human dignity, and autonomy. Theyenlistsocial,spiritual, and functional support systems to reach these goals. They help patients and families make the most out of each day in spite of the disease trajectory.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"2012 1","pages":"84, 113"},"PeriodicalIF":0.0,"publicationDate":"2001-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87977225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-06DOI: 10.1002/J.2048-7940.2001.TB02214.X
J. Gross, E. Faulkner, S. Goodrich, M. Kain
We undertook to develop a tool based on the FIM instrument to predict the number of nursing hours required to care for stroke patients in an acute inpatient rehabilitation program. The initial study to evaluate the feasibility of using the FIM instrument revealed that the total FIM score had a strong inverse relation to the level of care indicated by the Patient Care Index (PCI) at days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = -.76 to -.87). The results warranted continued investigation of the FIM instrument as a guide for nurse staffing decisions. Based on data from the initial study, five categories of FIM score ranges were designated that demonstrated the most accuracy of placing patients at the correct level of care. Special care considerations unique to institutional settings were identified and incorporated into the tool's final format, as were the calculations to determine the amount of assistance needed. The study reported here was undertaken to evaluate the level of care indicated by the adapted tool, compared with that of the PCI, in a sample of 67 stroke admissions. Spearman correlations revealed a moderate relationship (rs = .49 to .54) between the amount of care determined by the Patient Acuity and Staffing tool and through the PCI at the first, second, and third team meetings. We conclude that the system is an effective, efficient guide for scheduling nurse staffing on the stroke rehabilitation unit.
{"title":"A patient acuity and staffing tool for stroke rehabilitation inpatients based on the FIM instrument.","authors":"J. Gross, E. Faulkner, S. Goodrich, M. Kain","doi":"10.1002/J.2048-7940.2001.TB02214.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB02214.X","url":null,"abstract":"We undertook to develop a tool based on the FIM instrument to predict the number of nursing hours required to care for stroke patients in an acute inpatient rehabilitation program. The initial study to evaluate the feasibility of using the FIM instrument revealed that the total FIM score had a strong inverse relation to the level of care indicated by the Patient Care Index (PCI) at days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = -.76 to -.87). The results warranted continued investigation of the FIM instrument as a guide for nurse staffing decisions. Based on data from the initial study, five categories of FIM score ranges were designated that demonstrated the most accuracy of placing patients at the correct level of care. Special care considerations unique to institutional settings were identified and incorporated into the tool's final format, as were the calculations to determine the amount of assistance needed. The study reported here was undertaken to evaluate the level of care indicated by the adapted tool, compared with that of the PCI, in a sample of 67 stroke admissions. Spearman correlations revealed a moderate relationship (rs = .49 to .54) between the amount of care determined by the Patient Acuity and Staffing tool and through the PCI at the first, second, and third team meetings. We conclude that the system is an effective, efficient guide for scheduling nurse staffing on the stroke rehabilitation unit.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"58 1","pages":"108-13"},"PeriodicalIF":0.0,"publicationDate":"2001-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78015011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-06DOI: 10.1002/J.2048-7940.2001.TB02210.X
D. Humpage
{"title":"Community reintegration: getting back to life!","authors":"D. Humpage","doi":"10.1002/J.2048-7940.2001.TB02210.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB02210.X","url":null,"abstract":"","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"64 1","pages":"85-7"},"PeriodicalIF":0.0,"publicationDate":"2001-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88930398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-06DOI: 10.1002/J.2048-7940.2001.TB02212.X
M. Burman
Less than 20% of stroke survivors enter rehabilitation or long-term care facilities after their stroke. Stroke recovery is extremely variable and the resulting uncertainty places a heavy burden on the survivors' family caregivers. According to the trajectory framework, chronic conditions have a defined course that can be shaped and managed. This grounded theory study, part of a larger research project, explored the expectations of family caregivers of the stroke trajectory and their management strategies. Thirteen family caregivers of stroke patients in a sparsely populated area participated in semi-structured interviews. The caregivers were without ideas about what the recovery of their loved ones would be like and had difficulty making projections about the trajectory. They used several strategies, however, in attempts to manage the stroke trajectory. They constructed a positive recovery, reconstituted family life, maintained family routines, created a safety net, and redoubled self-reliance. The findings have implications for how nurses support family caregivers of stroke survivors.
{"title":"Family caregiver expectations and management of the stroke trajectory.","authors":"M. Burman","doi":"10.1002/J.2048-7940.2001.TB02212.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB02212.X","url":null,"abstract":"Less than 20% of stroke survivors enter rehabilitation or long-term care facilities after their stroke. Stroke recovery is extremely variable and the resulting uncertainty places a heavy burden on the survivors' family caregivers. According to the trajectory framework, chronic conditions have a defined course that can be shaped and managed. This grounded theory study, part of a larger research project, explored the expectations of family caregivers of the stroke trajectory and their management strategies. Thirteen family caregivers of stroke patients in a sparsely populated area participated in semi-structured interviews. The caregivers were without ideas about what the recovery of their loved ones would be like and had difficulty making projections about the trajectory. They used several strategies, however, in attempts to manage the stroke trajectory. They constructed a positive recovery, reconstituted family life, maintained family routines, created a safety net, and redoubled self-reliance. The findings have implications for how nurses support family caregivers of stroke survivors.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"5 1","pages":"94-9"},"PeriodicalIF":0.0,"publicationDate":"2001-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79137859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-05-06DOI: 10.1002/J.2048-7940.2001.TB02213.X
L. Pierce
Expressions of stability by urban family caregivers are the focus of this study. Data presented here were collected as part of a larger ethnographic descriptive study that examined caregivers' (N = 24) experience and the meaning of caring as it influences their ability to care for persons with stroke within their African American family systems. For family caregivers, unmet needs and problems with caregiving may occur as depleted resources are compounded by urban decay in many communities. This study was completed within the Framework of Systemic Organization described by Friedemann, in which families, as open systems, strive for well-being. Stability in the family, a component of well-being, addresses traditions and common behavior patterns rooted in basic values and cultural beliefs. Through data analysis, four themes concerning expressions of stability were identified for all caregivers. Caring expressions of stability are defined as (a) emotional burden; (b) evasion of conflicts; (c) motivation from love and a sense of duty between caregivers, the care recipients, and their families; and (d) a filial, ethereal value. Rehabilitation nurses can incorporate these expressions of stability into their assessment, intervention, and evaluation processes, and thereby increase the potential to strengthen successful caring and stability within the caregivers' family systems.
{"title":"Caring and expressions of stability by urban family caregivers of persons with stroke within African American family systems.","authors":"L. Pierce","doi":"10.1002/J.2048-7940.2001.TB02213.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB02213.X","url":null,"abstract":"Expressions of stability by urban family caregivers are the focus of this study. Data presented here were collected as part of a larger ethnographic descriptive study that examined caregivers' (N = 24) experience and the meaning of caring as it influences their ability to care for persons with stroke within their African American family systems. For family caregivers, unmet needs and problems with caregiving may occur as depleted resources are compounded by urban decay in many communities. This study was completed within the Framework of Systemic Organization described by Friedemann, in which families, as open systems, strive for well-being. Stability in the family, a component of well-being, addresses traditions and common behavior patterns rooted in basic values and cultural beliefs. Through data analysis, four themes concerning expressions of stability were identified for all caregivers. Caring expressions of stability are defined as (a) emotional burden; (b) evasion of conflicts; (c) motivation from love and a sense of duty between caregivers, the care recipients, and their families; and (d) a filial, ethereal value. Rehabilitation nurses can incorporate these expressions of stability into their assessment, intervention, and evaluation processes, and thereby increase the potential to strengthen successful caring and stability within the caregivers' family systems.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"100 1","pages":"100-7, 116"},"PeriodicalIF":0.0,"publicationDate":"2001-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76553968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-03-04DOI: 10.1002/J.2048-7940.2001.TB01926.X
J. Pearson
Patients commonly experience a complete new set of caregivers as they progress from acute to subacute care settings. As a result, managing continuity of care, patient satisfaction, and cost containment across the rehabilitation continuum becomes impossible. In addition, accountability for overall outcomes is fragmented, and patients often feel abandoned by their primary caretakers. To eliminate these problems, a rehabilitation liaison nurse followed patients from the acute to subacute setting. A mutually beneficial partnership evolved between the facilities. Continuity of care improved, transdisciplinary teams shared resources, the subacute length of stays decreased significantly, and patients gained a sense of support throughout the continuum of care. This article describes the development of an extended pathway, clinical implications for rehabilitation of joint replacement patients, some unexpected outcomes, and the role of a rehabilitation liaison nurse.
{"title":"Extending a rehabilitation pathway to include multiple providers: outcomes and pitfalls.","authors":"J. Pearson","doi":"10.1002/J.2048-7940.2001.TB01926.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB01926.X","url":null,"abstract":"Patients commonly experience a complete new set of caregivers as they progress from acute to subacute care settings. As a result, managing continuity of care, patient satisfaction, and cost containment across the rehabilitation continuum becomes impossible. In addition, accountability for overall outcomes is fragmented, and patients often feel abandoned by their primary caretakers. To eliminate these problems, a rehabilitation liaison nurse followed patients from the acute to subacute setting. A mutually beneficial partnership evolved between the facilities. Continuity of care improved, transdisciplinary teams shared resources, the subacute length of stays decreased significantly, and patients gained a sense of support throughout the continuum of care. This article describes the development of an extended pathway, clinical implications for rehabilitation of joint replacement patients, some unexpected outcomes, and the role of a rehabilitation liaison nurse.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"26 1","pages":"54-7, 65"},"PeriodicalIF":0.0,"publicationDate":"2001-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84475082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-03-04DOI: 10.1002/J.2048-7940.2001.TB01927.X
V. Kennedy, S. Steinfeld, G. Sims
The care of patients with multidrug-resistant organisms (MDROs) varies in rehabilitation settings. Implementation of strict contact isolation in some facilities may limit patients from reaching their rehabilitation goals. This article describes our rehabilitation and long-term acute care facility's efforts to develop a policy that would enable patients with MDROs to meet their rehabilitation goals within a safe environment. A multidisciplinary team developed a two-track care process allowing staff to quickly identify appropriate activities for these patients. The team also developed educational materials for staff and families, addressed cleaning practices, and standardized the criteria for follow-up cultures and discontinuation of isolation. The MDRO policy was instituted throughout the hospital in August 1999. The incidence of nosocomially acquired MDROs has decreased slightly from the baseline rate of .076 per 100 patient days to .039 per 100 patient days during the 4-month period following the implementation of the policy.
{"title":"Improving care practices for patients with multidrug-resistant organisms: one facility's evolution.","authors":"V. Kennedy, S. Steinfeld, G. Sims","doi":"10.1002/J.2048-7940.2001.TB01927.X","DOIUrl":"https://doi.org/10.1002/J.2048-7940.2001.TB01927.X","url":null,"abstract":"The care of patients with multidrug-resistant organisms (MDROs) varies in rehabilitation settings. Implementation of strict contact isolation in some facilities may limit patients from reaching their rehabilitation goals. This article describes our rehabilitation and long-term acute care facility's efforts to develop a policy that would enable patients with MDROs to meet their rehabilitation goals within a safe environment. A multidisciplinary team developed a two-track care process allowing staff to quickly identify appropriate activities for these patients. The team also developed educational materials for staff and families, addressed cleaning practices, and standardized the criteria for follow-up cultures and discontinuation of isolation. The MDRO policy was instituted throughout the hospital in August 1999. The incidence of nosocomially acquired MDROs has decreased slightly from the baseline rate of .076 per 100 patient days to .039 per 100 patient days during the 4-month period following the implementation of the policy.","PeriodicalId":94188,"journal":{"name":"Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses","volume":"192 1","pages":"58-60, 63-5"},"PeriodicalIF":0.0,"publicationDate":"2001-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74186124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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