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Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
2014 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, Vol. 9, no 1, 25-33 p.Article in journal (Refereed) Published
Abstract [en]

Background

There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people.

Aim

The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people.

Methods

Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis.

Results

Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: ‘giving ‘hands-off’ support’ and ‘being in a home environment’. The second main category, working across professional boundaries, consisted of the subcategories: ‘coordinating resources’ and ‘learning from each other’.

Conclusion

Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation.

Implications for practice

Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on ‘hands-off’ support in order to incorporate an individual's everyday activities as a part of their rehabilitation.

Place, publisher, year, edition, pages
2014. Vol. 9, no 1, 25-33 p.
Keyword [en]
Focus group, Home rehabilitation, Multidisciplinary team, Municipality, Older people
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-17698DOI: 10.1111/opn.12013Scopus ID: 2-s2.0-84894484062OAI: oai:DiVA.org:miun-17698DiVA: diva2:576393
Available from: 2012-12-12 Created: 2012-12-12 Last updated: 2014-04-14Bibliographically approved
In thesis
1. Hemmet som arena för äldres rehabilitering
Open this publication in new window or tab >>Hemmet som arena för äldres rehabilitering
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Avhandlingens övergripande syfte var att studera multidisciplinära teams, äldre personers och familjemedlemmars erfarenheter av hemrehabilitering. Avhandlingen baseras på fyra studier (I-IV). Alla studierna har en kvalitativa beskrivande design. Datamaterialet utgjordes av fokusgruppsintervjuer med personal arbetande i team i kommunal hälso- och sjukvård (I), intervjuer med äldre personer, över 65 år, som vårdats på sjukhuset och därefter fortsatt rehabilitering i hemmet (II,III,IV), samt familjemedlemmar involverade i de äldres rehabilitering (II).

Studie I visade på betydelsen av att möta äldres individuella behov och att arbeta utifrån ett rehabiliterande förhållningssätt i avsikt att ge en hjälp som inte innebär att ta över handlingar från den äldre. Väsentligt var att i teamet reflektera över hur man agerar utifrån den egna professionen för att kunna utveckla ett rehabiliterande förhållningssätt i det dagliga arbetet. I resultatet framkom att teamen uppfattade hemrehabilitering som positiv för de äldre, men mindre lämpligt om de äldre var svårt sjuka och de kände sig otrygga i sitt hem. Respekt för de äldres integritet i deras hem och att göra de närstående delaktiga i rehabiliteringen betonades. Resultatet visade på att för att kunna utveckla samarbetet i teamet finns behov av att diskutera varje professions ansvarsområde och klargöra gränser mellan varandras ansvarområden. Behovet av att tillföra psykosocial kompetens i teamet framhölls för att möta de äldres behov. I studie II framkom att de äldre upplevde rehabiliteringen vara en balansgång i att känna av vad kroppen orkar med för dagen och vad som är realistiskt att uppnå för att känna välbefinnande. Tryggheten i att ha någon i familjen nära sig i hemmet var oumbärligt för att våga utföra träning och vardagliga aktiviteter. Resultatet visar på de äldres upplevelse av otillfredsställelse med att vara beroende av andra. Familjemedlemmar var engagerade i de äldres rehabilitering genom att finnas till hands, hjälpa till och vara stödjande, vilket var en självklar handling men också utmanande i att kunna hjälpa på rätt sätt. Bristande information om hjälpmedels funktion och användning skapade frustration. Resultatet visar att både de äldre och deras familjemedlemmar ser hemmiljön bidra till att underlätta rehabilitering. Det som försvårar är när gränsen för det egna hemmet inskränkts i och med att och personal ofta gick "in och ut" i det egna hemmet.

Studie III visar på ett flertal faktorer i de äldres vardag och i det omgivande samhället som inverkat underlättande eller hindrande på aktiviteter och delaktighet vid hemrehabilitering. Resultatet beskrivs utifrån Klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) i 19 kategorier i domänen omgivningsfaktorer. Som underlättande faktorer framträder bl.a. tillgång till hjälpmedel, en fysisk miljö tillgänglig för aktiviteter samt att få stöd från närstående, vänner och personal i hälso- och sjukvård och omsorg. I resultatet framkom betydelsen av ett empatiskt förhållningssätt när personal möter den äldre personen i dennes hem. Resultatet indikerar att hemrehabilitering inte till fullo tillgodoser äldres behov av rehabilitering. I studie IV framkommer personliga faktorer som inre styrka, motivation, engagemang och tålamod för att nå positiva resultat i en rehabilitering som sträcker sig över flera år. Rehabilitering beskrivs i fysiska och psykiska faser som övergick i att hantera en fysisk funktionsnedsättning med svårigheter att gå i dagligt liv. Resultatet visar på betydelsen av adekvat information, vikten av socialt stöd och tillgänglighet till hälso- och sjukvårdspersonal under rehabiliteringsprocessen.

Avhandlingen bidrar till en ökad kunskap om hur multidisciplinära team, äldre personer och familjemedlemmar upplever rehabilitering i hemmiljö. Nyttan med avhandlingen kan medföra att hemrehabilitering som vårdform kan bli föremål för diskussioner om hur det utformas och organiseras för att på bästa sätt stödja de äldre och närstående med utgångspunkt från de äldres och närståendes erfarenheter och upplevelser. Detta kan ses gagna deltagarna på individnivå men även för utveckling inom yrkesprofessionen. Avhandlingen har även visat på möjligheten att implementera ICF i rehabiliterande omvårdnad.

Abstract [en]

The aim of the thesis was to study home rehabilitation as experienced by multidisciplinary teams, older people and their family members. The thesis is based on four studies (I-IV), all of which used a qualitative descriptive design. The data consisted of focus group interviews with rehabilitation practitioners working in teams in local health care services (I), interviews with seniors, i.e. over 65 years, who, because of illness or injury had been hospitalized and where their rehabilitation continued in their own home environment (II,III,IV) and interviews with family members involved in home rehabilitation (II).

Study I showed the importance of meeting the individual needs of the elderly person while applying a rehabilitative approach to provide help, without compromising the individual´s independence. It was imperative that the team reflected on how to perform professionally in order to develop a rehabilitative approach in their daily work. The results show that the team regarded home rehabilitation as having a positive effect on the seniors. However, it was less suitable if the individuals in question were seriously ill and therefore felt less safe at home. Respect for the integrity of the individual in their own homes as well as the involvement of their family members in the rehabilitation process, were emphasized. The results showed that in order to develop cooperation within the team of team members it was necessary to clarify the duties and responsibilities of the different groups of healthcare professionals involved. It was emphasized, that there was a need to enhance the psychosocial competence of the team regarding senior care. Study II revealed that the elderly individuals themselves experienced their rehabilitation as a balance between sensing what their body could actually cope with and what was realistically acceptable to achieve a feeling of well-being. The feeling of security that a member of the family was at hand, proved vital for the individuals to dare to attempt the rehabilitation exercises and other everyday activities. Results show that the individuals are uncomfortable with having to be dependent on others. Family members were involved in the rehabilitation process by being on-hand, providing support and generally helping out, all of which can be considered as quite ordinary, yet it was challenging to know when to help in the right way. Unfamiliarity with technical aids and appliances was cause for frustration. Results showed that the elderly individuals and their families alike consider the home environment to be a contributing factor in facilitating the rehabilitation process. However, what made this difficult was when the boundaries for the home were breached by healthcare staff coming and going in and out of one´s own home. Study III shows several aspects of senior care, in everyday life and society in general, that have facilitating or hindering impacts on participation in exercise rehabilitation in the home environment. The results are described according to International Classification of Functioning, Disability and Health (ICF) in 19 categories in the domain of environmental factors. Facilitating factors include access to aids and equipment, a physical environment which enables exercise and support from family members, friends and healthcare practitioners. The results showed the importance of an empathetic approach when healthcare practitioners meet older people in their own home environment. The results indicate that home rehabilitation does not fully meet the rehabilitation needs of the elderly. Study IV describes personal factors such as inner strength, motivation, commitment and willingness to achieve positive results in rehabilitation extending over several years. Rehabilitation is described in physical and psychological phases that evolved into dealing with physical impairment effecting everyday activities. The results showed the importance of adequate information, the importance of social support and accessibility to healthcare professionals during the rehabilitation process. The thesis contributes to an increased understanding of how multidisciplinary teams, the elderly individuals themselves and their families experience rehabilitation in the home environment. The findings in this thesis can contribute to discussions about how home rehabilitation as a form of senior care can be organized in ways to best support elderly individuals in need of rehabilitation and their family members according to their own experiences. This can benefit individual participants and also promote the development of the healthcare profession. This thesis has also demonstrated the possibility to implement the ICF as a tool for describing healthcare needs in rehabilitation nursing.

Place, publisher, year, edition, pages
Östersund: Mittuniversitetet, 2013. 49 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 145
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-19209 (URN)978-91-87103-68-1 (ISBN)
Supervisors
Available from: 2013-06-13 Created: 2013-06-13 Last updated: 2013-06-13Bibliographically approved

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