Based on action research as a practitioner‐involving approach, this article communicates the findings of a two‐year study on implementing patient participation as an empowering learning process for both patients and rehabilitation nurses. At a rehabilitation facility for patients who have sustained spinal cord injuries, eight nurses were engaged throughout the process aiming at improving patient participation. The current practice was explored to understand possibilities and obstacles to patient participation. Observations, interviews and logbooks, creative workshops and reflective meetings led to the development and testing of four new rehabilitation initiatives aimed at enhancing patient participation. This study suggests that skills of critical reflection from action research toolbox shed light on both the notion of patient participation and caring in nursing rehabilitation. By actively involving nurses in research, the knowledge development stems from practice and the solutions therefore became practice‐oriented. In addition, the personal and professional development experienced by the involved nurses points to a secondary gain in the form of an analytical and reflective approach to complex issues in relation to patient participation, rehabilitation in general and the individual nurses' sense of professional pride.
Introduction Persons with spinal cord injury have experienced a life‐changing event, and they need to engage in the rehabilitation process to adjust to their current situation and future living conditions. Due to the highly contextual and varying psychological and physical ability to participate from patient to patient during rehabilitation, this is difficult for the injured person and for health professionals to support. Therefore, the aim of the study was to develop and facilitate patient participation by engaging nursing staff and from this engagement in the process, disclose methods to support participation. Methods The processes conducted were based on an action research approach, from problem identification to the development, test and evaluation of four new nursing initiatives. The initiatives were developed by eight nursing staff members who participated actively as co‐researchers in a 2‐year study conducted at a Spinal Cord Injury Centre in Denmark from 2016 to 2018. Data evolved from workshops, transcriptions of meetings and written evaluations and was further analysed using Ricoeur's phenomenological‐hermeneutic approach. Results Action research processes facilitated the development of four communicative initiatives and a shift in the nursing staff's support of the patient. In a collaborative process, the nursing staff acted as participants in the patient's rehabilitation. Awareness of the patient's perspective facilitated a caring, attentive and engaged approach from the nursing staff, which promoted rehabilitation tailored to the individual. Conclusion Patient participation was enhanced when nursing staff actively participated in the development of initiatives and a culture supporting a person‐to‐person approach involving the patient and themselves as equal participants in the collaborative rehabilitation process. Patient or Public Contribution Eight nursing staff members from the rehabilitation centre participated throughout the study as co‐researchers. Patients participated in observations and as informants in interviews during the first phase to identify challenges to patient participation. Patients also participated in testing the nursing initiatives during the action phase (Phase 3). Furthermore, a former patient was a member of the advisory board.
Purpose To explore if SCI-SCREEN was applicable as nutritional screening model in a neurorehabilitation unit, able to detect spinal cord injury (SCI) persons at nutritional risk. Design and Methods SCI-SCREEN underwent reliability test by 3 specialist nurses, using 10 consecutive SCI in-patients. Audit of 41 SCI-patients was conducted comparing SCI SCREEN with the Danish-Nutritional-Screening-Model-for-hospitalized-persons (DNSM). Findings Inter- and intra-tester reliability (Cohen’s Kappa: 0.89-0.93) was high. SCI-SCREEN estimated average energy needs 23% lower (mean difference± SD: 2516.2±1349.1kJ) and protein needs 10% lower (9.5±19.7g/day). Risk assessment differed in 61% (CI95: 42.1; 73.7%) of cases and risk-agreement was obtained in 22% (CI95: 10.6; 37.6%). SCI-SCREEN detected 66% (CI95: 44.5; 75.8%) and DNSM 39% at risk of malnutrition. Conclusions The SCI-SCREEN model estimates SCI-energy and protein needs more accurately than DNSM by adjusting to SCI-consequences. However, more studies are needed. Clinical Relevance SCI-SCREEN is a reasonable starting-point in the screening procedure and may be a valuable instrument to identify SCI-patients at risk of malnutrition.
Objective This scoping review explores the constitution of a meaningful life as perceived by adults with acquired neurological impairment following an injury or a disease. Introduction A neurological injury or disease imposes extensive life changes on the affected person and his or her close relatives. Including the patients’ perception of a meaningful life is crucial to facilitate adjustment of any rehabilitation initiatives to the patients’ wishes, hopes, needs, and preferences. Even so, the descriptions and common traits of a meaningful life from the impaired person’s perspective are scarcely covered in the literature. Hence, a scoping review of existing knowledge is needed to facilitate quality rehabilitation and research initiatives. Inclusion criteria All studies, regardless of their design, are included provided they describe a meaningful life as considered or experienced by persons aged 18 years or more with neurological impairment. Methods A PICo framework defines the search algorithms used in the databases MEDLINE, Cinahl, PsycINFO and Embase. Using Covidence, the scoping review systematically organizes the identified articles to provide a broad description of the study phenomenon. Furthermore, titles, abstracts, and full-text articles are screened independently by two reviewers to determine if they meet the inclusion criteria. In case of disagreement, a third and fourth reviewer are consulted. The scoping will be reported according to the PRISMA- SCR checklist.
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