Australasian Rehabilitation Nurses' Association

An ambulatory rehabilitation service is a multidisciplinary rehabilitation service that provides an organised system of care in an ambulatory outpatient setting. Ambulatory rehabilitation services play an important role in mitigating patient readmission to hospital and maximising community integration. However, there is a paucity of studies concerning how consumers engage in an ambulatory rehabilitation service. Positive associations have previously been noted between patient experience and clinical effectiveness of specialised ambulatory rehabilitation across a wide range of disease areas, population groups and rehabilitation outcome measures. This relationship between patient experience and clinical effectiveness also appears to hold true for patients receiving inpatient rehabilitation. However, limited research exists exploring patient experience within an ambulatory rehabilitation setting.

This quality assurance project builds on a previous 2008 patient survey and explores patient satisfaction within a rehabilitation day therapy unit (RDTU) at The Prince Charles Hospital (TPCH). To explore patient satisfaction, a 22-item questionnaire covering different components of patient interaction with the service was developed and delivered to 40 outpatients across 2017 and 2019. Participants were, on average, 71 years old and attended multidisciplinary therapy. Participants reported high levels of engagement with the rehabilitation process and reported high levels of satisfaction across most therapy disciplines. Lower satisfaction was noted for participants required to repeat information to therapists and attend multiple therapy disciplines on one day. Another key finding is that participants preferred face-to-face feedback over written or phone contact. This preliminary quality assurance project helps address an important gap in the literature and in our current ambulatory service.

Purpose This study examines if the MATRIX staffing grid (MSG) can predict which patients need additional time to prepare for their morning therapy session.

Design and methods This is a prospective observational study where data were collected on morning interruptions of patients and on nurses’ perception of patient preparedness and acuity via research observation in an inpatient rehabilitation facility (IRF).

Results Higher MSG scores were predictive of which patients would need more time in the morning to get prepared (r²=.13, p<.05). Nursing assessments and MSG scores did not predict preparedness for morning therapy for patient education (r²=.007, p=.634), physical assessment (r²=.004, p=.729), a plan of care (r²=.002, p=.770) or meeting patient goals (r²=.001, p=.568).

Conclusions Higher MSG scores were predictive of patients needing more time to be prepared for morning therapies in the IRF. However, nursing assessments suggested MSG scores may not predict nurses’ perception of patient preparedness.

Clinical relevance to the practice of rehabilitation nursing This is a staffing tool-based prediction of interruptions during morning therapy to identify when patients may be unprepared for therapy. Additional research is needed to assist with streamlining morning therapy routines in the IRF setting.

Background Rehabilitation nursing lacks a documentation framework representative of nursing’s contribution to rehabilitation outcomes. The Rehab ABC nursing documentation framework (Rehab ABC) was designed to improve the structure and content of rehabilitation nursing documentation. The framework acts as a mental model and memory aid using a basic mnemonic structure. It contains all the items of the Functional Independence Measure (FIM^TM) and additional, comprehensive care responsibilities such as nutrition, pressure care, falls management, cognition and continence care.

Aim To evaluate introducing the Rehab ABC with the Normalisation Process Theory (NPT) NoMAD survey using two different implementation processes.

Methods The Rehab ABC was introduced in two independent rehabilitation units using different implementation models of practice development (PD) and quality improvement (QI). The NPT NoMAD survey was used to evaluate four domains of normalisation.

Results The Rehab ABC had become a normalised process in both units, reflecting how well the framework can be embedded using PD or QI. Providing evidence, the Rehab ABC makes sense and is coherent, creating change using local ‘buy-in’ through reflexive participation. Audit results reinforced individual and focus group feedback that the Rehab ABC provides users with a logical and understandable framework that supports multidisciplinary team (MDT) communication.

Conclusion The Rehab ABC provides nurses with a simple sense-making tool to improve documentation and MDT communication. It reflects how rehabilitation nurses integrate functionally focused, comprehensive and goal-oriented rehabilitation in their care. NPT is an easily administered evaluation process that can help guide implementation and gauge the success of the Rehab ABC framework in different clinical contexts.