Journal of the Australasian Rehabilitation Nurses' Association

The use of grounded theory in nursing research has proliferated, including rehabilitation nursing, both as a methodology and as a method. Previously we explored the ‘thinking’ behind grounded theory research by looking at the theoretical aspects of grounded theory. This article offers an overview to assist novice (and perhaps experienced) researchers with the ‘doing’ of grounded theory research. It offers one explanation about grounded theory methods while acknowledging that the type of grounded theory methodology a researcher is using will influence the methods used. The application of commonly used processes to develop a grounded theory are explored along with the evaluative criteria to judge the quality of grounded theory research. Grounded theory is a useful tool for the ongoing development of rehabilitation nursing’s body of knowledge and evidence base nationally and internationally.

Aims To report on assessing and managing risk, the problem-solving strategies male nurses use to keep themselves safe while providing rehabilitation nursing care.

Design Constructivist grounded theory.

Methods The study consisted of two stages involving semi-structured interviews with 11 male nurses followed by stage 2 observation of practice of 12 male nurses coupled with semi-structured interviews, and 15 patients in inpatient rehabilitation facilities.

Results A new theorised understanding is presented about assessing and managing risk that involves three phased problem-solving strategies: claiming nursing identity, developing a trusting relationship, and negotiating my scope of practice. The use of problem-solving strategies was often influenced by contextual conditions which could both enable and limit male nurse practice.

Conclusion Male nurses engaged in active problem-solving strategies to practise safely and effectively within the inpatient rehabilitation environment. The successful implementation of a diverse range of strategies emerged as crucial for male nurses to fully undertake their role.

Aims To evaluate the impact of a model for evidence-based wound management in a tertiary geriatric rehabilitation setting

Design A longitudinal, pre-post design

Methods The Champions for Skin Integrity (CSI) model uses multiple evidence-based strategies to facilitate transfer of knowledge into practice. Data were collected before, and ten months after introduction of the model in a tertiary geriatric rehabilitation setting. Data on wound management and skin integrity were obtained from all consenting inpatients via a prevalence survey and medical record review in geriatric rehabilitation wards of a metropolitan tertiary hospital (n=64 pre; n=42 post). Staff interviews, focus groups and a survey were also undertaken (n=88 pre; n=63 post). Descriptive statistics were calculated for all variables. Where relevant, Chi square for independence or t-tests were used to identify differences between pre/post data.

Results There was significantly increased implementation of evidence-based wound management and prevention strategies following the implementation phase, in comparison to pre-implementation data. This included increased documented skin integrity risk assessments (39% pre vs 93% post, p<0.001), increased wound prevention strategies (22% pre, to 43% post, p=0.05), and documented wound assessments (31% pre vs 86% post, p<0.001). Associated with these changes was a significant decrease in severity of skin tears (p=0.02) and lower prevalence of pressure injuries (19% pre, to 14.6% post) and skin tears (25% pre, to 17% post, ns).

Conclusion This multifaceted implementation model was successful in facilitating uptake of evidence-based wound management and prevention strategies in a hospital rehabilitation setting, leading to improved clinical outcomes.

Education to support rehabilitation nurses in their multifaceted roles needs to be dynamic and reflective of current and best practice. To this end, our small private hospital in Sydney developed and facilitated a one-day rehabilitation nursing workshop that aimed to strengthen our current team, plan for future success, promote evidence-based practice, and champion the role of rehabilitation nurses and their important contribution to safe, quality patient care. In this discussion paper we share our ‘Six Tips’ for developing and facilitating a successful, interactive one-day workshop that met our aims, with plans for future offerings on an ongoing basis.