Journal of the Australasian Rehabilitation Nurses' Association

This article offers an overview of a quality improvement project using the Productive Ward Programme: Well Organised Ward in a rehabilitation and acute stroke unit in one metropolitan hospital in Brisbane, Queensland. The quality improvement project was conducted in response to nursing concerns about patient safety, nursing workload, complexity of care for people who have suffered a stroke and the early admission process for access to stroke specific services. The quality improvement project specifically addressed the workplace environment, stock ordering systems, improvements to nurses’ working conditions and workflow efficiency. The effectiveness of the quality improvement project revealed the amount of distance and time nurses spent walking about the unit searching for equipment; time that could have been spent on direct patient care if the unit was more efficiently organised. Implications for rehabilitation nursing are discussed.

Purpose Nurses document their practice every day, however it is unclear whether this output fully reflects their contribution to client rehabilitation. This paper reports on one component of a larger study which aimed to understand the nature of nurses’ documentation practice within the context of a brain injury facility in Aotearoa New Zealand.

Design Critical realist methodology underpinned case study methods within this doctoral research project.

Methods Descriptive analysis was used to explore the nurses’ documentation patterns.

Results Our study demonstrated that the typical documentation practices of rehabilitation-nurses encompassed an impersonal, task completion style. This focused on recording that the physiological aspects of clients’ routines were addressed, with little attention paid to coaching, education, and support roles. However, some documentation aspects revealed a shared language structure where nurses similarly articulated their inputs, such as a phased approach to teaching client’s medication self-administration.

Conclusions The largely impersonal-regulatory style of documentation that was the normative cultural pattern within the facility, alongside the absence of nurses’ rationales and team recommendations, rendered the breadth of the nursing contribution invisible. In contrast, when shared language was used, it gave nurses a structure, assisting in making those activities visible. This structure has potential to recognise and formalise these activities as legitimate ‘rehabilitation nursing work’ of relevance to nurses and other members of the team.

Clinical Relevance Rehabilitation nurse leaders should consider provision of documentation exemplars within text and standards documents. Additionally, documentation that guides shared language within nursing intervention areas has the potential to collectively empower nurses.

Background The theory of nursing systems outlines three care types a nurse may employ in response to a patient’s self-care deficits: wholly compensatory, partly compensatory, or supportive-educative care. A patient may require all three types of nursing care throughout their inpatient rehabilitation. The choice of nursing approach is based upon an assessment of the patient in their context at a point in time.

Aim The aim of this review is to answer: what evidence is there of nurses providing supportive-educative care when working with rehabilitation inpatients?

Review methods A broad systematic search was undertaken in the databases CINAHL, Medline, Scopus and Pubmed using the following search syntax: nurs* AND patient educat* OR support* care OR support* educat* care AND rehab* AND inpatients OR hospital units. Focused searches were also undertaken to focus on specific impairment groups including brain injury, spinal cord injury, stroke and hip fractures. 38 articles met the inclusion criteria and were included in the review.

Findings This review found evidence of nurses providing supportive-educative care in inpatient rehabilitation settings in the form of coaching patients to self-care and rehabilitative thinking, outcomes of that care as well as the enablers and barriers of supportive-educative care.

Conclusion Orem’s supportive-educative care characterised rehabilitative nursing practice, commonly referred to by nurses as coaching. This approach was informed by nursing’s understanding of rehabilitation as a continuous process.

Background Neurogenic bowel dysfunction (NBD) is a debilitating consequence of spinal cord disorders (SCD). The time to complete bowel care can increase over time for some people and can have a profound effect upon health and wellbeing. Several studies have suggested that the time to complete bowel care may be reduced using trans anal irrigation (TAI), therefore a randomised controlled trial has been designed to test this theory.

Study Design Protocol for community based randomised controlled trial (TAI Study).

Objectives To determine whether TAI is quicker than ‘standard bowel care’ in people living with a SCD.

Setting Community sites in Greater Sydney and South East Queensland.

Methods A pragmatic randomised controlled trial is planned. Twenty four people with chronic SCD will be randomised to receive usual care or TAI. The primary outcome is time to complete bowel care at six weeks. Secondary outcomes include: participant reported time to complete bowel care; measures of constipation; measures of faecal incontinence; measures of quality of life; participant and nurse perceptions of bowel care routine effectiveness and measurements of bowel care burden. The protocol complies with the SPIRIT guideline for reporting clinical trial protocols.

Conclusions The findings of the TAI Study will guide recommendations for nurses prescribing bowel care plans for people living in the community with SCD.

Trial Registration: ACTRN12621000406808 (19.04.2023)