Nursing staff facilitate patient participation by championing the patient's perspective: An action research study in spinal cord injury rehabilitation

Abstract

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.

Needs to be met to enhance life for people with SCI

“…In the exosystem, our results corroborate earlier work which states that it is fundamental that the health care professionals should show respect for the persons' way of doing things and that they are able to demonstrate empathy, sensitivity attentiveness and responsiveness to the individual needs [45,[61][62][63]. Health care professionals with supportive attitudes have been identified by people with SCI as being central to their recovery, well-being, autonomy and hope [64].…”

Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis

“…This article explores challenges in changes resulting from an action research (AR) study investigating nurses' possibilities to facilitate patient participation in a Danish rehabilitation unit for patients with spinal cord injury ( 1 , 2 ). Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for nursing practice.…”

“…During the AR study by Steensgaard ( 1 ), the involved nurse co-researchers were surprised how little they knew about the patient's situation, perspective, and preferences and how little this knowledge had been included in their nursing so far ( 1 , 2 ). The AR study showed that the patient's perspective was of major importance to the nurses to adjust their care to the patient's needs.…”

“…The need to engage the patient was highlighted by Kirkevold (23) and described as nurses' therapeutic function; (1) Interpretive; elaboration of what had happened and what that means to the patient, (2) Consoling; emotional support related to distress and loss in the difficult situation, (3) Conserving; protecting physical integrity, function and preventing complications, (4) Integrating; helping patients integrate newly learned activities to gain a well-functioning everyday life. These therapeutic roles and functions are consistent in rehabilitation nursing (24).…”

“…A dialogic approach to the patient is common in all of these functions. This was also underlined by the result of our AR study showing the need to prioritize dialogue with the patient to promote the patient's participation (1,2). Within the AR design, we experimented with how to make the needed changes to provide time and space for the necessary dialogue.…”