Staff perspectives on the role of the nurse in rehabilitation wards for elderly people

Abstract

The increasing demand for cost-effective and efficient health care may create a demand for more demonstrably effective hospital-based rehabilitation services, with the explicit goal of enabling patients to return home after short admissions; thus rehabilitation is centre stage. This paper reports the findings from a study of the rehabilitation of elderly people in hospital; in particular it focuses on an aspect of the process of care: namely staff perceptions of rehabilitation work, with particular emphasis on the role of the nurse. A conversational style of interviewing was used with 56 staff respondents from two rehabilitation wards for elderly people. Findings suggest that therapists are often seen as experts, and nursing is viewed as separate from rehabilitation, and hence nurses are an under-utilized resource in this field. It is suggested that there is a need to examine further the reality of multidisciplinary teamwork in rehabilitation, particularly with respect to maximizing the potential contribution of nurses, with the end goal of improving patient outcomes.

Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis

“…The positive outcomes of the mechanism for patients were diverse including greater continuity of care, improved discharge planning and decreased median length of stay and a reduced risk of readmission to hospital or death within 30 days (Atwal & Caldwell, 2002;Baggs, Ryan, Phelps, Richeson, & Johnson, 1992;Dutton et al, 2003;Robson & Kitchen, 2007;Waters & Luker, 1996). There were also benefits for team members, as collaboration and coordination helped to build respect for colleagues' professional expertise, create an intellectually challenging and learning environment, and improve job satisfaction (Atwal & Caldwell, 2002, Baggs & Schmitt, 1997Robinson & Cottrell, 2005).…”

“…When role clarity was present, team members understood the demands of their own and others' roles and were aware of the specific skills and expertise of their colleagues (Baxter & Brumfitt, 2008;Huby & Rees, 2005;Pryor, 2008;Walshe, Todd, Caress, & Chew-Graham, 2008). The definition was further supported as evidence was found of team members collaborating and coordinating their work through joint planning and working, ensuring that they reinforced each other's goals and solved problems together (Atwal & Caldwell, 2002;Freeman, Miller & Ross, 2000;Long, Kneafsey, & Ryan, 2003;Waters & Luker, 1996). The mechanism was not always present however and teams that failed to collaborate did not coordinate their theor* OR feature* OR trait* OR characteristic* OR attribute* AND interprofessional OR multiprofessional OR interdisciplinary OR multidisciplinary OR transdisciplinary OR multi agency OR collaborat* OR integrate* AND teamwork* OR team work* OR team-work* AND health* activities or included members who resisted collaborative initiatives (Baggs & Schmitt, 1997;Freeman et al, 2000;Morris, Payne, & Lambert, 2007).…”

“…However, role blurring did not occur across all team members and only some professions undertook the role of others. Most commonly it was nursing staff who practised this mechanism by carrying out therapists' recommendations at evenings or weekends in order to maximise the effectiveness of therapy (Long et al, 2003;Miers & Pollard, 2009;Waters & Luker, 1996). There were also boundaries to the extent to which professional roles could be blurred and it was important that all team members were aware of these otherwise their colleagues could feel professionally threatened (Nancarrow, 2004).…”

Nursing contributions to mobilizing older adults following total hip replacement in Ireland

“…Waters and Luker (1996), however, found that nurses were not perceived by themselves or by other professionals as making a major contribution to the rehabilitation process of hospitalised elderly people. Long et al (2002) identified assessment, co-ordination and communication, technical and physical care, therapy integration and therapy carry-on, emotional support and involving the family as core nursing roles in rehabilitation.…”

Stroke units: the implementation of a complex intervention

“…O'Connor (1993) states that the nurse in rehabilitation tends to see the therapist as the expert and to see themselves as implementing the plans of therapists. Waters & Luker (1996) reported that nursing staff felt rehabilitation was not inherent, but additional to their role and that they had difficulty elucidating their contribution in this area. However, in this study it was seen that in part, by creating a geographically defined stroke unit in which stroke patients were recognised as a speciality, it also importantly contributed to a sense of expertise for the nurses.…”