scholarly journals P62 Getting to know you: a quality improvement project designed to enhance paediatric inpatient rehabilitation for those with non-inflammatory musculoskeletal pain

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Dearbhla McKenna ◽  
Madeline Rooney ◽  
Paul Jackson ◽  
Cathyrn Harkness
Keyword(s):  
Conflicts Of Interest ◽  
School Attendance ◽  
Inpatient Rehabilitation ◽  
Self Management ◽  
Rehabilitation Service ◽  
Management Approach ◽  
Improvement Project ◽  
Time To Build ◽  
Self Discovery ◽  
Typical Day

Abstract Background In November 2018 the paediatric rheumatology team in Belfast attended the Bridges self-management course. Bridges reflects on what works well as a team and how you can build upon current practice, with an emphasis upon a self-management approach. There are eleven Bridges principles aiming to help interdisciplinary team’s co-ordinate their service around the patient. Bridges believes that the language we use can improve our clinical practice, especially with regards to problem solving, encouraging self-discovery, encouraging patients to reflect and enabling them to take action. Our team felt that we should use this approach to enhance our inpatient rehabilitation service. We chose this group of patients as we felt that this can be a challenging group to treat and it can take a long time to build supportive and trusting relationships. Methods Prior to commencing this project each member of the multidisciplinary team assessed the patient individually on the first day of admission. In retrospect we discovered that this led to repetition for the patient and this assessment was very clinician led. It also focused on clinician led (SMART) goals and achieving these. We furthermore realised we did not separately ask patients and parents what they wanted to gain from our service. Our method of improvement was to devise three questionnaires. One for a parent, one for a child under fourteen and over fourteen. These are distributed prior to being assessed by the team, allowing us to gather information and negating the need for repetition. The questionnaire gathers information regarding family members, education, school attendance, additional educational assistance, past medical history. For the patient we ask, what are their main concerns, what has helped so far, what support the patient has, what activities they enjoy as a family and what they hope to gain from their inpatient stay. The patient must fill out a description of their typical day, including their mood. Questions specifically for the parents are asking why their child has been referred, what their main concerns are, to outline their typical day, what do they feel has helped and what do they aim to gain from our team. Results We have utilised the questionnaires for every inpatient since January 2019. All team members feel that this new approach allows us to gain valuable information from patients and their parents thus encouraging them to adopt a self-management approach and to prioritise the patient’s story. As a team we feel that we learn a lot about our patients using this method and that it is more time effective. It allows us to identify unrealistic hopes and discuss these. Conclusion We believe that using the Bridges approach and by mainly adapting our language skills and organisation we have improved this service. Conflicts of Interest The authors declare no conflicts of interest.

A quality improvement project targeting physical, cognitive and social activity levels in inpatient rehabilitation

2021 ◽  
Vol 28 (4) ◽  
pp. 1-15
Author(s):  
Rosemarie Marsiglio ◽  
Dina Watterson ◽  
Valentina Maric ◽  
Anne E Holland
Keyword(s):  
Patient Satisfaction ◽  
Therapy Group ◽  
Social Activity ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Service ◽  
Independent Practice ◽  
Activity Levels ◽  
Table Tennis ◽  
Improvement Project ◽  
Rehabilitation Outcomes

Background/aims People undergoing inpatient rehabilitation largely spend their day by the bedside, inactive and alone. Increasing patients' physical, cognitive and social activity levels may improve rehabilitation outcomes for both the individual and the service. The aim of this study was to trial an activity programME that aimed to increase inpatient physical, cognitive and social activity levels, provided within existing resources whilE maintaining or increasing patient satisfaction. Methods A mixed-methods approach was used to develop and evaluate a multi-component activity programme for patients undergoing inpatient rehabilitation. Results Patient activity across the unit did not change but the amount of time spent alone during a weekday was significantly reduced. Patient satisfaction levels remained high. Each new therapy group was well received by patients and the volunteers who supported implementation. Novel programmes included table tennis coaching and independent gym access for selected inpatients, which were well used and not resource intensive. Therapist prescription of independent practice programmes remained low. Broader initiatives such as patient education folders require revision and further investment to succeed. Conclusions It is possible to change and evaluate multiple therapy services concurrently. The absence of change in overall activity levels demonstrates a need to establish the most successful components, harness support from the organisation to address some of the physical/environmental barriers and expand smaller programmes, and invest more time to consolidate the whole-of-service changes required to push the rehabilitation service in the direction of greater patient activity and ownership. Clinicians should pursue, implement, evaluate and revise novel programmes to engage their patient population.

Setting up school-based diabetes clinics to engage adolescents who frequently ‘were not brought to clinic’ and improve self-management

2019 ◽  
Vol 105 (6) ◽  
pp. 598-599
Author(s):  
Yolanda Alins Sahun ◽  
Kerry Camara ◽  
Kathryn Gething ◽  
Daniel Shenck ◽  
Jason Gane ◽  
...  
Keyword(s):  
School Attendance ◽  
Clinical Care ◽  
Intervention Group ◽  
Outcome Data ◽  
Self Management ◽  
Semistructured Interview ◽  
Improvement Project ◽  
School Based ◽  
Multidisciplinary Clinics

Optimising attendance rates in outpatient’s clinics is important to ensure good clinical care and to avoid waste of scarce medical resources. We identified a cohort of teenagers that frequently were not brought (WNB) to the paediatric diabetes multidisciplinary clinics, compromising patient care and reducing compliance with National Padiatric Diabetes Audit (NPDA) standards. As these teenagers attend five local secondary schools, we initiated a quality improvement project to test the benefit of taking clinics into schools. From January 2017, after extensive engagement with stakeholders, quarterly clinic at school with a diabetic nurse and physician were offered to all teenagers with type 1 diabetes mellitus in these five schools. A semistructured interview was administered to identify their concerns about diabetes. HbA1c was checked, and glucose meters were downloaded. Outcome data were compared with previous 9 months. 34 teenagers were targeted (17 initially identified as frequent non-attenders and 17 controls at same schools). The hospital WNB rate was reduced in the intervention group by 50%, and patients not seen at least once in 3 months reduced from 9/17 to 1/17. Teenage patients expressed an increased positive experience. Relevant knowledge gaps and emotional difficulties were additionally identified and addressed. Lifestyle issues not previously known to team were also unveiled, for example, poor school attendance, bullying or high-risk behaviours. School clinics improved contact in this difficult to reach group. It shows promise as a vehicle to enhance engagement of young people in self-care, actively preparing them for transition.

Self-Management and Social Skills Training

1980 ◽  
Vol 7 (2) ◽  
pp. 161-184 ◽  
Author(s):  
Alan M. Gross ◽  
Thomas A. Brigham ◽  
Chris Hopper ◽  
Nancy C. Bologna
Keyword(s):  
Social Skills ◽  
Behavior Modification ◽  
Rating Scales ◽  
School Attendance ◽  
Teacher Rating ◽  
Management Training ◽  
Skills Training ◽  
Self Management ◽  
Management Approach ◽  
Baseline Design

In a multiple baseline design across groups study, ten predelinquent and delinquent youths were given behavior modification, social skills, and self-management training. The youths were also required to conduct one behavior modification project on another person and one self-management project. Measures of the youths' behavior included parent and teacher rating scales, court records, and school attendance and grades. Parents, youths, and the referring community agencies also filled out program evaluation questionnaires. The youths demonstrated a decrease in the number of problem behaviors exhibited at home and in school. The results of the consumer evaluations also indicated the program was judged effective. The benefits of a self-management approach to juvenile offenders are discussed.

Treatment of Polydipsia Using a Contingency Management Procedure Incorporating a Self-Management Approach: A Single Case Study

1993 ◽  
Vol 21 (3) ◽  
pp. 275-279 ◽  
Author(s):  
John Turnbull
Keyword(s):  
Single Case ◽  
Contingency Management ◽  
Research Literature ◽  
Self Management ◽  
Pharmacological Intervention ◽  
Management Approach ◽  
Management Procedure ◽  
Management Techniques ◽  
One Year

Polydipsia is a disorder that has received little attention in the research literature. Treatment has been mainly confined to medical or pharmacological intervention. Few studies have reported the use of contingency management techniques and none have sought to encourage self-management. This study shows how such a procedure brought about a significant change in rates of water drinking in a thirty-one year old man with a mild learning disability.

scholarly journals Factors Related to Greater Functional Recovery after Suffering a Stroke

2021 ◽  
Vol 11 (6) ◽  
pp. 802
Author(s):  
María Vázquez-Guimaraens ◽  
José L. Caamaño-Ponte ◽  
Teresa Seoane-Pillado ◽  
Javier Cudeiro
Keyword(s):  
Functional Status ◽  
Hospital Discharge ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Primary Diagnosis ◽  
Rehabilitation Service ◽  
Bivariate Analysis ◽  
Linear Regression Models ◽  
Functional Assessments

Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge.

Improving WeeFIM score completion rates: An interdisciplinary inpatient rehabilitation unit quality improvement project

2021 ◽  
pp. 1-8
Author(s):  
Ashlee Jaffe ◽  
Maura Powell ◽  
Tami Konieczny ◽  
Carlene Osweiler ◽  
Genna Kreher
Keyword(s):  
Quality Improvement ◽  
Interdisciplinary Team ◽  
Inpatient Rehabilitation ◽  
Visualization Tool ◽  
Completion Rates ◽  
Intervention Period ◽  
Rehabilitation Unit ◽  
Improvement Project ◽  
Comprehensive Therapy ◽  
Therapy Services

PURPOSE: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation units. This Quality Improvement (QI) project aimed for 95%of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017. METHODS: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness. RESULTS: On-time admission completion rates increased from 0%to 95%during the intervention period. On-time discharge completion rates increased from 0%to 89%during the intervention period. This change has been sustained over 2 years with on-time admission and discharge scores averaging 79.4%and 77.9%respectively, and 96.4%of scores completed. CONCLUSION: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.

The development of the rehabilitation community transition support team as a response to COVID-19

2021 ◽  
Vol 10 (4) ◽  
pp. 1-11
Author(s):  
Kelly Fenton ◽  
Katherine Kidd ◽  
Rachel Kingman ◽  
Sara Le-Butt ◽  
Michelle Gray
Keyword(s):  
Community Setting ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Service ◽  
Structured Interviews ◽  
Face To Face ◽  
Community Transition ◽  
Support Team ◽  
Staff Experiences ◽  
Community Team ◽  
Transition Support

Background/aims The rehabilitation community transition support team was created as a response to the COVID-19 pandemic, resulting in faster discharges from the inpatient rehabilitation service. The aim of this evaluation was to explore the perspectives of staff and patients on their experience of the rehabilitation community transition support team. Methods Staff and patients in the new team were interviewed using semi-structured interviews. The data were analysed using thematic analysis. Results Staff interviews generated seven main themes: positive staff experiences; defining the ‘team’; mode of working; link role for the team; technology; relationships with patients; and support from colleagues. The patient analysis generated five themes: positive experiences of the rehabilitation community transition support team; relationship with rehabilitation community transition support team worker; mode of working; handling the hurdles of discharge; and defining the ‘team’. There were crossovers of staff and patient themes, particularly surrounding around face-to-face visits, defining the team and relationships. Patients indicated that contact with the community team helped them to overcome both practical and emotional hurdles of discharge. Conclusions The presence of a team supporting the transition from hospital to a community setting may be helpful for people who have been discharged.

The Self-Management of School Phobia: A Case Study

1988 ◽  
Vol 16 (3) ◽  
pp. 217-229 ◽  
Author(s):  
E. McNamara
Keyword(s):  
School Attendance ◽  
Self Regulation ◽  
Self Report ◽  
Self Management ◽  
Successful Outcome ◽  
Clinical Report ◽  
Stage Model ◽  
Two Stage ◽  
School Phobia ◽  
Self Confidence

The successful resolution of a problem of school phobia using self-management strategies is reported. The clinical report is prefaced by the observation that differences of emphasis are apparent when authorative reviews of the field of self-management are considered—and the conclusion drawn is that the successful outcome could be used to lend support to Kanfer's two-stage model of self-regulation. The client, Anne, was a pupil in the first year of comprehensive schooling. She attended school on only four days during the first term. Problem analyses in terms of operant and classical learning theories are described, and intervention strategies were generated which were accommodated within Kanfer's two-stage model of self regulation. Anne self-recorded school attendance, lesson attendance and self-confidence. School attendance was immediately achieved and progress towards full lesson attendance was made over a seven-week period. Affective state (self-confidence) as assessed by self-report was observed to increase as lesson attendance improved but a temporal lag was observed. The report concludes with some observations of a theoretical nature and justification for the intervention to warrant the descriptor “self-management”.

scholarly journals Insights from Australians with respiratory disease living in the community with experience of self-managing through an emergency department ‘near miss’ for breathlessness: a strengths-based qualitative study

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e017536 ◽  
Author(s):  
Tim Luckett ◽  
Jane Phillips ◽  
Miriam Johnson ◽  
Maja Garcia ◽  
Priyanka Bhattarai ◽  
...  
Keyword(s):  
Emergency Department ◽  
Self Efficacy ◽  
Near Miss ◽  
Self Management ◽  
Integrative Approach ◽  
Future Research ◽  
Management Approach ◽  
Chronic Obstructive ◽  
Pharmacological Management ◽  
Near Misses

ObjectivesBreathlessness ‘crises’ in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED ‘near misses’ where they considered going to the ED but successfully self-managed instead.Design and methodsA qualitative approach was used with a phenomenological orientation. Participants were eligible if they reported breathlessness on most days from a diagnosed respiratory condition and experience of ≥1 ED near miss. Recruitment was through respiratory support groups and pulmonary rehabilitation clinics. Semistructured interviews were conducted with each participant via telephone or face-to-face. Questions focused on ED-related decision-making, information finding, breathlessness management and support. This analysis used an integrative approach and independent coding by two researchers. Lazarus and Cohen’s Transactional Model of Stress and Coping informed interpretive themes.ResultsInterviews were conducted with 20 participants, 15 of whom had chronic obstructive pulmonary disease. Nineteen interviews were conducted via telephone. Analysis identified important factors in avoiding ED presentation to include perceived control over breathlessness, self-efficacy in coping with a crisis and desire not to be hospitalised. Effective coping strategies included: taking a project management approach that involved goal setting, monitoring and risk management; managing the affective dimension of breathlessness separately from the sensory perceptual and building three-way partnerships with primary care and respiratory services.ConclusionsIn addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients’ generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.

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