Building rehabilitation capacity in rural New South Wales

Abstract

The aim of this article is to report on a study of the expansion of specialist rehabilitation services in central New South Wales, Australia, through the introduction of rehabilitation as a new service type at 2 small rural multi-casemix hospitals, within an integrated area-wide model of rehabilitation service delivery. Mixed methods were used. Information about bed occupancy and patient participation in rehabilitative activities were collected from hospital data bases and patient observation by staff over a 10 month period, and analysed quantitatively using descriptive statistics. During the same time period 10 staff from each hospital participated in a series of 3 audio-taped interviews each. These semi-structured interviews were conversational in nature and asked about the staff member's experiences and perceptions of the introduction of rehabilitation. Inductive qualitative analysis of the interview transcripts captured the enablers and threats to rehabilitation at each site. The introduction of rehabilitation as a new service type at 2 small rural hospitals was facilitated by an integrated area-wide model of rehabilitation service delivery, and the support of a regional specialty rehabilitation service provider. The formal introduction of rehabilitation at the 2 small hospitals was delayed while processes to ensure that patients were transferred to the appropriate hospital were developed, equipment purchased and building modifications undertaken. Despite this, staff came to appreciate the benefits of rehabilitation for their patients and to see rehabilitation potential in their usual patient population. Some staff took longer than others to embrace the changes; however, staff generally appreciated that the introduction of rehabilitation was not hurried. When linked to a specialty rehabilitation provider, small multi-casemix rural hospitals appear to have the potential to support the rehabilitation of patients in their local communities whose rehabilitation needs are uncomplicated. To fully realise the potential of small rural hospitals, and because these hospitals are primarily staffed by nurses, nursing staff working in these facilities need to be supported to develop their rehabilitative potential. This support should come from the collective wisdom of specialist rehabilitation nurses, medical rehabilitation specialists and allied health staff, and must be provided at the broader structural level. Through cross-disciplinary sharing of knowledge and skills, residents of rural communities could spend less time hospitalised at long distances from their homes.