Evaluation of a nurse-led social rehabilitation programme for neurological patients and carers: An action research study

Abstract

Background Very few neurological rehabilitation programmes have successfully dealt with patients’ and relatives’ social needs. Furthermore, the nurses’ contribution in those programmes is poor or unclear. Objectives To determine the rationale, effectiveness and adequacy of a nurse-led social rehabilitation programme implemented with neurological patients and their carers. Design In this action research study Hart and Bond's experimental and professionalizing typologies were applied through Lewinian cycles. A social rehabilitation programme was planned, based on the results of an in-depth baseline assessment of the context and individual needs. The programme focused on increasing the level of acceptance/adaptation of the disease through verbal and written education, easing the discharge planning, and offering social choices based on the social assessment of individual needs and possibilities at home. Settings Two neurological wards of a hospital in Spain. Participants The programme evaluation included 27 nurses, and two groups of patients and relatives (control group = 18 patients and 19 relatives, intervention group = 17 patients and 16 relatives). Methods The two groups of patients and relatives were compared before and after discharge to determine the effectiveness of the programme. Socio-demographic forms, semi-structured interviews, participant observations, and validated scales to measure activities of daily living and social life were used, and data were analysed using content (QSR Nudist Vivo, v.2.0) and statistical (SPSS v. 13.0) analyses. Results The new programme resulted in social care being integrated in daily practice and developed knowledge about social rehabilitation. This had a positive impact on nurses’ attitudes. Patients and relatives had more realistic expectations and positive attitudes towards social life, and developed a wider variety of choices for social changes. Better adaptation, and more coping skills and satisfaction were achieved. Conclusions This rehabilitation programme was feasible and effective. Patients and relatives benefited from better understanding of the socialisation process, as a result of advancing nurses’ knowledge, experience and role in psychosocial care.