Abstract
Aims and method To build on previous research findings by examining engagement and problematic behaviours of patients in 10 residential rehabilitation units. Two measures were completed on patients in community rehabilitation, longer-term complex care and high-dependency units (109 patients in total). Data were analysed and categorised into higher-engagement ratings across the domains of engagement and behaviour over the past 6 months and lifetime in terms of presence of the behaviour and likelihood of resulting harm.Results Data were available for 73% of patients. All aspects of engagement were consistently low for all units, with highest levels in community rehabilitation units. Levels of problematic behaviours were similar across all units. Socially inappropriate behaviours and failure to complete everyday activities were evident for over half of all patients and higher for lifetime prevalence. Verbal aggression was at significantly lower levels in community units. Lifetime behaviours likely to lead to harm were much more evident in high-dependency units.Clinical implications Despite some benefits of this type of care, patients continue to present challenges in engagement and problematic behaviours that require new approaches and a change in focus.
Highlights
All aspects of engagement were consistently low for all units, with highest levels in community rehabilitation units
There remains a group of longer-stay patients in both acute wards[8] and in-patient rehabilitation settings who exhibit problematic behaviours that act as enduring barriers to successful community living.[3]. This study examines these two key factors, patient engagement and problematic behaviours, in patients on 24h nurse-staffed residential rehabilitation units
The poor level of engagement reported for patients in all three types of rehabilitation unit was striking
Summary
Of the 10 units included, 5 were classified as community rehabilitation units (44 patients), 3 as complex care units (36 patients) and 2 as high-dependency units (29 patients). There were significant differences between the units on 4 of the 16 variables; greater levels of engagement were reported for patients in community rehabilitation than in complex care or high-dependency units. Over half of the patients continued to present with verbal aggression, showed socially inappropriate behaviours (e.g. making excessive demands/complaints or urinating in public), and failed to complete everyday activities (e.g. refused to wash/dress appropriately or stayed in bed/their room); the last two items were significantly more common in patients on complex care units. Lifetime prevalence of problematic behaviours was uniformly high, with the exception that absconding was significantly lower for those in complex care units, as were levels of verbal aggression for patients in community rehabilitation units (Table 3). The ratings for problematic behaviours leading to imminent physical harm to self or others were evident to a much greater degree across the board for patients in high-dependency units; in most instances these findings were statistically significant. Self-harm Verbal aggression Physical aggression against objects Physical aggression towards others Sexually inappropriate behaviours Fire risk behaviours Compulsive behaviours Acquisitive behaviours Absconding Socially inappropriate behaviours Failure to perform range of everyday activities ns, non-significant
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
