Community Rehabilitation Teams Research Articles

Enhancing empathy in healthcare: mixed-method evaluation of a pilot project implementing the CARE Approach in primary and community care settings in Scotland

The importance of empathic, person-centred care that is responsive to the individual patients’ needs is increasingly visible in national and international healthcare policies but there is a need for practical tools to help healthcare practitioners. The CARE Approach is a new ‘generic’ learning tool that aims to foster the achievement of empathic, person-centred communication in healthcare encounters. This study aimed to evaluate a pilot project which used the CARE Approach in peer facilitated groups in primary and community healthcare settings in Scotland. The CARE Approach was piloted in 5 sites (4 general practice and 1 community rehabilitation team) serving different areas and populations. Evaluation employed a mixed-methods approach, with questionnaires and semi-structured interviews with a purposive sample of participating facilitators and healthcare practitioners. 131 practitioners took part in the CARE Approach pilot across the five sites. 84 participants (64.1%) completed a baseline questionnaire and 51 (38.9%) a post-pilot questionnaire. Semi-structured interviews were conducted with all facilitators and with a purposive sample of 23 participants from the sites. Overall the results indicate that the CARE Approach was perceived as useful and relevant to practice across different disciplines and settings. The flexibility of the CARE Approach materials facilitated its delivery and implementation across the sites. Healthcare professionals’ self-perceived empathy at baseline and follow-up suggested a possible impact on daily practice. The CARE Approach appears to be useful to practitioners in primary and community care and can feasibly be delivered in peer facilitated learning groups. Further work is required to determine the utility of the approach when used in other ways and in other settings and to ascertain the effectiveness of the approach in the longer-term.

Increasing the health, activity and participation levels of people attending day centres

Background: Day centres can enable people with mild-to-moderate physical and mental health conditions to continue living at home, delaying their move into residential care. ‘Access to Wellbeing’ is a programme designed to help day centres improve service users’ health and participation in meaningful physical, mental and social activities. This paper documents the programme and people's experiences of its implementation. Methods: This study used a retrospective observational design, and studied a day centre that caters for 40 disabled and/or frail adults daily. The Access to Wellbeing programme development started with a structured assessment of the day centre to identify aspects of the environment and working practices that impeded physical activity. Service users were interviewed to understand their needs, abilities and interests, and establish meaningful activities to improve their health and wellbeing. Alterations to organisational structures, the physical environment and work practices were instigated to increase opportunities for physical activity and involvement. Shortly after implementation of the Access to Wellbeing programme in a day centre, semi-structured interviews were conducted with three day centre staff and three members of the community rehabilitation team exploring their experiences of the programme and its implementation. Findings: Despite staff's initial scepticism about the programme and concerns about their increased workload, and its effect on their relationship and interaction with service users, the programme was successfully implemented. The programme increased service users’ physical health and wellbeing, and satisfaction with the service, and improved staff motivation and job satisfaction. A committed team working together was the most important factor determining successful implementation. Few additional resources were required. Conclusions: A holistic programme that aims to improve meaningful activities can be implemented in day centres. These programmes can bring wide-ranging benefits to service users health, wellbeing and participation, and staff motivation job satisfaction and productivity.

Complex needs survey: informing the development of a community recovery and rehabilitation team

Aims and methodTo inform the development of a new, recovery-oriented rehabilitation service, identify local needs and create a pathway for appropriate referrals, accelerating the build up of case-load. We surveyed 1353 secondary service users using a purpose-made needs assessment and case identification questionnaire, completed by nominated care coordinators.ResultsSignificant unmet need for rehabilitation and recovery-oriented interventions was found. The results were used to invite referrals, create a case-load of 150 and allocate the appropriate resources for the new team.Clinical implicationsThe results highlight the untapped recovery potential among users of mainstream secondary mental health services and support investment in rehabilitation at a time of resource restriction. This work also supports a similar, evidence-based approach to targeting appropriate referrals during the development and the early stages of rehabilitation services.

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

BackgroundGoal setting is considered ‘best practice’ in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke.MethodsG-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation.ResultsG-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient’s well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process.ConclusionsG-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings.

Ten principles of good interdisciplinary team work.

BackgroundInterdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes.MethodThis study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work.ResultsTen characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles.ConclusionsWe propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

PHS120 - Medical Re-Admissions At The Royal London Hospital – Patient Specific And Disease Specific Factors At One Week And One Month

The Royal London Hospital is a teaching hospital in East London, UK. We hypothesised that medical patients with multiple co-morbidities and complex disease are likely to present with a new diagnosis when re-admitted within a month. Further, re-admission within a week is likely to be related to the initial diagnosis. We conducted a retrospective audit of all non-elective adult acute medical admissions over a 6 week period during 2012. We collected information on patient demographics, ICD-10 diagnosis, length of hospital stay, along with readmissions within one week and one month. We reviewed the original and subsequent electronic discharge summaries. We highlight patient specific and disease specific factors. There were a total of 124 readmissions from the original audit (n=859). A large proportion (40%) of all readmissions were in the elderly (over the age of 70). There were 73 (59%) readmissions within 1 month, and 37 (30%) within a week. Fourteen patients (11%) were readmitted within a week, and again within a month. COPD (33%), PE (29%), sepsis (26%) and cellulitis (24%) had the highest re-admission rates. Our audit points to a 14.4% readmission rate in our cohort. We aim to address the precipitating factors in our new physician led ambulatory care clinic. We highlight the bed days saved through such a clinic. Contrary to our hypothesis readmissions within a month were related to the original diagnosis, interestingly this was less so when re-admitted within a week. Our audit has helped highlight the need for better community management plans prior to discharge. This has led to closer links with the Community Rehabilitation and Support Team (CReST) in order to reduce readmission rates.

Are we using support workers effectively? The relationship between patient and team characteristics and support worker utilisation in older people’s community-based rehabilitation services in England

This research explores the relationship between support worker utilisation and patient- and team-level characteristics using a prospective longitudinal study of 20 older people's community rehabilitation teams. Between January and September 2009, 462 Whole Time Equivalent Staff and 1913 patients participated in the study. Patient dependency, health status (Therapy Outcome Measures, EQ-5D and Levels of Care tool) and demographic data were collected alongside detailed staff activity data for patients during the recruitment period. Multivariate analyses were used to determine the relationship between the proportion of care delivered by support workers team and patient variables. Support workers delivered up to 36% of direct patient care and spent less time per patient contact (36.0 minutes, SD 37.7, range 0-600) than qualified professionals (mean time per contact 75.8 minutes, SD 32.9, range 0-334). Less-dependent and female patients had a greater proportion of support worker input, with a 4.9% increase in face-to-face support worker time for every 0.1 unit increase in EQ-5D (95% CI 0.3-9.6, P = 0.038), while females had an additional 5.1% of their total contact time with support workers compared with males (95% CI 1.9-8.4, P = 0.002). In an analysis without EQ-5D, older patients had a greater proportion of support worker time (P = 0.006). Other factors associated with support worker input include the referral source, intensity of care, usual living arrangements and proportion of support staff in a team. Results indicate that patient- and team-level factors are a determinant in the proportion of support worker care delivered to older people in the community, suggesting that it may be appropriate to introduce a more explicit targeted deployment of support workers based on patient-level characteristics, which may facilitate a more effective use of qualified practitioner time for more complex, dependent patients.

A medication workshop for patients with schizophrenia living in community care homes.

Psychoeducation for patients with schizophrenia can improve a range of outcomes. Our aim was to test a workshop intervention enabling service users to learn more about mental illness and their medication. A Quality Improvement Project was undertaken to create a workshop for patients with a diagnosis of schizophrenia within the Haringey Community Rehabilitation Team (HCRT) . The response was tested using anonymous questionnaires after each workshop. We held ten workshops (total of 47 participants), after which 83% of patients felt that the workshop had helped them to understand more about their mental health, 77% felt they were able to understand the purpose of their medication, 79% felt they were able to understand the side effects, and 70% felt they could have a say in prescribing. Objectives for the Quality Improvement Project were met. This workshop will be used for other patients within the HCRT and is transferable to other community mental health teams.

The impact of a new end of life care occupational therapy post in a community rehabilitation team

IntroductionA newly funded EoLC occupational therapy post was recruited to in 2010 to work within a multi-professional generic adult community rehabilitation team. It was evaluated after 1 year.AimsThe post was...

Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery

Purpose. To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models.Methods. Analytical cross-sectional study arising from baseline assessments from 107 subjects drawn from a randomised controlled trial of community rehabilitation service delivery models.Setting. A community rehabilitation team based in Brisbane, Queensland, Australia.Measures. Primary outcome variables include quality of life (EQ-5D & VAS) and Carer Strain Index. Predictor variables include participation in functional activities, history of falls, number of medications, number of co-morbidities, depression, environmental hazards, physical function and nutrition. Association between variables assessed using linear regression.Results. Major factors contributing to reduced quality of life were having reduced participation in daily activities, depression, and having poor vision. Having poor nutrition and no longer driving also contributed to poor quality of life. The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person.Conclusions. Community rehabilitation services working with older populations must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain.

Increasing delivery of an outdoor journey intervention to people with stroke: A feasibility study involving five community rehabilitation teams

BackgroundContrary to recommendations in a national clinical guideline, baseline audits from five community-based stroke rehabilitation teams demonstrated an evidence-practice gap; only 17% of eligible people with stroke were receiving targeted rehabilitation by occupational therapists and physiotherapists to increase outdoor journeys. The primary aim of this feasibility study was to design, test, and evaluate the impact of an implementation program intended to change the behaviour of community rehabilitation teams. A secondary aim was to measure the impact of this change on client outcomes.MethodsA before-and-after study design was used. The primary data collection method was a medical record audit. Five community rehabilitation teams and a total of 12 professionals were recruited, including occupational therapists, physiotherapists, and a therapy assistant. A medical record audit was conducted twice over 12 months (total of 77 records pre-intervention, 53 records post-intervention) against a guideline recommendation about delivering outdoor journey sessions to people with stroke. A behavioural intervention (the 'Out-and-About Implementation Program') was used to help change team practice. Active components of the intervention included feedback about the audit, barrier identification, and tailored education to target known barriers. The primary outcome measure was the proportion of medical records containing evidence of multiple outdoor journey sessions. Other outcomes of interest included the proportion of medical records that contained evidence of screening for outdoor journeys and driving by team members, and changes in patient outcomes. A small sample of community-dwelling people with stroke (n = 23) provided pre-post outcome data over three months. Data were analysed using descriptive statistics and t-tests.ResultsMedical record audits found that teams were delivering six or more outdoor journeys to 17% of people with stroke pre-intervention, rising to 32% by 12 months post-intervention. This change represents a modest increase in practice behaviour (15%) across teams. More people with stroke (57%) reported getting out of the house as often as they wanted after receiving the outdoor journey intervention compared to 35% one year earlier; other quality of life outcomes also improved.ConclusionsThe 'Out-and-About Implementation Program' helped rehabilitation teams to change their practice, implement evidence, and improve client outcomes. This behavioural intervention requires more rigorous evaluation using a cluster randomised trial design.

Delivering an evidence-based outdoor journey intervention to people with stroke: Barriers and enablers experienced by community rehabilitation teams

BackgroundTransferring knowledge from research into practice can be challenging, partly because the process involves a change in attitudes, roles and behaviour by individuals and teams. Helping teams to identify then target potential barriers may aid the knowledge transfer process. The aim of this study was to identify barriers and enablers, as perceived by allied health professionals, to delivering an evidence-based (Level 1) outdoor journey intervention for people with stroke.MethodsA qualitative design and semi-structured interviews were used. Allied health professionals (n = 13) from two community rehabilitation teams were interviewed, before and after receiving feedback from a medical record audit and attending a training workshop. Interviews allowed participants to identify potential and actual barriers, as well as enablers to delivering the intervention. Qualitative data were analysed using theoretical domains described by Michie and colleagues.ResultsTwo barriers to delivery of the intervention were the social influence of people with stroke and their family, and professionals' beliefs about their capabilities. Other barriers included professionals' knowledge and skills, their role identity, availability of resources, whether professionals remembered to provide the intervention, and how they felt about delivering the intervention. Enablers to delivering the intervention included a belief that they could deliver the intervention, a willingness to expand and share professional roles, procedures that reminded them what to do, and feeling good about helping people with stroke to participate.ConclusionsThis study represents one step in the quality improvement process. The interviews encouraged reflection by staff. We obtained valuable data which have been used to plan behaviour change interventions addressing identified barriers. Our methods may assist other researchers who need to design similar behaviour change interventions.

A break‐even analysis of a community rehabilitation falls prevention service

To identify and compare the minimum number of clients that a multidisciplinary falls prevention service delivered through domiciliary or centre-based care needs to treat to allow the service to reach a 'break-even' point. A break-even analysis was undertaken for each of two models of care for a multidisciplinary community rehabilitation falls prevention service. The two models comprised either a centre-based group exercise and education program or a similar program delivered individually in the client's home. The service consisted of a physiotherapist, occupational therapist and therapy assistant. The participants were adults aged over 65 years who had experienced previous falls. Costs were based on the actual cost of running a community rehabilitation team located in Brisbane. Benefits were obtained by estimating the savings gained to society from the number of falls prevented by the program on the basis of the falls reduction rates obtained in similar multidisciplinary programs. It is estimated that a multi-disciplinary community falls prevention team would need to see 57 clients per year to make the service break-even using a centre-based model of care and 78 clients for a domiciliary-based model. The service this study was based on has the capability to see around 300 clients per year in a centre-based service or 200-250 clients per year in a home-based service. Based on the best available estimates of costs of falls, multidisciplinary falls prevention teams in the community targeting people at high risk of falls are worthwhile funding from a societal viewpoint.

Effect of community rehabilitation team model on the ADL among cerebral apoplexy patients

Objective To probe into the effect of community rehabilitation team to the activities of daily living(ADL) among cerebral apoplexy patients. Methods We use quasi-experimental design, a total of 46 cerebral apoplexy patients living in community were divided into experimental group (n = 26) and control group (n=20) randomly. For the experimental group patients, the community rehabilitation team which includes community medical doctor, preventive health care doctor and community nurses gaving health education, function training and nursing. For the control group patients, the doctor and the nurses gave the routine treatment and nursing. The activities of daily living (ADLs) of the patients were measured before intervention, 1 months, 3 months and 6 months after intervention, and the results were compared between to groups. Results The ADLs of experimental group patients were improved significantly (P=0.000) more than the control group patients.Conclusions The intervention of community rehabilitation team can improve the ADL and the QOL among cerebral apoplexy patients, this community rehabilitation model can be recommend extensively. Key words: Community; Cerebral apoplexy; ADL

Community rehabilitation for severe enduring mental illness: a naturalistic, observational study

Dear Editor, The development of rehabilitation and recovery services forms a key element of national mental health policy in Ireland [1]. Over the past 10 years, mental health services in Monaghan and Cavan have developed Assertive Outreach Teams (AOT) as part of Community Rehabilitation Teams (CRT), with the aim of providing individualised care programmes for clients with severe and enduring mental illness and their carers, based on identified needs and implemented as much as possible in a non-institutional settings. The CRT provides specialised services for people disadvantaged by a range of problems that can develop with severe mental illness, and which cannot be adequately met by generic mental health services. This approach helps to optimise social inclusion, reduce the need for repeated admissions and increase patient satisfaction and quality of life. On 1 July 2006, 24 patients were selected from the case-load of the CRT in Cavan; these patients were receiving intensive community treatment for psychiatric symptoms at that time. This naturalistic, observational study aimed to determine the benefits of the CRT in terms of (1) the health and social needs that the CRT was addressing, and (2) the number and duration of hospital admissions before and after intervention by the CRT. The CRT reviewed the cases of each of the 24 patients being treated by the CRT on 1 July 2006 and used the Camberwell Assessment of Need (CAN) [2] to determine the areas of health and social need in which each patient was receiving assistance (see Table 1). Case notes were reviewed to determine the number and duration of hospital admissions before and after intervention by the CRT. Patients were receiving treatment and assistance from the CRT in all 16 areas of health and social need, most commonly psychotic symptoms, psychological distress and information about illness (Table 1). Prior to intervention by the CRT, these 24 patients had an average of 0.93 admissions per year (standard deviation [SD] 0.63); in the 3 years following intervention by the CRT, they had an average of 0.18 admissions per year (SD 0.39) (Z = -3.94; P \ 0.001). Prior to intervention by the CRT, these 24 patients spent an average of 49.53 days in hospital per year (SD 69.12); in the 3 years following intervention by the CRT, they spent an average of 3.37 days in hospital per year (SD 7.04) (Z = -4.17; P \ 0.001). The introduction of the CRT has resulted in (1) interventions aimed a broad range of medical and social needs and (2) a reduction in the number and duration of hospital admissions in patients with severe, enduring mental illness. This is an observational study without a comparison group and was primarily aimed at establishing the effects of the CRT in a ‘‘real life’’ setting. These naturalistic data support research findings [3] that community rehabilitation programmes are valuable in reducing need for admission, optimising provision of individualised care and improving quality of life for patients with enduring mental illness in community settings. A. Niazi B. D. Kelly (&) Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland e-mail: brendankelly35@gmail.com

What do mental health rehabilitation services do and what are they for? A national survey in England

Background: The specialty of rehabilitation is under represented in current national policy, current service provision is unclear and there are no guidelines on what constitutes a standard rehabilitation service.Aim: To carry out a national survey of rehabilitation services in order to describe current service provision and to formulate a consensus definition of the term “rehabilitation”.Method: A structured telephone survey was carried out with consultants in rehabilitation psychiatry or senior service managers in all Trusts in England. As well as information about their services, interviewees were asked to give a definition of the term “rehabilitation”.Results: A response rate of 89% (65/73 Trusts) was achieved constituting interviews with representatives from 93 local authority regions (75% consultants, 25% service managers). The majority (77%) had short term (length of stay up to 12 months) rehabilitation units with a mean 13 beds. There were no differences between urban and rural services in bed numbers. Most services had input from all members of a multidisciplinary team and where services had short and longer term units, staff tended to cover both. The majority (79%) had specific referral criteria, 42% had exclusion criteria and 85% carried out a preadmission assessment. Over half (56%) had a community rehabilitation team and in 29%, assertive outreach teams were considered part of the rehabilitation service. Two models of community rehabilitation service provision emerged and a consensus definition of “rehabilitation” was formulated.Conclusions: This is the first national survey of rehabilitation services which has allowed the description of current service provision in some detail as well as two models of community rehabilitation services.Declaration of Interest: None.

The implementation and evaluation of a community rehabilitation team: a case study

Purpose: In the UK, intermediate care schemes have been implemented with short-term funding, targeted at reducing pressures on hospitals/nursing homes. Many have lacked a reliable evidence-base and there are few publications on one form of intermediate care, the community rehabilitation team (CRT). This study was conducted to establish whether one specific CRT should gain recurrent funding.Methods: This qualitative case study took a multi-method, multi-perspective approach. Data sources included: three focus groups and 40 semi-structured interviews with patients, carers and health services/local authority/CRT staff, document review, and field notes. The resulting data were analysed thematically.Results: The CRT was designed without sufficient reference to reliable evidence and consultation with local health/social services, and implemented against a background of cultural divides between and within these services. It was also hampered by an ambitious remit and premature attempts at outcome evaluation. Patients/carers were satisfied with interventions, functional gains and social aspects of input but there was no reliable evidence of cost-effectiveness.Conclusions: The study highlighted problems related to service implementation, which exposed flaws within current policy of providing short-term funding for schemes that must demonstrate cost-effectiveness quickly in order to gain recurrent funding.

Interdisciplinary teamwork in the community rehabilitation of older adults: an example of flexible working in primary care

This paper presents a section of the findings of a case study of a newly established community rehabilitation team (CRT) comprising physiotherapists, occupational therapists and nurses. The findings reported here address issues of interdisciplinary teamwork that arose during the project. All eight members of the team were interviewed as well as three ex-team members. The data were collected by semi-structured interviews and analysed using thematic content analysis (Strauss and Corbin, 1990). The findings suggest that when recognized barriers to teamwork are eradicated, such as geographical separation and different employers, teams such as the CRT can achieve high levels of teamwork. A problem that took longer for the CRT to resolve, however, was that of flexible working across traditional professional and hierarchical role boundaries. The paper concludes that the difficulties that need to be overcome when a new team and new service are established concurrently, should not be underestimated.

The Clinical Practice of a Community Rehabilitation Team for People with Acquired Brain Injury

AbstractThe aim of this study was to examine the clinical practice of a community team that is one component of the statewide, government-funded, specialist Brain Injury Rehabilitation Program for New South Wales, Australia. The 467 clients served by the community team of the Brain Injury Rehabilitation Service at Liverpool Hospital, Sydney during the calendar year 2000 were identified and their use of clinical services described. A random sample of 50 clients from this group was studied in further detail, with specific reference to the type of therapy interventions they received. This was compared with the therapy interventions received 2 years later, in 2002. A total of 8046 occasions of service (OoS) were recorded for the 467 clients during 2000, with a median number of 8 OoS per client. All disciplines contributed to this number, with case managers providing the largest number of OoS (n = 2734). Between 65–75% of clients attended medical clinics and received services from case managers, with between 15–30% of clients receiving services from allied health disciplines. The random sample received a median of 9 OoS during 2000, and a median of 3 therapy interventions per client. Therapy interventions pertaining to living skills were addressed in 66% of the group, interpersonal relationships in 54%, and occupational activity in 44%. Although the community team continued to provide a comparable number of OoS in 2000 and 2002, 56% of the random sample had been discharged by 2002. There were significant group differences between those who were discharged and those who remained in the service. Additionally, for those who remained in the service, there was a significant reduction of OoS and therapy interventions between 2000 and 2002. The data were used to draw together a model of clinical practice of the community team.

Developing self-evaluation skills: a pragmatic research-based approach for complex areas of nursing.

Using a newly established community rehabilitation service as the research context, Gill Hek explores ways in which practitioners pragmatically developed self-evaluation research skills. Within the practice setting, community practitioners learnt how to conduct and analyse interviews with service users, and to develop connected database records that could be used across health and social services. The teaching-learning process and the teacher-learner relationship were used as models for researching in this complex area. The project demonstrated how community rehabilitation teams developed self-evaluation research skills to a point where they were able to reflect critically on the service they were providing. Supported by a research team, they were able to use research skills to analyse the volume and throughput of their service. They were also able to establish what needed to be done next within the challenging environment at the interface of health and social care in the community.