Provision of Rehabilitation Nursing in Long Term Care Facilities, Research Proposal Example

Introduction to Problem and Problem Statement

In today’s long term care facilities, nurses play a significant role in shaping the outcomes for patients who require rehabilitation from an injury or other condition. These nurses must demonstrate their knowledge and skill set to patients by providing high quality rehabilitation care and treatment to restore optimal mobility and capacity for this group. It is important to determine the best possible outcomes for patients in this category and to identify the impact of nurses on the rehabilitation process. One of the key problems to consider is that the provision of care for these patients is often limited by self-care behaviors and other related factors; therefore, the level of rehabilitation nursing care is not always effective if patients are unable to conduct self-care behaviors during their recovery. It is necessary to determine if improved nursing care through expanded efficiencies could be achieved to produce successful self-care outcomes.

Significance of the Problem

In long term care facilities, it is important to establish an effective relationship between rehabilitation nurses and patients through efficiencies that will have a positive and lasting impact for a large group of patients. These alternatives must play a critical role in shaping the lives of patients who require rehabilitation, given the challenges of this process and the limitations in many long term care facilities. The effectiveness of rehabilitation care is often questioned because of the limitations placed upon nurses; however, care has been proven effective for some patients (Forster et.al, 2010). It is necessary to explore self-care and its relationship to rehabilitation nursing to determine how self-care improves patient recovery rates when considering such factors as cultural identity.

Search Terms

The following terms will be addressed in the discussion:

Self-care: the ability of patients to care for themselves, either independently or in conjunction with other forms of supported care

Culturally Competent Rehabilitation Nursing: The capacity of nurses to recognize the importance of cultural awareness in providing rehabilitation care to patients (Galanti, 2005)

Literature Review Summary

The association between rehabilitation nursing and self-care is often identified in conjunction with cultural competence; however, this is not always a favorable scenario in cultures where there is a high degree of interdependence, such as Hispanics (Galanti, 2005). This article examines the different aspects of nursing care for rehabilitation patients and how it is influenced by cultural knowledge and awareness (Galanti, 2005). To be specific, “to become culturally competent, you must understand your own culture and biases and become sensitive to and appreciate the differences of other cultures (Galanti, 2005, p. 123). Under these conditions, self-care may be a difficult task to accomplish, particularly when some cultures are highly interdependent rather than independent (Galanti, 2005). Patients from cultures without significant independence may struggle with the idea of self-care because they are accustomed to working with others to obtain what they need (Galanti, 2005). This article provides one perspective regarding self-care for rehabilitation patients and the challenges that nurses might face in promoting this objective.

Nelson et.al (2007) address the importance of nurse staffing rates in rehabilitation settings and how these levels impact patient care. It is known that “The quality of healthcare in rehabilitation care settings may be compromised by external forces that have increased patient acuity, while simultaneously reducing the ratio of nursing staff to patients and the proportion of RN staffing” (Nelson et.al, 2007, p. 181). From this perspective, it may be argued that rehabilitation care is not always at an optimal level and requires further evaluation to determine if nurse staffing rates contribute to this problem (Nelson et.al, 2007). If nurse staffing levels are limited, then it may be difficult to put forth a strategy that promotes self-care for rehabilitation patients when there is insufficient staffing to provide guidance in this area (Nelson et.al, 2007). This article provides an important summary regarding how nurse staffing rates play a role in supporting successful and comprehensive rehabilitation treatment for these patients, including self-care outcomes for this population group.

Gaps in Literature

In reviewing these literature sources, there are a number of questions that have not been addressed with respect to self-care for rehabilitation patients. Information regarding this area of study is less available because of the challenges associated with self-care, particularly in older patients who require rehabilitation for an injury or condition. Therefore, additional studies must be developed to determine how self-care is limited by these practices.

Research Question

The proposed research questions are as follows: Do rehabilitation patients benefit from self-care and does it actively contribute to their recovery? How do nurses influence self-care in rehabilitation patients and does this improve compliance rates? These questions must be addressed in greater detail in order to determine the best possible approaches to the rehabilitation patient population so that their care and treatment is both comprehensive and effective.

Research Approach and Design

The proposed research questions regarding an effective study approach and design in order to determine if they are feasible and might be accomplished with the appropriate practice methods. Therefore, a survey questionnaire with nurses as the target audience is likely to determine if current trends in nursing rehabilitation programs are effective in providing patients with sufficient means and guidance to perform self-care techniques when required. The design must encompass a reflective approach to ask nurses the appropriate questions that will provide the desired responses that are specific to rehabilitation care and treatment. This is an opportunity to determine how different issues and behaviors that impact nurses also impact self-care for rehabilitation patients.

Strengths and Weaknesses of Approach and Design

The research approach and design must encompass a variety of key principles to determine if patients are positively impacted by trends in patient care and delivery from nurses. Questions must be detailed yet specific enough to target the intended audience and focus on the issues at hand related to nursing practice and its impact on rehabilitation patient care and treatment. The study’s core strength is the questions that it addresses through the survey instrument to attract the appropriate audience and to obtain honest and forthright responses. The study may be considered weak because it may not consider each of the variables associated with rehabilitation care and treatment for which nurses are not directly involved. Therefore, by using nurses as the target audience for the survey instrument, it is likely that other potentially beneficial responses will not be considered.

Research Hypothesis

The proposed research hypothesis considers the role of nurses in shaping rehabilitation care and treatment and if self-care has a significant role in the improvement of recovery rates. These results may shape the manner in which nurses approach rehabilitation patients and their responses to self-care.

Independent and Dependent Variables

For the proposed study, the independent variables are the primary responsibilities of rehabilitation nurses in providing basic care and treatment to patients. The independent variables address the role of nurses in providing this care. The dependent variables include such factors as cultural competence and self-care in shaping the recovery of rehabilitation patients.

Target and Accessible Population

The proposed target population is a sampling of nurses who specialize in providing rehabilitative care to patients in dedicated units in long term care facilities. This population is accessible to the researchers through an evaluation of nursing employees within long term care facilities who specialize in rehabilitation care and treatment.

Sampling/Recruitment Procedure

The proposed participant sample will include nurses who are employed in specialized units in long term care facilities. Nurses for the sample will be identified through a recruitment phase which consists of promotional flyers in several nursing homes in a metropolitan community with a significant focus on rehabilitation care. Furthermore, the study will be introduced at staff meetings in specialized rehabilitation units so that nurses will consider participating in the study.

Researchability and Feasibility

The feasibility of this study is a critical component of its potential success, and since the issues in question regarding the recovery outcomes of patients requiring rehabilitation are important, there is an opportunity for the study results to impact future activities in other rehabilitation units. This will enable the researchers to apply the results to future studies and to units with specialized rehabilitation care where there have been significant opportunities to promote improvements in rehabilitation care for this patient population.

Lessons Learned

In evaluating the efficacy of the proposed research study, it is important to establish a greater understanding of the impact of nurses on how well patients respond to rehabilitative care and treatment and improve their recovery rates accordingly. However, long term care facilities are a difficult environment to embrace a high level of quality and innovation; therefore, it may be difficult for the nurses who work in these settings to fully embrace such factors as self-care and cultural diversity. These environments often serve as a breeding ground for challenging circumstances associated with rehabilitative care and treatment, and as a result, could place additional strain on patients who require significant attention and commitment. The limitations of these environments must be recognized and how this impacts the ability to provide high quality nursing care to all patients.

Conclusion

The development of a survey questionnaire instrument to capture the practices of nurses working in long term care rehabilitation settings requires an effective understanding of the different elements which contribute to the successful recovery outcomes of this patient population. The promotion of consistency across all units is one objective that must be considered to improve patient responses to care and related outcomes. In addition, patients must be provided with the tools that are necessary to express themselves during the rehabilitation phase so that their needs are met more successfully. This is achieved through the creation of an environment which enables nurses to better embrace the care and treatment of their rehabilitation patients to ensure that their needs are fully met and optimized at all times. This includes such factors as cultural diversity awareness and self-care for patients as they begin to recover more fully.

References

Forster, A., Lambley, R., and Young, J.B. (2010). Is physical rehabilitation for older people in long-term care effective? Findings from a systematic review. Age and Ageing, 39(2), 169-175.

Galanti, G.A. (2005). Culturally competent rehabilitation nursing. Rehabilitation Nursing, 30 (4), 123-126.

Nelson, A., Powell-Cope, G., Palacios, P., Luther, S.L., Black, T., Hillman, T., Christiansen, B., Nathenson, P., and Coleman Gross, J. (2007). Nurse staffing and patient outcomes in inpatient rehabilitation settings. Rehabilitation Nursing, 32(5), 179-202.