Abrahamson Vanessa, Jensen Jan, Springett Kate, Sakel Mohamed
a Senior Lecturer, Canterbury Christ Church University , Canterbury , Kent , UK.
b School of Allied Health Professions , Canterbury Christ Church University , Canterbury , Kent , UK.
Disabil Rehabil. 2017 Aug;39(17):1683-1694. doi: 10.1080/09638288.2016.1211755. Epub 2016 Aug 24.
To explore the experiences of individuals who have had a severe traumatic brain injury (TBI) and their carers in the first month post-discharge from in-patient rehabilitation into living in the community.
Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers.
Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future.
Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead - this dissonance adds to anxiety. The study's findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.
探讨重度创伤性脑损伤（TBI）患者及其照顾者在从住院康复出院后的第一个月融入社区生活的经历。
采用基于批判实在论的定性方法，我们在出院后约一个月通过半结构化访谈探索了10名患者和9名照顾者的经历。两名研究人员独立进行了主题分析。
首先，对支持的看法不一，但许多患者和照顾者在住院阶段、在不同科室之间转换以及准备出院时感到缺乏支持。其次，他们难以接受能力改变、角色丧失和自主权丧失的新现实。第三，出院后的早期经历加剧了对未来的担忧。
大多数患者和照顾者难以确定一个支持他们过渡到社区生活的连贯计划。获得服务需要照顾者付出很大努力，而且往往是短期的，因此无法满足他们的长期需求。我们建议需要一名个案经理在康复早期介入，并作为获取持续康复和其他支持服务的信息和途径的关键点。对康复的启示创伤性脑损伤（TBI）是长期残疾的主要原因。它会影响日常生活的各个方面，并显著降低患者和照顾者的生活质量。一旦患者回家，专业人员似乎低估了能力的变化和对日常生活的影响。社区服务关注短期，而患者和照顾者希望展望更远的未来——这种不一致加剧了焦虑。该研究关于服务碎片化的发现表明迫切需要在卫生服务内部以及卫生、社会护理和志愿部门之间更好地整合。一名从患者入院起就监督其整个康复过程的联系人/个案经理将有助于改善综合护理，并确保患者和照顾者处于服务提供的中心位置。
