Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
BMJ Open. 2017 Dec 21;7(12):e018226. doi: 10.1136/bmjopen-2017-018226.
An enriched environment embedded in an acute stroke unit can increase activity levels of patients who had stroke, with changes sustained 6 months post-implementation. The objective of this study was to understand perceptions and experiences of nursing and allied health professionals involved in implementing an enriched environment in an acute stroke unit.
A descriptive qualitative approach.
An acute stroke unit in a regional Australian hospital.
We purposively recruited three allied health and seven nursing professionals involved in the delivery of the enriched environment. Face-to-face, semistructured interviews were conducted 8 weeks post-completion of the enriched environment study. One independent researcher completed all interviews. Voice-recorded interviews were transcribed verbatim and analysed by three researchers using a thematic approach to identify main themes.
Three themes were identified. First, staff perceived that 'the road to recovery had started' for patients. An enriched environment was described to shift the focus to recovery in the acute setting, which was experienced through increased patient activity, greater psychological well-being and empowering patients and families. Second, 'it takes a team' to successfully create an enriched environment. Integral to building the team were positive interdisciplinary team dynamics and education. The impact of the enriched environment on workload was diversely experienced by staff. Third, 'keeping it going' was perceived to be challenging. Staff reflected that changing work routines was difficult. Contextual factors such as a supportive physical environment and variety in individual enrichment opportunities were indicated to enhance implementation. Key to sustaining change was consistency in staff and use of change management strategies.
Investigating staff perceptions and experiences of an enrichment model in an acute stroke unit highlighted the need for effective teamwork. To facilitate staff in their new work practice, careful selection of change management strategies are critical to support clinical translation of an enriched environment.
ANZCTN12614000679684; Results.
在急性脑卒中病房中嵌入丰富环境可以提高脑卒中患者的活动水平，并且这种变化在实施后 6 个月仍然持续。本研究的目的是了解参与实施急性脑卒中病房丰富环境的护理和相关卫生专业人员的看法和经验。
描述性定性方法。
澳大利亚一家地区医院的急性脑卒中病房。
我们有目的地招募了 3 名相关卫生专业人员和 7 名护理专业人员，他们参与了丰富环境的实施。在完成丰富环境研究 8 周后，对他们进行了面对面的半结构化访谈。一名独立研究人员完成了所有访谈。录音访谈被逐字转录，并由 3 名研究人员使用主题分析方法进行分析，以确定主要主题。
确定了三个主题。首先，工作人员认为患者“已经开始康复之路”。丰富的环境被描述为将重点转移到急性环境中的康复，这通过增加患者的活动、提高心理幸福感和赋予患者和家属权力来实现。其次，“需要一个团队”才能成功创建丰富的环境。建立团队的关键是积极的跨学科团队动态和教育。丰富环境对工作人员工作负荷的影响因人而异。第三，“保持下去”被认为具有挑战性。工作人员反映，改变工作常规很困难。环境因素，如支持性的物理环境和个人丰富机会的多样性，被认为有助于实施。维持变革的关键是员工的一致性和使用变革管理策略。
调查急性脑卒中病房丰富模式的工作人员看法和经验，强调了有效团队合作的必要性。为了帮助工作人员适应新的工作实践，精心选择变革管理策略对于支持丰富环境的临床转化至关重要。
ANZCTN12614000679684；结果。
