Bright Felicity A S, Kayes Nicola M, McPherson Kathryn M, Worrall Linda E
Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand.
Health Research Council, Auckland, New Zealand.
Int J Lang Commun Disord. 2018 Sep;53(5):981-994. doi: 10.1111/1460-6984.12409. Epub 2018 Jul 13.
Engagement is commonly considered important in stroke rehabilitation, with some arguing it is essential for positive patient outcomes. An emerging body of research indicates the practitioner influences engagement through their ways of relating, communicating and working with the patient. People experiencing communication disability may face particular challenges with engagement as a practitioner's communication and interactional patterns may limit their ability to engage.
To understand how rehabilitation practitioners worked to engage people experiencing communication disability throughout the course of rehabilitation.
METHODS & PROCEDURES: A qualitative study using the Voice Centred Relational Approach. Longitudinal observational and interview data were gathered from 28 practitioners and three people experiencing communication disability in inpatient and community stroke rehabilitation services. Data were analyzed using the Listening Guide.
OUTCOMES & RESULTS: Engagement was a relational practice on the part of the rehabilitation practitioner. It was underpinned by a relational philosophy and characterized by three core processes: embedding relational work throughout rehabilitation; getting to know the patient and working in ways valued by the patient; and communicating using relational dialogue and supported conversation. Practitioners wove these together with their technical, disciplinary-based work and rehabilitation tasks.
CONCLUSIONS & IMPLICATIONS: Patient engagement was constructed through relationships and strongly influenced by the practitioners' way of thinking about and enacting practice, challenging the idea that engagement is solely an intrinsic patient state and behaviour. The findings raise questions about which aspects of rehabilitation work and communication are most valuable when working to engage people experiencing communication disability. Viewing engagement as a relational practice and understanding the different ways this is enacted may support practitioners to reflect on their understandings of engagement, their patient's engagement, their ways of working, and the frames and philosophies that surround and influence their practice.
参与在中风康复中通常被认为很重要，有些人认为它对患者取得积极疗效至关重要。越来越多的研究表明，从业者通过他们与患者建立关系、沟通和合作的方式来影响患者的参与度。有沟通障碍的人在参与方面可能面临特殊挑战，因为从业者的沟通和互动模式可能会限制他们的参与能力。
了解康复从业者在整个康复过程中如何促使有沟通障碍的人参与进来。
采用以声音为中心的关系方法进行定性研究。从28名从业者以及住院和社区中风康复服务中的三名有沟通障碍的人那里收集了纵向观察和访谈数据。使用倾听指南对数据进行分析。
参与是康复从业者的一种关系实践。它以关系理念为基础，具有三个核心过程：在整个康复过程中融入关系工作；了解患者并以患者重视的方式开展工作；使用关系对话和支持性对话进行沟通。从业者将这些与他们基于专业技能和学科的工作以及康复任务结合在一起。
患者的参与是通过关系构建的，并受到从业者思考和实施实践方式的强烈影响，这挑战了参与仅仅是患者内在状态和行为的观点。研究结果引发了关于在促使有沟通障碍的人参与时，康复工作和沟通的哪些方面最有价值的问题。将参与视为一种关系实践并理解其实施的不同方式，可能有助于从业者反思他们对参与的理解、患者的参与情况、他们的工作方式以及围绕并影响其实践的框架和理念。
