Tijsen Lian M J, Derksen Els W C, Achterberg Wilco P, Buijck Bianca I
LUMC, Leiden University Medical Center, Department of Public Health and Primary Care, Postzone V0-P, Postbus 9600, 2300 RC Leiden, The Netherlands.
Oktober, 5531 LJ Bladel, The Netherlands.
J Clin Med. 2023 Feb 3;12(3):1231. doi: 10.3390/jcm12031231.
There is a trend towards the formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment on rehabilitation wards. So far, literature on the principles of the CRE is scarce. This study aims to explore the perspectives regarding the CRE of healthcare professionals through a qualitative study. Therefore, between 2018 and 2020, six international and 69 Dutch professionals were interviewed in focus groups, and 180 professionals attended workshops on two Dutch congresses. Data were thematically analyzed using ATLAS.ti. Seven themes emerged regarding the rehabilitation processes: (1) rehabilitant (attention for cognitive functioning and resilience); (2) goals (setting personal goals); (3) exercise (increasing exercise intensity); (4) daily schedule (following the daily rhythm); (5) involving the client system (involving informal caregivers); (6) nutrition (influences rehabilitation capability); and (7) technology (makes rehabilitation more safe and challenging). Regarding organizational aspects, four main themes were identified: (1) environmental aspects (encourages exercises); (2) staff aspects (interdisciplinary team); (3) organizational aspects (implementing CRE requires a shared vision); and (4) factors outside the ward (a well-prepared discharge process). To offer effective rehabilitation, all elements of the CRE should be applied. To improve the CRE, specific interventions need to be developed and implemented. Consequently, the effectiveness and efficiency of the CRE need to be measured with validated tools.
在具有挑战性的康复环境（CRE）中，老年康复患者的康复过程有形式化的趋势。这一概念涉及康复病房护理、支持和环境的全面组织。到目前为止，关于CRE原则的文献很少。本研究旨在通过定性研究探索医疗保健专业人员对CRE的看法。因此，在2018年至2020年期间，对6名国际专业人员和69名荷兰专业人员进行了焦点小组访谈，180名专业人员参加了两次荷兰大会的研讨会。使用ATLAS.ti对数据进行了主题分析。出现了七个关于康复过程的主题：（1）康复患者（关注认知功能和恢复力）；（2）目标（设定个人目标）；（3）锻炼（增加锻炼强度）；（4）日常安排（遵循日常节奏）；（5）涉及客户系统（让非正式护理人员参与）；（6）营养（影响康复能力）；（7）技术（使康复更安全且更具挑战性）。关于组织方面，确定了四个主要主题：（1）环境方面（鼓励锻炼）；（2）人员方面（跨学科团队）；（3）组织方面（实施CRE需要共同愿景）；（4）病房外因素（准备充分的出院流程）。为了提供有效的康复服务，应应用CRE的所有要素。为了改善CRE，需要制定和实施具体干预措施。因此，需要使用经过验证的工具来衡量CRE的有效性和效率。
