The purpose of this study was to implement and evaluate the adapted SBAR tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. Issues of patient safety and communication have been studied in the literature, but usually from the perspective of acute care and involving nurse-physician communication. This study contributes to the literature in patient safety by examining the influence that strong inter-professional team collaboration and communication can have on falls prevention and management in rehabilitation. These results suggest that the adapted SBAR process is an effective way to communicate urgent and non-urgent safety issues and has the potential to be widely used among inter-professional teams. Our next steps are to consider SBAR as one of our organizational best practices and as part of "how we do business". While SBAR has been adapted for use within our setting, it is one of a number of structured team communication tools. Our hope is that these learnings are transferable to other healthcare settings, settings that also recognize the importance (and challenges) of communicating in inter-professional teams.
We used falls incidence and near-miss reporting as well as severity of falls as proxy measures for safety. While near-miss and total major falls showed a decreasing trend, total falls on the study units increased. It does not seem that SBAR had a significant impact on these measures for a few reasons. First, the data may be trended across a time frame that is too short to determine accurate results and may therefore be inconclusive. Second, the nature of rehabilitation is to push patients to the limits of their abilities in order to maximize function. In this way, the risk of falls and other events are an inherent part of the rehabilitation process.
Most of the work examining healthcare communication and teamwork and associated strategies has focused on acute care settings and nurse-physician relationships (Storch 2005). There has been little focus within the rehabilitation literature on the use of structured communication tools for enhanced teamwork and patient safety. Rehabilitation offers a unique setting, differing from acute care in the types of clinical issues faced, team composition and interaction, the higher involvement of rehabilitation professionals and the greater involvement of patients and family members within a client-centred care model.
Effective communication and teamwork have been identified in the literature as key enablers of patient safety. The SBAR (Situation-Background-Assessment-Recommendation) process has proven to be an effective communication tool in acute care settings to structure high-urgency communications, particularly between physicians and nurses; however, little is known of its effectiveness in other settings. This study evaluated the effectiveness of an adapted SBAR tool for both urgent and non-urgent situations within a rehabilitation setting.
In phase 1 of this study, clinical staff, patient and family input was gathered in a focus-group format to help guide, validate and refine adaptations to the SBAR tool. In phase 2, the adapted SBAR was implemented in one interprofessional team; clinical and support staff participated in educational workshops with experiential learning to enhance their proficiency in using the SBAR process. Key champions reinforced its use within the team. In phase 3, evaluation of the effectiveness of the adapted SBAR tool focused on three main areas: staff perceptions of team communication and patient safety culture (as measured by the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture), patient satisfaction (as determined using the Client Perspectives on Rehabilitation Services questionnaire) and safety reporting (including incident and near-miss reporting).
Findings from this study suggest that staff found the use of the adapted SBAR tool helpful in both individual and team communications, which ultimately affected perceived changes in the safety culture of the study team. There was a positive but not significant impact on patient satisfaction, likely due to a ceiling effect. Improvements were also seen in safety reporting of incidents and near misses across the organization and within the study team.
Results from this study suggest that SBAR was widely and effectively used by inter-professional rehabilitation teams as part of a broader program of safety activities. In particular, we have seen compelling changes in staff perceptions of safety culture, as well as effective team processes and communication. Based on experiences with both our pilot and expanded studies, we offer the following recommendations to other organizations considering adopting structured communication tools:
For this purpose, there are many treatment centers that offer different rehabilitation programs for persons in need (Doweiko, 2012).These programs mainly include weekly individual counseling sessions, group session, and activities, utilize existing support services (12 step groups) and treatment planning goals designed in such a way, to program the patient and help him/her gain self-confidence to stand on their...
First of all it is necessary to look at the notion “prison rehabilitation” and understand its meaning. In my opinion we should look at roots of this problem and our analysis will describe this notion in a right way. This term has a barbaric origin and it was appeared many years ago in the medieval dungeon and torture chamber. Despite of these medieval traditions prisons have combined different elements of punishment with elements of rehabilitation and prisons have had dual character. People of that time understood the necessity of punishment with an aim to discipline the body but also to combine it with another element of punishment with an aim to discipline the mind or the “soul”. There were developed many programs of rehabilitation in prison from the medieval period. I want to pay our attention on the specific but widespread problem with drugs. The program of rehabilitation should include the strict row of concrete steps that intended in order that a person could break off to accept drugs and begin to live without drugs.
On this account every step of the program of drug rehabilitation must be executed exactly how it is fixed. All steps of the program are executed in the set sequence. In according to the previous words I want to add that every step is intended for the receipt of certain results and achievements. The prosecution of awareness of the errors and correction of them begin in the first days in prison. For example, first steps of work are based on the individual support. The developed program deserves the special attention on the rehabilitation of drug addicts.
Thus, taking into account all above mentioned we can conclude that there are many different programs of drug rehabilitation and all of them have own advantages and disadvantages. In my opinion the “New Life program” can help people in prison to destroy their old life with drugs and find new way of life. As a conclusion of this essay I want to say that rehabilitation in prison is very important and the correction of criminality does not depend on punishment, but straight depends on renewal for the criminal of self-esteem.
However, some patients admitted to the ICU also suffer from body deconditioning, neuropathy, myopathy, body weakness, increase length of ICU stay, prolonged ventilatory support, delayed weaning and prolonged pulmonary rehabilitation post-ICU (Schweickert & Hall, 2007)....
Thus, this paper will focus on the efficacy of home-based cardiac rehabilitation compared to center-based cardiac rehabilitation, and as a result, its potential aid in widening access and participation.
In order to be able to rehabilitate the client and set up obtainable goals and a treatment plan, the rehabilitation counselor must first understand ADA, the client’s functional limitations, challenges and obstacles they are facing, along with barriers that may pose a threat to the success of the client....