Background There is increased interest in how hospices can improve patients’ independence whilst supporting them living with a life-limiting illness.
Aim To explore how a rehabilitative approach can be integrated into a 15-bedded hospice inpatient unit using participatory action research.
Methods Two volunteers, one non-clinical and five clinical members of staff participated in a co-operative inquiry group (CIG) whose aim was to bring about a change in hospice practice whilst reflecting on the activities undertaken and how it affected practice. Purposive sampling was used to ensure that nurses and therapists were represented in the CIG to reflect the potentially different perspectives to providing inpatient palliative care.
The CIG and a patient advisory group assessed whether a rehabilitative approach was suitable in this setting using data from the Integrated Palliative Outcome Scale (IPOS) and Minimum Data Set. The CIG then planned what action to take and after each period of activity, assessed the outcome before further action was planned and executed.
Data collection was concurrent, iterative, informed by the activity that took place and used to influence smaller changes as the study progressed. It was also retrospective and included: notes from ten CIG meetings (25 hours), field notes, research diary, organisation documents and data from 16 questionnaires. A thematic analysis approach was adopted.
Results Preliminary analysis showed that a group of staff and volunteers identifying, owning and acting collaboratively (Pascale & Sternin 2005) can successfully integrate a rehabilitative approach in to an inpatient setting. However: the terminology, rehabilitative palliative care (RPC), can be both a facilitator and barrier to change finding the balance between enabling and caring can be difficult.
RPC challenges traditional role boundaries between healthcare professionals.
Conclusions Conceptually, there is agreement that RPC is desirable but implementation can be challenging. A multidisciplinary team working collaboratively can mitigate and overcome resistance.
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