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Rehabilitation medicine
Research
Qualitative investigation of the perceptions and experiences of nursing and allied health professionals involved in the implementation of an enriched environment in an Australian acute stroke unit
  1. Ingrid C M Rosbergen1,2,
  2. Sandra G Brauer1,
  3. Sarah Fitzhenry3,
  4. Rohan S Grimley4,
  5. Kathryn S Hayward1,5,6,7
  1. 1 Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
  2. 2 Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
  3. 3 Community Integrated Services and Subacute Services, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
  4. 4 Sunshine Coast Clinical School, The University of Queensland, Birtinya, Queensland, Australia
  5. 5 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
  6. 6 Stroke Rehabilitation and Brain Recovery, NHMRC Centre of Research Excellence, Melbourne, Australia
  7. 7 Department of Physical Therapy, University of British Columbia, Vancouver, Canada
  1. Correspondence to Ingrid C M Rosbergen; ingrid.rosbergen{at}health.qld.gov.au

Abstract

Objective 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.

Design A descriptive qualitative approach.

Setting An acute stroke unit in a regional Australian hospital.

Participants 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.

Results 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.

Conclusion 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.

Trial registration number ANZCTN12614000679684; Results.

  • enriched environment
  • stroke rehabilitation
  • qualitative research
  • environment design

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-018226

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    Footnotes

    • Contributors ICMR, RSG, SGB and KSH designed the study. SF conducted the semistructured interviews. ICMR, SF and KSH performed data analysis. All authors contributed to the manuscript and approved the manuscript.

    • Funding Wishlist, Sunshine Coast Health Foundation research grant and a Queensland Health, Health Practitioner research grant, supported this study. Wishlist, Sunshine Coast Health Foundation higher research degree scholarship, Sunshine Coast Hospital and Health Service (SCHHS) Scholarship, the Acute Stroke Unit and Allied Health Services, SCHHS, supported IR. The University of Queensland provided funding for the transcriptions. KH was supported by postdoctoral funding from the Michael Smith Foundation for Health Research British Columbia Canada (15980), and the National Health and Medical Research Council of Australia (1088449).

    • Disclaimer The views expressed in the publication are those of the authors.

    • Competing interests None declared.

    • Ethics approval Ethical approval was obtained from the Prince Charles Hospital and the University of Queensland ethics committees (HREC/14/QPCH/21 and MREC/2014000371).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Staff-level data are available from the corresponding author. Informed consent for data sharing was not obtained, but presented data are de-identified and the risk of identification is low.