Efficacy Orientated Care Project

Description
Acquired Brain Injury (ABI) is a life-changing event that requires the active mobilisation of family and friends in support of the injured person. However in many cases, the long term hospitalisation and extensive inpatient rehabilitation required, may lead to social dislocation and relationship breakdown.
Exploring the perspectives of people with ABI and their family, the first phase of this study will applied a self-efficacy framework to investigate how to enhance the social capacity and efficacy of family and close relationships within and throughout hospitalisation.  In subsequent phases, findings were translated and contextualised within the rehabilitation unit (BIRU), through application workshops with key hospital staff

Rationale
The maintenance of social and familial support is vital to the psychosocial welfare and community integration of people with ABI. Improving these avenues of support will enhance long term outcomes for people with ABI.

Participants
Individuals with ABI and their family members

Inpatient rehabilitation staff

Key Features
This project formed part of an extended research programme in the PAH Brain Injury Unit around enhancing psychosocial and environmental supports for people with brain injuries

The aims of the study were:

• To identify factors which result in Efficacy Oriented Care around patients with brain injuries
• To select key factors which are within the sphere of influence of staff and family members in their current routines, and
• To implement these in the form of selected strategies for promoting efficacy and resilience around people with ABI in the hospital-rehabilitation continuum
• To identify qualitative differences in their described experiences, which may be reflective of outcomes from such an intervention

It was expected that Efficacy Oriented Care would build greater resilience in patients and family members and prevent the breakdown of social support

Funding
This project was funded under research grants from Griffith University and the Princess Alexandra Hospital Foundation

Research / Evaluation Strategies
Phase 1 - Semi-structured telephone interviews with ex-patients of BIRU and family members of ex-patients. 
Phase 2 - Multiple semi-structured staff focus groups to investigate staff perspectives on the building of resilience and self efficacy throughout hospitalisation. 
Phase 3 - Implementation  and / or evaluation of Efficacy Oriented Care strategies through staff and family member training in the PAH Brain Injury Rehabilitation Unit.  Follow-up semi structured telephone interviews with staff and family members

Outputs and Outcomes
Interviews with 6 people with ABI and 8 family members in Phase 1

In Phase 2, focus groups were conducted with over 20 staff including nurses, physiotherapists, social workers, psychologists and occupational therapists

The importance of engaging family members in rehabilitation was reinforced as was the importance of informational, emotional, practical and peer support

The need for health professionals to foster hope was a key finding

Phase 3 was modified to include provision of inservices presentations to staff due to significant context changes related to NPA Funding in BIRU that had addressed many identified aspects of care

Publications
Kuipers, P., Doig, E., Kendall, M., Turner, B., Mitchell, M., & Fleming, J. (2014). Hope: A further dimension for engaging family members of people with ABI. NeuroRehabilitation, 35, 475-480.



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