Incongruence between nurses' and patients' understandings and expectations of rehabilitation

Aims and objectives. To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation.
Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation.
Design. Qualitative.
Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice.
Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect.
Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation.

Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.

Offender rehabilitation : a normative framework for forensic psychologists

Community protection from offenders is addressed through punishment, deterrence, incapacitation, and/or rehabilitation. The current public policy debate about community protection refers to community rights as opposed to offender rights as if the two are mutually exclusive. However, in this article it will be argued that offender rehabilitation can enhance community protection if it addresses community rights and offender rights. The author proposes a normative framework to guide forensic psychologists in offender rehabilitation. The normative framework considers psychological theory—the risk-need model to address community rights and the good lives model to address offender rights. However, forensic psychologists operate within the context of the criminal justice system and so legal theory will also be considered. Therapeutic jurisprudence can balance community rights and offender rights within a human rights perspective. The proposed normative framework guides forensic psychologists in the assessment of risk, the treatment of need, and the management of readiness in balancing community rights and offender rights. Within a human rights perspective, forensic psychologists have a duty to provide offenders with the opportunity to make autonomous decisions about whether to accept or reject rehabilitation.

Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs

Objective: The objectives of this study were to: (i) identify local barriers and enablers to the uptake of hospital-based cardiac rehabilitation (CR) programs, and (ii) identify preferred alternatives for the delivery of CR.

Design: A questionnaire administered by local CR coordinators and focus groups facilitated by the research team.

Setting: Six regional hospitals in south-west Victoria offering hospital-based CR programs.

Participants: Patients and their carers referred to and eligible for local CR programs; health professionals working within local CR programs.

Main outcomes measures: CR attendees and decliners demographics, patient and health professional perceived factors which contribute to enabling hospital-based CR attendance, patient and health professional perceived barriers to CR attendance, and receptiveness and preferences for alternative modes of CR delivery.

Results: This study identified distance to travel to hospital-based CR programs the only statistically significant factor in determining uptake of CR. Easy access to transport (63%) and to a lesser extent family support (49%) and work flexibility (43%) were the primary enablers to attendance. Of the 97 study participants, 38% were receptive to alternative CR methods such as programs in outlying communities, evening facility-based programs, home and GP based programs, telephone support and a patient manual/workbook.

Conclusions: The results of this study provide valuable information for designing strategies to increase utilisation and improve patient acceptability of existing hospital-based CR programs. It provides a basis for pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.

The process of change in offender rehabilitation programmes

Whilst the overall effectiveness of offender rehabilitation programmes in reducing recidivism is now well established, there has been less discussion of the reasons why rehabilitation programmes may be unsuccessful for some offenders. In this paper we suggest that models of change developed in counselling and psychotherapy may have utility in explaining how offender rehabilitation programmes bring about change, and argue that the dominance of cognitive-behavioural treatments in the rehabilitation field means that those offenders who have particularly low levels of problem awareness may be at increased risk of treatment failure. Understanding more about the mechanisms by which programmes help offenders to desist from offending is likely to lead to the development of more responsive and, ultimately, more effective programmes. Some suggestions for those involved in the delivery of offender rehabilitation programmes include: being mindful of the sequence of components of programmes, the development of preparation (or readiness) programmes and offering a broad suite of programmes to cater for different stages of problem awareness and assimilation among offenders.

Offender rehabilitation down under

In this paper we offer an overview of reintegration policies in both Australia and New Zealand. We describe the rehabilitative practices of both countries, and their basis in the Risk—Needs—Responsivity model of offender rehabilitation, before outlining the recently developed Good Lives Model of offender rehabilitation. Our conclusion is that the model has much to offer the future development of reintegration programmes in Australasia (and elsewhere), given its ability to conceptualise the change process, and accommodate those cultural and contextual factors that are so important to the correctional population in these countries.

Assessing suitability for offender rehabilitation : development and validation of the treatment readiness questionnaire

Although the need to assess appropriate candidates for offender rehabilitation programs is widely acknowledged, few assessment tools are available that have been validated for use with offender populations. This article reports on the development and validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to a cognitive skills program. The measure, the Corrections Victoria Treatment Readiness Questionnaire, displayed acceptable levels of convergent and discriminant validity, and was able to predict treatment engagement and treatment performance at the midpoint of the program. Suggested cutoff points are reported for use in assessing offenders for this type of program. It is concluded that the measure can play a valuable role in the assessment of offenders who are being considered for rehabilitative treatment.

Outpatient cardiac rehabilitation attendance in England

Abstract
PURPOSE:
Cardiac rehabilitation is an effective but underprovided treatment for patients recovering from acute cardiac events. The geographical spread of provision has not been investigated recently in any country. This study aimed to investigate the level of participation in cardiac rehabilitation programs of patients following myocardial infarction or revascularization (eligible patients) and the geographical equity of attendance.
METHODS:
Questionnaire data were collected from all cardiac rehabilitation centers in England for the year 2003/2004. The number of patients attending rehabilitation was compared with eligible patients across the 9 Government Office Regions of England as indicated by Hospital Episode Statistics.
RESULTS:
Nationally, 29% of eligible patients attended rehabilitation, while within various regions, the proportion of eligible patients participating in rehabilitation ranged between 14% (95% CI, 13.2-14.3) and 37% (95% CI, 36.6-37.6). Participation also differed significantly by primary cardiac event: myocardial infarction, 25%; percutaneous coronary intervention, 24%; and coronary artery bypass surgery, 66% (P < .001).
CONCLUSION:
The participation rate of eligible patients in cardiac rehabilitation was low in all regions. There were large differences between regions with widely varying incidence of attendance in different parts of the country.

Factors affecting the offer of pulmonary rehabilitation to patients with chronic obstructive pulmonary disease by primary care professionals : a qualitative study

Aim: To explore health professionals’ experiences of barriers and facilitators to referring patients for pulmonary rehabilitation in a primary care setting.

Background: Pulmonary rehabilitation involves a multidisciplinary teamwork approach to improving
the quality of life for people with chronic obstructive pulmonary disease. This study aimed to find out about health care professionals’ experiences when referring patients. Reports suggest that a health care professional’s attitude towards a treatment affects the willingness of patients to accept advice.

Methods: Five focus group interviews were undertaken with 21 health professionals from North Midlands, UK. Data were analysed using a thematic analysis drawing on the techniques of grounded theory.

Findings: Chronic disease management has been delegated to Practice Nurses in many cases leaving some nurses feeling unsupported and some General Practitioners feeling deskilled. Problems with communication, a lack of adequate and timely local service provision, a difficult referral process, time pressures and lack of information were barriers to health care professionals making an offer of pulmonary rehabilitation. An explanatory model is proposed to describe how addressing barriers to referral may improve health care professionals views about pulmonary rehabilitation and therefore may mean that they present it in a more positive manner.

Improving the uptake of pulmonary rehabilitation in patients with COPD : qualitative study of experiences and attitudes

Background
Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim
To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study
Qualitative interviews with patients.

Setting
Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method
In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results
Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion
A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.

Problem assimilation and offender rehabilitation

Whilst the overall effectiveness of offender rehabilitation programs in reducing recidivism is now well established, there has been less discussion of the reasons why rehabilitation programs may be unsuccessful for some offenders. In this paper we suggest that the Assimilation model of change (Stiles et al., 1991) may have utility in explaining how offender rehabilitation programs bring about change, and argue that those offenders who have particularly low levels of problem awareness may be at increased risk of treatment failure. Methods of measuring problem awareness and treatment readiness are discussed along with possible methods of intervention, including the Pennebaker method.

Offender emotion and self-regulation : implications for offender rehabilitation programming

Despite a growing body of evidence pointing to the central role of negative emotional states in the offence process, there has been relatively little work, either theoretical or applied, investigating this area. This paper offers a review of the literature that has sought to investigate the association between negative emotion and offending. It is concluded that there are grounds to consider negative emotional states as important dynamic risk factors that should be addressed as part of any psychological intervention to reduce the risk of re-offending amongst forensic clients.

Promoting forgiveness in violent offenders: A more positive approach to offender rehabilitation?

In this paper we suggest that the effectiveness of many offender rehabilitation programs may be further enhanced by the inclusion of interventions that build on existing motivation to change. Taking the example of anger management interventions delivered within the context of violent offender rehabilitation, we propose that the emphasis on positive personal change implicit in therapies designed to promote forgiveness may hold some promise. Such therapies may be useful in so far as they facilitate the development of perspective-taking skills, and assist in the therapeutic management of shame and guilt in ways that are likely to be engaging for violent offenders.