Benefits of Family Members in the Rehabilitation of Neurological Inpatients - Literature review Example

Benefits of family members in the rehabilitation of neurological inpatients Name Adnan Mazhar Alkilani Student ID 2144746 Course Independent Study Abstract The aim of the paper is to examine the existing literature on benefits of family members in the rehabilitation of neurological inpatients. The review focuses on neurological inpatients in Australia. Neurological illness is common in Australia and it is the third largest cause of death and disability among adults (Pollack & Disler, 2002: 153). Neurological illnesses usually affect the ability of the patients to carry out normal bodily functions such as walking or swallowing. The rehabilitation process is aimed at ensuring that inpatients are able to carry out these normal bodily functions and ideally return to previous neurological function. Neurological inpatients experience depression and other emotional issues such as feeling of neglect which often act as a deterrent to the rehabilitation process (Australian, 2005: 11). Family members play an integral role during the rehabilitation process, as they will provide the required background information about the inpatient. They also have the ability to provide the emotional support to the patient required during the rehabilitation process. They are generally committed and can be relied upon by the patients during the rehabilitation process (Australian, 2005: 11). The family members can encourage the patient to go through the rehabilitation process effectively. Bowen (2007:348) recommends family therapy techniques in the rehabilitation process. Training of the family members is also essential in order to make sure that they are able to enhance their ability and capacity to support neurological inpatients. Introduction Neurological illnesses include stroke, brain tumors, brain trauma, spinal cord disorders and cardiopulmonary complications of brain injury (Wilson, Bladin & Saling, 2007: 13). Rehabilitation of neurological inpatients is significant in ensuring that they are able to restore their normal body function (Khan, Pallant, Brand & Kilpatrick, 2008: 1230). This includes activities such as walking, eating swallowing and other neurological functions. Rehabilitation process requires a host of activities such as physiotherapy. Family members play a critical role in the rehabilitation of the inpatients. Neurological inpatients spend a lot of time with their families and they require support and care. Most neurological diseases have unpleasant manifestations. This includes depression, mood cognitive dysfunction, Huntington disease or dementia (Khan, Baguley & Cameron, 2003: 292). As a result, the support of the family is required to assist the inpatients during the rehabilitation process. Encouraging inpatients to go through rehabilitation process is essential as some of the processes may be quite difficult. Some of the physical activities such as psychotherapy and exercises may be required to be performed frequently. This may be difficult for the inpatients if they do not have adequate support from the people close to them such as their family members (Khan, Pallant, Brand & Kilpatrick, 2008: 1233). The participation of family members has a lot of benefits for the patients (Khan, Pallant, Brand & Kilpatrick, 2008: 1233). This paper is a review of literatue pertaining to the benefits of family participation in the rehabilitation of neurological inpatients. Background Information In Australia, the number of neurological inpatients has been on the increase over the years (Pollack & Disler, 2002: 444). Stroke is is the third highest cause of death and chronic disability among adults in Australia (Pollack & Disler, 2002: 444). Rehabilitation of people with neurological illnesses is a continuous process. Effective rehabilitation of neurological patients requires a coordinated approach. One of the major stakeholders required during the rehabilitation process is family members (Pollack & Disler, 2002: 446). Regular meetings with the other stakeholders have to be organized and coordinated in consultation with the family members. The role of the family members is paramount and they play an important role in enabling the patients deal with the consequences of the neurological illness (Pollack & Disler, 2002: 446). This includes depression and comorbidities, which are common among the neurological inpatients. Counseling on interpersonal relationships is required for the neurological inpatients. Support of the family members is required during the counseling sessions in order to provide encouragement to the inpatients (Australian, 2005: 11). The dependence of the inpatient is an important aspect that determines where the rehabilitation process should be carried out. The wish of the family members has to be respected during the rehabilitation process. In Australia, most of the inpatients with extended families usually prefer the involvement of the family members (Pollack & Disler, 2002: 446). Aim of the Review The aim of the review is to examine the existing literature on the neurological inpatients and identify the benefits of involving family members during the rehabilitation process in Australia. The second aim of the review is to identify the implications for practice which may arise from the findings. This may play an essential role in recommending future improvements in the rehabilitation of the neurological patient. Methodology and research design The literature review was based on the qualitative review articles. A comprehensive search for literature was carried out through the use of online databases. The databases that were used during the research included Google Scholar, CINAHL and PubMed. During the search, the keywords that were used were ‘neurological inpatients’, ‘Rehabilitation of neurological patients’, ‘neurological patients process.’ The literature review materials were only based in Australia. Only the secondary sources were used during the research. Secondary sources involve the use of existing materials during the research which includes journals (O’Donoghue & Punk, 2003: 18). An inclusion and exclusion criteria was used to select the most appropriate material for the literature review. All the articles that were more than 25 years old were excluded. Due to the limited number of materials that were published in the last five years, the materials published in the last 15 years were used. This indicates that there is a gap in the literature and more research is required. Search results Using the keywords described above, more than 100 articles were elicited. Most of the articles provided general information about rehabilitation of the neurological patients. Upon close scrutiny of the articles, 10 were selected as they provided useful information that was relevant to the topic. The scrutiny involved determining whether the articles had information relevant to the topic. Search details table Inclusion Criteria Exclusion Criteria Published between 2000-2015 Published prior to 2000 Article published in English only Published in other languages Primary research article Secondary sources Qualitative Quantitative/Mixed methods Relates to benefits of family members in rehabilitation of neurological inpatients in Australia Not relating to benefits of family members in rehabilitation of neurological inpatients in Australia Literature review Provision of emotional support In-patients with neurological diseases require specialized care during the rehabilitation process (Rebekah, et al, 2010). The family members of the patient or other caregivers can provide the needed support during care-giving (Wilson, Bladin & Saling, 2007: 15). However, most of the inpatients in Australia prefer being with the family members during the rehabilitation process (Pollack & Disler, 2002: 446). The family members usually provide the neurological patients with illness related care and emotional support. Managing the consequences of neurological illnesses such as depression and mood swing is one of the most important roles that the family members play (Bowen, 2007: 345). One of the main benefits of involving the family members during the rehabilitation process is that they are adequately prepared. This is beneficial to the patient during the rehabilitation process. The involvement of the family members usually lead to improved patient outcomes (Wilson, Bladin & Saling, 2007: 15). The duration of the therapy may be shortened with the involvement of the family members since the patients feel more encouraged to go through the rehabilitation process. During the rehabilitation process of the patients, there is usually a change in the mood as a result of depression (Graven, et al., 2011: 2). This takes place as the patient continues to recover. The changes can be attributed to the transition from chronic disability to sudden wellness. The support from the family members is therefore required in order to assist the patient with the transition process. The presence of the family members creates a sense of comfort among the patients and hence encouraging them to cope with their situations (Wilson, Bladin & Saling, 2007: 15). Neurological illnesses have direct impacts on the family members of the patient (Bowen, 2007: 344). The family may be faced with the challenge of increased responsibility and decreased intimacy. The increased level of mood swing is also a problem that may be witnessed by the patient. Dealing with such challenges requires the presence and support by the family members. According to clinicians, engaging the family members is crucial to the success of the rehabilitation process (Bowen, 2007: 344). The chronic brain injured patients with healthy family functioning have a higher chance of success during the rehabilitation process. The family members usually play a crucial role in supporting the patient on issues related to intimacy, positive reappraisal, communication and problem solving (Bowen, 2007: 345). The presence of intimate relationship with the neurological patients provides emotional support which has positive impacts on the rehabilitation process. The communication process may present a challenge during the rehabilitation process of neurological patients. The problem can be solved through involving the family members who are close to the patient (Bowen, 2007: 345). In most cases, the neurological patients with spouses usually feel more hopeful by the presence of the family members or spouses and hence impacting positively on the rehabilitation process (Bowen, 2007: 345). The rehabilitation of the neurological illness may be a difficult process for the patient. This is because their lives usually change completely after the illness. The family members are always present and ready to support the patients leading to positive outcomes. The family members are usually willing to support the patient every step of the rehabilitation process, which indicates that they are reliable. The family members play a prominent role in the care of their loved ones with neurological illnesses (Bowen, 2007: 348). The providers as well as other care givers who are not related to the patient usually find it difficult to meet the information and emotional needs of the patients. The family members usually play an important role in matching the communication and behavioural needs of the patient during the different stages of the rehabilitation process (Khan, Baguley & Cameron, 2003: 293). The family members are usually close to the patient and this makes it easy for them to interact with the patients and know their needs. The neurological patients require a lot of support during the rehabilitation process (Khan, Baguley & Cameron, 2003: 292). This is because their lives have completely changed. Lack of support and love may see the patients developing other conditions such as depression. The family members are better positioned to offer the patients love and support (Bowen, 2007: 348). This plays an important role in ensuring that the patients are able to accept their conditions and carry on with the rehabilitation process. The neurological patients in some instances may end up feeling lonely and they also require people they can trust. The patients can fully trust the family members which play an essential role in ensuring that the rehabilitation process is successful (Pollack & Disler, 2002: 446). Family members have the ability to act in the best interest of the patients. Family members can make inquiries on behalf of the patients during the rehabilitation process. They can also be involved in the decision making process during the rehabilitation process. Providing best fit relationship with the patient The confidence of the patients is usually enhanced with the presence of the family members (Pollack & Disler, 2002: 446). The family members are more reliable to the patients as compared to the other caregivers. The vulnerable nature of the neurological patients requires the patient to be confident about the process. The neurological patients usually value relationships during the rehabilitation process (Graven, et al., 2011: 2). It is easy for the patients to relate to the family members and hence improving on the rehabilitation process. A best fit relationship which is appreciated by the patients is usually developed with the family members. The family members usually have personal knowledge of the patient. Personal knowledge of the patients is important during the rehabilitation of the neurological patients as different activities have to be performed (Australian, 2005: 11). During the rehabilitation of the patient, the information about the likes and dislikes of the patient can be useful. The information can be used for motivating the patients and hence contributing to the success of the process. This is useful to the patients as they may be required to relearn some of the activities like walking and speaking (Pollack & Disler, 2002: 446). Having the family as part of the team is an added advantage to the patients as it enhances the rehabilitation process (Graven, et al., 2011: 6). The family is also able to obtain information that can be used to handle the patients once they have fully been discharged from the hospital. It is also important for the family members to fully understand what the patient is going through during the rehabilitation process so as to provide the required assistance. Improved communication with patient and stakeholders Neurologists consider the family as the primary support system for the rehabilitation of the neurological patients (Australian, 2005: 11). This is because of the critical role that the family plays during the rehabilitation process. The neurological patients rely completely on the family members during the rehabilitation process (Australian, 2005: 11). Inpatients are more likely to feel comfortable if the family members provide the required assistance, for instance, giving the right information about their medical history. Family members have the ability to identify the best way possible to motivate the patients (McNab, 2010: 59). Speech impairment is at times common among the neurological patients (Pollack & Disler, 2002: 446). The family members may be more helpful in interpreting the communication signs, as they know the patient better. During the rehabilitation process, the level of commitment among the family members is usually high. The patients usually require a high level of commitment during the rehabilitation process and the family members can best provide it. The commitment of the family members during the rehabilitation process usually makes a lot of difference to the lives of the neurological patient (Australian, 2005: 11). The neurological patients require motivation and positive attitude. This is because the depression is among the neurological patients and it may rob them the willingness to undergo the rehabilitation processes. It is for this reason that the support and involvement of the family members is important. Findings Neurological illnesses are a major problem in Australia. Neurological patients require rehabilitation in order to restore their bodily functions (Khan, Baguley & Cameron, 2003: 292). The rehabilitation process for inpatients requires a lot of activities and it may present difficulties to the patients if they do not have adequate support. Involvement of family members is beneficial to the patients during the rehabilitation process (New, 2008: 679). The family members are more committed to the process and are likely to be more involved in the motivation of the patient. The family members fully understand the neurological patients, which is useful during rehabilitation. The neurological patients face a lot of challenges in terms of managing their emotions. Constant mood swing is common and this requires the support of the family members to calm them down (Bowen, 2007: 345). The neurological patients are more comfortable being with the family members since they trust them. The level of confidence of the neurological patients is usually improved when the family members are involved. Depression is a major problem for the neurological patients and this may hinder their ability to go through the rehabilitation process (Khan, Baguley & Cameron, 2003: 292). Motivation, love and support can only be well provided by the family members and hence making it useful to involve the family members during the rehabilitation of the process. In Australia, Neurological diseases are the third leading cause of death. This indicates that a high number of people die as a result of the neurological diseases. Involvement of family is important in ensuring that the consequences of the disease are managed. Discussion The involvement of the family members in the rehabilitation of the neurological patients plays a vital role. The healthcare personnel have to consider the important role that the family members play in the rehabilitation of the neurological inpatients because the family members have first hand information and medical history of the inpatient (Bowen, 2007: 345). In Australia, the family members are considered as the primary support system for the neurological patients. Most of the facilities usually encourage the family members to be involved in the rehabilitation process. The nature of the neurological diseases usually creates a sense of unworthiness among the patients and this has negative impacts on the rehabilitation process. The rehabilitation of the neurological patients requires an environment that is comfortable to the patient. A friendly environment is important in ensuring that the patients are able to recover and deal with the consequences of neurological diseases (Australian, 2005: 7). The family has the potential of providing the patients with all the emotional support that they require. This is considering that the lives of the neurological patients usually experience drastic changes. The family members greatly contribute to the success of the rehabilitation process. The neurological patients who used to live on their own and had no immediate family members are likely to experience more challenges during the rehabilitation process. In Australia some of the elderly people who are vulnerable to neurological illnesses live on their own and do not have immediate family members. Caring for the neurological patients is a challenging experience and hence the need for the family members as they are usually fully committed to the processes (Australian, 2005: 11). Implications for practice and future research The neurological diseases usually put the life of the patient at a high risk of permanent disability and death. The rehabilitation process is critical in the treatment of the neurological patients. The outcome of the rehabilitation process may determine the ability of the patient to fully recover and restore the normal body function. The involvement of the family members should be a requirement during the rehabilitation of the neurological patient. The hospitals should encourage the close family members to be involved in the rehabilitation of the neurological patients. Facilities must be developed at the hospitals to accommodate the family members who are involved in the rehabilitation of the patients. This will play an essential role in ensuring that the family is fully involved in all the processes that are involved in the rehabilitation of the family members. The hospitals need to develop policies that will clearly identify the role of the family members during the treatment of the neurological patients. The family members play a crucial role in the rehabilitation of the patients and a program that educates them needs to be developed. Educating the family members on the role that they should play is useful in enhancing their levels of participation in the process. The family members in most cases are not trained on how to handle the patient (Australian, 2005: 11). Training is required in order to ensure that they are able to provide the neurological patients with all the assistance that they require. The importance of family support should not be underestimated, as it is useful in enabling the neurological patients deal with emotional challenges and consequences of the neurological problem. Limitations Most parts of the article provide generalized information. This limits the ability to obtain adequate information about the topic from the articles. The information available in the articles regarding the topic is quite limited. This means that more research about the topic is required in future so as to ensure information is available. The biases of the researchers as well as the conflict of interest have not been discussed in the articles. The sample size that has been used in the articles is too small. More research is required in future with a larger sample size being used so as to obtain more information. Recommendations and conclusion It is recommended that the family members should be encouraged to fully participate in the rehabilitation of the neurological patients. The family members who are involved in the rehabilitation of the neurological patients must be provided with education and training (Bowen, 2007: 347). It is recommended that the training should focus on aspects such as transfer of the patient. This involves moving the patient from the bed to the wheelchair. Most of the neurological patients usually have difficulties in movement and hence the importance of the training. It is also recommended that the family members should be taught how to carry out rehabilitation exercises (Bowen, 2007: 347). This will ensure that they are more involved in the rehabilitation process of the patient. The exercises are important in strengthening and stretching the weakened muscles. It is recommended that the family members should be provided with empowerment tips which may aid in the rehabilitation of the patient. The empowerment tips include communicating with the patient through the use of gentle inquiries. Swallowing is a problem among most of the neurological patients. It is recommended that the family members should be provided with information about food preparation as well as the type of food that they prepare for the patient. The family is a great resource during the rehabilitation of the neurological patients (Pollack & Disler, 2002: 456). It is recommended that policies should be developed to ensure the involvement of the family members in the rehabilitation of the neurological patients. The family members should also be prepared to deal with the negative consequences of the neurological illness. In conclusion, it is evident that the neurological illnesses usually take a heavy toll on the patient. The patients with neurological illnesses require a lot of support during the rehabilitation process as they cannot do any activity on their own. The lives of the neurological patients usually change completely and this makes them depend on others for all their daily activities. It is evident that the family members are able to provide the neurological patients with the emotional support as well as any other support that they require. It is evident that the neurological patients usually experience a lot of mood swing and emotional problems. The family members are in a better position to offer help to the patients, as they know them well. The patients have trust and confidence on the family members, which is beneficial during the rehabilitation process. The level of commitment by the family members is also high when dealing with the neurological patients. This is required, as a lot of activities have to be performed during the rehabilitation process. It is evident that the love and support provide by the family members has the potential of motivating the family members during the rehabilitation process. It is evident that the neurological patients in Australia require a lot of support as the illness requires a lot of attention from the family members. It is evident that most of the specialists are aware of the important role that the family members play in the rehabilitation of the neurological patients. Bibliography Australian, R., 2005. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry, 39(1-2). Bowen, C., 2007. Family therapy and neuro-rehabilitations: Forging a link. International Journal of therapy and Rehabilitation 14(8), pp. 344-349. Graven, C., et al., 2011. From rehabilitation to recovery: protocol for a randomized controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post stroke. BMC neurology, 11(1), p. 73. Khan, F., Baguley, I. J. & Cameron, I. D., 2003. 4: Rehabilitation after traumatic brain injury. Medical Journal of Australia, 178(6), pp 290-297. Khan, F., Pallant, J. F., Brand, C. & Kilpatrick, T. J., 2008. Effectiveness of rehabilitation in persons with multiple sclerosis: a randomized controlled trial. Journal of Neurology, Neurosurgery & Psychiatry, 79(11), pp. 1230-1235. McNab, E., 2010. Music therapy in progressive neurological disease: A neuropalliative rehabilitation perspective. Australian Journal of Music therapy, 21, pp 59. New, P.W., 2008. Survey of patients’ preference for the location of rehabilitation ward rounds. Journal of rehabilitation medicine, 40(8), pp. 678-680. O’Donoghue, T. & Punk, K. 2003. Qualitative educational research in action: Doing and reflecting. Routledge. Pollack, P. R. M., & Disler, B. P., 2002, Rehabilitation of Patients after Stroke. The medical Journal of Australia, 177(8), pp 452-456. Rebekah, M. A. et al. 2010. A new model for neurology care in the emergency department. The medical Journal of Australia, 192: 30–32. Wilson, S. J., Bladin, P. F. & Saling, M. M., 2007, The burden of normality: a framework for rehabilitation after epilepsy surgery. Epilepsia, 48 (s9), pp. 13-16. Read More