Journal of the Australasian Rehabilitation Nurses' Association

Power analysis is a common methodological process undertaken in quantitative health research. This process is central to the validity and overall quality of such research. Power analysis, however, can be unfamiliar to consumers of research, such as rehabilitation nurses, and interpreted as difficult to undertake by researchers leading to incorrect application or being omitted. Nonetheless, for researchers’ power analysis is crucial in determining whether a study has sufficient power to ensure a Type II error can be avoided (false negative). Type I errors are also a key consideration for clinical nurses as applying false positive study results to practice could have grave consequences. Ultimately, establishing a study’s power through power analysis is a systematic process needing consideration when designing a study and research consumers should keep these aspects in mind when appraising the research literature. This is the second paper in a two-part series with the overall aim to aid the understanding of methods used in health research by clinical nurses and beginner researchers. In this paper power and power analysis are explored.

Background Nurse coaching is a core clinical practice used by rehabilitation nurses to enable people recovering from life-changing illness and injury to adapt to living with disability. For rehabilitation nursing to become a recognised part of multidisciplinary care, the profession must identify and investigate person-centred practices such as coaching that enhance the enabling role of rehabilitation nursing.

Aim To review and synthesise the research literature on the nature and extent of rehabilitation nurse coaching as a nursing practice within the inpatient setting.

Design An integrative review was conducted. Research papers were identified by two reviewers against selection criteria using a systematic search strategy of the leading digital databases. Following the screening of research quality, extracted data was critically examined, grouped and summarised using inductive thematic processing. Findings were synthesised using abductive reasoning.

Findings Two inherent normative forms of nurse coaching contribute to rehabilitation care; generic and personalised nurse coaching. Nurse coaching is part of the rehabilitative milieu that nurses construct with consumers. Rehabilitation nurse coaching practice is influenced by system-based constraints and nursing’s position within the professional hierarchy.  Examples of evidence-based nurse coaching programs are emerging that improve care outcomes and enhance consumers’ and clinicians’ rehabilitation care experiences.

What is already known about this topic? Coaching is gaining recognition in healthcare as a valuable person-centred practice that aligns with the biopsychosocial philosophy of rehabilitation, emphasising patient empowerment and enablement.

What this paper adds This review identifies two distinct forms of inpatient rehabilitation nurse coaching, characterised by their generic or personalised approaches to care. Personalised nurse coaching is a relational form of rehabilitation that consumers prefer.

The implications of this paper Nurses should be equipped with a repertoire of evidence-based coaching skills that safeguard hope and foster self-determination, helping to empower people recovering from disabling illnesses or injuries to envision positive futures.

Aims To evaluate the acceptability, uptake and impact of a teach-back communication intervention for inpatient falls reduction on the rehabilitation wards of a large private, not-for-profit Australian health service.

Design Quasi-experimental mixed-methods design.

Methods Intervention ward clinical staff received education on teach-back communication and were surveyed pre- and post-training. Post-intervention staff focus groups, patient interviews, and a retrospective audit of administrative falls data were conducted. Falls rates per 1000 bed days were analysed using process-control charts. The study adhered to the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.

Results Before implementation, most staff expected teach-back to be effective and easy to use. These positive perceptions remained post-implementation, though staff reported increased workload and requested additional training. Documented use of teach-back in patient records was modest. Falls rates decreased but showed spikes coinciding with COVID outbreaks.

Conclusion Healthcare staff perceived teach-back communication to be a useable strategy. Documentation rates were low but improved with training.

Implications for patient care Teach-back communication for falls reduction can be implemented in inpatient rehabilitation settings with high levels of staff acceptability and measurable reductions to rates of patient falls on the wards. Teach-back positively impacted falls rates but did not mitigate spikes caused by disruptions to the ward environment. Robust implementation of teach-back communication strategies that are also nested within further multimodal strategies for falls reduction are required for consistency of falls reduction. Future research should explore implementational aspects of this technique to support consistent application of fall prevention for all inpatients.

Introduction Clothing protectors are often used during hospital care to maintain cleanliness during mealtimes. However, limited research exists on adults’ perceptions of this garment. The aim of this study was to explore if current care practices regarding mealtime clothing protectors align with person-centred values for fostering dignity and respect.

Methods This randomised intervention study of mealtime clothing protectors, a white terry towelling bib and a coloured and patterned dining scarf, was conducted in the Geriatric and Rehabilitation Unit of a tertiary hospital. Participants included ‘Wearers’ (people admitted to the hospital who used clothing protectors) and ‘Observers’ (hospital staff, health students, family and other admitted people at the dining table). Data were collected face-to-face through structured surveys with quantitative (Likert scale, multiple choice) and qualitative (open comments) responses. Non-parametric tests assessed quantitative responses, with thematic analysis of qualitative responses.

Results Participants rated the dining scarves more highly than bibs for dignity, appropriateness for adults, colour, and ability to hide stains. The scarf significantly differed from the white bib in its ability to hide stains across all groups. Qualitative analysis of clothing protectors identified five themes concerning: usability; respecting individuality; appearance; most important criteria; and suggestions for improvement.

Conclusion Results highlight the importance of addressing both practicality, and values aligning with person-centred care. Providing choice in clothing protectors during mealtimes in geriatric and rehabilitation dining rooms supports dignity and person-centred care.