Title: Multi dimensional care approach for managing complex rehabilitation needs of people with disabilities: A grounded theory study
Abstract:
Background: The growing elderly population, increasing prevalence of chronic diseases, and high incidence of injuries have led to a rising demand for rehabilitation nursing care. The challenges, gaps, and ambiguities in the provision of rehabilitation nursing care highlight the necessity of conducting qualitative research to gain a deeper understanding and develop effective strategies for improvement. This study aims to explore and define the process of rehabilitation nursing care in inpatient settings.
Methods: This qualitative study was conducted using the grounded theory methodology of Strauss and Corbin (2014). Participants included inpatient rehabilitation nurses as the primary group, along with a limited number of patients, family caregivers, and rehabilitation team members. Data collection involved 24 semi-structured in-depth interviews with 22 participants (including rehabilitation nurses, patients, caregivers and other rehabilitation team members) and six observation sessions using purposive sampling, followed by theoretical sampling until data saturation was achieved. Data collection and analysis were conducted simultaneously using the five-phase approach of Strauss and Corbin (2014).
Results: The data analysis in this study led to the emergence of 48 sub-categories and 11 main categories, collectively capturing various dimensions of the rehabilitation nursing care process. Guided by Corbin and Strauss’s (2014) approach, these categories were organized within the framework of context, process, and outcome. The study identified multiple contextual factors influencing rehabilitation nursing care, including environmental suitability, nurses’ professional competency, patient health complexities, and caregiver readiness. In response to these factors, rehabilitation nurses adopted multi-dimensional care strategies such as restorative patient care, caregiver empowerment, interdisciplinary team integration, and enhancement of patient self-management. These interventions contributed to improved rehabilitation outcomes, enhanced patient quality of life, and a reduced burden on caregivers. Moreover, the study revealed ambivalent consequences for nurses—while many experienced professional fulfillment, they also faced significant occupational strain arising from systemic challenges and high workload demands. Overall, the experiences of the rehabilitation team indicated that nurses deliver comprehensive, multi-dimensional care to meet the complex rehabilitation needs of patients with disabilities, which remains their central concern.
Conclusion: The findings provide insights into patient characteristics, nursing roles, environmental conditions required for effective rehabilitation care, interactions with caregivers and rehabilitation teams, and associated care outcomes. The findings of this study can guide rehabilitation nurses in both clinical and managerial fields by identifying key factors influencing care, helping to overcome barriers and enhance facilitators. Additionally, modifying nursing actions and interactions to achieve desirable outcomes while minimizing negative consequences can be valuable for administrators, researchers, and policymakers in shaping effective rehabilitation strategies.
Keywords: Rehabilitation nursing care, individuals with disabilities, comprehensive nursing care, inpatient rehabilitation
