JCPSLP
Volume 16, Number 2 2014
51
in the literature (Eames et al., 2010; Leith et al., 2004;
O’Callaghan et al., 2011). In O’Callaghan et al.’s study
(2011), the majority of carers / family members reported
positive satisfaction with education during inpatient
rehabilitation, with 74.3% reporting receiving adequate
general information, and 72.6% reporting receiving
adequate information regarding the progress of their family
member.
In Leith et al.’s (2004) and Eames et al.’s (2010) studies,
a range of similar themes was identified; however, there
was diversity in the responses of consumers within each
study. Identified themes included information provision
and education regarding TBI/ABI (too much, not enough,
use of jargon, too general); education on external services
and availability (not enough); timing and presentation
of information (too early, too late, overwhelming);
client-centred factors (poor recall of information, poor
comprehension of information). Other factors impacting
the perspectives of consumers included the hospital
environment, with issues identified including staffing and
access (reduced staffing impacting availability for education,
changes in staffing impacting education provision,
difficulties accessing resources) (Leith et al., 2004; Eames
et al., 2010). The variations in consumers’ perspectives
regarding their education needs may reflect differences
between specific services (e.g., in staffing, availability of
resources, individual service provision of clinicians) as
well as individual differences of consumers within the
rehabilitation process.
Additionally, difficulties are seen in the uptake and
utilisation of educational information by families during this
time (Paterson, Kieloch & Gmiterek, 2001). Gan, Gargaro,
Brandy, Gerber and Boschen (2010) suggest that during
inpatient rehabilitation, families are dealing with major life
changes including the long-term challenge of having a
family member with ABI, which may impact their ability
to take in and utilise information. This may help explain
the differences reported between the education provided
by health professionals and families’ perceptions of
that education/information (regarding content, type and
amount of education provided) (Paterson et al., 2001). The
frequency and types of education delivered by BIRU SLPs
to consumers and how this compares with patient/family
perceptions reported in the literature is currently unknown.
SLPs’ service perceptions
While research increasingly investigates the perspectives and
experiences of consumers accessing ABI/TBI rehabilitation,
there is minimal published information relating to allied health
perceptions of service in sub-acute ABI/TBI rehabilitation. One
general community-based study investigated consumer and
allied health staff perspectives of health services in regional
Victoria (Rowan, 1998). Both groups identified similar issues
(including access, social issues, service delivery and local
context issues). However, consumer perspectives focused
mainly on outcomes and broader social issues, while staff
perspectives emphasised a service delivery context. There
has been no research to date examining whether staff
perspectives and consumer perspectives of BIRU SLP
services (e.g., in regards to education and involvement of
families in rehabilitation) are consistent.
Within the profession, researchers have investigated
the perceptions of SLPs regarding clinical services across
a range of disorders and service environments including
knowledge of TBI in paediatric SLP services (Hux, Walker
& Sanger, 1996); intervention practices for people with
patient dependent”, “often” and “everyday” was utilised.
The majority of services (62.5%, n = 5) provided therapy
interventions with “active involvement” of family members,
“sometimes – patient dependent” with only 37.5% (n = 3)
providing this “often”. No services reported working with
families as an “everyday” clinical activity. SLP services
reported that staffing impacted on overall service delivery,
with SLP staffing levels below Australasian Faculty of
Rehabilitation Medicine (AFRM) guidelines (2011) in 87.5%
(n = 7) of services surveyed.
Issues specific to the population and nature of BIRU
services further impact upon family involvement with SLPs
(e.g., for education or to participate in interventions),
including families’ ability to attend the service and the
availability of staff. BIRU services are based in metropolitan
areas and cater to a large geographical region (e.g., a state-
wide service). As the prevalence rate for ABI in Australia
is higher for people living outside major cities (2.2%) than
for those living in major cities (1.6%; O’Rance & Fortune,
2007), many patients attending BIRU are from a different
geographical area, impacting the ability of families to attend
the hospital throughout the rehabilitation period. In addition,
given that the “typical” TBI population is young (under 30)
and male (Katz, Zasler & Zafonte, 2007), their families and
partners tend to be of working age / in the workforce and
may have difficulties attending the hospital within working
hours. Families have identified difficulties accessing allied
health staff in BIRU during working hours as a barrier
(Fleming et al., 2012).
Education provision in inpatient ABI/TBI
rehabilitation
Uncertainty regarding the future is a key concern reported
by people with TBI and their families (Lefebvre, Pelchat,
Swaine, Gelinas & Levert, 2005). Overall, families of patients
in BIRU want more education, particularly regarding injury,
disability, realistic status, prognosis and treatment (Fleming
et al., 2012; Lefebvre et al., 2005; Rotondi, Sinkule, Balzer,
Harris & Moldovan, 2007), and knowledge on how to
access information, education and other services (Leith,
Phillips & Sample, 2004).
Providing education during inpatient rehabilitation should
also assist in addressing other needs reported by clients
and families with ABI/TBI. It should empower patients and
families, assist in adjustment to changes following injury,
provide support during the rehabilitation process and
help aid upcoming transitions home (Cott, 2004; Eames,
Hoffmann, Worrall & Read, 2010; Fleming et al., 2012;
Lefebvre et al., 2005; Rotondi et al., 2007).
Education can also impact patient functioning and lead to
better health outcomes. In a preliminary study investigating
individualised patient education during TBI rehabilitation,
positive changes were demonstrated in patient effort,
cognitive function and patient satisfaction (Pegg, Auerback,
Seel, Buenaver, Kiesler & Plybon, 2005).
The perspectives of people with ABI/TBI and their family
members/caregivers regarding their education and support
needs during inpatient rehabilitation have been investigated,
utilising a range of processes including semi-structured
interviews (Eames et al., 2010; Rotondi et al., 2007), focus
groups (Leith et al., 2004) and surveys (O’Callaghan,
McAllister & Wilson, 2011).
Consumers’ views regarding education and information
provision by health professionals during sub-acute ABI/
TBI rehabilitation varies widely, with both high and low
levels of satisfaction and education provision reported
Anna Copley
(top) and Emma
Finch
