STUDY SETTING

The study was conducted at the Western Cape Rehabilitation Centre (WCRC). This centre came into existence in October 2004 when the old Conradie Hospital and Karl Bremer Centre for Care and Rehabilitation of the Disabled (CCRD) amalgamated and relocated to Lentegeur Hospital in Mitchell’s Plain. These two institutions had different approaches and methods of work. Conradie Hospital was a big institution with an intensive care section, acute care wards, rehabilitation wards and wards for admitting patients with secondary complications. This required a much bigger staff complement, which lead to a departmental structure. This structure as well as rotation of staff members through different areas made multi-disciplinary team work more feasible than interdisciplinary teamwork. In contrast CCRD was a small rehabilitation unit which only admitted patients for intensive rehabilitation, the staff complement was small and an interdisciplinary teamwork approach could be followed.

Since the amalgamation the teams have been striving towards implementing client managing methods that are in compliance with national policies like the National Rehabilitation Policy (Department of Health 2000), for example, by working within the social model of disability and following an interdisciplinary teamwork approach, where the patient and family are included in the decision-making process from the time of admission while simultaneously addressing societal barriers through multi- sectoral collaboration. This is a continuous process and while rehabilitation services offered at WCRC have made progress towards realising this objective they still have some way to go in the quest of a full realisation as discussed in Chapter 2.

Staff members are designated to one of three functional service units and not to discipline-specific departments. Each of these functional units services two 26-bed wards. An interdisciplinary teamwork approach should be followed in each of the functional units. Each team consists of the following professionals: medical doctor, physiotherapists, occupational therapists, social workers and nursing staff. Support staff includes administrative personnel, radiographers, pharmacists, wheelchair repair workshop staff, a clinical psychologist, dietician, auxiliary services workers, technical staff and volunteers. The three units share the services of two speech therapists.

There are three wards at WCRC that accommodate patients who have suffered a stroke (together with patients with other diagnoses, like amputations, head injuries and other neurological deficits). A further three wards are dedicated to patients who have suffered spinal cord injuries.

Each member of the interdisciplinary team should assess newly admitted patients within 48 hours after admission. The social worker establishes contact with the patient and family/significant others in order to determine and verify background information discuss future care plans as well as work through the loss/trauma experienced by the patient and the family (WCRC Strategic Planning Task Team 2007) The ward doctor should assess the patient on the day of admission and should spend time with the patient explaining the diagnosis, prognosis and medication. The doctor answers any questions that the patient or family may have. The family is encouraged to be present in order to include them on the team. The rest of the team should reinforce the information on stroke and explain the rehabilitation programme in order for the patient and family to develop insight into the rehabilitation process. The nursing staff should assess the patient on the day of admission and explain the functioning of the ward, the rehabilitation process, what the professional team expects of the patient and family and determine what the patient and family expect of the professional team (WCRC Strategic Planning Task Team 2007).

During the first consultation with the patient the therapists should find out what the patient’s goals and expectations are. After the assessment and at the first team meeting these are discussed and compared. These goals set by the patient; the outcome level on admission as well as the proposed rehabilitation outcome level on discharge and the proposed date of discharge are agreed upon by the professional

team and recorded (WCRC Strategic Planning Task Team 2007). Family conferences, which include the team members working with the patient, the family/caregiver and any significant others, may be held once, twice, or more often depending on the needs of the patient and family. The first family conference should take place as soon as the team has assessed the patient. It is arranged and chaired by the case co-coordinator. The aim of the family conference is for the family to meet the team working with the patient, to determine the family’s expectations of rehabilitation, to make them understand that they are part of the team and that all are working towards a common goal. It also provides an opportunity for the professional team to answer questions and clarify uncertainties experienced by the patient or the family (WCRC Strategic Planning Task Team 2006).

Every member in the team should have an opportunity to contribute and participate in the goal-setting process. Goals can be altered and changed depending on the progress of the patient. This is done through consultation by the team which includes the patient and family. It creates a positive working relationship between the rehabilitation team, the patient and the family (WCRC Strategic Planning Task Team 2006).

The case co-ordinator should maintain contact with the family and encourages the family to maintain contact and report any difficulties, fears or major progress experienced, for example, during weekend leave. Therapists should then attend to these issues. During regular team meetings/discussions the therapist should update the team on the patient’s progress. This information should then be relayed to the family by the case co-ordinator (WCRC Strategic Planning Task Team 2007).

The families should also be involved in family training sessions. They should be trained to physically care for the patient by the therapists and nursing staff before the patient can spend his/her first weekend at home. Weekend leave to the family home is encouraged as soon as the patient and the family are ready. After the weekend the patient and family may consult with the rehabilitation team or any member of the team if they are experiencing any difficulties. This is then assessed and attended to by the team (WCRC Strategic Planning Task Team 2006; WCRC Strategic Planning Task Team 2007). Home visits are arranged only when the team has determined this is necessary, (either from information gained from the patient or the family) to train the family within the home environment and to advise them on any adaptations or

changes in the home that will make the environment more accessible and safe for the patient (WCRC Strategic Planning Task Team 2006; WCRC Strategic Planning Task Team 2007).