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Reivonen S1, Cachia E1, Findlay N2, Bulley C1
1Queen Margaret University Edinburgh, Edinburgh, United Kingdom, 2City of Edinburgh Council, Edinburgh, United Kingdom
Background: People with long-term neurological conditions may experience difficulty altering their position and require 24-hour postural care (24hPC). This focuses on optimising a person's position to prevent secondary complications such as pain, pressure ulcers and contractures and promote comfort, function and participation. Despite the reliance of this intervention on carers there is limited research regarding their experiences of 24hPC, particularly in relation to adult service users.
Purpose: Recognition of the need for 24hPC in adults has led to development of the Lothian Postural Care/Management Steering Group in Scotland and associated Postural Management Link Workers Group (LWG). These groups aim to share good practice, facilitate and promote 24hPC. Group members facilitated this study, which aimed to investigate carers' experiences of the provision of 24hPC in Edinburgh, Scotland and explore implications for the development of a 24hPC service.
Methods: Ethical approval was granted to allow individual semi-structured interviews with six adults (18+y) who were: formal or informal carers of adults currently receiving 24hPC from the City of Edinburgh Council; and able to participate in an English-language interview. Members of the LWG provided study information to possible participants and those interested returned their information directly to the researchers using standardised forms. On receipt, the lead researcher arranged interviews in the service users' homes with two researchers present. Interviews were audio-recorded, transcribed verbatim andanalysed using Interpretative Phenomenological Analysis.
Results: Four formal carers and two informal carers participated with mean interview duration of 25 minutes. Analysis resulted in 11 themes and 12 subthemes. The first set of themes highlighted that several environmental and structural conditions are required to sustain successful and holistic 24hPC. The second set of themes elucidated the fluidity of aspects impacting 24hPC and its outcome, highlighting the requirement for a dynamic and collaborative approach to provision. The third theme set revealed the interconnectedness of the carer and service user and their symbiotic relationship within the context of 24hPC.
Conclusion(s): Explanatory theory resulted from analysis, which reveals a complex web of interdependencies within 24hPC and the context-dependency of its outcome. Carers impact and are impacted by 24hPC and therefore should be given a voice in service provision and planning. Based on these findings, future research should aim to better understand the complex societal and environmental factors involved in the provision and execution of 24hPC.
Implications: The results emphasise the value of a proactive 24hPC service that is dynamic and adapts to changes in the broader social and environmental context of the service user. In planning and developing 24hPC consideration must be given to the carer and their relationship with the service user. Importantly, the results bring forward the value of qualitative research designs in 24hPC and in physiotherapy more broadly, as they have the potential to reveal the contextuality and complex structures involved in physiotherapy interventions. These results support a shift in the paradigm of evidence-based practice that grants a wider significance to qualitative methods and involvement of carers.
Keywords: Postural management, carers, qualitative research
Funding acknowledgements: This project was unfunded.
Purpose: Recognition of the need for 24hPC in adults has led to development of the Lothian Postural Care/Management Steering Group in Scotland and associated Postural Management Link Workers Group (LWG). These groups aim to share good practice, facilitate and promote 24hPC. Group members facilitated this study, which aimed to investigate carers' experiences of the provision of 24hPC in Edinburgh, Scotland and explore implications for the development of a 24hPC service.
Methods: Ethical approval was granted to allow individual semi-structured interviews with six adults (18+y) who were: formal or informal carers of adults currently receiving 24hPC from the City of Edinburgh Council; and able to participate in an English-language interview. Members of the LWG provided study information to possible participants and those interested returned their information directly to the researchers using standardised forms. On receipt, the lead researcher arranged interviews in the service users' homes with two researchers present. Interviews were audio-recorded, transcribed verbatim andanalysed using Interpretative Phenomenological Analysis.
Results: Four formal carers and two informal carers participated with mean interview duration of 25 minutes. Analysis resulted in 11 themes and 12 subthemes. The first set of themes highlighted that several environmental and structural conditions are required to sustain successful and holistic 24hPC. The second set of themes elucidated the fluidity of aspects impacting 24hPC and its outcome, highlighting the requirement for a dynamic and collaborative approach to provision. The third theme set revealed the interconnectedness of the carer and service user and their symbiotic relationship within the context of 24hPC.
Conclusion(s): Explanatory theory resulted from analysis, which reveals a complex web of interdependencies within 24hPC and the context-dependency of its outcome. Carers impact and are impacted by 24hPC and therefore should be given a voice in service provision and planning. Based on these findings, future research should aim to better understand the complex societal and environmental factors involved in the provision and execution of 24hPC.
Implications: The results emphasise the value of a proactive 24hPC service that is dynamic and adapts to changes in the broader social and environmental context of the service user. In planning and developing 24hPC consideration must be given to the carer and their relationship with the service user. Importantly, the results bring forward the value of qualitative research designs in 24hPC and in physiotherapy more broadly, as they have the potential to reveal the contextuality and complex structures involved in physiotherapy interventions. These results support a shift in the paradigm of evidence-based practice that grants a wider significance to qualitative methods and involvement of carers.
Keywords: Postural management, carers, qualitative research
Funding acknowledgements: This project was unfunded.
Topic: Disability & rehabilitation; Service delivery/emerging roles; Research methodology & knowledge translation
Ethics approval required: Yes
Institution: Queen Margaret University & City of Edinburgh Council
Ethics committee: Queen Margaret University Divisional Ethics Committee, Cit of Edinburgh Council
Ethics number: Dissertation proposal, Research access questionnaire
All authors, affiliations and abstracts have been published as submitted.
