Study Rationale
The RT practice entails continued improvement of interventions including fitness programs to help improve care for developmentally and intellectually challenged people. This study draws from a research by Wilhite, Biren and Spencer (2012) that examines the impact of a fitness intervention on the disabled and their caregivers.
This study will examine the experiences of disabled adults and caregivers involved in the RT care within clinical settings. In medical practice, patient experiences of an intervention are crucial; they help improve care delivery through patient-focused care and enhanced communication. Often, documentation in RT practice entails a record of the patient’s leisure profile and a quarterly description of the patient’s past experiences in the RT program.
The quarterly description has six basic components that guide recreational therapists in providing care and are entered in the patient’s chart: (1) the goal of the treatment/intervention; (2) the intervention plan; (3) the RT practitioner’s views on the patient’s leisure profile; (4) the resident’s views; (5) the patient progress; and (6) future directions regarding the plan of care.
The outlined procedure fails to incorporate the findings of Wilhite et al., (2012) study and thus, may not portray an accurate picture of the patient’s actual experiences. Wilhite et al., (2012) establish that RT intervention participants derive such benefits as lower level of stress, improved muscle tone and decreased weight (p.257). Thus, for patients participating in a particular RT activity, their experiences should be incorporated in the intervention planning process.
This will help improve the quality of RT care for the disabled. Further, although most recreational therapists participate in routine rounding as other professionals, their perceptions regarding RT activities and leisure opportunities in residential care will help align RT practice to medical models. This will enable the RT practitioners to give patient care that not only focuses on recreational leisure but is also patient centered.
Purpose of the Study
The proposed study aims to provide a framework for intervention planning for adult disabled residents. It will identify appropriate RT activities and leisure opportunities in a geriatric care setting (Shank & Coyle, 2002). In this regard, this study has two objectives; first, to find out the perceptions and views of RT professionals about the current organization of RT activities; and second, to explore the participating patients’ experiences regarding RT benefits.
It is hoped that the findings will help develop a framework that reflects the patients’ experiences and is consistent with medical models of patient care. The findings will also enable RT practitioners to describe the leisure opportunities in professional terms and enhance their ability to provide holistic, patient-focused care through improved communication.
A statement of the problem
In healthcare, recreational therapy, which in the context of a care facility is the patients’ plan of care, is essential. It helps improve clinical practice by incorporating the views of caregivers and their patients into the care plan. Medical care plans also function as legal documents in case of a lawsuit, and therefore, should be prepared in all clinical settings (Navar, 1991).
Most care plans are based on measurable patient or nursing outcomes of a given clinical intervention. According to Shank and Coyle (2002), a “systematically organized and process-focused plan is an important basis for quality patient care” (p. 132). However, patient experiences are often not incorporated most care plans.
In RT practice, very few studies have examined the organization/planning of RT interventions. Navar (1991) states that, in clinical settings, patient-focused care is rooted in the RT concept.
However, often, RT practitioners offer limited patient-focused services because the RT frameworks employed are largely borrowed from the nursing profession. In the recreational therapy context, the RT activities, when expressed in measurable terms, help practitioners achieve the goals of the intervention. Also, by examining the current TR practices, practitioners will be able to provide quality patient care.
Literature Review
Modern nursing practice is generally grounded on the concept of human becoming (Shank & Coyle, 2002). The concept entails patient involvement in his or her care planning (Richeson, 2003). The same theory has been adapted in TR practice, whereby patients’ views and experiences inform practice.
Based on the human becoming philosophy RT practitioners can develop organized interventions that incorporate patients’ perceptions and experiences (Ross & Ashton-Shaeffer, 2003). Most providers have developed patient-focused care (PFC) models to guide the practice.
Spring (2007) writes that patient-focused care entails a system of “health that is defined by the individual and the goal in practice is enhancing quality of life as defined by the person rather than the health provider” (p. 617). In the TR context, the choice of PFC model affects both the organization of care delivery and perspectives within the RT field (Mikhail et al., 2005).
Most providers aim to develop an effective and efficient RT practice simplified documentation in a manner that reflects patient needs by simplifying the documentation process in a manner that reflects patient needs (Mikhail et al., 2005). It also entails a shift in the caregivers’ beliefs and values to promote interaction as a basic tenet of PFC model. This helps to strengthen nurse-patient relationships in the care settings.
It is important to note that, though the RT profession is largely patient-centered, evidence on how recreational therapy and leisure contribute to a more patient-focused care is limited (Whitman, Flynn & Fritz, 2003).
Nevertheless, research findings indicate that RT interventions reduce the level of stress, improve muscle tone, or decrease weight in patient participants (Wilhite et al., 2012, p. 257). Also, the practitioner-patient interactions during RT activities improve the practitioners’ understanding of the patients’ unique needs so that the care plan is organized to reflect the realities of the patients.
Clinical planning is a critical element of RT practice; however, the quality and consistency of organization often vary from one care facility to another (Shank & Coyle, 2002). Various previous studies focus on ways of improving the quality of RT interventions to achieve improved patient outcomes.
A study by Townsend, Cox and Li (2010), which involved interviewing of nurses, found that internal factors such as nurses’ perceptions, nursing or medical terminology and unclear theories prevent nurses from using developing nursing care plans for each patient.
Also, factors such as clinical charting requirements and organizational values also affect care planning (Carter, Van Andel & Robb, 2003). Studies also show that extrinsic factors such as lack of time, redundancy in charting and noise disruptions affect documentation and organization of RT activities. Thus, RT activities the disabled should be organized to reflect the dynamics of the RT field.
In addition, evidence-based practice in recreational therapy promotes the quality of services to patients (Donnelly, 2005). Richeson and McCullough (2002) state that relying on research evidence is essential in RT in three ways: (1) research evidence helps in the design, delivery and assessment of the RT program; (2) use of evidence promotes the achievement of desired patient outcomes; and (3) evidence ensures that the care services are quality and up-to-date. Also, evidence can help facilitate accreditation and accountability in the RT field (Buettner & Fitzsimmons, 2007). Besides evidence, practitioners should consider the client needs, health outcomes and the recreation activities, when developing an intervention program.
Therefore, it is imperative that RT professionals have relevant skills to help them to select interventions that will result in high patient outcomes (Kinney et al., 2004). Kinney et al., further state that the choice of the physical activities is essential in achieving positive treatment outcomes for a given RT program. Positive client outcomes indicate that the quality of service offered is high. Stumbo (2003) writes that positive patient outcomes are indications of the progress of the client, either mentally or physically, in the course of treatment.
To achieve this, measurable outcomes must be identified, documented and disseminated to other health care professionals. RT professionals treat a number of health problems such as neurological impairment, orthopedic problems and psychiatric illnesses. Thus, to enhance treatment efficacy, the choice of the right intervention is important.
Though there are a number of interventions used by RT professionals, the type of illness determines the type of RT intervention to be used. Shank and Coyle (2002) write that RT practitioners can use different interventions for physically handicapped clients. Examples of health interventions in the RT field include; physical activity, self-expression, creative expression, social interaction and educational activities (Shank & Coyle, 2002).
Mind activities include meditation, aromatherapy, yoga, sensory stimulation and humor. Other RT interventions for the physically disabled involve physical activities such as exercises, swimming and exercise (Cameron et al., 2005). On the other hand, creative interventions include activities such as music, visual arts, dancing and storytelling. Self-expression interventions include reminiscence, spiritual therapy and adventure.
A study conducted by Kinney, Kinney, and Witman, which involved a survey of 276 RT practitioners nationally established that the most common forms of interventions used by the respondents within the RT field include exercise, music, games, arts and activities of daily living (ADLs).
The practitioners employed a number of facilitation approaches including leisure counseling, stress management, group therapy and reminiscence (Kinney et al., 2004). This implies that it is through a combination of RT approaches and activities that the health outcomes of physically handicapped residents can be improved.
Hypothesis
This study hypothesizes that a multifaceted RT intervention focusing on physical activities and leisure has more benefits to the disabled residents than a single approach. Findings from previous studies indicate that the participants derive such benefits as lower level of stress, improved muscle tone, or decreased weight (Wilhite et al., 2012, p. 257).
More importantly, the participants learn to interact with people who might not be closely familiar to them (Wilhite et al., 2012, p. 260). Thus, a multifaceted, patient-focused intervention has the potential of significantly improving the clients’ health outcomes.
Research Questions
The analysis of various studies reveals that the organization of RT care or activities should involve various activities. RT care planning frameworks should be evidence-based and must provide for opportunities for leisure (Richeson & McCullough, 2002). To meet the study’s objectives, this study will involve the following research questions:
- How should RT professionals organize recreation activities for the disabled residents, while providing opportunities for leisure?
- How do the RT practitioners perceive recreation activities in residential care settings?
- Do recreational therapy activities achieve higher patient outcomes than standard practice?
Research Methodology
This study will use an action research approach to explore the patients’ experiences and RT practitioners’ perceptions regarding the RT activities and leisure opportunities for the disabled. The action research technique facilitates knowledge development as it allows the researcher to cooperate with the participants in the course of the research (Domholdt, 2005). Action research is used in studies involving human subjects and in real-life situations. It is cyclical and involves observation, brainstorming and self-reflection.
To determine the physical activities and leisure opportunities appropriate for the disabled residents, it is important that the participants and the RT practitioners are involved (Navar, 1991). In this study, the experiences of the patient and the perceptions of the practitioners will be used to develop a care plan for the disabled.
Thus, through this approach, the research will identify new activities and frameworks of health care delivery for disabled residents in a Geriatric Hospital. A total of 100 participants will be randomly selected from this residential facility. The sample participants will include patients and registered RT practitioners (certified RT practitioners).
Data Collection
In the proposed study, the main instruments that will be used in data collection will be questionnaires. The questionnaires will aim to identify the perceptions and attitudes of the participants in the RT practice (Domholdt, 2005). Email notifications will be randomly sent to potential participants.
Individuals will be included in the sample upon sending a confirmation email. The study will use two sets of questionnaires: (1) participant survey questionnaires; and (2) practitioner survey questionnaires. The core questions in the practitioner survey questionnaires will include:
- In your view, which RT activities improve the patient outcomes for the disabled?
- What leisure opportunities are available for the disabled in the care facility?
- Which set of activities (physical, spiritual and personality/self-esteem) improve the health outcomes of the participants?
- Does a multifaceted approach help achieve higher treatment outcomes than a single strategy?
- What advantages does intervention planning for disabled patients have over standard care?
On the other hand, the main questions in the patient questionnaire will include:
- Do the physical activities with RT help improve your health? (Does not help, slightly, to some extent, very helpful)
- What are your experiences regarding the RT intervention in this facility? (Less helpful, helpful, very helpful)
- How can you rate the RT intervention services in this facility? (Very poor, poor, good, very good)
- How can you rate the effectiveness of the intervention? (Not effective, moderately effective, effective and very effective)
This study will use the random sampling technique (Domholdt, 2005). Email notification will be sent to potential participants. Only disabled residents in the Geriatric Hospital will participate in this research. The participants, selected through the inclusion criteria mentioned above, will undergo a multifaceted intervention program conducted by certified RT professionals for a period of one month. Their views and the perceptions of the practitioners about the intervention will be collected using structured questionnaires.
Data analysis will involve a qualitative approach. The participants’ responses will be grouped into common themes (Domholdt, 2005). Sub-themes will be drawn from the major themes to further explain the client’s experiences of the RT intervention. The researcher will further analyze the sub-themes to identify the concerns and pressures related to RT practice in geriatric/special care settings.
Techniques for Recording and Reporting the Findings
The themes identified from the analysis of the participants’ responses will be compared with the patient-focused care (PFC) framework and the researcher’s notes. The RT activities identified will be recorded in the charts.
This will guide future intervention planning for the disabled in long-term care facilities. Also, the themes identified from the patients’ responses will be used to develop a patient-focused, evidence-based care model that is specific to the organization (Donnelly, 2005). The new RT model will be published in recreational therapy and medical journals.
Suggestions for the Future
The proposed research will only focus on the residents’ experiences regarding a multi-faceted RT intervention and the RT practitioners’ perceptions about the intervention. A framework for organizing or planning recreational activities and leisure will be developed from the findings of the study. Future studies should focus on evaluation techniques for the new framework. Peer review of the framework will enable the researchers to assess the quality of the research.
As Domholdt (2005) suggests, the participants should be involved in the evaluation of the new framework to ensure that the model reflects the actual experiences of the participants. This approach will also increase the RT practitioners’ ability to offer patient-focused care within the Geriatric Hospital setting. Incorporating the views and experiences of the disabled residents is a core element of the patient-focused care that guides recreational therapy practice in clinical care settings.
References
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