“Have they got rehab potential?” – An ethnographic study exploring meaning and evaluations of rehabilitation potential for an older person following an acute admission

Bradley, Gemma (2018) “Have they got rehab potential?” – An ethnographic study exploring meaning and evaluations of rehabilitation potential for an older person following an acute admission. Doctoral thesis, Northumbria University.

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Abstract

Rehabilitation potential is the potential of an individual to benefit from interventions which aim to optimise and restore function after a period of ill-health or new onset of disability. Health professionals are frequently required to evaluate this potential to determine who may be most likely to benefit from the provision of ongoing rehabilitation services.

This doctoral study explored decision-making related to the assessment of rehabilitation potential of older people in hospital and the recommendation of rehabilitation pathways. To explore this in real-time, and in the shared patient and professional context in which decision-making occurred, principles of ethnographic and case-study research were utilised. The case study site was one acute medical ward within a local acute hospital in the North East of England. Three phases of fieldwork were undertaken, including a 2-week orientation and mapping phase, an 8 week period centred on the practice of occupational therapists and physiotherapists in relation to five patient cases, and finally a phase which involved five in-depth interviews with individual health professionals. Data was generated through observation, interviews and the review of clinical records. The whole data-set was analysed using thematic analysis.

Key findings highlight that rehabilitation in this context was understood as a process to facilitate physical improvements and associated with an organisational aim for optimum safety rather than optimum function. And, although idealised as a phase of care, rehabilitation was often linked to a specific place, with the evaluation of rehabilitation potential subsequently linked with a hospital transfer. Furthermore, rehabilitation potential was ambiguous and poorly explained to patients and families. Health professionals recognised that their evaluation of rehabilitation potential was linked to high-stakes decisions about access to, or withholding services, and therefore the
ethical dimensions of this decision had far-reaching influence. The involvement of the older person in judgements about rehabilitation potential and pathways was minimal, and there were many critical challenges to older people receiving fair and just access to services.

The research findings conclude that there are significant tensions between the context of acute hospital care and the philosophy and ideals of rehabilitation. Furthermore, findings can assist professionals to recognise and reconcile tensions in practice and to move towards reframing rehabilitation to place the individual needs of older people at the centre of service delivery.

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