Paper
Thursday, 20 July 2006
This presentation is part of : Research Theoretical and Methodological Strategies
Learning Readiness Trajectories of Rehabilitation Patients: A Qualitative Study
Barbara J. Olinzock, RN, EdD, School of Nursing, University of North Florida, Jacksonville, FL, USA
Learning Objective #1: Discuss the significance of the Rehabilitation Learning Readiness Model as a research-based methodology for examining learning readiness trajectories of rehabilitation patients.
Learning Objective #2: Describe the relationship between learning readiness trajectories of rehabilitation patients and nurse teaching roles.
Preparing rehabilitation patients to be self-directed for reintegration into their communities is a major nursing outcome. With shorter lengths of stay (LOS), patient teaching now occurs within a compressed amount of time. How LOS relates to the readiness of patients to learn and direct complex self-care regimens is not known. Using qualitative methods, a retrospective study of narrative nursing progress notes recorded during the late 1990s was conducted to collect data about the teaching-learning relationship between rehabilitation patients and nurses during an era of declining LOS. The purpose of this research was to examine teaching-learning challenges as documented by nurses in progress notes over the course of rehabilitation. Thirty cases of patients with traumatic spinal cord injury representative of varying time in rehabilitation, age and severity of injury were purposively selected for this research study. Data were gathered and transcribed documenting evidence of patient responses to the teaching of nurses about self-care management and self-direction of care. In preliminary data analysis, a Rehabilitation Learning Readiness Model (RLRM) consisting of five stages of learning readiness (Dependent, Involvement, Engagement, Self-Initiation and Self-Direction) and five corresponding teaching roles (Authority, Guide, Motivator, Mentor and Consultant) was developed based on adult learning principles and models. Further detailed analysis of data using the RLRM was conducted to examine the teaching-learning challenges of patients and nurses from the perspective of time. To control for variations in LOS among cases, each patient LOS was subdivided into four equal time periods (quartiles). By doing so, learning readiness trajectories could be analyzed for a given case or compared among cases. Findings suggest a highly dynamic and unique relationship between learning readiness trajectories of patients and the teaching roles of nurses. The RLRM is proposed as a valuable methodology for qualitatively depicting learning readiness trajectories from the perspective of time.   

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