Optimising person-centred care and rehabilitation experience for adults with spinal cord injury (SCI) through implementation of psychosocial guidelines in rehabilitation units – Phase 2.

This is a mixed methods study consisting of 3 stages. The intervention will be conducted in Stage 2, informed by Stage 1, and evaluated in Stage 3. In Stage 1, we will assess the context for implementation through surveying and interviewing a range of healthcare professionals in three SCI Units (Royal North Shore Hospital [RNSH], Prince of Wales Hospital [PoWH], and Royal Rehab [RR]) in NSW Australia. In Stage 2 we will integrate the 2023 version of the Psychosocial Guidelines that promote psychological adjustment, including guidelines for cognitive impairment, into the SCI Units in Sydney, NSW, Australia. The duration of the intervention will be guided by the findings from Stage 1. In Stage 3 we will monitor the efficacy of the implementation and translation process, evaluate facilitators and barriers to successful implementation of these guidelines, explore health care professionals’ perceptions towards the implementation of these guidelines, and explore the rehabilitation experience of people with a SCI. Stage 1 will be completed over approximately 6 months, with Stage 2 commencing directly after data collection has been completed. Stage 3 will commence directly after Stage 2 has been completed and will be conducted over approximately 6 months. Stage 2: Implementation Stage 2 consists of a multi-dimensional intervention that will be conducted over a period of 18 months (beginning mid-2024) and delivered by the multidisciplinary research team who have a background in psychology. The intervention will be delivered through a mixture of face-to-face and online strategies to groups of healthcare professionals, the content based on their discipline and the context of their workplace (i.e., RNSH, PoWH, RR). Sites may trial up to 3 interventions during the same time period. The interventions will all be based on the 2023 version of the Psychosocial Guidelines but may be tailored for different health disciplines within the SCI Units (e.g., nurses, physiotherapists, dieticians), taking into account specific contexts and unique challenges identified during the Stage 1 survey and focus group processes. A variety of “time sensitive” interventions will be trialled, such as education sessions designed for each discipline (e.g., regular team/discipline-based seminars, employee onboarding education sessions, discussions of team cultures), and training skills-based workshops designed to encourage the use of psychosocial skills in accord with the guidelines (e.g., master classes or basic level of training, audit and feedback, and active choice through prompts). Regular training sessions for Unit staff as well as training for new staff that embeds the psychosocial guidelines into practice will be needed. Further to this, interventions may include in-service training on psychosocial topics delivered on a regular basis, development of checklist of competencies for delivering person-centred care for people with SCI and providing feedback of the experience of people living with SCI at team meetings. The interventions will be designed to educate and familiarise all healthcare professionals working in the SCI Units about psychosocial care. The purpose is to optimise the implementation of the psychosocial guidelines into the practice of the SCI Units. The training materials provided to health care professionals will be based on the 2023 version of the Psychosocial Guidelines and will be designed specifically for this study incorporating feedback from the baseline qualitative and quantitative analysis of the healthcare professionals’ views on psychosocial care and the current practices in the SCI Units. The duration of the intervention will be guided by the findings from Stage 1. The anticipated frequency and duration of the education sessions and skills-based workshops is two 1-hour sessions at each site over a 6-month period. If we incorporate online education sessions, we anticipate one 10-minute module to be completed in the participants own time over the same 6-month period. The frequency and duration of these education sessions and workshops may vary and be tailored based on the qualitative and quantitative findings from Stage 1 (survey and focus groups). The strategies used to monitor adherence to the interventions will depend on the mode of intervention used. This is yet to be determined as we have not progressed to this stage of the study yet. However, session attendance checklists and an online feedback survey will be used for face-to-face sessions and website analytics to determine website usage will be used if online training is implemented along with an online feedback survey. The implementation program will involve only healthcare professionals. The interventions are intended to improve rehabilitation outcomes for future SCI patients who are receiving in-patient rehabilitation. The participants with SCI involved in this study may benefit from the outcomes of the intervention if they are still in-patients after the intervention has been implemented. The SCI participants interviewed in Stage 3 will be in-patients and potentially benefiting from the intervention as healthcare professionals will have received training in the delivery of person-centred health care during this period. However, it is likely that the SCI participants interviewed in Stage 1 will be discharged before the intervention is implemented. Although SCI out-patients will not participate in the study, future SCI out-patients may indirectly benefit from the intervention as result of improved knowledge and delivery of person-centred care within SCI units.