Polytrauma Transitional Rehabilitation in the Veterans Administration: Implementing the Principles of Person-Centered, Participation-Oriented Rehabilitation.

OBJECTIVE: To review principles of person-centered, participation-oriented (PCPO) rehabilitation and introduce their implementation in Veterans Administration (VA) Polytrauma Transitional Rehabilitation Programs (PTRPs). BACKGROUND: Post-hospital rehabilitation for individuals with acquired brain injury (ABI) has evolved toward PCPO rehabilitation, an approach that makes participation goals identified by the person served and his or her significant others the primary focus of rehabilitation. Goals to reduce impairments and increase activities contribute to the achievement of primary participation goals. Research, primarily in the nonveteran population, confirms the effectiveness of PCPO rehabilitation. OVERVIEW: In the civilian sector, PCPO programs are generally provided locally or regionally in outpatient or community settings to individuals with moderate-severe ABI associated with other traumatic injuries and comorbidities. Because of the geographical dispersion of veterans, the VA provides these services in residential centers serving larger geographical areas. The group of veterans served more often has sustained milder traumatic ABI associated with neuropsychiatric comorbidities, particularly posttraumatic stress disorder and depression. Measuring progress and outcome is important to establish a feedback loop for process improvement. VA PTRPs use state-of-the-science standardized outcome measures and methods for identifying successful cases, that is, the minimal clinically important difference. Vocational reintegration is an important element of PCPO rehabilitation. Articles in this special section detail the development and effectiveness of PTRPs.

The Never-Ending Promise.

The editor-in-chief extends thanks to all contributors to this special focus on nursing leadership in home and community care. Thank you for leadership, thoughtful reflections and call to action. The possibilities for a different "person-centered", "people-powered" home and community-oriented health system can be realized with nursing at the helm.

La recuperación centrada en la persona y sus implicaciones en salud mental / Person-centered recovery and its implications in mental health

Una fuente importante de la confusión que rodea el uso del término recuperación deriva de la falta de claridad sobre las funciones respectivas de los profesionales de la atención a la salud y de las personas con problemas de salud mental. En este artículo se ofrecen dos definiciones para distinguir entre el proceso de recuperación y la provisión de atención orientada a la recuperación. La recuperación se refiere a las formas en que una persona maneja un problema de salud mental tratando de restaurar o desarrollar un sentido significativo de pertenencia y un sentido positivo de identidad independiente de este problema. La recuperación es un proceso de cambio mediante el cual los individuos mejoran su salud y bienestar, conducen sus vidas de forma autónoma y se esfuerzan por alcanzar su máximo potencial. La atención orientada a la recuperación es lo que los profesionales del tratamiento y rehabilitación en salud mental ofrecen para apoyar los esfuerzos de recuperación de la persona a largo plazo. La promoción del bienestar mediante el autocuidado y la intervención temprana, tanto mental como física, es un componente importante de la misma. La atención orientada a la recuperación requiere que las personas en recuperación se impliquen en todos los aspectos y fases del proceso de la atención. En este artículo se clarifica la terminología y se discuten algunas de las maneras en que la recuperación y la atención orientada a la recuperación se ven comúnmente desde las perspectivas de la política y de la práctica. Así, defendemos que la persona «en recuperación» ha de permanecer en el centro de todas las conceptualizaciones y debates, así como la necesidad de considerar la cultura en la configuración de cómo se ve la recuperación y se promueve en diferentes sociedades. Creemos necesario promover este enfoque con adaptaciones culturales e incluirlo en las escuelas de salud y en los programas de residencia. Así, los estudiantes y futuros profesionales de la salud conocerán el modelo y podrán decidir sobre su integración en la práctica diaria (AU)

One major source of confusion surrounding the use of the term recovery derives from a lack of clarity about the respective roles of health care practitioners and people with mental health problems. We offer two definitions of recovery in order to distinguish between the process of recovery and the provision of recovery-oriented care. Recovery refers to the ways in which a person manages a mental health condition trying to restore or develop a meaningful sense of belonging and a positive sense of identity apart from this condition. Recovery is a process of change through which individuals improve their health and wellness, conduct self-directed lives, and strive to reach their full potential. Recovery-oriented care is what mental health treatment and rehabilitation practitioners offer in support of the person’s own long-term recovery efforts. The promotion of wellness through self-care and early intervention, both mental and physical, is an important component of it. Recovery-oriented care requires that people in recovery be involved in all aspects and phases of the care delivery process. In this article we clarify the terminology and provide a discussion of some of the ways in which recovery and recovery-oriented practice are commonly viewed from the perspectives of policy and practice. In contrast, we argue for a paradigm shift in which the role of the person «in recovery» remains at the center of all conceptualizations and debates while considering the role of culture in shaping how recovery is viewed and best promoted in different societies. We propose to promote this approach with cultural adaptations and to include this model in health schools and residency programs. Students and future professionals of health will thus have information about this model and will be able to decide on its integration in their daily practice (AU)

El grupo y la recuperación / Group and recovery

En el presente trabajo se presentan las aportaciones realizadas por la atención grupal a los pacientes graves y su contribución a la comprensión de la complejidad de los procesos de recuperación. Para ello se señalan los intentos de confluencia de dos disciplinas históricamente separadas como la psicoterapia y la rehabilitación y se plantea que el campo de la recuperación puede servir como un espacio de integración de ambas. Asimismo, se describen resumidamente las tareas-guía del proceso de recuperación, subrayando su carácter relacional o vincular y cómo los enfoques terapéuticos grupales (no solo psicoterapéuticos) pueden potenciar dicho proceso. Teniendo en cuenta el contexto, se muestra que el proceso grupal es acorde con los principios-guía de la recuperación en cuanto al fomento de la autonomía y de una autoestima realista. Por último, se diferencian esquemática y didácticamente dos modos de intervención grupal útiles en una intervención rehabilitadora orientada hacia la recuperación (AU)

The aim of the present article is to discuss contributions made by group therapy for severely ill patients and its usefulness for understanding the complexity of recovery processes. To this end, we describe attempts made to achieve some sort of confluence between two historically separated disciplines, psychotherapy and rehabilitation, and we approach recovery as an area that can provide a framework for their integration. We summarize the tasks that guide the recovery process, emphasizing their binding or relational character and the fact that group therapeutic approaches (and not only psychotherapeutic ones) can enhance this process. Taking into account the context of the patient, group processes are in full agreement with the guiding principles of recovery, aiming at greater autonomy and a realistic self-esteem. Finally, we differentiate in a schematic and didactical way between two useful forms of group intervention in a recovery-oriented rehabilitation work (AU)

Contemporary Treatment Approaches to Major Depression and Bipolar Disorders.

Mood disorders have a high incidence of coexisting psychiatric, substance use, and physical disorders. When these disorders are unrecognized and left untreated, patients are likely to have a reduced life expectancy and experience impaired functional and psychosocial deficits and poor quality of life. Psychiatric nurses are poised to address the needs of these patients through various approaches. Although the ideal approach for mood disorders continues to be researched, there is a compilation of data showing that integrated models of treatment that reflect person-centered, strength, and recovery-based principles produce positive clinical outcomes.

A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial.

BACKGROUND: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. AIM: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. DESIGN: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument. SETTING/PARTICIPANTS: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. RESULTS: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. CONCLUSION: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.