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Developing a person-centred intervention to facilitate transition between rehabilitation, home and community participation after life-changing illness


School of Health Sciences

About the Project

Background
Complex conditions, such as stroke, head injury and other life-threatening conditions requiring intensive care admission often cause physical, communication, cognitive and psychological changes that have profound effect on wellbeing and functioning in daily life (1). However, co-ordination of transitions between hospital and community care services for people with these conditions is complex and multi-factorial. Hospital services prepare survivors for expedient and safe discharge home, with onward care from community rehabilitation and social services providing support for adjustment to living with disability. However, service pathways vary, and many people find transition to home difficult. Survivors report that they are poorly prepared before and after discharge for the physical and psychosocial adjustments necessary to enable them to return to social and community participation (2). Furthermore, survivors and their families report not being involved in decision-making, feeling abandoned, and having to navigate complex community care systems without support (3). Consequently, rates of unmet need, hospital readmission and family levels of care burden are high and adjusting to life with disability is challenging (4). Development of a person-centred approach to transitions that fits with multiple service delivery models is required to improve quality of life and adjustment required to promote recovery and support return to community participation.

Aims
1. To explore the experiences of transitions for people with complex disabling conditions within different service model configurations across health and social care pathways and seek their views on how transitions can be improved
2. To explore health and social care practice in transitions between services and seek their views on how these can be improved
3. With survivors, their families and other stakeholders, to co-design and explore the feasibility and acceptability of a new model to underpin person-centred transitions and return to community participation.

Methods
The project is likely to use mixed methods. The experiences of survivors and their families will be explored using qualitative methods. Health and social care practice will be explored using qualitative methods, but may also involve ethnographic observational methods and/or a survey. Qualitative and ethnographic data will be analysed using thematic analysis, survey data using relevant statistical methods. The intervention will be modelled using the MRC framework for complex intervention development or equivalent. The intervention will be evaluated in a small-scale pilot study to explore its feasibility, acceptability and potential effectiveness in improving transitions and supporting return to community participation. The output of the project will be an intervention ready for feasibility testing in a future project or post-doctoral fellowship study. The intervention will be co-designed with survivors, their families and relevant health and social care professionals and charitable organisations.

Impact
The project will produce a new approach for co-ordination of person-centred transitions that can be adopted by health and social care services across the UK for people with a range of complex life-changing conditions. The aim is to improve the quality of life of people with these conditions, to reduce unmet need and to facilitate adjustment to life with disability and return to community participation.

For informal enquiries about the project, contact Dr Jacqui Morris ()
For general enquiries about the University of Dundee, contact


QUALIFICATIONS
Applicants must have obtained, or expect to obtain, a first or 2.1 UK honours degree, or equivalent for degrees obtained outside the UK in a relevant discipline.

English language requirement: IELTS (Academic) score must be at least 6.5 (with not less than 5.5 in each of the four components). Other, equivalent qualifications will be accepted. Full details of the University’s English language requirements are available online: http://www.dundee.ac.uk/guides/english-language-requirements.


APPLICATION PROCESS

Step 1: Email Dr Jacqui Morris () to (1) send a copy of your CV and (2) discuss your potential application and any practicalities (e.g. suitable start date).

Step 2: After discussion with Dr Morris, formal applications can be made via UCAS Postgraduate. When applying, please follow the instructions below:

Apply for the Doctor of Philosophy (PhD) degree in Nursing and Health Sciences: https://digital.ucas.com/coursedisplay/courses/bb40be12-d003-4ca1-8834-ec9dccff7103. Select the start date and study mode (full-time/part-time) agreed with the lead supervisor.

In the ‘provider questions’ section of the application form:
- Write the project title and ‘FindAPhD.com’ in the ‘if your application is in response to an advertisement’ box;
- Write the lead supervisor’s name and give brief details of your previous contact with them in the ‘previous contact with the University of Dundee’ box.

In the ‘personal statement’ section of the application form, outline your suitability for the project selected.

Funding Notes

There is no funding attached to this project. The successful applicant will be expected to provide the funding for tuition fees and living expenses, via external sponsorship or self-funding.

In addition to self-funding, this project could be submitted to the Scottish Graduate School for Social Sciences or charitable organisations such as The Stroke Association or The Dunhill Trust for consideration. These organisations fund UK students. If a funding application to these bodies is under consideration, the applicant will receive support and guidance on the application process from the supervisory team.

References

1) Gustafsson L & Bootle K. Client and carer experience of transition home from inpatient stroke rehabilitation Disability & Rehabilitation, 2013; 35(16): 1380–1386

2) Lutz BJ, Young ME, Creasy KR, Martz C, Eisenbrandt L, Brunny JN, Cook C. Improving Stroke Caregiver Readiness for Transition From Inpatient Rehabilitation to Home. Gerontologist. 2017 Oct 1;57(5):880-889.

3) Wissel, J., Olver, J., & Sunnerhagen, K. S.(2013). Navigating the poststroke continuum of care. Journal of Stroke and Cerebrovascular Diseases, 22(1), 1–8.

4) McKevitt C1, Fudge N, Redfern J, Sheldenkar A, Crichton S, Rudd AR, Forster A, Young J, Nazareth I, Silver LE, Rothwell PM, Wolfe CD. Self-reported long-term needs after stroke. Stroke. 2011 May;42(5):1398-403.

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