title: Opting in and opting out: a grounded theory of nursing's contribution to inpatient rehabilitation.
abstract: OBJECTIVE
  To develop a grounded theory of nursing's contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.
  
  
  METHODS
  Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.
  
  
  METHODS
  Five inpatient rehabilitation units in Australia.
  
  
  METHODS
  Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice.
  
  
  RESULTS
  The analysis revealed a situation whereby nurses made decisions about when to 'opt in' and when to 'opt out' of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about 'opting in' and 'opting out' were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, 'opting out' of addressing them. They did this not to make their working lives easier, but more manageable.
  
  
  CONCLUSIONS
  System-based problems impacted negatively on the nurses' ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.
authors.affiliation: Rehabilitation Nursing Research and Development Unit, Royal Rehabilitation Centre Sydney, Flinders University, Sydney, Australia. julie.pryor@royalrehab.com.au
authors.forename: Julie
authors.initials: J
authors.lastname: Pryor
authors.forename: Annette
authors.initials: A
authors.lastname: Walker
authors.forename: Beverly
authors.initials: B
authors.lastname: O'Connell
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
mesh_terms: D002055:Burnout, Professional; D006801:Humans; D007297:Inpatients; D007588:Job Satisfaction; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D019370:Observation; D019145:Rehabilitation Nursing