title: Institutional contexts contribute to the low priority given to developing self-care independence in a rehabilitation ward: a qualitative study.
abstract: OBJECTIVE
  To examine the institutional contexts that contribute to the low priority given to the development of self-care independence in a rehabilitation ward.
  
  
  METHODS
  Research was guided by ethnographic principles of Martyn Hammersley and Paul Atkinson (2007). Individual in-depth interviews were completed. Participant observation was done daily during the rehabilitation stay of the patients.
  
  
  METHODS
  Six men and three women with neurological impairments and their caregivers.
  
  
  RESULTS
  Patients' daily routines on a rehabilitation ward in Taiwan are described. Four prominent themes emerged from the data: (1) the attitudes of patients, caregivers, and staff facilitated extended rehabilitation stays within the first year after disability, (2) attending therapy sessions was the most important activity, (3) pragmatic considerations, such as 'faster and easier', outweighed the value of developing self-care independence, and (4) strategic organization of daily routines to keep therapy the priority was critical for daily activity.
  
  
  CONCLUSIONS
  Multiple institutional factors jeopardize the development of self-care independence in a rehabilitation ward. The factors include the primacy of biomedical-oriented rehabilitation ideology, insurance reimbursement policies, and cultural values associated with family caregiving. They legitimize the low priority given to developing self-care independence. Therapists need to include a critical review of daily routines (what and how activities are carried out inside and outside of therapy clinics) as part of therapy regime to identify opportunities and institutional constraints to the development of self-care independence.
authors.affiliation: Department of Occupational Therapy, National Cheng-Kung University, College of Medicine, Tainan, Taiwan.
authors.forename: Ling-Hui
authors.initials: LH
authors.lastname: Chang
authors.forename: Jye
authors.initials: J
authors.lastname: Wang
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001930:Brain Injuries / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006292:Health Priorities; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D036301:Qualitative Research; D012648:Self Care; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D013624:Taiwan; D055815:Young Adult
keywords: Activities of daily living; qualitative study; rehabilitation