title: Facilitating patients with disorders of consciousness to sit without trunk support: a qualitative study.
abstract: OBJECTIVE
  This study aimed to clarify why and how clinical nurses facilitate sitting without trunk support among patients with disorders of consciousness.
  
  
  BACKGROUND
  Recent attention has focused on encouraging patients with disorders of consciousness to sit without trunk support, but no reports describe this intervention among patients with poor awareness and physical disuse.
  
  
  METHODS
  Qualitative research design.
  
  
  METHODS
  We enrolled five clinical nurses with interventional experience in rehabilitating patients with disorders of consciousness to sit without trunk support. Participant observation and semi-structured interviews were used to collect data. The data were analysed by text-mining method.
  
  
  RESULTS
  Three reasons for nursing in the sitting position were identified: to raise the patient's body to assess the recovery of activities of daily living, to adjust their circadian rhythm and encourage the will to sit, and to make it easier to breathe. Five practices were identified: moving the patient to the prone position to sit in safety and comfort, developing postural stability by improving the flexibility of the lower limbs, improving the flexibility of the hip joints, developing trunk balance and encouraging hand use for stability, and ensuring safety by terminating the sitting practice when symptoms of respiratory failure, heart failure, or excessive tiredness developed.
  
  
  CONCLUSIONS
  The rationale for nursing patients with disorders of consciousness to sit without trunk support was to establish a foundation for independent living. This was achieved by preparing patient's disused body for activity by improving the flexibility of hip joint in the prone position. This represents a new intervention for patients with disorders of consciousness that could facilitate independent living.
  
  
  CONCLUSIONS
  This study provides empirical and practical evidence from nurses who perform novel clinical interventions that specifically promote independent living. Further accumulation of quantitative clinical results and physiological verification are required.
authors: Department of Nursing, Hokkaido University of Science, Sapporo, Hokkaido, Japan.
authors: Kumiko
authors: http://orcid.org/0000-0001-7165-7868
authors: K
authors: Miyata
authors: Department of Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan.
authors: Sadako
authors: S
authors: Yoshimura
authors: Department of Nursing, Hokkaido University of Science, Sapporo, Hokkaido, Japan.
authors: Yuko
authors: Y
authors: Hayashi
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003244:Consciousness Disorders / Q000451:nursing / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007564:Japan; D008875:Middle Aged; D009736:Nursing Process; D004856:Postural Balance; D016896:Treatment Outcome
keywords: Disorders of consciousness; nursing intervention; rehabilitation; sitting; text-mining approach