ABSTRACT

The processes by which working alliances develop in stroke rehabilitation are not well understood. The aim of this study was to explore the ways in which experienced allied health clinicians establish and maintain alliances with people with stroke-related communication impairment, and to identify factors that may influence the strength of these alliances. In-depth interviews were completed with 11 clinicians from the disciplines of occupational therapy, speech-language pathology and physiotherapy. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory. Participants described processes that were captured by the themes of enabling interaction, being responsive, building relational capital and building credibility. Practices that supported communication and emphasized responding, both within an interaction and over time, aligned with examples of strong alliances. Professional credibility and relational practices such as everyday conversations and the use of humour were viewed as important. Difficulty accessing a shared mode of communication due to stroke-related communication impairment altered relational processes and influenced perceptions of the alliance, although examples of strong alliances were present. In this study, reflections on challenging alliances highlighted potentially helpful practices. A responsive approach to rehabilitation, supported by reflective practice, may assist clinicians to better navigate their working alliances with this population.

摘要

工作联盟在中风康复中发展的过程尚不清楚。本研究的目的是探索经验丰富的联合健康临床医生与中风相关沟通障碍患者建立和维持联盟的方式，并确定可能影响这些联盟强度的因素。对来自职业治疗、语言病理学和物理治疗学科的 11 位临床医生进行了深入访谈。使用与建构主义扎根理论一致的策略对访谈记录进行编码和分析。参与者描述了由促进互动、响应、建立关系资本和建立可信度等主题捕获的过程。支持沟通并强调回应的做法，无论是在互动中还是随着时间的推移，都与强大联盟的例子保持一致。专业可信度和关系实践（例如日常对话和幽默的使用）被认为是重要的。尽管存在强大联盟的例子，但由于中风相关的沟通障碍而难以获得共享的沟通模式改变了关系过程并影响了对联盟的看法。在这项研究中，对具有挑战性的联盟的反思强调了可能有用的做法。由反思性实践支持的响应式康复方法可以帮助临床医生更好地应对与该人群的工作联盟。专业可信度和关系实践（例如日常对话和幽默的使用）被认为是重要的。尽管存在强大联盟的例子，但由于中风相关的沟通障碍而难以获得共享的沟通模式改变了关系过程并影响了对联盟的看法。在这项研究中，对具有挑战性的联盟的反思强调了可能有用的做法。由反思性实践支持的响应式康复方法可以帮助临床医生更好地应对与该人群的工作联盟。专业可信度和关系实践（例如日常对话和幽默的使用）被认为是重要的。尽管存在强大联盟的例子，但由于中风相关的沟通障碍而难以获得共享的沟通模式改变了关系过程并影响了对联盟的看法。在这项研究中，对具有挑战性的联盟的反思强调了可能有用的做法。由反思性实践支持的响应式康复方法可以帮助临床医生更好地应对与该人群的工作联盟。尽管存在强大联盟的例子。在这项研究中，对具有挑战性的联盟的反思强调了可能有用的做法。由反思性实践支持的响应式康复方法可以帮助临床医生更好地应对与该人群的工作联盟。尽管存在强大联盟的例子。在这项研究中，对具有挑战性的联盟的反思强调了可能有用的做法。由反思性实践支持的响应式康复方法可以帮助临床医生更好地应对与该人群的工作联盟。