This chapter reports on a qualitative research project which explored patients’ experiences of counselling and which provided the impetus for changes to be incorporated in the rehabilitation and health care provided at a spinal cord rehabilitation unit in Auckland, New Zealand. Navigating different landscapes of meaning, philosophies, ideas and practices from approaches such as the relationship-centred model and narrative medicine developed into a collaborative meaning-making partnership between the patient team and the multidisciplinary team that further shaped practices of doing reasonable hope together.
TopBackground
The Spinal Unit offers services to in-patients and outpatients. The medical multi-disciplinary team consists of doctors, nurses, physiotherapists, occupational therapists, dieticians, nutritionists, pharmacists, social workers and counsellors. Patients are admitted to the Spinal Unit once they are medically stable and ready for active rehabilitation, usually about four to eight weeks after they were injured, depending on the waiting list at the unit.
The Spinal Unit aims to work in a partnership relationship with patients. This partnership relationship was informed and co-constructed by the findings from the research study and patient feed-back. Negotiating a partnership that speaks of respect for multiple perspectives and collaboration as described in this chapter will draw on positioning theory and post structuralist definitions of agency.
Providing health care services poses different challenges for both the multidisciplinary team and the patient team (members of a patient’s support team can include caregivers, friends and family). The health professionals’ purpose at the Spinal Unit is to enable patients to be as independent in their activities for daily living as possible and live a quality life. Quality of life depends on a person’s subjective evaluation of the degree to which his/her most important needs, goals and wishes are fulfilled (Frisch, 2006). Independence may be gained through equipment, for example, a wheelchair, or through learning about personal care so that patients can direct others to assist them. Independence can also be gained through education about aspects of the patient’s body that may have changed and/or through managing the psychological and emotional adjustments that result from a spinal cord injury. The discourse of what “independence” might look like in the lives of patients with spinal cord injuries becomes a site of deconstruction, questioning and is being held up for review. The process of negotiating new meaning of “independent” may open the possibility of a spectrum of dependencies, independence and interdependence. Health care professionals of the Spinal Unit are committed to working alongside patients to provide the best possible spectrum of service to patients in assisting them with this challenge.