14 Chapter 1 The studies described in this thesis follow one another and jointly work towards this conceptualization and tool. Chapter 2 describes a narrative review into aspects known to be relevant for CRE, and therefore answers the question what is known in literature about a challenging rehabilitation environment. Chapter 3 describes the perspectives of rehabilitants and informal caregivers regarding CRE. In focus groups and telephone interviews, the participants were asked about themes they thought were relevant for CRE and the content of these themes. Participants were currently rehabilitating or had recent experience with rehabilitation. In Chapter 4 the perspectives of professionals regarding CRE were examined. In a qualitative study consisting of focus groups and workshops, over 180 professionals gave their perspectives on themes relevant to CRE and on the content of these themes. The participating professionals all worked in (geriatric) rehabilitation, both nationally and internationally. The professional positions of the participants included e.g. researchers, physicians, nurses, and paramedics. Using the concept mapping methodology, chapter 5 combines the knowledge of chapter 2 to 4 in an evidence-based conceptualization of CRE. With the input of nursing staff, (para)medical staff, and rehabilitants and informal caregivers, a statistical consensus was achieved regarding the conceptualization. This led to a broadly supported conceptualization, which combines evidence-based, expert-based, and experience-based knowledge, and therefore answers the first research question. In chapter 6, the conceptualization from chapter 5 has been converted into a team self-evaluation tool, and the second research question is answered. This tool was pilot tested on five rehabilitation wards in the Netherlands. Interdisciplinary teams of these wards performed the protocol of this tool and completed an evaluation survey on the use of the tool. The aim of this study was to investigate if the tool identifies areas for improvement for rehabilitation wars regarding CRE, and whether the methodology of the tool feasible is.
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