190 Summary tation. The concept describes the entire environment in which the rehabilitation takes place and is intended to challenge rehabilitants to achieve the best possible result from the rehabilitation. This total concept will be referred to in this thesis as the Challenging Rehabilitation Environment. In this thesis the following research questions were addressed: 1. Which aspects are important in a challenging rehabilitation environment and how can these be combined in a conceptualization? 2. To which extent is a team self-evaluation tool feasible to support rehabilitation wards by implementing a challenging rehabilitation environment? Main research findings In Chapter 2, evidence for the challenging rehabilitation environment was sought in the literature. Because there was no scientific evidence for the entire concept, a narrative review was used to examine various aspects that are relevant to the challenging rehabilitation environment. This review included 51 articles, from which a total of 7 main topics were identified. These involved: 1) therapy time; the level of physical activity and the relationship with rehabilitation outcomes, 2) group training; can be used to increase therapy time and achieve goals, e.g. in the areas of mobility and activities of daily living, 3) patient-regulated exercise; this increases the level of self-management and therapy time, 4) family participation; this can have a positive effect on rehabilitation outcomes and increases therapy time, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this can challenge rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals and good communication in a transdisciplinary team improves the quality of rehabilitation. As the challenging rehabilitation environment was a relatively new concept with different interpretations on various wards, it was unclear if this review captured all relevant aspects. Therefore, the two qualitative studies described in chapters 3 and 4 were conducted simultaneously. Chapter 3 describes a qualitative study into the perspectives of rehabilitants and informal caregivers regarding the challenging rehabilitation environment. A total of 15 rehabilitants and six informal caregivers participated in telephone interviews or focus groups. These partici-
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