69 Rehabilitants and informal caregivers’ perspectives of a Challenging Rehabilitation Environment seem to indicate the currently insufficient communication on these aspects and the types of therapy, although rehabilitants and informal caregivers emphasize the importance of good communication during the rehabilitation process. This includes communication about their rehabilitation process, diagnoses, and practical aspects such as the daily routine on the ward. Literature has shown that a lack in communication has a negative effect on the rehabilitation process, as the personal needs of rehabilitants are unclear to the professionals.25 Good communication is complex and there can be multiple barriers and facilitators related to organization, staff, and rehabilitant factors.26 Barriers can, for example, relate to mixed wards, power imbalance between staff and rehabilitants, staff perception of time pressures, personality, lack of knowledge and skills regarding communication, or a rehabilitant’s functional and medical status. Examples of facilitators are shared rooms, staff knowledge and utilization of communication strategies, and personality of staff.26 This emphasizes the complexity and importance of communication, so rehabilitants know what to expect in a CRE and what they can do themselves. Therefore, when implementing a CRE, attention must be paid to all these aspects of communication. Consideration should be given to optimizing the physical environment and training staff in communication skills. Participants in the current study see peer support as important for learning from each other, but also for support and recognition. For example, group training stimulates peer support and learning from each other, and peer support facilitates rehabilitants’ and caregivers’ adaptation to long-term disabilities.27,28 Group training and peer support during the rehabilitation process may result in better rehabilitation outcomes. We therefore recommend professionals stimulate group training, and peer support in a CRE. Participants support the planning of therapy moments, so they can arrange visits around the therapy moments. Working with individualized timetables for rehabilitants and structured activities can increase a rehabilitants’ activity during inpatient rehabilitation.29 It is important to tailor the therapy moments to the needs of the rehabilitant, and therefore to follow the daily rhythm of rehabilitants with practicing meaningful tasks at the moment these tasks occur. We recommend providing clarity to rehabilitants about the day structure and possibilities 3
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