To adopt is to adapt: the process of implementing the ICF with an acute stroke multidisciplinary team in England

Figures & data

Table I.  The data collection methods and the participants who chose to engage in the formal data collection procedures.

	Exploratory phase	Innovatory phase	Reflective phase
Data collection methods	•Documentation analysis (minutes from working party meetings and email communications) •Participant based observational field notes •Reflections from researcher
	•One-to-one semi-structured interviews •Focus group employing the nominal group technique		•One-to-one semi-structured interviews •Focus group employing the force field analysis
Participants	STEP meetings: Representations from all members of the acute stroke multidisciplinary team were present at one or more STEP meetings
	One-to-one semi-structured interviews (n = 11) comprising: doctor, nurses (n = 2), occupational therapists (n = 2), physiotherapists (n = 2), speech and language therapist, clinical psychologist, carer and family support worker; social worker One focus group (n = 9) comprising: clinical psychologist; psychology assistant; speech and language therapist; dietician; occupational therapists (n = 2); physiotherapists (n = 3)		One focus group (n = 4) comprising: dietician, speech and language therapists (n = 2), physiotherapist One-to-one interviews (n = 3) comprising: clinical psychologist, occupational therapist, dietician (NB: the same dietician from the focus group who wished to expand upon some of the discussions from the focus group)

STEP, Stroke Treatment for Every Person.

Figure 1.  Project procedure. ICF, International Classification of Functioning, Disability and Health; STEP, Stroke Treatment for Every Person.

Table

Overarching theme	Initial subthemes	Operational definition	Sources(from exploratory phase data)
7. To use the ICF as a structure for a transfer of care report	7.1 All writing own reports	There is a joint occupational therapy and physiotherapy report but it is still time consuming and everyone else does their own reports. The nurse has to chase everyone in order to pull them all together before faxing them off and sometimes there is incongruent information on different reports which causes a delay.	Interview 7 pg 4, 13, 14 Interview 9 pg 10 Field notes pgs 2, 38a, 38b, 92, 96, 134

Table II.  Ways the ICF could benefit the service as identified by the exploratory phase participants, in ranked order of preference.

Ways the ICF could be used within an acute stroke multidisciplinary team
1.	To help define what the service is able to offer in its acute capacity.
2.	To communicate a patient’s rehab agenda when referring on.
3.	To structure a multidisciplinary team transfer of care report.
4.	To identify gaps in the current service provision and target areas for development either within the team or, to see who else can/does offer a particular service to meet a patient’s needs.
5.	To guide areas for care planning and goal setting.
6.	As a flow chart to guide decision making when referring on.
7.	To use in the multidisciplinary team meeting to enhance the structure and provide a written record.
8.	As a laminated prompt at the front of the multidisciplinary notes to use as a ready reference.
9.	To use as language within the multidisciplinary notes.
10.	For a structure in care booklets (as a checklist to see everything is covered) e.g. when a person is being transferred to a nursing home for long term care.
11.	To help define which professionals take the lead in different areas of care to assist organising the patient journey.
12.	As a “one stop” record of the multidisciplinary team plan.
13.	To structure an induction booklet for new staff and students.
14.	As a pocket guide for staff to use as a ready reference.

ICF, International Classification of Functioning, Disability and Health.

Table III  Amended headings for the ICF chapters within body functions.

ICF chapter headings for Body Functions	Amended headings on final version of report
Mental functions	Cognition (thinking abilities)
	Alertness and motivation
	Mood and behaviour
Sensory functions and pain	Sensory systems and pain
Voice and speech functions	Not included at body level: incorporated into activities and participation. Replaced by: Swallowing
Functions of the cardiovascular, haematological, immunological and respiratory systems	Cardiovascular, haematological, immunological and respiratory systems
Functions of the digestive, metabolic and endocrine systems	Digestive, metabolic and endocrine systems
Genitourinary reproductive functions	Genitourinary/reproductive systems
Neuromusculoskeletal and movement-related functions	Neuromusculoskeletal system and movement
Functions of the skin	Skin condition

ICF, International Classification of Functioning, Disability and Health.

Figure 2.  An extract (environmental factors) from the transfer of care report to highlight the use of the (amended) chapter headings.

Figure 3.  An extract (environmental factors) from the ICF glossary to highlight the use of the ICF core set for stroke, which helped participants to learn the meanings of the chapter headings. ICF, International Classification of Functioning, Disability and Health.