Current PhD Students
Faculty Mentor: Natalie Leland PhD, OTR/L, BCG, FAOTA
Research Lab: Rehabilitation Health Services Research Lab
Year of Entry: 2014
Master of Science (MS)
2014 | University of Southern California
Bachelor of Science (BS)
in Human Development and Aging
2013 | University of Southern California
My research is focused on nursing home activity engagement. Many nursing home residents are found to be inactive and do not engage in meaningful activities. This lack of engagement can contribute to a loss of physical function, social isolation, depression, and a lower quality of life. Conversely, residents who are engaged have a higher quality of life, less depression, and greater overall well-being. However, there is limited research on appropriate activity-based interventions for residents and how activity sessions are designed and provided. Thus, my research is on understanding current practices for activity engagement in nursing homes with a focus on how activities are currently provided for nursing home residents and how residents are engaged in activities.
Leland, N. E., Lepore, M., Wong, C., Chang, S. H., Freeman, L., Crum, K., Gillies, H., & Nash, P. (2018). Delivering high quality hip fracture rehabilitation: The perspective of occupational and physical therapy practitioners. Disability and Rehabilitation, 40(6), 646-654. https://doi.org/10.1080/09638288.2016.1273973 Show abstract
Aim. The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation.
Methods. Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach.
Results. Seven themes emerged: objectives of care; first 72h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration.
Conclusions. Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation. While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers. Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.
Wong, C., & Leland, N. E. (2018). Clinicians' perspectives of patient engagement in post-acute care: A social ecological approach. Physical & Occupational Therapy In Geriatrics, 36(1), 29-42. https://doi.org/10.1080/02703181.2017.1407859 Show abstract
Aims. To identify rehabilitation providers' perspectives on barriers and facilitators of patient engagement in hip fracture patients in skilled nursing facilities (SNFs) within the social ecological model.
Methods. We conducted 13 focus groups in SNFs throughout Los Angeles County comprised of rehabilitation staff (n = 99). Focus groups were audio-recorded and transcribed. A secondary analysis of themes related to patient engagement were identified and organized within the social ecological model.
Results. Clinicians identified barriers and facilitators of patient engagement across all levels of the social ecological model: public policy (e.g., insurance), organizational (e.g., facility culture), interpersonal (e.g., clinicians fostering self-reflection), and intrapersonal (e.g., patients' anxiety).
Conclusions. Examining barriers and facilitators to patient engagement has highlighted areas which need to be sustained and improved. Thus, these findings will inform future efforts to enhance patient engagement in order can to optimize patient healthcare decisions.
Wong, C., Martínez, J., Fagan, B., & Leland, N. E. (2018). Understanding communication between rehabilitation practitioners and nurses: Implications for post-acute care quality. Journal of Applied Gerontology. Advance online publication. https://doi.org/10.1177/0733464818794148 Show abstract
Objective. This study examined post-acute care (PAC) rehabilitation practitioner’s perspectives on communication.
Method. This is a secondary data analysis of a larger qualitative study, which included PAC rehabilitation provider (n = 99) focus groups that were held in a purposive sample of 13 skilled nursing facilities (SNFs).
Results. Participants emphasized the importance of bidirectional communication between rehabilitation and nursing. Three themes were identified: (a) communication between rehabilitation practitioners and registered nurses or licensed practical nurses, (b) communication between rehabilitation practitioners and certified nursing assistants, and (c) communication between rehabilitation practitioners and nursing leaders. Two subthemes within each of the three themes were further characterized to understand how information was exchanged: (a) static communication and (b) action-oriented communication.
Conclusion. Our findings highlight opportunities for better communication in PAC between rehabilitation practitioners and nursing and thus lay a foundation for future efforts to improve care coordination through enhancing interdisciplinary communication.
Wong, C., & Leland, N. E. (2016). Non-pharmacological approaches to reducing negative behavioral symptoms: A scoping review. OTJR: Occupation, Participation and Health, 36(1), 34-41. https://doi.org/10.1177/1539449215627278 Show abstract
The management of negative behavioral symptoms among residents with dementia is a challenge that nursing homes face in delivering quality care. This study examines evidence documenting non-pharmacological interventions that reduce negative behavioral symptoms among nursing home residents with dementia and the role occupational therapy practitioners have in this area. A scoping review was completed for intervention studies published from 1987 to 2014, targeting negative behavioral symptoms among nursing home residents above 60 years of age with dementia. Interventions were categorized based on the American Occupational Therapy Association (AOTA) Occupational Therapy Practice Framework. Twenty-two studies met the inclusion criteria. Four types of interventions were identified: occupation-based interventions, context and environment interventions, exercise interventions, and daily routine-based interventions. The non-pharmacological interventions were found to align with the scope of occupational therapy. This suggests that occupational therapy practitioners can contribute to the development and evaluation of non-pharmacological interventions aimed to reduce negative behavioral symptoms.