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Rehabilitation
The document discusses rehabilitation and the rehabilitation nursing role. It defines rehabilitation as a dynamic process that assists ill or disabled individuals achieve their greatest level of functioning. The goals of rehabilitation are to restore independence and quality of life. A rehabilitation team takes an interdisciplinary approach involving nurses, physical therapists, dietitians, and others. Rehabilitation nursing aims to promote self-care, prevent complications, and improve quality of life. Specific nursing roles in rehabilitation include teaching, providing care, collaborating with the team, advocating for patients, and consulting.
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Rehabilitation
- 1. M R S. N A M I T A B A T R A G U I N A S S O C I A T E P R O F E S S O R , C O M M U N I T Y H E A L T H N U R S I N G D E P A R T M E N T REHABILITATION
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- 3. REHABILITATION Rehabilitation isa dynamic, health-oriented process that assists an ill person or a person with disability (restriction in performance or function in everyday activities) to achieve the greatest possible level of physical, mental, spiritual, social, and economic functioning. restore functional ability for a person who has experienced an illness or injury. enable regaining function and self-sufficiency to the level prior to that illness or injury within the constraints of the medical prognosis for improvement. develop functional ability to compensate for deficits that cannot be medically reversed
- 4. REHABILITATION THE ABILITIESOF THE PERSON ARE EMPHASIZED- HABILITATION Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination. (WHO)
- 5. GOAL AND AIMSOF REHABILITATION GOAL To restore the patient’s ability to function independently or at a pre-illness or pre-injury level of functioning as quickly as possible AIM Maximal independence and A quality of life acceptable to the patient.
- 7. COMPONENTS OF REHABILITATION Body. Somatic and psychological interventions. These are medical oriented interventions after regular medical treatment has terminated, i.e. interventions more on the impairment level focusing on rehabilitative goals. Functions, including both functions and skills. These interventions can, for example, be physiotherapy, physical training, special pedagogic oriented interventions. Environment. These are, for example, adaptations of physical environments, universal design, assistive technology, personal assistance, attitudes of the society.
- 8. NATURE OF REHABILITATION Dynamic Time-limited process Well- defined Goals Need based Planned process Requires a team effort Variety of disciplines involved Patients active participation Emphasize on abilities Community reentry Patient/ family education
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- 10. Seriously ill Disabled people People recovering from serious illness or injuries Chronic illness Functional limitation
- 11. CONCEPTS USED INREHABILITATION DISABILITY: A person is considered to have a disability, such as a restriction in performance or function in everyday activities, if he or she has difficulty talking, hearing, seeing, walking, climbing stairs, lifting or carrying objects, performing activities of daily living, doing school work, or working at a job.
- 12. CONCEPTS USED INREHABILITATION Activities of daily living (ADLs), which include bathing, dressing, feeding, and toileting, or Instrumental activities of daily living (IADLs): which include grocery shopping, meal preparation, housekeeping, transportation, and managing finances.
- 13. CONCEPTS USED INREHABILITATION Restorative care: aims to enhance the physical and cognitive function of people who have lost or are at risk of losing condition through active involvement in low intensity therapy and personal care support. Rehabilitation Team: an interdisciplinary team made up of numerous allied health professions
- 14. PRINCIPLES OF REHABILITATION The prevention, diagnosis and treatment of concomitant medical problems (co-morbid illnesses, complications) Training for maximum functional independence To support psychosocial coping and assist in the adaptation of patients and families To support the return to community life To improve the quality of life of patient and family members who provide care
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- 16. REHABILITATION TEAM Therehabilitation team is formed based on the illness of the patient. For example the doctors, nurses and therapists in a drug rehabilitation team will be different from those in an accident rehabilitation team. Each member of the team with his/her individual expertise has a different approach in healing the patient.
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- 18. THE PHYSIATRIST ThePhysiatrist is the leader of the rehabilitation team. He assesses the patient carefully and monitors the patient’s progress. He decides what all medical services the patient needs and then designs the program as per the patient’s need. He will design a patient oriented treatment program based on which the other members of the team will be decided. His specialization is physical medicine and rehabilitation.
- 19. NURSES Nurses whodeal with rehabilitation patients are trained to take care of the everyday need of the patients. Often after severe brain or physical injury a person may find it difficult to take care of oneself, so these nurses are trained to take care of patients. They are also the rehabilitation care coordinators.
- 20. PHYSICAL THERAPISTS Developtreatment programs to help improve mobility through exercise and training. Assess the disability and uses various techniques and technology.
- 21. REGISTERED DIETITIANS Adviseabout healthy diet choices and special dietary needs. Calculate the dietary needs and provide the diet in accordance with the rehabilitation program
- 22. SPEECH THERAPIST Aspeech therapist helps the patient by checking his condition and then designing a specific program of exercises and therapies that would help him communicate with the society.
- 23. OCCUPATIONAL THERAPIST Thework of an occupational therapist is to make a patient learn advanced independence skills that will help him in various ways in his personal life. The patient will be taught cooking, laundering, shopping and banking by an occupational therapist.
- 24. RECREATIONAL THERAPIST Thejob of a recreational therapist is to make a patient indulge in all those activities that the patient enjoys. He brings a positive attitude in a patient by making the latter realize that life can be fun and enjoyable.
- 25. COUNSELOR After anykind of a traumatic incident, be it accident or illness a patient goes through depression and other negative feelings. It is very important that a rehab counselor counsels the patient and adds positive attitude in him. This is important as healthy mind will lead to a faster healing.
- 26. MEDICAL SOCIAL WORKER Provide emotional support, identify economic resources and community agencies and help you make arrangements to leave the hospital and find follow-up care.
- 27. VOCATIONAL CASE COORDINATOR Help in developing a plan to return to work in your community.
- 28. CLERGY Support thespiritual, religious and emotional needs of patient and family.
- 29. PATIENT Key memberof the rehabilitation team. He or she is the focus of the team effort and the one who determines the final outcomes of the process. The patient participates in goal setting, in learning to function using remaining abilities, and in adjusting to living with disabilities.
- 30. PATIENT’S FAMILY Thefamily is a dynamic system, so disability of one member affects the other family members. By incorporating the family into the rehabilitation process, the family system adapt to the change in one of its members. The family provides ongoing support, participates in problem solving, and learns to provide necessary ongoing care
- 31. GOALS OF REHABILITATIONTEAM Foster self care, self efficiency Encourage maximal independence level Maintain function Prevent complications Restore optimum functions Promote maximum potential Emphasize abilities Promote adaptation Restore acceptable quality of life
- 32. GOALS OF REHABILITATIONTEAM Maintain dignity Re-educate Assist with community reintegration/ re-entry Promote optimal wellness
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- 35. REHABILITATION MODEL OFCARE It describes the range of settings in which rehabilitation occurs and identifies key principles which should be in evidence across each of the care settings. It supports:- Early, intensive rehabilitation, commencing in the acute setting through appropriate and early identification of relevant patients Collaboration and education with acute services regarding the role of rehabilitation services Access to a variety of care settings including intensive ambulatory settings for those patients who do not require inpatient care Reduced length of stay by offering rehabilitation services in the least restrictive setting depending on patient need
- 36. REHABILITATION MODEL OFCARE Coordinated and integrated care across the rehabilitation continuum Patient centered and evidence based care
- 37. COMPREHENSIVE REHABILITATION PLAN Thisis an overall individualized comprehensive rehabilitation plan of care. It is initiated within 24 hours of admission and ready for review and revision by the team within 3 days of admission for each individual. The plan is developed based on the results of the interdisciplinary admission assessment. All clinicians treating the patient will use the comprehensive plan of care.
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- 39. REHABILITATION NURSING Rehabilitationnursing help individuals affected by chronic illness or physical disability to adapt to their greatest potential and work toward productive, independent lives. It considers holistic approach to meet patient’s medical, vocational, educational, environmental and spiritual needs
- 40. General responsibilities -Nurse Coordinates educational activities and uses appropriate resources. Performs hands-on nursing care by utilizing the nursing process. Provides direction and supervision of ancillary nursing personnel, demonstrates professional judgment. Coordinates nursing care activities in collaboration with other members. Demonstrates effective oral and written communication skills.
- 41. General responsibilities -Nurse Acts as a resource and a role model Applies nursing research to clinical practice and participates in nursing research studies
- 42. SPECIFIC PROBLEMS OF REHABILITATIONPATIENTS SKIN CARE: patients face various skin problems, particularly those confined to bed for long periods of time. The same risk also applies to people sitting in a wheelchair. PRESSURE ULCERS: ulcers occurring as a result of skin and subcutaneous tissue injury due to poor circulation in the pressure area that come into contact with the bed.
- 43. SPECIFIC PROBLEMS OF REHABILITATIONPATIENTS Hygiene: It includes difficulty in swallowing as well as poor oral hygiene. Difficulty in emptying the bladder leading to accumulation of urine and bacterial infection. Bathing: After returning home, it would be beneficial for the patient to take a bath at frequent intervals (depending on the person's health status). This stimulates blood circulation and allows the opening of skin pores.
- 44. SPECIFIC PROBLEMS OF REHABILITATIONPATIENTS Bed Bath: Water-repellent products should be placed under the patient to protect the bed. Toilet: Toilet grip handles can be used to facilitate the ability to sit and stand. Sometimes, raising the toilet seat height can be of critical value Eating: Eating with other family members at the same table at home can improve the morale of the patient.
- 45. SPECIFIC PROBLEMS OF REHABILITATIONPATIENTS Exercise: The aim of exercise is to regulate the distribution of oxygen and metabolic processes, enhance strength and endurance, reduce body fat, and improve muscle-joint movements. PEG (percutaneous gastrostomy) or nasogastric tube: If a PEG or NG has been inserted due to poor feeding, the patient's head should be elevated at least 45 degrees during and one to two hours after feeding.
- 46. SPECIFIC PROBLEMS OF REHABILITATIONPATIENTS Traveling: It should be kept in mind that a change in air pressure in aircraft travel can have different effects on metabolism, and a medical examination should be done and necessary recommendations should be followed.
- 47. REHABILITATION NURSE Setpatient goals for independent functioning and activities of daily living Encourage self-care Prevent complications and further disability Strengthen positive coping behaviors Promote optimal quality of life Help patients access continuing care as needed
- 48. NURSING INTERVENTIONS Selfcare deficits Impaired physical mobility Impaired skin integrity Altered elimination pattern
- 49. FOUR TYPES OFROLE FUNCTIONS SUPPORTIVE FUNCTIONS • Emotional support • Enhancing lifestyle • Facilitating self expression RESTORATIVE FUNCTIONS • Assessment of skills • Undertaking essential care elements EDUCATIVE FUNCTIONS • Self medication • Increase competence in activities of daily living LIFE ENHANCING FUNCTIONS • Relieving pain • Ensuring adequate nutrition
- 50. ROLES AND FUNCTIONSOF THE REHABILITATION STAFF NURSE
- 51. ROLE AS TEACHER Shares information about the disease processes underlying disabilities and teaches nursing techniques to help clients and their families develop the self-care skills. Prepares clients and their families for future self- management and decision-making responsibilities.
- 52. ROLE AS TEACHER Reinforces the teaching done by specialists in rehabilitation and other healthcare disciplines and provides resource materials for clients’ changing needs. Provides in-service education for healthcare team members and members of the community regarding the prevention of disabilities
- 53. ROLE AS CAREGIVER Assesses the physical,psychological, sociocultural, and spiritual dimensions of clients and their families. Plans nursing care while acknowledging that rehabilitation nursing is practiced within a dynamic, therapeutic, and supportive relationship.
- 54. ROLE AS CAREGIVER Implements a plan of care by providing nursing care and education directly or through ancillary personnel. Evaluates the nursing care that is being provided and modifies the plan, as needed, to achieve measurable goals and objectives
- 55. ROLE AS COLLABORATOR Develops goals, in collaboration with clients, their families, and the rehabilitation team. Participates in the interdisciplinary team process at team conferences and other team meetings and offers input into team decision making. Intervenes with team members and other healthcare professionals to ensure that the optimal opportunity for recovery is made available to the client.
- 56. ROLE AS COLLABORATOR Collaborates with team members to achieve cost- effective care by utilizing appropriate clinical measures.
- 57. ROLE AS CLIENTADVOCATE Actively listens, reflects, and guides clients and their families through the stages of the grieving process. Advocates for policies and services that promote the quality of life for individuals with disabilities and participates in activities that will positively influence the community’s awareness of disabilities. Contributes to a safe and therapeutic environment and supports activities
- 58. ROLE AS CLIENTADVOCATE Intervenes on behalf of clients to ensure that medical professionals and nonmedical professionals work to maximize clients’ success.
- 59. ROLE AS CONSULTANT Identifies clients and families who could benefit from rehabilitation home care services Provides case management expertise within the home care environment Serves as a liaison with third- party payers and justifies the use of funds for rehabilitation home care
- 60. ROLE AS CONSULTANT Serves as a resource for rehabilitation nurses and as a process consultant to staff in the home care setting Promotes rehabilitation nursing services to community health professionals and to the community at large
- 61. ROLE AS RESEARCHER Participates in research involving home care clients and their families Participates in the analysis and dissemination of evaluative data that may have an impact on clients and their families Incorporates evaluative data into nursing practice
- 62. SELF CARE DEFICITS Assess the ability of the patient to perform ADLs (activities of daily living) Bathing Grooming Toileting Dressing Feeding
- 63. SELF CARE DEFICITINTERVENTIONS Foster Self-care abilities Allow as much time as possible independence within safe limits Give positive reinforcements for the successful attempt Recommend assistive devices Focus on gross movements initially, then finer motor Monitor frustrations and tolerance Assist in accepting self-care dependence
- 64. IMPAIRED PHYSICAL MOBILITY Complications of IMMOBILITY 1. Contractures 2. Foot drop 3. DVT 4. Hypostatic pneumonia 5. Pressure ulcers 6. Muscle atrophy 7. Osteoporosis 8. Dependent edema 9. Urine stasis 10. Constipation
- 65. IMPAIRED PHYSICAL MOBILITY- ASSESSMENT Assess patient’s ability to move Assess muscle tone, strength Assess joint movement and positioning
- 66. IMPAIRED PHYSICAL MOBILITY- NURSINGINTERVENTIONS 1. Position properly to prevent contractures. Place trochanter roll from the iliac crest to the mid thigh to prevent EXTERNAL rotation Place patient on wheelchair 90 degrees with the foot resting flat on the floor/foot rest Place foot board or high-heeled shoes to prevent foot drop
- 67. IMPAIRED PHYSICAL MOBILITY- NURSINGINTERVENTIONS 2. Maintain muscle strength and joint mobility Perform passive ROME Perform assistive ROME Perform active ROME Move the joints three times TID
- 68. IMPAIRED PHYSICAL MOBILITY- NURSINGINTERVENTIONS 3. Promote independent mobility Warn patient of the orthostatic hypotension when suddenly standing upright 4. Assist patient with transfer Assess patient’s ability to participate Position yourself in front of the patient Lock the wheelchair or the bed wheel Use devices such as transfer boards, sliding boards, trapeze and sheets In general, the equipments are placed on the side of the STRONGER , UNAFFECTED body part Nurses assist the patient to move TOWARDS the stronger side In moving the patient, move to the direction FACING the nurse
- 69. IMPAIRED PHYSICAL MOBILITY- NURSINGINTERVENTIONS 6. Assist patient in crutch ambulation Measure correct crutch length STANDING (Kozier) Make sure that the shoulder-rest of the crutch is at least 1- 2 inches below the axilla Measure correct crutch length Utilizing the patient’s HEIGHT Height MINUS 40 cm or 16 inches
- 70. IMPAIRED PHYSICAL MOBILITY- NURSINGINTERVENTIONS 7. Assist patient in crutch gait 8. Assist patient in ambulation with a walker Correct height of the walker must allow a 20-30 degrees of elbow flexion 9. Assist patient in ambulation with a cane Correct cane measurement: With elbow flexion of 30 degrees, measure the length from the HAND to 6 inches lateral to the tip of the 5th toe
- 71. IMPAIRED SKIN INTEGRITY Pressure ulcers Are localized areas of dead soft tissue that occurs when pressure applied to the skin overtime is more than 32 mmHg leading to tissue damage
- 72. PRESSURE AREAS 1.Sacrum and cocygeal area 2. Ischial tuberosity 3. Greater trochanter 4. Heel and malleolus 5. Tibia and fibula 6. Scapula and elbow
- 73. RISK FACTORS FORPRESSURE ULCERS 1. Patients with sensory deficits 2. Decreased tissue perfusion 3. Decreased nutritional status 4. Friction and shearing forces 5. Increased moisture and edema
- 74. REFERENCES http://www.fernuni-hagen.de/FTB/telemate/demo- crs/fund/fw-05-01.htm MaximisingIndependence: The role of Nurse in supporting the rehabilitation of older people.
Editor's Notes
- #41 Coordinates educational activities and uses appropriate resources to develop and implement an individualized teaching and discharge plan with clients and their families Performs hands-on nursing care by utilizing the nursing process to achieve quality outcomes for clients Provides direction and supervision of ancillary nursing personnel, demonstrates professional judgment, uses problem solving techniques and time-management principles, and delegates appropriately Coordinates nursing care activities in collaboration with other members of the interdisciplinary rehabilitation team to facilitate achievement of overall goals Demonstrates effective oral and written communication skills to develop a rapport with clients, their families, and health team members and to ensure the fulfillment of requirements for legal documentation and reimbursement
- #42 Acts as a resource and a role model for nursing staff and students and participates in activities such as nursing committees and professional organizations that promote the improvement of nursing care and the advancement of professional rehabilitation nursing Applies nursing research to clinical practice and participates in nursing research studies