Rehabilitation is based on the principle that individuals have control over their own health and are the catalysts in recovering from a disabling condition. Each person is viewed as a unique and comprehensive being that is entitled to the acquisition of holistic care. Rehabilitation consists of a multidisciplinary team that works together to promote self-care, maximize independence, and restore function. The goals of this experience were to gain an understanding of rehabilitation in the extended care facility as well as how cultural influences/values of patients and their family’s plays an integral role in the delivery of care. The patient’s stated goals of rehabilitation while at Evergreen were to become as self-sufficient as possible and to return home to family.
Focusing on the patient as a holistic being is an intrinsic aspect of the rehabilitation process. When a life altering situation occurs, it is important for the health care team to remember that the person in treatment has had other experiences in the past. Beliefs, values, and experiences should be incorporated into the rehabilitation process and used to aid the patient throughout therapy. Medical professionals are taught to treat the person as a whole, not just the ailment or disease and understand that no matter how much contribution is put towards that patient’s success; it is ultimately the patient’s decision to return to optimal levels of self-sufficiency. Although rehabilitation may be long and daunting, maintaining optimism and setting achievable goals will help the patient feel a sense of accomplishment (Mauk, 2012). Every person handles the stress of needing rehabilitation differently, therefore it is pivotal to include the patient’s culture, religious beliefs, values, and family in the rehabilitation plan of care made by the healthcare team.
Rehabilitation is a collaborative effort between the physician, nurses, and occupational or physical therapists. The physician assesses the level at which the patient can participate in therapy, prescribes medication for pain management, and predicts possible outcomes of rehabilitation. They consult with the occupational or physical therapist to coordinate a plan of care best suited to the patient’s specific needs in order to achieve the desired outcomes. Both physical and occupational therapists ensure that the patient is receiving quality and effective rehabilitation services which provide meaningful interventions pertaining to their specific needs (Rafeedie, Metzler, & Lamb, 2018). An occupational therapist assists the patient in regaining motor skills, completing activities of daily living, and educates on how to safely use assistive devices. Physical therapists focus primarily on education and implementation related to strength, gait, and transfer training. (Lewis, Bucher, Mclean-Heitkemper, & Harding, 2017). Registered nurses and rehabilitation nurses work with the interdisciplinary team to aid in restoration of the patient to the previous level of functioning, but their duties differ greatly. While the fundamentals of nursing remain the same throughout nursing specialties (assess, diagnose, plan, implement, and evaluate), duties vary based on their specialty and the healthcare setting.
127 our experts are availableright now
According to Mauk, in an acute care setting, nurses provide care that involves performing activities of daily living for the patient, whereas a rehabilitation nurse’s primary focus is on educating the patient how to perform activities themselves (2012). The nurse’s primary focus while caring for patients in the hospital is patient survival pertaining to the illness or disability which placed them there. Activity orders are put in place for each patient with the expectation that ambulation (if capable) will be performed by the nurse or other member of the healthcare team if qualified. Early ambulation in acute care is the registered nurses responsibility and is associated with increased mobility and independence which decreases complications. (Sepulveda, Soderman, & Kertesz, 2016). Ambulation has also been shown to increase the mobility of muscles and joints leading to shorter hospital stays. Nurses who claim responsibility for patient ambulation results in an increased collaboration with physical therapy and the physician which leads to accurate activity orders and the promotion of patient progression (Doherty-King & Bowers, 2013). Once they are stabilized, they may be sent to subacute care or a rehabilitation center if they’ve lost functionality or independence. In these settings, the licensed practical nurse or registered nurse’s primary role is as a care coordinator (Kokonya & Fitzsimons, 2018). Nurses work closely with patients and families to create a plan of care that allows them to place trust in the staff while maintaining or improving their health. Medication administration, assessments, range of motion exercises, and activities of daily living all fall under the registered nurse’s scope of practice, but certain things can be delegated to the PCT or CNA. From there, a rehabilitation nurse and the interdisciplinary team can proceed with a patient centered plan of care.
Rehabilitation nurses specializes in rehabilitative care to assist the patient in regaining independence. These nurses can work in a wide variety of settings such as acute care, long term care facilities, and outpatient facilities. Their main focus is complication prevention, evidence based medical care, and the delivery of patient and family-centered education (Mauk, 2012). A collaborative approach which honors the values and beliefs of the patient and their family increases optimal outcomes and satisfaction with the rehabilitation process (Vaughn, et al., 2016). In order to become a rehabilitation nurse, you need to have your bachelor’s degree in nursing or an advanced practice degree (Association of Rehabilitation Nurses, 2018). Pursuing a master’s degree in Rehabilitative Services or Administration can further the career of a nurse looking to pursue rehabilitation. The Rehabilitation Nursing Certification Board (RNCB) offers a Certified Rehabilitation Registered Nurse (CRRN) certification for interested nurses. According to the Association of Rehabilitation Nurses, in order to take the exam, two years of practice as a registered professional nurse in rehabilitation nursing within the last five years or one year of practice as a registered professional nurse in rehabilitation nursing and one year of advanced study in nursing within the last 5 years (2018). After completion of the CRRN exam, the certification is valid for five years (Association of Rehabilitation Nurses, 2018). What sets the rehabilitation nurse apart from an acute care nurse is their integrative, comprehensive perspective and the expertise in their field that is utilized with each patient. Together with the help of registered nurses, rehabilitation nurses, and the multidisciplinary team, functional independence is attainable when a patient centered plan is put into action.
At Evergreen Health & Living, an observatory experience of rehabilitation therapy gave student nurses an inside look at the benefits of therapy as well as functions of the multidisciplinary team. Students were told to choose a patient and observe their therapy and interview them afterwards. Patient J.W., a 91 year old male, was admitted after falling on the right hip while trying to carry a 40 pound bag of dog food into the house from the garage. J.W. stayed in the hospital for two days for testing and when it was determined the pelvis had three fractures, the patient was placed at Evergreen to complete six weeks of rehabilitation therapy. The patient lived alone and had a cleaning lady who came once a week. J.W.’s son did the grocery shopping, and the daughter and neighbors would bring hot meals a few times a week. J.W. would also occasionally grocery shop when craving something that wasn’t available at home or when wanting to cook for friends and family. The patient stated that grandchildren and friends would also help with manual labor that needed to be done to maintain the house and farm. Every Tuesday morning, J.W. attended Catholic Church for adoration and stated that prayer and family is what keeps up the patent’s motivation and positivity throughout therapy. The facility offered religious services which J.W. attended and stated that this made the stay a much more positive experience. The patient stated that to become self-sufficient and avoid injury again, slowing down when moving and asking for help were the two hardest things to overcome. J.W. stated progress had been made in the five weeks since admission and that healing fractured bones takes time, but walking pain-free is possible again.
The patient arrived for rehabilitation therapy in a wheelchair and was first asked to stand up with the use of a walker and to use the Colorado Cycle arm bike for five minutes. The patient asked for the physical therapist to increase the resistance because it was “too easy.” The physical therapist said the purpose of the arm bike was to increase strength in the patient’s arms which will enable one to use the walker with more ease. Once completed, the physical therapist instructed J.W. to reach back with both hands when trying to sit in the wheelchair and to sit down slowly to avoid injury. The nurse came in and gave J.W. blood pressure medication and a Tylenol for lingering hip pain. The next two exercises were cone stacking and moving rings while standing on a rubber mat. It consisted of moving a cone or ring from one side of a stack to the other. Once completed, the patient was instructed to move them back to the side of origin. This exercise was performed to build bilateral posture control and to increase gait balance which would make it easier for J.W. to walk and complete activities of daily living.
The patient then moved onto activities of daily living. J.W. was asked to put on a button up shirt, take off shoes and socks and put them back on, use the toilet with an elevated seat, and to walk to the bedroom to hang the button up shirt. These activities simulated real world experiences the patient would have to face once home and allowed the physical therapist to assess the progress made and areas of weakness. Throughout rehabilitation, the physical therapist was very encouraging and asked if J.W. was in pain or tired every few minutes to determine if a break was needed. The patient seemed very optimistic throughout therapy and couldn’t stop talking about being excited to go home to see one’s family and dog.
The rehabilitation experience created a better understanding of the different roles of the interdisciplinary team throughout a patient’s stay in both acute care and the rehabilitation setting. It is a multifaceted approach to care that includes a holistic approach from every team member and should focus not only around the patient’s ability to regain functional independence, but also on the values the patient and their family live by. In order to make this experience more immersive, spending an entire day in the rehabilitation therapy room would have been beneficial. If the students spent the day there, it would allow for the observation of different types of therapies performed depending on the patient’s condition which would help them understand the best way to assist their patients in the future.
