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Unit 3
Applying concepts from the nursing process
rehabilitation—sometimes called habilitation—patients adjust
to disabilities by learning how to use resources and focus on
existing abilities. In
habilitation
, making able; learning new
skills and abilities to meet maximum potential abilities, not
disabilities, are emphasised.
An important goal of rehabilitation is to assist the patient
to return to the home environment after learning to manage
the disability. A referral system maintains continuity of care
when the patient is transferred to the home or to a long-term
care facility. The plan for discharge is formulated when the
patient is first admitted to the hospital, and discharge plans
are made with the patient’s functional potential in mind. Thus,
rehabilitation begins in acute care.
The principles of rehabilitation are basic to the care of all
patients, and rehabilitation efforts should begin during the
initial contact with a patient. The goal of rehabilitation is to
restore the patient’s ability to function independently or at
a pre-illness or pre-injury level of functioning as quickly as
possible. If this is not possible, the aims of rehabilitation are
to maximise independence and prevent secondary disability as
well as to promote a quality of life acceptable to the patient.
Rehabilitation team
Rehabilitation is a creative, dynamic process that requires
a multidisciplinary team of professionals working together
with patients and families. The team members represent a
variety of disciplines, with each health professional making a
unique contribution to the rehabilitation process. In addition
to nurses, members of the rehabilitation team may include
physicians, nurse practitioners, physiotherapists, occupational
therapists, diversional therapists, speech-language therapists,
psychologists, psychiatric liaison nurses, spiritual advisors,
social workers, vocational counsellors and sex counsellors.
Nurses assume an equal or, depending on the circumstances
of the patient, a more critical role than other members of the
healthcare team in the rehabilitation process.
The evidence-based plan of care that nurses develop must
be approved by the patient and family and is an integral part
of the rehabilitation process. The rehabilitation process is
cyclical and includes a comprehensive assessment; establish
ment of short-term, medium-term and long-term goals; devel
opment of a collaborative plan to work towards achieving the
goals; and evaluation of progress towards the goals (Booth &
Jester, 2007). In working towards maximising independence,
nurses affirm the patient as an active participant and recognise
the importance of informal carers in the rehabilitation process.
The patient is a key member of the rehabilitation team, the
focus of the team’s effort, and the one who determines the
final outcomes of the process. The patient participates in goal
setting, in learning to function using his or her remaining abil
ities, and in adjusting to living with disabilities.
The patient’s family is also incorporated into the team.
Families are dynamic systems; therefore, the disability of one
member affects other family members. Only by incorporating
the family into the rehabilitation process can the family system
adapt to the change in one of its members. The family provides
ongoing support, participates in problem solving, and learns to
participate in providing ongoing care. The nurse develops a
therapeutic and supportive relationship with the patient and
family. The nurse emphasises the patient’s assets and strengths,
positively reinforcing the patient’s efforts to improve self-
concept and self-care abilities. During nurse–patient
interactions, the nurse actively listens, encourages and shares
patient and family successes.
Using the nursing process, the nurse develops a plan of
care designed to facilitate rehabilitation, restore and maintain
optimal health and prevent complications. Coping with the
disability, fostering self-care, identifying mobility limitations,
and managing skin care and bowel and bladder training are
areas that frequently require nursing care. The nurse acts as a
caregiver, teacher, counsellor, patient advocate, case manager
and consultant. The nurse is often responsible for coordinat
ing the total rehabilitative plan and collaborating with and
coordinating the services provided by all members of the
healthcare team, including community nurses, who are respon
sible for directing patient care after the patient returns home.
Areas of specialty rehabilitation
Although rehabilitation must be a component of every
patient’s care, specialty rehabilitation programs have been
established in general hospitals, free-standing rehabilitation
hospitals and outpatient facilities. Examples of specialty reha
bilitation are as follows:
•
Stroke recovery programs
and
traumatic brain injury
rehabilitation
emphasise cognitive remediation, helping
patients compensate for memory, perceptual, judgement
and safety deficits as well as teaching self-care and
mobility skills. Other goals include helping patients
swallow food safely and communicate effectively.
Neurological disorders treated in addition to stroke and
brain injury include multiple sclerosis, Parkinson’s disease,
amyotrophic lateral sclerosis, and nervous system tumours.
•
Spinal cord injury rehabilitation programs
promote
understanding of the effects and complications of spinal
cord injury; neurogenic bowel and bladder management;
sexuality and fertility enhancement; self-care, including
prevention of skin breakdown; bed mobility and transfers;
and driving with adaptive equipment. The programs also
focus on vocational assessment, training and re-entry into
employment and the community.
•
Orthopaedic rehabilitation programs
provide comprehensive
services to patients with traumatic or non-traumatic
amputation, patients undergoing joint replacements, and
patients with arthritis. Independence with a prosthesis or
new joint is a major goal of these programs. Other goals
include pain management, energy conservation, and joint
protection.
•
Cardiac rehabilitation
for patients who have had
myocardial infarction begins during the acute
hospitalisation and continues on an outpatient basis.
Emphasis is placed on monitored, progressive exercise;
nutritional counselling; stress management; sexuality; and
risk reduction.
•
Pulmonary rehabilitation programs
may be appropriate for
patients with restrictive or chronic obstructive pulmonary
illness or ventilator dependency. Physiotherapists and
nurses help patients achieve more effective breathing
patterns. The programs also teach energy conservation
techniques, self-medication, and home ventilator
management.
•
Comprehensive pain management programs
are available for
people with chronic pain, especially low back pain. These
programs focus on alternative pain treatment modalities,
