and the Rehabilitation Team Member Rehabilitation is a philosophy of practice and an attitude toward caring for people with disabilities and chronic health problems. It is an approach to caring for people with disabilities which leads to the development of a meaningful context in which to live. In this self-directed learning module is information you are expected to know to provide a safe environment in which to care for and respond to our rehabilitation patients, and family needs. Target Audience: RN, LPN, PT, PTA, OT, COTA, SLP, TR, SW, MS Recommended: Ancillary Team Members including RN, LPN all teams Contents Instructions...2 Learning Objectives...2 Module Content...3 Job Aid...9 Posttest...10-11 Rehabilitation Nursing In 2013 Page 1 of 12
The material in this module is an introduction to important general information. After completing this module, contact your manager to obtain additional information specific to your unit. Read this module. If you have any questions about the material, ask your manager. The Job Aid on page 7 may be used as a quick reference guide. Complete the online post test for this module. Completion of this module will be recorded under My Learning in PeopleLink. Learning Objectives: When you finish this module, you will be able to: Define the concept of Rehabilitation and the role of the Rehabilitation Nurse Identify legislative issues impacting rehabilitation from 1973, 1975 and 1990. Describe four models for team functioning in rehabilitation Recognize and identify client-centered care, setting-centered and providercentered care Define the primary goal of rehabilitation nursing Page 2 of 12
I. Rehabilitation Defined Over the next few decades, two trends will combine to increase the need for rehabilitation. First the numbers of people with chronic illnesses and disability are expected to rise and second, the number of older adults is increasing rapidly as Baby Boomers are aging. Rehabilitation is a philosophy of practice and an attitude toward caring for people with disabilities and chronic health problems. It is an approach to caring for people with disabilities which leads to the development of a meaningful context in which to live. The overall goal of rehabilitation is to improve the quality of life and to help a person, who has a disability or chronic health problem in restoring, maintaining and promoting his or her maximal health. Rehabilitation is contingent on a team approach. (Association of Rehabilitation Nurses ARN Core Curriculum 2007 p. 3) The World Health Organization in 1980 developed the International Classification of Impairment, Disability and Handicap. This classification system defines the following: Impairment- A loss or abnormality of a psychological, physiological, or anatomical structure or function. Disability A restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap- A disadvantage for a given person resulting from impairment or disability that limits or prevents fulfillment of a role that is normal for a human being. II. Evolution of Rehabilitation Advances in health care over the past century have enabled people to live longer lives and to recover from injuries and illnesses that were previously fatal. With these advances, however, have come disabilities and chronic (lasting more than 3 months) illnesses, that forever change the way a person lives in the world. The field of rehabilitation arose to help such individuals and families integrate the changes associated with disability and chronic illness into their lives. Ancient Western civilizations viewed disease and disability as a result of evil spirits. Consequently these individuals were considered possessed and they were feared and shunned. Parents in ancient Rome could legally drown infants with congenital anomalies. The Middle Ages saw disabled individuals burned as witches and other individuals were used as court jesters. World War II society in Germany viewed those living with disabilities or handicaps as flawed and Page 3 of 12
these individuals were the first to be exterminated in the Holocaust. Here in the U.S. Individuals with disabilities were often employed by carnivals and circus side shows. Thankfully the philosophical approaches and attitudes have changed radically over time. Rehabilitation, as we know it today, grew out of the wars of the 20 th century- World War I, World War II, the Korean Conflict, and the Vietnam War- and it continues to evolve with our service personnel returning from the Middle East. Large numbers of soldiers survived their injuries, but often faced serious disabilities in returning from the wars. As a result, military hospitals established rehabilitation units that focused extensive efforts on returning these men to society. In 1974 the Association of Rehabilitation Nurses was formed and nursing, which had always been involved in rehabilitation, formally became recognized as a specialty. III. Legislative Initiatives Legislation in the United States has played a significant role in rehabilitation. - The Rehabilitation Act of 1973 encouraged efforts to hire people with disabilities and prohibited unfair treatment of individuals with disabilities in activities supported in any way by federal funds. - In 1975, the Education for All Handicapped Children Act required states to provide education free of cost to any school-age child. -The Americans with Disabilities Act (ADA) of 1990 is most comprehensive in requiring that public buildings and transportation be made accessible to all. This act also prohibits discrimination against people with disabilities in the workplace. Results of these legislative acts have served to increase social acceptance of people with disabilities and to provide opportunities for them to maximize their potential. Rehabilitation is a vital component of healthcare and the need is greater than ever before. IV. Rehabilitation Team Models The rehabilitation team consists of, first and foremost, the individual and his or her family. Team members contributing to a person s rehabilitation are varied and across many disciplines. Four models for team functioning have been described: medical, multidisciplinary, interdisciplinary and transdisciplinary. Page 4 of 12
A. Medical Model: This model is a physician centered model of care in which all care is directed by the physician. This model is not consistent with rehabilitation philosophy or goals and is uncommon in rehabilitation practice. B. Multidisciplinary Model: The multidisciplinary team, which may be seen in rehabilitation, is one in which the professionals work in parallel; each discipline works toward particular client goals, with very little overlap between disciplines. Each discipline takes responsibility for their own activities. Communication is more vertical than lateral, with the leader controlling team conferences. In this model the person working directly with the patient does not always participate in team planning; rather, the department managers usually attend team conferences. Teams combine the efforts of various disciplines. Each discipline within a multidisciplinary team sets its own discipline-specific goals, and works within the discipline boundaries to achieve these goals independently. This model is effective when the team membership is not stable. C. Interdisciplinary Model: The interdisciplinary model is a matrix-like model in which lateral communication is predominant. This is an effective model when team membership is stable and is most effective in an inpatient rehabilitation setting. This model of care applies a holistic view of the person. Holistic care requires that each client be viewed as a whole, with the entire team working toward the attainment of common client-centered goals. Decisions are made by the group working directly with the patient. This means that mutual trust among team members must be established, and conflict resolution is an important skill to be used by team members. Team goal setting is an important feature of this model. D. Transdisciplinary Model: This is a newer team model. In this model the patient has a primary provider from the team, who then is guided by the team in caring for the client. For instance the primary provider may be the nurse who provides physical, speech or occupational therapy based on the advice and counsel he or she receives from team members in those disciplines. Similarly, the primary therapist could be a physical therapist or a speech therapist. This model requires flexibility and receptiveness on the part of the team members because individual roles are less distinct. This model raises many issues regarding licensure and accountability. This is best suited for situations in which the client is in stable condition and most probably in need of long term services such as SNFs or Home Care services. Page 5 of 12
Regardless of the rehabilitation team model, all team members can increase their effectiveness by understanding collaborative practice, group dynamics, conflict resolution, and team functioning. Components for any effective team include the following: Trust Communication Shared responsibility Mutual Respect Knowledge Cooperation Coordination Optimism, and lastly, Commitment from each member of the team V. Provision of Services The rehabilitation philosophy can infuse any healthcare setting. Collaboration between team members, the individual, family and community is a vital aspect of rehabilitation. In acute rehabilitation units, the client: must require 24-hour nursing care at a skilled level, must require physician contact at least daily, can be medically unstable or stable, is able to participate in a least 3-4 hours of therapy per day ; and, requires the interdisciplinary services of the entire rehab team of professionals. Achieving continuity across the continuum of care means, 1. providing physical and emotional support to the client before and during transfers 2. ensuring timely transfer of pertinent information in accordance with HIPAA standards 3. continuing the treatment plan without interruption 4. maintaining consistency of the treatment approach across all disciplines 5. managing pain so the patient can participate in therapy 6. concise documentation of the care delivered, goals established and progress toward these goals. Clients may feel overwhelmed or lack confidence when they move into the rehab. setting, and may not be able to transfer skills without assistance from the rehab staff, thus physical and emotional support are essential. Communication among staff should be timely, detailed, complete, and to the right people. Facilities and programs need to develop information systems to share data and avoid repeated assessments so that treatments can be continued in a consistent, uninterrupted manner. A. Client-centered care: Client-centered models are those serving specialized populations. The focus may be on a specific developmental stage, such as pediatric or elderly clients, or on a type of impairment, such as spinal cord or head injury. Providers can focus their resources and gain extensive expertise through experience. Page 6 of 12
B. Setting-centered care: Acute, long term, outpatient, home care and community are the traditional models focusing on settings. Another category of setting-focused rehabilitation is subacute care in which individuals continue to require substantial medical care and who are slower to progress. C. Provider-centered care: Provider-centered models reflect how healthcare providers have decided to organize the provision of care. Many models have been used over the years with the goal of maximizing the use of human resources. Within nursing, functional, team, and primary nursing, and case management have been the prevalent models. In the rehabilitation field, no single model dominates, and several models coexist. VI. Rehabilitation Nursing Perspectives Nursing brings a unique, holistic focus to rehabilitation. While members of other disciplines treat particular aspects of a person, nurses focus on the person as a whole, thus providing continuity and integrity to the client s rehabilitation experience. The goal of rehabilitation nursing is assisting the individual with a disability or a chronic disease toward maximal health through health restoration, maintenance, and program. The role of the rehabilitation nurse is to help the client take charge of his or her own care and to achieve optimal physical functioning. The nurse must work with all members of the rehab team to bring everything together to help the patient to meet team and personal goals and expectations. VII. Rehabilitation Core Values Individuals with functional limitations have intrinsic worth that transcends their disability and or chronic illness. Individuals are complex yet unified, whole persons who have the right and the responsibility to make informed decisions about their future. Individuals may benefit from rehabilitation at any stage of the life span. Page 7 of 12
References: Association of Rehabilitation Nurses. Professional rehabilitation nursing manual. Glenview, IL: Author 2001. Association of Rehabilitation Nurses. Standards and Scope of Rehabilitation Nursing Practice. Glenview, IL: Author 2008. Association of Rehabilitation Nurses. The Specialty Practice of Rehabilitation Nursing A Core Curriculum. 6 th edition. Glenview, IL, 2011. Institute of Medicine. Disability in America: Toward a national agenda for prevention. Washington, D.C.: National Academy Press. 1991 Mauk, Kristen L.. (Ed.). The Specialty Practice of Rehabilitation Nursing: A Core Curriculum (5th ed.). Glenview, IL: Association of Rehabilitation Nurses 2007 McCourt, A.E. (Ed.). The specialty practice rehabilitation nursing: A core curriculum (3 rd ed., p 180-182). Glenview, IL: Association of Rehabilitation Nurses 1993. Mumma, C.M., & Nelson, A. (2002). Theory and practice models for rehabilitation nursing. In S.P. Hoeman (Ed.). Rehabilitation nursing: Process, application, & outcomes (3 rd ed., pp.32). St. Louis: Mosby. Smeltzer,Suzanne C., Textbook of Medical Surgical Nursing 10 th ed. Philadelphia, Pa.: Lippincott Williams and Watkins 2004. Smith. Sandra.F,. Clinical Nursing Skills 7 th edition Upper Saddle River, N.J. Pearson Prentice Hall 2008. Page 8 of 12
JOB AID Chronic illnesses are those that last more than 3 months. Rehabilitation is the process of providing comprehensive services for persons with disabilities. The Rehabilitation Act of 1973 prohibited unfair treatment of individuals with disabilities. The Americans with Disabilities of 1990 required public buildings to be made accessible to all. The rehabilitation team consists of, first and foremost, the individual and family. In acute rehabilitation, patients must require 24 hour nursing care, as well as physician care and three hours of therapy. The goal of the rehabilitation professional is to assist the individual with a disability and to take charge of his or her care to the best of their ability. Page 9 of 12
Posttest Name: Date: Circle the correct answer. 1. The members of a multidisciplinary team take responsibility for a. The whole group b. Coordinating plans of care c. Issues of team maintenance d. Activities of their own discipline 2. The benefits of using an Interdisciplinary model of care delivery include which of the following? a. It conserves resources. b. It involves the community. c. It requires minimal coordination d. It applies a holistic view of the person. 3. Which of the following federal laws is the most comprehensive in providing accessibility for the individual with disabilities? a. The Americans with Disability Act b. The Architectural Barriers Act c. The Rehabilitation Act of 1973 d. The Vocational Rehabilitation Act of 1967 4. A chronic illness is an illness that a. Has an erratic course. b. Has existed for at least three months. c. Causes disability. d. Is easily resolved 5. According to the definition of rehabilitation nursing established by the American Nurses Association and the Association of Rehabilitation Nurses, the major goal of rehabilitation nursing is to assist the individual or group in a. Achieving optimal physical functioning b. Obtaining therapy services. c. Restoring and maintaining health. d. Identifying resources. 6. The role of the Rehabilitation Professional is to a. Help the client take charge of his or her own care. b. Take care of the client. c. Teach the therapist how to give nursing care. d. Discourage the family from helping the client. Page 10 of 12
7. In acute rehabilitation units, the client must receive the following services daily: a. Registered nursing care, physical or occupational therapy, spiritual counseling b. Occupational or speech therapy, medical social services, neuropsychology c. Respiratory therapy, pharmacy, recreational therapy d. Registered nursing care, physician services, physical or occupational therapy 8. Achieving continuity across the continuum of care means a. Providing physical and emotional support to the client before and during transfers, ensuring timely transfer of pertinent information, continuing the treatment plan without interruption, and maintaining consistency of the treatment approach. b. Sending a copy of the discharge summary with the client that provides referrals to community agencies, orders equipment, and make follow up appointments. c. Always having a joint meeting of the new and old treating teams, letting the client visit the new setting prior to actual transfer, and calling the client after discharge to determine satisfaction. 9. Which of the following major events has (have) impacted the development of rehabilitation and rehabilitation nursing? a. Advances in health care over the past century b. Wars that occurred in the 20 th century c. Legislative initiatives d. All of the above e. A and C 10. Which is the definition of rehabilitation? a. The process of providing, in a coordinated manner, those comprehensive services deemed appropriate to the needs of a person with a disability in a program designed to achieve objectives of improved health, welfare, and the realization of the person s maximal, social, psychological, and vocational potential for useful and productive activity b. Help for recovery including training, therapy, or other help given to someone who has survived a serious injury or illness or an addition that will enable him or her to live a healthy and productive life c. To make the most of one s abilities d. All of the above Page 11 of 12
Module Rehabilitation Nursing Did any of the questions/answers change? o Yes o No o New module and test Instructions: List all questions copy and paste Post Test in separate file, labeled as Answer Key Highlight correct answers see example below. List page number for hint with each question see example below. Changes made: Reference update. Page 12 of 12