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Care in hospital settings powerpiont


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Care in hospital settings powerpiont

  3. 3.  The word patient comes from the Latin word patiens, originally meant “one who suffers”. verb, patior, meaning “I am suffering” The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse or other health careprovider.patient is one whom needs care,attention and support from healthcare professionals and family.
  4. 4. Care in hospital is the attention or watchful oversight o supervision and attentive assistance or treatment for the needed by the nurse or other heath care professional and health care setting is a place of organized systems of medical care, including prepaid group medical practices, collective group insurance-covered, fee-per-service medical care, and community clinics organized and run by non-profit or profit-making organizations.
  5. 5.   As an increasing proportion of population and with the shift in disease patterns from acute illnesses to chronic illnesses,the traditional disease management and care focus of the health care professions has expanded.The health care focus must center more on prevention,health promotion and management of chronic conditionsthan in previous times.
  6. 6.   It is the ability to walk from place to place with or without assistance. In ambulation Individual is able to walk at least 10 feet outside the parallel bars with supervision or physical assistance from only one person
  7. 7.   Ambulatory care is a personal health care consultation, treatment or intervention using advanced medical technology or procedures delivered on an outpatient basis (i.e. where the patient’s stay at the hospital or clinic, from the time of registration to discharge Ambulatory health care is provided for the patients in the community or in hospital settings.
  8. 8.      0 Non functional patient cannot ambulate,ambulates in parallel bars only,or requires supervision or physical assistance from more than 1 person to ambulate 1 Ambulator –dependent dependent for physical assistance patient requires manual contacts of no more than one person during ambulation.manual contacts are continuos and necessary to support body weight
  9. 9.    patient requires manual contacts of no more than one person during ambulation.manual condact consists of continuos or intermittent light touch for assistance 3 Ambulator –dependant for supervision patient can physically ambulate on level surfaces without manual condact with another person but for safety requires stand by guarding
  10. 10.    4Ambulatory – independent level  patient can ambulate independently on level surfaces but requires supervision  5Ambulator – independent  patient can ambulate independently on non level and level surfaces,stairs and inclines
  11. 11.  Ambulatory care nursing includes those clinical,management,educational ,and research activities provided by registered nurse for and with individuals who seeks care and assistance with health maintainence and or health promotion. - AAACN  AMBULATORY SETTINGS  SITES CARE
  13. 13.         Providing direct patient care Conducting patient intake screenings Treating patients with acute or chronic illnesses or emergency conditions Reffering patients to other agencies for additional services Teaching patients self care activities Offering health education programmes that promote health maintainence Nurses also work as clinical managers,direct the operation of clinics and supervise other health team members Providing advice and emotional support to patients family members.
  14. 14.     Teach patients and their families how to manage their illness or injury, including post-treatment home care needs, diet and exercise programs, and self-administration of medication and physical therapy counseling to family members of critically ill patients RNs work to promote general health by educating the public on various warning signs and symptoms of disease and where to go for help RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing or the internet
  15. 15.      Research in ambulatory care is needed for many reasons; To help to develop new models of nursing care delivary To develop standards of client care To create both performanceimprovement programmes and nursing intensity systems to determine the number and types of nursing personals needed
  16. 16.   ACUTE CARE HOSPITALS An acute care hospital is a healthcare facility that offers patient care services of a limited duration to diagnose and/or treat an injury or short-term illness. Services include medical and surgical inpatient services and outpatient diagnostic services.
  17. 17. GOVERNMENT SPONSERED PROFIT HOSPITALS – receives local, state and federal gov support eg: army,navy, and public VOLUNTARY OR NOT-FORHEALTH AGENCIES Eg: Hospitals that arechurch affliated,hospitals treating health services etc FOR PROFIT HOSPITALS Goal is business to generate profit, Owned privately by large corporations reputation for providing excellent Or by single owners. medical organ are specialities such a cancer MAGNET HOSPITALS Designation is given to hosptals that have nursing care and good Outcomes Eg:clients who require transplantation Care after serious injury Cared in this institutions
  21. 21.     Critically ill patients are defined as those patients who are at high risk for actual or pot ential life-threatening health problems. Critical care is a term used to describe “the care of patients who are extremely ill and whose clinical condition is unstable or potentially unstable”. Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients
  22. 22.            Damages general(injury),special(all losses and expenses),emotional,punitive Eg: INTENTIONAL TORTS Civil wrong committed againt a person or persons property Assault Eg:Threatening a pt with an injection. Battery Eg:Forcing a patient to ambulate False imprisonment Eg:Refusing to allow a patient to leave against medical advice
  23. 23. . Invasion of privacy  Eg:Taking unauthorized pictures of the patient,releasing confidential information to others without consent.  Defamation  Use of adverse language that affects ones reputation.  Eg:falsely accusing staff members in front of others,making false chart entries about patients life style
  24. 24.         It includes; INFECTIOUS HAZARDS HIV exposure Viral hepatitis exposure MUSCULOSKELETAL INJURIES Occupational back injury(back pain) CHEMICAL HAZARDS Skin irritants,eye irritants,antineoplastic agents etc
  25. 25. NOISE             Sources of noise includes; Ventilators suction machines telephones infusion pumps doors staff conversations monitor alarms Effects; Prolonged exposure can cause hearing loss and mental irritability CHEMICAL DEPENDANCY Without healthy coping skills; a nurse may secretly turn to drugs or alcohol for emotional and spiritual support. Drugs that are abused commonly include cocaine, alcohol, narcotics and tranquilizers.
  27. 27.  Acute and Critical Care Expert Panel was established IN 2009 to inform health policy and influence relevant issues related to acute and critical care. Members of the panel have diverse areas of expertise to provide leadership and expert opinion on a variety of issues. The panel facilitates networking, and fosters research and scholarship between members. It also promotes exchange of information and ideas with other nursing and professional groups
  28. 28.  critical care nurses:  Respect and support the right of the patient.  Help the patient obtain necessary care.  Respect the values, beliefs and rights of the patient.
  29. 29.     Support the decisions of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse. Intercede for patients who cannot speak for themselves in situations that require immediate action. Monitor and safeguard the quality of care the patient receives. Act as a liaison between the patient, the patient's family and other healthcare professionals
  30. 30.     Critical care nurses work in a wide variety of settings, filling many roles including bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse specialists and nurse practitioners a particular specialty. The CNS is responsible for the identification, intervention and management of clinical problems to improve care for patients and families. They provide direct patient care, including assessing, diagnosing, planning and prescribing pharmacological and nonpharmacological treatment of health problems. CNS in the critical care setting focus on making clinical decisions related to complex patient care. Their activities include risk appraisal, interpretation of diagnostic tests and providing treatment, which may include prescribing medication.
  31. 31.   Home Care (also referred to as domiciliary care or social care)is health care or supportive care provided in the patient's home by health care professionals (often referred to as home health care or formal care) Home Health Nursing is about patients receiving nursing care in their home. Home health nurses have a new environment every day and face many challenges. Patients are going home from the hospital with more acute problems and the home health nurse must rise to the occasion.
  32. 32.  A Home Health Care Nurse works with patients in their homes. These nurses mainly work with the elderly, but sometimes work with younger children who have developmental or mobility issues. A Home Health Care Nurse is great for people that would rather work outside of a hospital.
  33. 33.  The Home Healthcare Nurses Association (HHNA) is a national professional nursing organization of members involved in home health care and hospice nursing practice, education, administration and research. HHNA provides leadership and a unified voice so that home care and hospice nurses may improve their specialty and influence public policy as it relates to home care and hospice
  34. 34.  The HHNA’s predecessor organization was founded in 1993 by the JB Lippincott Company with the vision of providing a forum for members to discuss and refine professional, educational and conceptual aspects of the home healthcare nursing practice as a specialty.
  35. 35.  The HHNA is committed to improving the specialty of home care and hospice nursing and influencing public policy as it relates to home care and hospice. HHNA is a forum that recruits and brings together energized home care and hospice nurses who want to become leaders in their field and enable them to speak out in a unified voice.
  36. 36.    Develop the specialty of home care and hospice nursing Foster excellence in the practice of home care and hospice nursing Promote high standards of patient care in home care and hospice Provide an organized and unified voice among the home care and hospice nursing profession Disseminate and exchange information with those involved in the home care and hospice nursing specialties
  37. 37.      Honor and select the top home care and hospices nurses across the country. Learn about changes in laws or regulations which impact your work. Establish home health and hospice care best practices. A subscription to Caring Magazine, the only publication received by the entire home care and hospice community as well as all U.S. hospitals and physicians who serve the home care community. Receive the Home Healthcare Nurse Journal and keep up to date on new protocols, best practices, and clinical and therapeutic advances.
  38. 38.  The National Association for Home Care & Hospice is the nation's largest trade association representing the interests and concerns of home care agencies, hospices, and home care aide organizations.
  39. 39.           Professionals providing home care include: licenced practical nurses, Registered nurses, Home Care Aids, and Social workers. Rehabilitation services are provided by: Physical therapists, Occupational therapists, Speech therapist pathologists and Dietitians. Home care aides are trained to provide non-custodial care, such as helping with dressing, bathing, getting in and out of bed, and using the toilet. They may also prepare meals.
  40. 40.  Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client's own home. These services may include some combination of professional health care services and life assistance services. Professional home health services could include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy. Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. Home care is often an integral component of the post-hospitalization recovery process, especially during the initial weeks after discharge when the patient still requires some level of regular physical assistance.
  41. 41.       To prepare for early hospital discharge and possible need for follow up care in home,discharge planning begins with patients admission. COMMUNITY RESOURCES AND REFERRALS Home health nurses and public health nurses act as case managers.after assessing patients needs they may refer to the other team members. Home health care nurse is responsible for providing information about various resources.resource booklet should be provided for the patient which includes the resources available in the community.
  42. 42.          Nurse should review the patients referral form to contavt the reffering agency if the purpose for the referral is unclear Call the patient and obtain permission and schedule the time for visit. Ask permission before entering the house and explain the purpose of referral. CONDUCTING A HOME VISIT Whenever the nurse makes a visit,the agency should know the nurses schedule and locations of the visits. Initiate the visit in which the patient is evaluated and a plan of carevis established Determine the needs for future visits such as current health status,home environment,level of self care abilities ,mental status etc
  43. 43.      Learn a cellular phone with the telephone numbers of the agency ,police and emergency services Let the agency know your daily schedule and telephone numbers of your patients Know where the patient lives Schedule visit only in day hours When making visits in crime areas visit with another person
  44. 44.       AMBULATORY SETTINGS Ambulatory health care is provided for the patients both in community and hospital settings.types of agencies includes medical clinics,ambulatory care units,mental health centres,student health centres etc OCCUPATIONAL HEALTH PROGRAMMES Occupational nurses work in industrial setting or they may serve as consultants on a limited or part time basis The occupational health nurses works in several ways and provide direct care to the employers who becomes ill or injured and conduct health education programmes .
  45. 45.    Some school nurse programmes provide community care.physical examinations are performed by advanced practice nurses who then diagnose and treat students and families for acute and chronic illnesses.nurse act as care provider.consultant.educator and counselor. CARE FOR HOMELESS Homeless have difficulty in affording or gaining acess to health care.they will experience high rates of trauma,tuberculosis and other communicable health nurses who works with homeless shoulb be patient,non judgemental and understanding.nursing interventions are aimed at obtaining health care services for homeless.
  46. 46.       A home health care nurse helps to care for the elderly, disabled, chronically ill or mentally impaired. Daily tasks for a home health care nurse can include administering medication, checking on patients' status, performing routine procedures and helping administer treatments that patients need. Some home health care nurses will also provide for the basic needs of patients, helping them to bathe or providing nutritious meals. At times, they must also provide support to patient's family members and other caretakers, instructing them on how best to care for the patient and providing emotional support.
  47. 47.       The roles of the home care rehabilitation nurse include, but are not limited to, those outlined below. Practitioner Serves as a clinical resource for those involved in rehabilitation nursing practice and in the care of clients with a complex chronic illness, a disabling condition, or both Acts as a resource during a crisis that is aggravated by a chronic illness or a disabling condition Assesses the appropriateness of a client's admission to, and the delivery of rehabilitation services in, the home environment Provides assistance with discharge planning to ensure a smooth transition into the community or, when appropriate,
  48. 48.    Collaborates with the interdisciplinary team in the management of the team function in the home environment Helps the client and the client's family adapt to changes in lifestyle necessitated by the disabling condition Implements rehabilitation nursing care based on scientific knowledge, home care standards, and rehabilitation principles that are appropriate to the home care environment
  49. 49.     Care coordinator Acts as a member of the interdisciplinary healthcare team and promotes the coordination of client care Coordinates the activities of rehabilitation professionals; integrates the knowledge and skills of various rehabilitation disciplines into a comprehensive continuum of care Facilitates the design and implementation of the plan of care for clients who are chronically ill or who have disabling conditions
  50. 50.      Advocate Advocates for clients and their families or caregivers Teaches clients and their families or caregivers to advocate for themselves Facilitates the client’s transition from the hospital to the home and the community Furthers an understanding of home care-based rehabilitation issues among people in the community and among those in government who are in a position to deal with issues related to this patient population
  51. 51.       Educator Provides education for clients and their families Provides staff orientation and guides staff development, both at the professional and the paraprofessional levels, in the area of rehabilitation home care Provides rehabilitation-focused continuing education programs Develops policies and procedures that are specific to rehabilitation home care Develops educational materials designed to help clients and their family members become knowledgeable consumers in the healthcare
  52. 52.      Consultant Identifies clients and families who could benefit from rehabilitation home care services Serves as a liaison with third-party payers and justifies the use of funds for rehabilitation home care 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 areas
  53. 53.     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
  54. 54.  Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes.
  55. 55.     Long-Term Care Nurse A Long-Term Care Nurse cares for patients who have a disability or illness in need of extended care. Many of their patients live in long-term care facilities, rehabilitation centers, or nursing homes What Is Long Term Care? When a person requires someone else to help him with his physical or emotional needs over an extended period of time, this is long-term care EG:WALKING,BATHING,DRESSING etc
  56. 56.       Temporary long term care (need for care for only weeks or months) Rehabilitation from a hospital stay Recovery from illness Recovery from injury Recovery from surgery Terminal medical condition
  57. 57.        Ongoing long term care (need for care for many months or years) Chronic medical conditions Chronic severe pain Permanent disabilities Dementia Ongoing need for help with activities of daily living Need for supervision
  58. 58.     SUBACUTE OR TRANSITIONAL CARE For people who require ongoing care or recovery for an acute conditionbut donot need to receive the services on an acute hospital unit. ASSISTED LIVING FACILITY A form of housing that provide 24 hr staffing,meals,supervision of medications,personal assistance care.
  59. 59.     ADULT DAY CARE A day time programme for people who typically have the same level of impairments as nursing home residants but who receive care in the community usually family members.the client is transported to the center and receives structured activities,meals,personal care assistance, and health care supervision. HOME CARE For community based people who are home bound and who need caregiving assistance or specialtreatments.
  60. 60.  For people who r terminally ill and in need of care.this care can b provided in the home or in a day hospital of dying is common experience in long term care.caring behaviours of staff at the time of death,allowing family to be involved with the resident and providing spiritual support are important and valued nursing functions.
  61. 61.        Long-term care services may be provided in any of the following settings: In the home of the recipient In the home of a family member or friend of the recipient At an adult day services location In an assisted living facility or board-andcare home In a hospice facility In a nursing home
  62. 62.   Residants of LTCFs can be of any age,although most of them are older adults.The risk of being in an LTCFs increases with each decade of life:average age of resiants is 82yrs.Women outnumber men ratio is 3:1. Most residents have conditions that impair their selfcae capacity or require interventions that they cannot perform independently.About one half have progressive cognitive impairment,such as alzheimers disease,arthritis,cardiovascular disease,impaired vision,impaired hearing or combination of illnesses.Most residents need assistance with atleast several ADL.Although most residents spend remainder of their lives in the facility,an increasing number do recover ,have restored function and return to the community.
  63. 63.  According to federal regulations a reggisterd nurse must be on dutyatleast 8 consecutive hours per day,7 days a week and a full time director of nursing must be on staff if the facility has more than60 beds.The propotion ofnursing staff is not stated,although it is required that “the facility to provide 24 hour nursing services which are sufficient to meet otal nursing care needs”.
  64. 64.   Health care plans such as health insurance plans, Medicare, Medicaid and the Veterans Administration. They are used primarily to differentiate care provided by medical specialists as opposed to care provided by aides, volunteers, family or friends. A patient receiving skilled care in a nursing home from Medicare not only receives care from skilled providers such as nurses, therapists or doctors but also receives care from custodial providers such as aides. This care usually consists of help with bathing, dressing, ambulating , toileting,
  65. 65.   ASSESMENT Nurse hav to assess residents within the first 14 days of admission and atleast annually there after;residants are to be reassed whenever thereis change in their status.    CARE PLANNNG Regulations require that a careplan be written for each resident within 7 days after completion of plan is a interdisciplinary one and is the blue blue print for nursing actions.
  66. 66.     CAREGIVING Nurses performs selected roles,such as administering medications and treatments and they may be involved in total care activities. NURSE have to make the residants to face many adjustments; ROUTINES AND SCHEDULES     ENVIRONMENT
  67. 67.   PEOPLE INDEPENDENCE      COMMUNICATION Proper communication helps the nurse for identifying and obtaining timely treatment of complications and new health problems and also nurse must make sure that physicians learn of changes in residants condition in a timely manner. Provide the physician with complete information that can aid in medical decision making. Eg: current and usual vital signs,clinical manifestations etc
  68. 68.            Avoid making th clinical manifestations and allow physicaian to make medical judgement. Take order directly from the physician If there is anything wrong in the order question the physician. MANAGEMENT Nurse performs some management functions such as: Delegating assignments Supervising other staffs Evaluating performance Implementing disciplinary actions Completing reports
  69. 69.       Reviewing and auditing records Communicating needs to other departments Handling complaints Ordering supplies Communicating with regulatory agencies.
  70. 70.      DEFINITION “Rehabilitation is a interdisciplinary speciality that supports a dynamic process of helping an individual to achieve a life that is as independence and self fulfilling as or vocational areas of functionaing” REHABILITATION NURSING Rehabilitation nursing is defined as the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle
  71. 71.        TO assist the individual who has a disability or chronic illness in restoring maintaining and promoting his or her maximal health To achieve maximam level of functioning and self sufficiency in all spheres of life;physical,mental,social,emotional,educational,voca tional,and economic. To manage chronic illness and disability Physical reconditioning Strength Restoration of function Stress reduction Patient and family education
  72. 72.   Attending Physician The physician, who is either a physiatrist (rehabilitation medicine) or a neurologist, will provide medical management and coordinate your rehabilitation program provided by the treatment team. Case Manager Your case manager will help you and your family cope with the recovery process, as well as understand your rehabilitation program. The case manager serves as your liaison among your team of treatment professionals, your family, your insurance carrier, and resources in the community.
  73. 73. Nurse The nurses and nursing assistants provide direct personal care. Using the nursing process the nurse is responsible for planning the nursing care necessary in your rehabilitation program. Your nurse also shares a key role in patient and family education.  PhysicalTherapist The physical therapist will help you develop strength and coordination to improve your function. Pt will work with therapist to become more independent with bed mobility, wheelchair mobility and, if appropriate, walking.
  74. 74.   Occupational Therapist The occupational therapist works to coordinate your physical and mental abilities with the activities of daily living. Your therapist will teach special skills and if needed, provide adaptive equipment to allow you to be as independent as possible in your self-care. The therapist will also work with you if you have any problems with sensation, coordination, balance, thinking, and visual perception. Speech/Language Pathologist Communication, swallowing, and thinking are skills our speech/language pathologist address. Difficulties in these areas may affect all other areas of your rehabilitation. Through practice, teaching new techniques and strategies, our speech/language pathologist can help you improve your communications.
  75. 75.  Dietitian Dietitian is responsible for evaluating, developing and implementing a plan to meet your nutritional needs. Nutrition is a very important part of recovery process. Neuropsychologist A neuropsychologist may be ask to see by attending physician. By concentrating on psychological needs, the neuropsychologist may contribute to rehabilitation program. Through psychological testing and counseling, and family will better understand the type of injury that have sustained. As continue through recovery, this professional may be working with in the area of thinking and behavioral retraining.  
  76. 76.       Patient & Family Actively participate in the rehabilitation process so that they can achieve the best outcome possible. Social Worker Provides support and counseling as needed for the patient and their family, and facilitates a safe and effective discharge plan. Rehabilitation Assistant Works under the supervision of the Physiotherapist and/or Occupational Therapist to provide individual or group therapy programs.
  77. 77.  Respiratory Therapist Evaluates, treats and cares for patients with breathing disorders  Physiatrists    are the main medical doctor on the rehabilitation team. A physiatrist is either an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine) with a specialty in physical medicine and rehabilitation. The physiatrist assesses patients at admission to rehabilitation and directs the patient's medical care, monitoring the course of rehabilitation to help the patient attain optimal function.
  78. 78.   According to the needs, the rehabilitation programs are divided in various types. are as follows: Occupational Rehabilitation: This particular type of Rehabilitation is for those victims who do have lost some important skills after they have met with a paralytic stroke or any unfortunate major accident. We have to perform these skills everyday in our life, without which it is impossible to survive. Skills like writing, reading, cooking food etc. We lose this skill if our brain is injured; therefore victims lose interest in communicating with other people. For this type of patients, doctor advises to visit occupational therapist. This particular therapist helps you to do regular physical exercises, meditation to make your muscle strong. The patient is given special care by their counselor and psychologist.
  79. 79.    Physical Rehabilitation: This sort of rehabilitation is used for patients who have suffered from bone and muscle injuries. The physiotherapist helps a lot in giving the right exercise regime to strengthen the muscles of back neck, shoulder, etc. This injury can happen due to accidents, sports, etc. A lot of treatment and technology is available in physical rehabilitation. The recovery time differs from person to person and so does the type of injury. The patients have to follow religiously the given exercise patterns. Aquatic Rehabilitation: This is a new trend in rehabilitation yet it is a successful in treating problems in joints. The therapists treat the patients by giving various water exercises like swimming, water aerobics, etc. This helps in giving strength, flexibility and mobility to the muscles of legs. Many patients with arthritis, joint pain, and paralytic stroke are treated with help of this rehabilitation. The program is customized according to an individual's needs and he or she is treated to recover from the injury so that he or she has a normal life.
  80. 80.       . OTHER TYPES; Above Knee Amputation Rehabilitation Orthopedic Rehabilitation Shoulder Injury Rehabilitation Spinal Cord Injury Rehabilitation
  81. 81.  Pain Management Rehabilitation  Pelvic Floor Rehabilitation  Post Polio Rehabilitation Patellar Tendonitis Rehabilitation  Hip Replacement Rehabilitation  Knee Injury Rehabilitation  Post Surgical Rehabilitation Aquatic Rehabilitation  Pulmonary Rehabilitation  Rehabilitation For Depression Outpatient Rehabilitation Programs  Paraplegia Rehabilitation  Parkinson Rehabilitation  
  82. 82.         Rehabilitation services are provided in a variety of settings,depending on thearrayand intensity of services that are required. Individuals with an impairment thatminimally impacts functional ability may be able to receive rehabilitation services in an outpatient settings More complex impairments may require servicesthat can be provided in the home setting or in day care treatment programme Individuals with impairments that affect multiple functional abilities may require period of inpatient rehabilitation services in either a subacute or acute rehabilitation seting Acute rehabilitation may be provided in free standing rehabilitation hospitals or ondedicated unit within hospitals Subacute rehabilitation may be provided in long term care facilities or on dedicated units within hospitals. Medicare rehab clients includes;
  83. 83.          Stroke Spinalcord injury Congenital deformity Amputation Major multiple trauma Fracture of femur Brain injury Rheumatoid arthritis Burns etc
  84. 84.    Recent research suggests that obesity and excess weight can influence cancer survival and recurrence. Given the increasing rate of obesity and an aging population more susceptible to cancer, there is mounting concern about obesity’s role in fueling tumor growth. At an IOM workshop, experts presented the latest evidence on the obesity-cancer link and the possible mechanisms underlying that link, as well as potential interventions to mitigate the effects of obesity on cancer, and research and policy measures needed to counter the expected rise of cancer incidence and mortality due to an increasingly overweight and older population. Washington University researchers trace pediatric tumors to stem cells in developing brain (07/10/2012) - ​ Stem cells that come from a specific part of the developing brain help fuel the growth of brain tumors caused by an inherited condition, researchers at Washington University School of Medicine in St. Louis report. Scientists showed in mice that disabling a gene linked to a common pediatric tumor disorder, neurofibromatosis type 1 (NF1), made stem cells from one part of the brain proliferate rapidly. But the same genetic deficit had no effect on stem cells from another brain region. The Washington University School of Medicine is home to the Alvin J. Siteman Cancer Center. 
  85. 85.   Our healthcare system is large and complex with many stakeholders. ALL stakeholders will benefit from a transformed health care system in which nurses play a much larger role.This is a very big issue. This really goes to the heart of whether health reform can reach its potential for the good of society.Establishing the workforce we need – and using it productively -- will enhance delivery, improve outcomes, and help contain costs.Improving delivery of care will help not only patients but also payers and providers.Nurses are in the main stream of service to both advantaged and disadvantaged clients.Nurses play a crucial role in delivering health care.Ambulatory care nursing is the fastest growing areas of nursing speciality practice.Ambulatory nurses are not only expert clinicians but also expert communicators.Aging nurses arenretiring or leaving critical care.Young or new nurses must step up to meet the exiting challenges of critical care nursing.
  86. 86.      “No man, not even a doctor, ever gives any other definition of what a nurse should be than this - 'devoted and obedient'. This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman” Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter's or sculptor's work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts. ~Florence Nightingale