This document discusses rehabilitation nursing. It defines rehabilitation as restoring an individual's physical, mental, social, vocational and economic capacity following an illness or injury. Rehabilitation requires assessing all aspects of a person's needs and addressing them. The document outlines the goals and principles of rehabilitation nursing, including maximizing quality of life and promoting independence. It also describes the roles of rehabilitation team members and the importance of a family-centered approach to care.

1. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 1
Rehabilitation Nursing
Hariom mehta
M.sc. Nag Previous

2. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 2
Rehabilitation Defined
• The process of restoring the individual to the
fullest physical, mental, social, vocational, and
economic capacity of which he or she is
capable
• Relearning of former skills; learning new skills
necessary to adapt and live fully in an altered
lifestyle
• Must begin from the very onset of a traumatic
event or diagnosis of a chronic illness
• Every aspect of the individual’s needs and care
assessed and addressed

3. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 3
Issues in Rehabilitation
• Quality of Life versus Quantity of Life
– Rehabilitation focuses on continually improving
the quality of the person’s life, not merely
maintaining life itself.
• Care versus Cure
– Many conditions are irreversible; therefore, the
focus of care is related to adaptation and
acceptance of an altered life rather than to
resolving an illness.

4. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 4
Issues in Rehabilitation
• High Cost of Interdisciplinary Care versus
Long-term Care
– Rehabilitation is expensive. Success is sometimes
seen as a return to productive employment; may
be if the individual becomes sufficiently
independent that no caregiver is required.

5. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 5
Need for Rehabilitation
• Need for Rehabilitation Precipitated by
– Impairment
• Any loss or abnormality of psychologic, physical, or
anatomic structure or function
– Disability
• Any restriction or lack of an ability to perform an
activity in the manner or within the range considered
normal for a human being

6. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 6
Need for Rehabilitation
• Handicap
– A disadvantage for a given individual resulting
from an impairment or disability that limits or
prevents fulfillment of a role that is normal for
that particular individual
• Functional limitation
– Any loss of ability to perform tasks and obligations
of usual roles and normal daily life
• Chronic illness
– An irreversible presence, accumulation, or latency
of disease states or impairments that involves the
total human environment

7. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 7
Goals of Rehabilitation
• All Rehabilitation Goals Shall
– maximize the quality of life of the individual
– address the individual’s specific needs
– assist the individual with adjusting to an altered
lifestyle
– be directed toward promoting wellness and
minimizing complications
– assist the individual in attaining the highest degree
of function and self-sufficiency possible
– assist the individual to return to home and
community

8. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 8
Cornerstones of Rehabilitation
• The cornerstones of rehabilitation may be seen as
stepping stones on the “road to recovery”
– Individually centered
– Community reentry
– Independence
– Functional ability
– Team approach
– Quality of life
– Prevention and wellness
– Change process
– Adaptation
– Patient/family education

9. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 9
Rehabilitation Team
• Models of Team Functioning
– Multidisciplinary Rehabilitation Team
• Characterized by discipline-specific goals, clear
boundaries between disciplines, and outcomes that are
the sum of each discipline’s efforts
– Interdisciplinary Rehabilitation Team
• Collaborates to identify individuals’ goals and is
characterized by a combination of expanded problem
solving beyond discipline boundaries and discipline-
specific work toward goal attainment

10. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 10
Rehabilitation Team
• Models of Team Functioning (continued)
– Transdisciplinary Rehabilitation Team
• Characterized by the blurring of boundaries between
disciplines, as well as by cross-training and flexibility to
minimize duplication of effort toward individual goal
attainment

11. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 11
Figure 39-1
Members of the rehabilitation team help a patient with ambulation
(From Leahy, J.M., Kizilay, P.E. [1998]. Foundations of nursing practice: a nursing process approach.
Philadelphia: Saunders.)

12. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 12
Rehabilitation Team
• Rehabilitation Nurse
– Must have a broad knowledge base of
pathophysiology of a wide range of medical-surgical
conditions and a body of highly specialized knowledge
and skills regarding rehabilitation
– Must believe that individuals with functional
disabilities have an intrinsic worth that transcends
their disabilities
– Specialized training necessary for the rehabilitation
nurse to become an effective team member
– Practices in a variety of settings

13. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 13
Rehabilitation Team
• Comprehensive Rehabilitation Plan
– This is 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 this
comprehensive plan of care.

14. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 14
Patient Education
• Crucial for the rehabilitation process to be
comprehensive
• An ongoing and integral process by which
patients and families build knowledge, skills,
and confidence to regain physical and
psychosocial functioning following an illness or
injury

15. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 15
Patient Education
• The following five-step process may be used.
– Assess the patient's and family’s needs, abilities,
and concerns.
– Plan interventions based on these needs, abilities,
and concerns.
– Implement the educational plan.
– Evaluate the educational plan.
– Review the educational plan.

16. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 16
Scope of Individuals Requiring
Rehabilitation
• Rehabilitation is a bridge for the patient,
spanning the gap between
– uselessness and usefulness
– hopelessness and hopefulness
– despair and happiness
• The scope of conditions requiring
rehabilitation is broad and spans the life
continuum.

17. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 17
Family and Family-Centered Care
• A philosophy that recognized the pivotal role
of the family in the lives of children with
disabilities and other chronic conditions
• Strives to support families in their natural
caregiving roles by building on their unique
strengths as individual parents
• Promotes normal patterns of living at home
and in the community and views families and
professionals as equals in a partnership
committed to excellence at all levels of health
care

18. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 18
Family and Family-Centered Care
• Key Elements of Family-Centered Care
– Incorporating into policy and practice the
recognition that the family is the constant in a
child’s life
– Facilitating family/professional collaboration at all
levels of hospital, home, and community care
– Exchanging complete and unbiased information
between families and professionals in a
supportive manner at all times

19. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 19
Family and Family-Centered Care
• Key Elements of Family-Centered Care
(continued)
– Encouraging and facilitating family-to-family
support and networking
– Appreciating families as families and children as
children; recognizing that they possess a wide
range of strengths, concerns, emotions, and
aspirations beyond their need for specialized
health and developmental services and support

20. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 20
Pediatric Rehabilitation Nursing
• This has evolved over the past 20 years from a
mere combination of pediatrics and rehabilitation
into a true specialty committed to the care of
children with disabilities or other chronic
conditions and their families.
• Nurses in this field provide a continuum of care
so those children can become contributing
members of society and function at their
maximum potential.
• Pediatric rehabilitation nurses in their roles as
leaders, advocates, and educators can have a
very positive influence on the lives of children
with disabilities and chronic conditions and on
their families.

21. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 21
Gerontologic Rehabilitation Nursing
• This specialty practice focuses on the unique
requirements of older adult rehabilitation
patients.
• The gerontologic rehabilitation nurse is
knowledgeable about both techniques of caring
for the aged and rehabilitation concepts and
principles.
• The main goal is to assist older adult patients in
achieving their personal optimal level of health
and well-being by providing holistic care in a
therapeutic environment.

22. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 22
Disabling Disorders
• Spinal Cord Injuries
– These injuries occur mainly as a result of
traumatic accident, and the individuals paralyzed
are primarily young males.
– Functional abilities are related to injury level and
extent of damage to the spinal cord; the higher
the injury point, the higher the level and loss of
function.
– Injury to the spinal cord is irreversible in that the
cord is unable to repair itself.

23. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 23
Disabling Disorders
• Spinal Cord Injuries (continued)
– Postural hypotension
• Some individuals may have a marked drop in blood
pressure while sitting.
– Autonomic dysreflexia
• Patients with spinal cord lesions above T5 may
experience sudden and extreme elevations in blood
pressure caused by a reflex action of the autonomic
nervous system.
• It is produced by stimulation of the body below the
level of injury, usually by a distended bladder.

24. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 24
Disabling Disorders
• Spinal Cord Injuries (continued)
– Heterotopic ossification
• This is the abnormal formation of bone cells in joints.
• It is commonly seen in people with spinal cord injuries,
and it occurs below the level of the lesion.
– Deep vein thrombosis
• This is clotting of blood within vessels of the legs
caused by slowing of the circulation or an alteration in
the blood vessel wall.

25. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 25
Disabling Disorders
• Traumatic Brain Injuries
– Most brain-related disabilities, including physical,
cognitive, and psychosocial difficulties, require 5 to 10
years of difficult and painful rehabilitation; many
require life-long treatment and attention.
– The primary goal of the rehabilitation professional
treating the survivor of brain injury is to restore the
person to the highest possible level of independent
functioning.
– Head injuries are classified as either penetrating or
closed head injuries.

26. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 26
Disabling Disorders
• Traumatic Brain Injuries (continued)
– Classified as mild, moderate, severe, or
catastrophic
• Mild: brief or no loss of consciousness; neurologic
examinations often normal
• Moderate: unconsciousness ranging from 1 to 24 hours;
usually cognitive impairments

27. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 27
Disabling Disorders
• Traumatic Brain Injuries (continued)
• Severe: unconsciousness or post-trauma amnesia in
excess of 8 days; cognitive, psychosocial, and
behavioral disabilities
• Catastrophic: coma lasting several months or longer;
generally never regains significant meaningful
communication

28. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 28
Key Points
• Rehabilitation is the process of maximizing an
individual’s capabilities or resources to foster
optimal independent functioning.
• The patient is the most important team
member and must be involved in planning the
programs and learning in detail about the
disabilities, the ways of accomplishing the
goals, and the options available

29. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 29
Key Points
• Rehabilitation nursing is directed toward the
prevention of complications of disease or trauma
and the maintenance or restoration of function.
• Basic rehabilitation can be used regardless of cause
of disability. The rehabilitation team must
individualize care by developing goal-directed,
comprehensive care plans for each patient
• Holistic nursing interventions should be used to
assist the patient in attaining an optimal level of
functioning and well-being.

30. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Slide 30
Key Points
• A disability can have a number of effects on both the
patient and the family, including behavioral and
emotional changes and changes in roles, body image,
self-concept, and family dynamics.
• A comprehensive rehabilitation plan is multifaceted
and should involve a functional assessment, an
evaluation conference (team meeting), and a family
conference.
• The focus of all rehabilitation should be on the
patient’s abilities, not on his or her disabilities.