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Rehabilitation Nursing

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Objectives Student should be able to:

Define rehabilitation Describe the philosophy of rehabilitation Discuss the cornerstones of rehabilitation Identify the primary goals of rehabilitation Describe the role of rehabilitation Describe the purpose of the team approach Discuss the “stigma” and attitude barriers

faced by a person with a disability Discuss with a disability

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Rehabilitation Rehabilitation Nursing Formal Definition “A dynamic process in which a disabled

person is helped to achieve optimum physical, emotional, psychological, social, or vocational potential in order to maintain dignity and self-respect in a life that is as independent and self-fulfilling as possible.”

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Rehabilitation DefinedTranslated

ACHIEVE TO BEST CAPACITY WHY?

Physically Emotionally Psychologically Socially Vocationally

Maintain personal dignity

Maintain self-respect

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What would be the result?

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Independent

Self-fulfillin

gLIFE

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Rehabilitation Nursing Discussion : Who can come to rehab?

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Impairment

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Woman and Man with Disability at Work

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Handicap Create limits Dependent on:

Age Gender Social factors Cultural factors

Think

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Chronic Illness Usually Irreversible Whole person involved Requires:

Supportive care Functional ability Prevention

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HistoryRehabilitation Medicine

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Rehabilitation Nursing Latin Word Ancient societies Rehabilitation

Habilitation

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Wars Brought Attention

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Further Need Social Security Act of 1935 Polio epidemics of the 1930-1940s Post WWII 1960s Rehabilitation Act of 1973 American Disabilities Act of 1990

Adult Polio patients

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Philosophy

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Philosophy Main Focus FIM Scoring One condition The Best Rehab continues

until____________?

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Cornerstone Principles

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Cornerstone Principles Patient –Centered Community Reentry Independence Functional ability Team approach Quality of life Prevention/wellness Change process Adaptation Patient/Family Education

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Primary Goals

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Primary Goals for the Patient

Reasonable Restoration Maintain Address specific needs Adjust Reenter community

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Characteristics of aComprehensive Rehab Unit

Prevention through teaching Early recognition Offers both In and Outpatient rehab

services

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Rehabilitation Desired Outcomes

Increased independence Improved quality of life

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Rehab Focus: Education Improved workable capacity of the client Proof

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Issues

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Issues Quality vs. quantity of life Care vs. cure Resource allocation/Personal productivity Society’s views High cost of comprehensive

interdisciplinary treatment vs. continued low maintenance cost of LTC

Different terms used in society Persons with disabilities vs. a disabled

person

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Nurses Role

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Rehab Nurses Role 50% Know-how 50% open-minded encouragement My Role

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Successful Nursing Characteristics

Must be assertive Low level of anxiety High self-concept and esteem

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Nursing Roles in Rehab Caregiver Coordinator Educator Advocate Case Manager Leader Collaborator

Facilitator Liaison Consultant Discharge planner Researcher Counselor Coach

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Rehab Nursing Focused Assessment on Coping Watch/ Listen Effective vs. ineffective coping behaviors Pre-morbid behavior Family/support systems Strengths/limitations Financial assessment

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Interventions for Coping Issues Encourage Assess q shift Focus on understanding/accepting client Prevent family/caregiver fatigue Prevent medical crisis Prevent social isolation Encourage to use community resources Relieve helplessness Minimize stress levels Counsel/listen Encourage cognitive restructuring Encourage spiritual support Educate Relaxation Involve family ASAP

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PurposeTeamConflict ResolutionCoordination of Rehab Team

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Rehab Team Approach Team has many members Each therapy is called a “discipline” One therapy vs. team of therapists Focus of team

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Team Conference Held when best time for all Weekly Lasts 5-10 minutes/client Informal Disciplines discuss recent FIM

scores/problems Room for civil disagreement Focus on best plan to accomplish goals Team evaluates itself based on outcomes

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Client and Family Also team members Key member Attend/contribute to team conference Open communication encouraged Problems are brought

out/discussed/resolved Boundary setting set as needed

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Team MembersCharacteristics

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Client/Family Client most important member Center of team Client included:

Decision making Team planning

Must be willing/active participant to reach goals

Demonstrates commitment to rehab program

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Rehabilitation Nurse Advocate Educator Team player Coordinator Understands discipline’s jargon Reinforces each discipline’s training Extremely important member for client’s

success

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Medical Doctor Physiatrist Responsible for primary medical management Directs overall POC Devises Treatment plan Then all disciplines put it into action Team coordinator

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Physical Therapy (PT) Movement/Comfort Performs Treatments Assess by Home Evaluations, client’s physical environment

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Occupational Therapy (OT) Focus on function ADL’s Self-care Improving fine motor control/skill Reeducation of muscles Perception/motor difficulties evaluated Home evaluation for safety with ADL’s

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Speech Therapy (ST) Evaluate/Treat:

Communication problems Developmental speech problems Post surgical procedures Swallowing disorders

Assess: Receptive abilities Integrative abilities Expressive language abilities Swallowing evaluations

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Social Worker (SW) Assists with personal problems of client/family Assess:

Lifestyle Discharge needs

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Respiratory Therapy (RT) Assess pulmonary status Begins Respiratory rehab program if

needed

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Therapeutic Recreational Therapy (TR)

Assists: Restoring self-confidence Re-socialization Basic functional skills

Directs social activities/outings Encourages group interaction Utilizes both rehab center/community

facilities for client to: Interact with society Overcome physical barriers

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Chaplain/Religious Leader Assess Client/Family:

Coping Spiritual needs Counsel as needed

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Dietician/Nutritionist Evaluates:

Nutritional status Dietary needs Consults

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Psychologist Treats psychological impairments Provides behavior modification program Assesses:

Cognitive status Emotional status

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Vocational Rehab Specialist(VRS)

Found in larger facilities Assesses:

Potential to return to work Other work possibilities

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Biomedical or Rehabilitation engineering

Evaluate need for assistive devices W/C with puffers or tongue control Special automotive hand controls Promotes independence

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Orthotics and Prosthetics Evaluate need for assistive devices with

limb loss Develop devices to promote:

Independence Self esteem/concept

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Case Manager Coordinates Plans Home Evaluation with OT, PT, client

and family Does not direct the team RN or SW

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Disability and SocietyStigma

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Disabilities and Society Rehab provides temporary shelter Rehab nurses understand these issues

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Stigma Defined Not quite normal Lots of devaluing words

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Elephant Man Joseph Merrick

Normal until age 2 Small growths on face Joined “freak show” age 21 Dr. Frederick Treves Head measured 36 inches Scoliosis Deformed right hand Disagreement among medical professionals of cause of death

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Modern Elephant Man Ou Guifeng, 22 Began to suffer from disease at age two Growing numbers of tumors led to:

Right eye nearly blind Face twisted Liver impaired Leg lame Lives in Southwest China Called "Elephant Man."

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Behavioral Barriers by the Stigmatized

Social isolation or Segregation Pain

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Behavior Barriers Revealed

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Behavior Barriers Revealed #1 Fear of abandonment

Chronically ill or disabled response Term: learned helplessness May observe fearful behavior

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Behavior Barriers Revealed #2 Origin of negative attitudes towards

people with disabilities May be seen as cultural influences and

what society values Result?

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Behavioral Barriers Revealed

#3 Psychodynamics observed between family and patient Mourning period Spread phenomenon Responsibility Fear of ostracism or guilt by association Punishment for sin

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Normal Behavior Responses

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Anxiety Provoking Situations

Normal response Guiding rule: Extend common courtesy or

ask Fear

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Threats to Body Image Vulnerable Catching?

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Coping Theories

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Coping Theories Shontz Theory Lindeman Theory

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Family Adjustment Theory

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Safilios-Rothschild Theory Family’s perception Family vs. control Family’s reality check Ideal family Assumptions

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Coping with Disability

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Coping vs. Succumbing

Wrong and Right attitudes Focus is changed Looking for solutions

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Rehabilitation NursingA team effort

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SummaryEach Student: Name one thing you learned How will you apply it to your nursing

practice?

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References http://lomalindahealth.org/common/legacy/lluhc/rehabilitation/inpatient/images/otknobs.jpg http://news.medill.northwestern.edu/uploadedImages/News/Chicago/Images/Science/SPINAL_SPLASH.jpg http://www.nytimes.com/2007/05/28/health/28stroke.html http://media.knoxnews.com/media/img/photos/2009/05/22/052209amputee-poster_t300.jpg http://www.understanding-medical-conditions.com/image-files/rheumatoid-arthritis-in-hand.jpg http://static.howstuffworks.com/gif/agent-orange-4.jpg http://img-greenbooks.theonering.net/guest/images/040102_image11.jpg http://images.ha.com/ http://www.littletonnhhospital.org/images/Departments/new_rehab_team.jpg http://www.nrh.ie/wp-content/uploads/2010/07/IF-nat-rehab-centre-1-300x200.jpg http://www.med.umich.edu/pmr/modelsci/images/SCI_04.jpg http://www.google.com/imgres?imgurl=http://www.enloe.org/medical_services/rehabilitation_center/images/ENLOEnu

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furl=http://www.cumc.columbia.edu/dept/rehab/patients/physiatrist.html http://www.google.com/imgres?imgurl=http://www.thomashospital.com/images/imgRehabSpeech.jpg&imgrefurl=http

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References http://www.google.com/imgres?imgurl=http://www.carolinacns.com/bob.jpg&imgrefurl=http://www.carolinacns.com/st

aff.htm http://www.minotdailynews.com/photos/news/md/552810_1.jpg http://www.latech.edu/coes/graphics/cbers/van%20wheelchair.jpg http://gtresearchnews.gatech.edu/wp-content/uploads/2009/11/tonguedriveP186_hires.jpg?phpMyAdmin=387c4b701

e2at54367afa http://www.alleghenyoandp.com/images/prosthetic_fitting.jpg http://www.covenantheartinstitute.com/HeartCenter/P06371/P06379/P06324/%7B90a45f00-9922-426d-a1a5-9d15bc

728415%7D http://www.glenbow.org/50s/pics/large/fear/na-5600-8286a.jpg