Rehabilitation Nursing

Presented By: Dr. Kailash Nagar

Department of community health

• The International Classification of Impairments, Disabilities and Handicaps (ICIDH) published in 1980 by WHO also contributed to a medical approach.

• ICIDH defines a model that progresses from disease, impairment and disability to handicap in a linear fashion

Disease Impairment Disability Handicap

HEALTH WHO’s definition:

Physical, psychological and socially complete well-being.

IMPAIRMENT

Definition: Any loss or abnormality of psychological, physiological, or anatomical

structure or function.

IMPAIRMENTImpairment includes clinical features or manifestations of the disease or condition.

Examples: weakness, confusion etc.In this definition function is the function of

a body part, not the whole-person function.

DISABILITY Any restriction or lack

resulting from impairment 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 individual resulting from an impairment or a

disability that limits or prevents the fulfillment of a role that is normal (depending on the age,

gender, social and cultural factors) for that

individual.

WHO DEFINITIONS

Impairment ↔ Organ or Tissue

Disability ↔ Whole Person

Handicap ↔ Society

Impairment is defined as defined as abnormality of structure or function of the body or an organ.

Disability is defined as restriction or lack of ability as a result of the impairment.

Handicap is defined as a social disadvantage faced by an individual resulting from either impairment or disability.

Disability: Global Statistics

Approximately 10% of the world population lives with a disability

An estimated 80% of people with disabilities live in developing countries

An estimated 15-20% of the world’s poorest people are disabled

No rehabilitation services are available to people with disabilities in 62 countries

Only 5- 15% of people with disabilities can access assistive devices in the developing world

Children with disabilities are much less likely to attend school than others

People with disabilities tend to experience higher unemployment and have lower earnings than people without disabilities

REHABILITATION Rehabilitation is the process of

helping a person to reach the fullest physical, psychological,

social, vocational, and educational potential consistent with his or her physiologic or

anatomical impairment, environmental limitations, and

desires and life plans.

According to WHO “ Rehabilitation is the combined and coordinated use of the medical, social, educational, and vocational measures for training and re-training the individual to the highest possible level of functional ability”.

REHABILITATION NURSING

Important and essential part of comprehensive nursing.

Rehabilitation nursing ideally starts at the moment a patient enter into the health care system.

However, rehabilitation programme may take place in the special units of hospital or independent centre in the community.

Objectives of Rehabilitation Nursing

There are 4 broad objectives of rehabilitation nursing:a. To restore affected abilities to the highest

possible level of function.b. To prevent further disability/ handicap.c. To protect the person abilities.d. To assist the person / patient to use his or her abilities

Principles Of Rehabilitation:

o Rehabilitation should begin during the initial contact with the patient.

o Restoring the patient to independent or to regain his pre-illness/pre-disability level of function in as short a time as possible.

o Maximising independence within the limits of the disability.

o He must be an active participant.

o The activities of daily living are facilitated.o The individual with a disability is encouraged

to wear his clothing enhances self-esteem and dignity.

o Motivates the patient and helps him to attain social independence.

o Focus is on the needs of groups of people with specific condition

o Every patient has a right to the rehabilitation services.

Scope of Rehabilitation

Scope of rehabilitation

Physiotherapy

Scope of rehabilitation

Vocational Guidance

Scope of rehabilitation

Speech Therapy

Scope of rehabilitation

Health Education

Scope of rehabilitation

Psycotherapy

Rehabilitation team

1. Nurse 2. Physiotherapist

Rehabilitation team

3. Psycologist 4. Dietician

Rehabilitation Team5. Speech Therapist

8. Recreational Therapist

7. Social Worker

6. Vocational Rehabilitation Counsellor

9. Occupational Therapist

Rehabilitation Team5. Speech Therapist

8. Recreational Therapist

7. Social Worker

6. Vocational Rehabilitation Counsellor

9. Occupational Therapist

Psychiatrist • Leader of the team.• Responsible for each intervention• Evaluates the patient• Plans. • Organizes.• Directs • Coordinates.• Controls.• Motivates.

NURSE• Controls environmental factors.• Directs personal care of the patient.• Manages medication.• Is responsible for skin integrity. • Helps ADL and adaptive devices.• Organizes bowel and bladder

program.• Helps the patient manage their time.• Informs the team about the status of

the patient• Educates the patient and the family

PHYSIOTHERAPIST• Performs muscle strength testing.• Evaluates the length and the tonus

of the muscle• Exercises the patient especially for

gross motor function.• Teaches how to transfer.• Instructs the use of wheelchair,

canes and crutches.• Offers physical therapy modalities.• Educates for posture and walking.

Occupational therapist• ADL.• Trains the patient in the

functional use of upper extremities.

• Explores the vocational skills.• Evaluates the home and suggest

modifications.• Trains patients in the use of

assistive technology.• Collaborates with all of the team

Speech Therapist• Evaluates patients with aphasia,

dysarthria, apraxia• Speech, comprehension, reading

and writing• Swallowing, feeding• Other communicative problems

and proper therapies• High technologies• Family and patient education

and counseling

Psycologist

• Evaluates the psychological status of the patients• Tests intelligence, memory and perceptual

functioning• Incorporates the test results into the care plan• Educates family and patient • Counseling of the family

Social worker• Evaluates patients (life-style, family, finances,

employment, environmental factors)• Maintains a continuing relationship with the patient

and family• Coordinates funding resources• Provides assistance in locating alternative living

situations• Assess vocational barriers• Provide emotional support in strressful situations• Facilitates discharge planning

Vocational Councellor• Assists in developing and attaining realistic

vocational goals• Evaluates vocational interests, aptitudes, and skills• Counsels patients in the work environment• Organizes activities to develop employer-employee

relationship behaviors• Acts as a liaison between the patient and agencies

that provide training or job placement services • Provides counseling, education, and support to

potential employers (job analysis on worksite)

ASPECTS OF REHABILITATION

1.Medical rehabilitation

Includes restoration of functions by prosthesis, artificial limbs, etc.

ASPECTS OF REHABILITATION

2. Social rehabilitation Includes restorations of family and social relationship by replacement in the family

ASPECTS OF REHABILITATION3. Educational rehabilitation: Include specialized training and educational facilities e.g. Braille for blind, Sign language for dumb and deaf

4.Psychological rehabilitation Includes restoration of personal dignity and confidence during the period of growth and development and in adult life

ASPECTS OF REHABILITATION

ASPECTS OF REHABILITATION5. Vocational rehabilitation Includes restoration of the capacity to earn a livelihood. This can achieve by community participation and social legislation for handicapped individual. The community needs to offer employment opportunity in shops, factories and other business establishment.

Approach of Rehabilitation

Community Based Rehabilitation (CBR)

Institution Based Rehabilitation ( IBR)

Approach of Rehabilitation

Community Based Rehabilitation (CBR)

CBR may be defined as “strategy within community development for the rehabilitation, equalization of opportunities, and social integration of all people with disabilities.

• CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services" 

-WHO

History

Community-based rehabilitation (CBR) was initiated by WHO following the Declaration of Alma-Ata in 1978 in an effort to;a. enhance the quality of life for people with

disabilities and their familiesb. meet their basic needsc. ensure their inclusion and participation.

Objectives of CBR:

To identify all persons with disability in the community.

To provide required rehabilitation service to disabled people.

To create awareness about all issues related to disability.

To transfer rehabilitations related skills to the community members.

To mobilize available resources and raise funds to carry out the problem.

To raise the level of community participation to an optimum level.

To make the CBR program sustainable until the needs of the disabled people are adequately met

To priorities service for disabled children.

Principles Of CBR

UtilizationParticipation

Transfer Strengthen

Principles Of CBR

i. Participation of community in planning, decision making and evaluation

ii. Utilization of available resources in the community.

iii. Utilization of a co-ordinated approach among education, health and social systems.

iv. Transfer of knowledge about disabilities and skills in rehabilitation of people with disabilities, families and communities.

v. Strengthening of referral services at the district, provincial, and national levels.

Components of CBR

HEALTH

EDUCATION

LIVELIHOOD

SOCIAL ACCEPTANCE

EMPOWERMENT

CBR Matrix In light of evolution of CBR into broader

multisectorial development strategy, a matrix was developed in 2004 to provide a common framework for CBR program.

It consists of five key components : Health, Education , Livelihood, Social and

Empowerment components. Each of these components have five

elements.

CBR Matrix

Advantage of CBR:

Home based. Less expensive

Existing community response and resources.

Focus on quality rather than quantity

Multiple approaches based on community needs.

REHABILITATION COUNCIL OF INDIA:On enacted in September , 1992 the RCI act by

parliamentit became statutory body in 22 june 1993.16 Categories of Professionals/ Personnel have been covered under the RCI Act as given below.1. Audiologists and Speech Therapists 2. Clinical Psychologists 3. Hearing and Ear Mould Technicians

4. Rehabilitation Engineers and Technicians 5. Special Teachers for Educating and Training

the Handicapped 6. Vocational Counsellors, Employment Officers

and Placement Officers 7. Multi-purpose Rehabilitation Therapists,

Technicians 8. Speech Pathologists 9. Rehabilitation Psychologists 10.Rehabilitation Social Workers

11.Rehabilitation Practitioners in Mental Retardation

12.Orientation and Mobility Specialists 13.Community Based Rehabilitation

Professionals 14.Rehabilitation Counsellors, Administrators 15.Prosthetists and Orthotists 16.Rehabilitation Workshop Managers

Role of Community Health Nurse in Rehabilitation

1. Assessment of the patients physical, mental, socioeconomic and vocational status

2. Diagnosis of the therapeutic, physiotherapeutic, vocational, education, training and supportive needs of the client

3. Deciding the minimum acceptable improvement in the patient’s health, capacity for independence and productivity level

Role of Community Health Nurse in Rehabilitation

7. Modification of plan of action, if necessary.

6.Evaluation of the result of interventions.

5. Implementing the action plan

4. Formulation of plan of action

Qualities of Community Health Nurse in Rehabilitation

Excellent listening skills.

High order counselling abilities

Effective Problem solving skill.

The ability to adopt innovative methods to help the patient realize

Important Areas in Nursing RoleCreate awareness of the problem in the

community.Reduce the consequences of the disabilities by

early detection (educate the family and the community in early detection of the disability).

Provide early interventionEstablish adequate number of aids in appliance

and workshops to fabricate atrophic, prosthetic and other items.

Appropriate are need-based rehabilitation programme.

Train families in functional rehabilitation. Modify inappropriate attitude of the family &

community towards disability. Arrange meeting of families with children

having similar disabilities so that they will be mutually supportive

Provide recreation facilities for disables children

Important areas in Nursing Role

Conclusion Rehabilitations a strategy for enhancing the quality of life of disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights. It should deliver the service and training to people with disabilities and their family.Hence it is necessary to mention that rehabilitation nursing is a complex task and one of the essential part of the comprehensive nursing.

Thank you !!