The Art Of Rehabilitation Nursing by sma39436


									The Art Of Rehabilitation

The Case of ‘Agnes’ and Her Route
  ? Similarities between stroke-rehab and
  ortho-rehab nursing
  Historical contextual role in the team
  Recent therapeutic direct team role
  Traditional-compensatory role vs.
  Rehabilitative-facilitatory role
The Nursing Role

                nursing role in ortho-rehab

 interpretive    consoling     conserving     integrative
     role           role          role            role
Agnes, an 89 Year Old Lady
  Admission to trauma unit DAY 1, sub-
  capital femoral fracture grade IV
  Theatre visit DAY 3, hemi-arthroplasty
  Transfer to rehab unit DAY 6
  Discharged home DAY 30
  NB previous DHS insertion 1 year ago
Underpinning Themes
  Therapeutic relationship
  Technically competent
  Patient as a team player
Interpretive Role
  Answer questions    Realistic goal planning
  Deal with agonies   Maintain hope

  Provide realistic   Generate motivation to
  info                work

  Ramifications       Understanding as
                      opposed to compliance
Examples of This Role
   - Working With Agnes
 Why is Agnes in the rehab unit
 What facilities are available to Agnes and her
 Ascertain from Agnes where she wants to ‘be’
 and plan for that goal
 Difference in surgery and its implications for
 Uncover what makes Agnes tick
 Humanising the ‘system’
Consoling Role
  Intensely directed at providing emotional
  Need to develop a therapeutic relationship
  This relationship is fundamental to all other
  Promoting hope and preventing depression
  are the major tasks
Examples of This Role
  – Working With Agnes
  The ‘camels back’- broken?
  Open visiting
  Older person’s mental health
  Identifying hobbies and pleasurable pastimes
  Promote hope through successful work
  Encourage the involvement of those who
  know Agnes
Conserving Role
Meeting basic needs:-   Preventing Complications:-
  Hygiene                 Reduced mobility
  Elimination             Skin
  Nourishment             Nutrition
  Energy conservation
                          Safe positioning
Examples of This Role
  – Working With Agnes
Relieving pain
Interventions to prevent post.Op. Problems
Risk assessments - skin, nutrition, falls > action
Safe movement to prevent dislocation
Compensatory interventions
Recognition of Agnes’ inherent worth as a
Integrative Role
 Create rehab environment
 Translate team therapy into the patient life
 ‘Therapy’ by nurses
 Education and counselling
 Issues of sexuality
 Administration of medicines
Examples of This Role
  – Working With Agnes
 Tuned into Agnes’ situation
 Direct Agnes’ new skills to practical ends
 Continuation of specific therapeutic interventions
 Agnes needs to be able to see the relevance of
 interventions – don’t take your eyes off the ball!
 Ability to enjoy life to the full
 Integrate drug therapy into daily living
 Discharge = culmination of ‘therapies’
Conceptual Similarities
  Alfano (1971)
‘Healing or care taking,
  which will it be?’

  Kneafsey et al (2001)
‘The role of the nurse within
  the multi-professional
  rehabilitation team’

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