TERM 3- MY NOTES FOUNDATIONS OF NURSING CH.39 "Rehabilitation Nursing" Flashcards
Rehabilitation nursing is really what holistic nursing is all about. In rehabilitation nursing, we assess and address every aspect of the individual’s needs and care.
A)true
B)false
A
Rehabilitation Nursing
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Rehabilitation is possible to define in a variety of ways. For our purposes, it is the process of restoring the individual to the fullest physical, mental, social, vocational, and economic capacity of which he or she is capable. It involves relearning former skills-relearning the activities of daily living (ADLs)-and learning the new skills necessary to adapt and live fully within the context of an altered lifestyle
A)true
B)false
A rehabilitation
Rehabilitation means adjusting to a new set of needs by innvolving and applying previous knowledge and skills in combination with a variety of new ideas, knowledge, and skills.
A)true
B)false
A
Rehabilitation has to begin from the very onset of a traumatic event or diagnosis of a chronic illness.
A)true
B)false
A
According to Ruth Stryker (1977), rehabilitation is a creative process that begins immediately with preventive care and continues throughout the course of the illness and through the restorative phase of care, and involves adaptation of the whole being to a new Life.
A)true
B)false
A
NEED FOR REHABILITATION
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What precipitates the need for rehabilitation is impairment, disability, handicap, functional limitation, or chronic illness, or some combination of these.
A)true
B)false
A
The World Health Organization (1980) defines these terms as follows:
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• Impairment: Any loss or abnormality of psychological, physical, or anatomical structure or function.
A)true
B)false
A
• __________: Any loss or abnormality of psychological, physical, or anatomical structure or function.
• Impairment: Any loss or abnormality of psychological, physical, or anatomical structure or function.
• Disability: Any restriction or lack (resulting from an impairment) of an ability to perform an activity in the manner or within the range considered normal for a human being.
A)true
B)false
A
• ___________: Any restriction or lack (resulting from an impairment) of an ability to perform an activity in the manner or within the range considered normal for a human being.
• Disability: Any restriction or lack (resulting from an impairment) of an 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 disability that limits or prevents the fulfillment of a role that is normal for that particular individuaL The handicap one individual with a given disability faces may not be a concern or handicap for another individual with the same disability.
A)true
B)false
A
• _________: A disadvantage for a given individual resulting from an impairment or disability that limits or prevents the fulfillment of a role that is normal for that particular individuaL The handicap one individual with a given disability faces may not be a concern or handicap for another individual with the same disability.
• Handicap: A disadvantage for a given individual resulting from an impairment or disability that limits or prevents the fulfillment of a role that is normal for that particular individuaL The handicap one individual with a given disability faces may not be a concern or handicap for another individual with the same disability.
• Functional limitation: Any loss of ability to perform tasks and obligations of usual roles and normal daily life. See discussion later in the chapter regarding functional assessment.
A)true
B)false
A
• __________: Any loss of ability to perform tasks and obligations of usual roles and normal daily life. See discussion later in the chapter regarding functional assessment.
Functional limitations
• Chronic illness: An irreversible presence, accumulation, or latency of disease states or impairments that involve the total human environment for supportive care, function, and prevention of further disability.
A)true
B)false
A
CHRONIC IllNESS AND DISABILITY
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Healthy People 2010 Focus Areas Related to Chronic Illness and Disability
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-Assess the quality of service • Arthritis, osteoporosis, and chronic back conditions • Cancer • Chronic kidney disease • Diabetes • Disability and secondary conditions • Heart disease and stroke • Human immunodeficiency virus (HIV) • Mental health and mental disorders • Respiratory diseases • Vision and hearing
True
CHRONICITY
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Unlike acute illnesses, which are usually abrupt in onset and self-limiting (the illness is either resolved or death ensues), chronic illnesses have the potential to be either abrupt or insidious in onset and by definition persist for an extended and indefinite period.
A)true
B)false
A
Theorists have developed many definitions of chronic illness. However, all definitions include one or more of the characteristics first outlined by the Commission on Chronic Illness (1957). These characteristics include any impairment or deviation from normal that has the following features:
- Is permanent
- Leaves a residual disability
- Is caused by a nonreversible pathologic condition
- Requires special training of the patient for rehabilitation
- Requires a long period of supervision, observation, or care
True
DISABILITY
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The Americans with Disabilities Act (ADA) became law in 1990. This landmark legislation provides protection against discrimination for people with disabilities. Universally accepted, the ADA defines an individual as disabled if he or she has a physical or mental impairment that substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having sudt an impairment.
A)true
B)false
A
One way to look at it is to assert that all individuals are only temporarily able bodied, and that at some point in life we will all experience some form of disability. It is essential to develop this level of awareness to avoid labeling groups of people in ways that risk disenfranchising them.
A)true
B)false
A
CROSS-CUlTURAL REHABILITATION
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We are called on to engage in genuine collaboration with our patients and colleagues, including those trained in other disciplines and community-level workers, in order to obtain the best possible functional outcome for the patient.
A)true
B)false
A
CULTURAL COMPETENCE
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Cultural competence acknowledges and incorporates all levels-the importance of culture, the assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs
A)true
B)false
A
The following describes a culturally competent practitioner:
- Has the capacity for cultural self-assessment
- Values diversity, with an awareness, acceptance, and even celebration of differences in life view, health systems, communication styles, and other life-sustaining elements
- Is conscious of the dynamics of difference
- Institutionalizes cultural knowledge
- Adapts to diversity
True
People develop cultural proficiency when they hold culture in high regard. The culturally proficient professional recognizes the need to conduct research, disseminate (spread)the results, and develop new approaches that promise to increase culturally competent practice.
A)true
B)false
A
Rehabilitation professionals have an ethical responsibility to strive for cultural competence and cultural proficiency.
A)true
B)false
A
ISSUES IN REHABILITATION
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In rehabilitation, several forces drive the rendering of care. The issues involved include but are not limited to the following:
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- 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: Because of the suddenness and catastrophic effect of many conditions necessitatting rehabilitation, it is necessary to consider the care of the individual versus the cure of the condition. Many conditions are irreversible; therefore, the focus of care is on adapting and accepting an altered life rather than resolving an illness.
- High cost of interdisciplinary care versus longterm care: Rehabilitation is expensive, mainly because the care is delivered by a team of highly trained professionals. In some cases, we view successful rehabilitation as a person’s return to productive employment. Studies of resource allocation have shown that for every dollar we spend on rehabilitation, we save an average of three dollars if the individual is able to live independently and return to the workforce, eliminating the exxpense of a caregiver or residential long-term care. Remember, however, that in some cases a disability means that two people become unemployed the individual with the disability and the caregiver. Rehabilitation in this scenario is successful, and the savings still considerable, if the individual with the disability becomes independent enough to not require a caregiver even though he or she remains unable to return to work.
True
The underlying philosophy of rehabilitation is to focus on abilities rather than disabilities, to continually make the most of the abilities that remain intact.
A)true
B)false
A
The individual, the family, and the support system are the focus of all rehabilitation efforts. Quality rehabilitation will result in people who are continually striving to reach their highest potential of living independently in today’s complex world.
A)true
B)false
A
GOAlS OF REHABiliTATION
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Rehabilitation is, as mentioned, a goal-oriented (outcome-oriented) process. These goals are personal, and in each case we individualize them to meet the holistic needs of each person we serve. To determine goals, we engage in a collaborative goal-setting process that includes the members of the rehabilitation team, with the individual and the family at the center of the process.
A)true
B)false
A
It is appropriate to include the following criteria in all rehabilitation goals:
- The goals maximize the quality of life of the individual.
- The goals address the individual’s specific needs.
- The goals assist the individual with adjusting to an altered lifestyle.
- The goals are directed toward promoting wellness and keeping complications to a minimum.
- All goals assist the individual in attaining the highest degree of function and self-sufficiency possible.
- The goals assist the individual with home and community reentry.
True
CORNERSTONES OF REHABiliTATION
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Rehabilitation is like a road, the road to recovery following a traumatic, life-changing event. The following building blocks or stepping stones pave the way as we travel along it:
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- Focus on the individual: Center all efforts at rehabilitation around the individual’s goals and objectives. When the individual sets or holds goals that are less than realistic, the team works with the individual in reshaping expectations.
- Community reentry: We consider rehabilitation successful if the individual is able to reenter the community tluough participation in social, vocational, and recreational activities.
- Independence: The goals of rehabilitation focus on promoting and maintaining physical and emotional independence.
- Functional ability: We measure progress in rehabilitation in terms of functional outcomes.
- Team approach: We achieve rehabilitation goals through the work of the rehabilitation team members, including the individual and the family.
- Quality of life: Goals focus on improving the quality of life rather than increasing the quantity of life.
- Prevention and wellness: Because many problems calling for rehabilitation are long term, our ·goals focus on preventing complications and maximizing function.
- Change process: All individuals and families who experience a disabling condition or chronic illness experience the change process. The rehabilitation team is responsible for directing the change in as positive a manner as possible.
- Adaptation: Although individuals with disabilities do not always accept their disability, learning to adapt to the circumstances created by the limits of their abilities is a positive method of coping.
- Patient and family education: Knowledge and skills are essential components of the rehabilitation program. Individuals with substantial disability have potential to gain a degree of independence through patient education, which enables them to direct their own care.
True
REHABiliTATION TEAM
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Because no one discipline offers the knowledge and expertise necessary to provide all the components of the rehabilitation program, the rehabilitation team is composed of people from multiple disciplines. The team coordinates the comprehensive rehabilitation program for each patient in an individualized manner
A)true
B)false
A
MODELS OF TEAM FUNCTIONING
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Primary models of rehabilitation team functioning. One model, primarily of service in the past, is the multidisciplinary rehabilitation team. Characteristic of this model are discipline specific goals, clear boundaries between Disciplines, and outcomes that are the sum of each discipline’s efforts. Effective communication is the key to success for this type of team.
A)true
B)false
A
The type of team most commonly used today in rehabilitation hospitals is the interdisciplinary rehabilitation team. This type of team collaborates to identify individuals’ goals and features a combination of expanded problem solving beyond the boundaries of the individual disciplines together with discipline-specific work toward goal attainment.
A)true
B)false
A
A third type of team is the transdisciplinary rehabilitation team. What characterizes this model is the blurring of boundaries between disciplines, as well as crosstraining and flexibility to reduce to a minimum any duplication of effort toward individual goal attainment.
A)true
B)false
A
Rehabilitation nurses-diverse in expertise, roles, and work settings-play a critical role in models for rehabilitation.
A)true
B)false
A
Rehabilitation Team
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Patient
Key member
Participates in goal setting; takes control of own life
Physiatrist
Rehabilitation physician
Team leader; coordinator of program
Rehabilitation RN
Coordinator, educator
Provides support; promotes independence
Rehabilitation LPN/LVN
Care provider; advocate
Assists in treatment plan and implementation
Physical therapist
Designs exercise program
Provides therapy; assesses needs; provides training
Occupational therapist
Assesses independent living needs
Recommends equipment modifications; adapts equipment
Speech pathologist
Designs rehabilitation communication program
Assists in regaining communication skills; educator
Clinical psychologist
Recreation planner
Activates leisure time; promotes interest in activities
Therapeutic recreation therapist
Emotional evaluator
Assists patient in developing realistic positive attitudes
Chaplain
Consultant
Provides support and guidance
Vocational rehabilitation counselor
Vocational planner
Helps obtain training and employment
True
REHABILITATION NURSE
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As a rehabilitation nurse, you need to have a broad knowledge base of the pathophysiology of a wide range of medical-surgical conditions and a -body of highly specialized knowledge and skills regarding rehabilitation
A)true
B)false
A
Rehabilitation nurses are obliged to be those who offer encouragement on a regular basis. Your role as a rehabilitation nurse is to put the individual in charge of his or her own care rather than taking charge yourself.
A)true
B)false
A
The Association of Rehabilitation Nurses (n.d.) gives the following definition:
Rehabilitation nursing is the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems relative to altered functional ability and lifestyle. The goal of rehabilitation nursing is to assist the individual who has a disability and/or chronic illness in restoring, maintaining, and promoting his or her maximal health. This includes preventing chronic illness and disability.
True
It is the rehabilitation nurse who reinforces teaching and training completed by the other disciplines on a 24-hour-a-day, 7-day-a-week basis. One hour of physical therapy is -w. possible to undo, or to reinforce, 23 hours a day. Solid rehabilitation nursing is essential for a successful rehabilitation outcome
A)true
B)false
A
Rehabilitation nursing roles include those of educator, caregiver, counselor, care coordinator, case manager, patient advocate, consultant, researcher, administrator or manager, and expert witness.
A)true
B)false
A
Your focus will be on enabling the individual to move from a totally dependent state to a level of independence
A)true
B)false
A
Extensive family and patient education, modern adaptive equipment, numerous community integration activities, specialized programs, and professional, effective team therapies all combine to help the patients learn to make the most of their lives
A)true
B)false
A
All basic nursing measures are essential, such as position changes and maintaining body alignment. This prevents skeletal and muscular deformities (contractures) and pressure ulcers.
A)true
B)false
A
Rehabilitation nursing is a challenge that requires knowledge, teamwork, coordination, planning, and patience. To care for people with disabilities, it is important for rehabilitation professionals to learn and stay abreast of current knowledge and techniques.
A)true
B)false
A
All rehabilitation nurses are expected to engage in professional role activities appropriate to their education, position, and practice setting.
A)true
B)false
A
COMPREHENSIVE REHABILITATION PLAN
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The more comprehensive the rehabilitation program, the better the chances for higher functional outcomes of the people served
A)true
B)false
A
According to the Commission on Accreditation of Rehabilitation Facilities (CARF) (a nonprofit, private, international standard-setting and -accreditation body whose mission is to promote and advocate the delivery of quality rehabilitation), it is necessary to initiate an overall individualized comprehensive rehabilitation plan of care within 24 hours of admission and have it ready for review and revision by the team within 3 days of admission. The results of the interdisciplinary admission assessment provide the basis for developing the plan.
A)true
B)false
A
Underlying it are individual goals incorporating the unique strengths, needs, abilities, and preferences of the person it serves. This plan will reflect the environment where the person will go upon discharge. It is necessary that goals are measurable, are described in functional or behavvioral terms, have associated time frames for achievement, and list the responsible team member(s).
A)COMPREHENSIVE REHABILITATION PLAN
B)false
A
Evaluation conferences and family conferences take place on a regular basis. The active participation of the people served is an integral part of planning and implementing the discharge process.
A)true
B)false
A
PATIENT EDUCATION
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Patient education is crucial for the rehabilitation process to be comprehensive. Patient education is 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.
A)true
B)false
A
The following five-step approach is an -option to guide this process:
- Assess the patient’s and the family’s needs, abilities, and concerns.
- Plan interventions based on these needs, abilities, and concerns.
- Implement the educational plan.
- Document the educational process.
- Evaluate and revise the educational plan.
True
Guidelines for patient teaching are available from the following:
- Americans with Disabilities Act
- The Joint Commission
- CARF
- American Nurses Association and Association of Rehabilitation Nurses Nursing Standards of Practice
- Individual facility or unit standards
- Patient Care Partnership (Patient’s Bill of Rights)
- State nurse practice acts
- National Health Planning and Resource Development Act
True
SCOPE OF INDIVIDUALS REQUIRING REHABILITATION
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Chronic illness and physiologic changes of aging increase the likelihood of physical limitations and disability disproportionately for older people compared with younger adults. However, families continue to care for most older people with disabling conditions; relatively few live in nursing homes.
A)true
B)false
A
Whether in the acute stage of an illness or injury or in the community, rehabilitation services for the older person are built around maintaining functional abilities, ensuring safety, promoting effective coping, preventing complications, and modifying the environment for maximum independence.
A)true
B)false
A
FAMILY AND FAMILY-CENTERED CARE
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Family and family-centered care is a philosophy that -recognizes the pivotal role of the family in the lives of children with disabilities or other chronic conditions. It is a philosophy that strives to support families in their natural caregiving roles by building on the parents’ unique strengths as individuals. This perspective 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.
A)true
B)false
A
The ability and willingness of nurses and health care providers to share knowledge and control of health resources with families, empowering them to act as advocates for themselves and their children, is an integral part of family-centered care.
A)true
B)false
A
The key elements of family-centered care include the following:
- Incorporating into policy and practice the recoggnition that the family is the constant in a child’s life, whereas the service systems and support personnel within those systems fluctuate
- 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
- 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
True
PEDIATRIC REHABILITATION NURSING
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Pediatric rehabilitation nursing is a specialty practice area that also continues to grow within the field of rehabilitation.
A)true
B)false
A
Nurses in this field, in a collaborative relationship with the interdisciplinary team, provide a continuum of care so those children can become contributing members of society and function at their maximum potential.
A) Pediatrics
B) False
A
Infants, children, and adolescents with a variety of disabling conditions receive specialized care from hospital to home, from clinic to school. Physical, emotional, social, cultural, educational, developmental, and spiritual dimensions are all the subject of consideration in a holistic approach to care. The goal is to cherish and foster the unique qualities of each child.
A) Pediatric nurse
B)false
A
The primary difference between rehabilitation of children and rehabilitation of adults is the developmental potential of the child. It is possible for the child or adolescent to receive an injury resulting in disability at any age, with very different consequences for his or her future depending on the age and developmental level at which the trauma occurred.
A)true
B)false
A
Children who are born with genetic disorders, who are premature, or whose fetal development is affected by maternal disease, injury, or substance abuse require services focused on habilitation rather then rehabilitation
A)true
B)false
A
Whereas rehabilitation refers to the relearning of skills or behaviors lost as a result of disease or injury,
A)true
B))false
A
habilitation refers to the process of acquiring skills and behaviors by an individual whose development has been affected by disease or other disabling conditions since birth or very early childhood
A)true
B)false
A
In summary, in your roles as leader, advocate, and educator, you will have the power as a pediatric rehabilitation nurse to have a very positive influence on the lives of children with disabilities and chronic conditions, as well as on their families
A)true
B)false
A
GERONTOLOGIC REHABILITATION NURSING
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