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Guest Editorial: The Essence of Rehabilitation Nursing
Rehabilitation is often referred to as post-acute care or tertiary care. Yet, we are always thinking about the days ahead, more so than the days gone by, for our patients and their families. Our role is to help patients anticipate these days and prepare them to face the days ahead with a sense of excitement, confidence, and a “can do” attitude. If we are successful, then patients and families have the knowledge, skills, and resources necessary to live well and achieve their goals. Recently a family member, reflecting on a recent rehab experience, commented, “as we left rehab, our lives took on a new sense of normal.” The new “normal” involves planning family routines or activities that allow time and privacy for intermittent catheterization or having caregivers available to assist with wheelchair transfers. For individuals with impaired swallowing, secondary to neurological injury, this means anticipating how to manage enteral feedings while participating in community activities. It is important for individuals and caregivers to learn not only the tasks necessary to stay healthy, but also how to integrate these tasks into their daily life.
Rehabilitation nurses specializing in neuro, especially spinal cord injury and stroke, have led the way in developing educational materials and programs to prepare patients for life in the community. Several trends in healthcare, such as the development of the Joint Commission (JC) stroke program standards and improved field immobilization and transport of individuals with suspected spinal cord injury, provide new opportunities for rehabilitation nurses. The JC standards encourage hospitals to provide, not only early treatment to minimize stroke injury, but also to develop an integrated approach to reduce complications and improve functional outcomes for patients with stroke. Advanced practice nurses in rehabilitation, as members of a stroke team, are in a position to initiate teaching and encourage rehabilitation activities while the patient is still in the acute setting.
Improvements in field immobilization, as well as more aggressive drug treatment to reduce spinal cord swelling, have resulted in more patients with incomplete spinal cord injuries. These patients have an uncertain trajectory, and at times may be reluctant to learn basic healthcare tasks, such as catheterization, bowel care, or skin care. Rehabilitation nurses are challenged to engage patients in learning these health skills, in addition to participating in therapy. There is also a sense of urgency in teaching these skills, because inpatient hospital stays are increasingly shorter. When the rehabilitation trajectory is uncertain, nurses not only must teach important health skills but also help individuals cope with uncertainty.
The articles in this issue describe how rehabilitation nurses anticipate and intervene to provide care for individuals affected by chronic illness or physical disability secondary to neurological impairments. The articles illustrate the importance of a rehabilitation nursing assessment and care plans designed to help individuals and their families to adapt to disability, achieve their greatest potential, and work toward productive, independent lives. For example, an individual’s fatigue at the end of the day limits his or her ability to transfer without assistance, and with no caregiver available in the home, a new method for transfers is needed prior to discharge. Sharing this information in a timely manner allows the team to explore different options or adjust care routines to reduce fatigue and promote independence. We are reminded that rehabilitation nursing can have a significant impact on the lives of individuals with disabilities and their families that extends far beyond the initial rehabilitation experience.
For the novice, Flanagan and colleagues describe key laboratory values and clinical issues commonly seen among neurological patients in the rehabilitation setting. Because daily labs are not the norm in the rehabilitation setting the authors stress the importance of observing patients and recognizing symptoms associated with electrolyte imbalances versus changes in neurogical condition. The vigilant nurse detects the symptoms and initiates interventions to address these imbalances. It is important to document the 24/7 monitoring and therapeutic interventions, to maintain health and promote function, to support payment for inpatient rehabilitation services.
When a rehabilitation team uses a truly interdisciplinary approach to overcome barriers and promote function, the patient benefits. Social isolation and impaired mobility are two barriers commonly associated with neurological impairments. Holley and Whipple address how nurses work with others members of the interdiscipinary team to design an indvidualized approach to overcome these barriers.
Rehabilitation professionals take into account the burden of care and the potential impact on family members and caregivers over time. King et. al. describes a pilot study of an intervention to promote problem solving with stroke caregivers. Previous work identified that these caregivers often had little preparation for their new role as caregiver for a spouse. Caregiver depression was not uncommon. The aim of the study was to test a problem solving intervention that could be implemented by trained nurses. Anticipating and using evidence-based approaches to promote care is an important characteristic of rehabiltiation nursing.
Bellin et al. describe how nurturing a “can do” attitude and sense of normalcy within the family is important to the individual’s sense of self and relationships within family and community. The conversations with adolescent women living with spina bifida remind us that, as rehabilitation nurses, our actions can influence attitudes of the child and parents in a way that will have an impact on their emotional, as well as physical, development.
Our commitment to planning and working with patients and families to create a life that is healthy and rewarding for all is the essence of our profession. There is something for every rehab nurse, from novice to expert, to enjoy and to learn in this issue of Rehabilitation Nursing.