Learning Objectives
By the end of this section, you will be able to:
- Identify members of the rehabilitation team
- Summarize the principles of patient-centered, rehabilitation-focused care
- Describe the nurse’s role in rehabilitative care
- Discuss the various specialties associated with rehabilitative care
- Explain the role of functional ability assessments in patient rehabilitation
The recovery and strengthening phase of nursing that a patient encounters following an acute illness, injury, or hospitalization is known as rehabilitative nursing. It forms the cornerstone of patient-centered health care, acting as an intermediary between medical interventions and a patient’s recovery of health, function, and independence. Rehabilitative nursing draws inspiration from holistic healing principles, which recognize that recovering from an illness or injury often involves physical, emotional, and psychological modifications. Individuals undergoing surgery, managing chronic conditions, or recovering from injuries often face unique difficulties during their recovery that go beyond medical treatments alone. Psychological, emotional, and spiritual dimensions of health should be included in the nursing plan of care. Rehabilitative nursing serves as a multidimensional solution to recovery, merging clinical expertise with compassionate care to guide individuals toward health and self-empowerment.
Nurses play an essential role in aiding rehabilitation processes as facilitators, educators, and advocates who assist their patients throughout the complex rehabilitation journey. Rehabilitative nursing care encompasses an expansive spectrum of interventions designed to restore mobility and build mental resilience, ultimately empowering patients to retake control over their lives throughout the healing process. Rehabilitative nursing care stands as one of the cornerstones of modern health care, helping patients maintain quality of life throughout the various stages of healing and wellness.
The Rehabilitation Team
Rehabilitation can be defined as an interdisciplinary effort among health-care providers to address complex patient needs such as injuries, surgeries, or chronic conditions. Typically, rehabilitation teams include the following professionals, who collaborate to meet the physical, emotional, and functional needs of each patient during their healing journey.
- Physiatrist: A physiatrist is a medical doctor specializing in physical medicine and rehabilitation. Physiatrists lead rehabilitation teams, assess functional abilities of their patients, and develop comprehensive treatment plans to increase mobility, function, and overall quality of life for each person they treat. They also oversee patients throughout treatment plans for ongoing improvements to mobility, function, and overall quality of life.
- Physical therapist: Physical therapists (PTs) specialize in movement and function. They create exercise plans, administer manual therapy techniques, and employ various other strategies to assist their patients in rebuilding strength, flexibility, balance, and mobility.
- Occupational therapist: Occupational therapists (OTs) specialize in helping their patients regain independence in daily activities such as working or leisure activities by conducting assessments, devising plans, and providing training tailored specifically for self-care needs, work situations, or recreational pursuits.
- Speech-language pathologist: Speech-language pathologists (SLPs) specialize in diagnosing and treating communication and swallowing disorders. They assess and treat issues regarding speech, language, cognition, and swallowing for patients recovering from neurological conditions or injuries.
- Rehabilitation nurse: Rehabilitation nurses specialize in care management for individuals recovering from injuries related to motion and undergoing rehabilitation. They help with ADLs, medication administration, wound-care management, and patient education while working alongside other members of the rehabilitation team.
- Social worker: Social workers assess the psychosocial needs of patients and their families. They provide counseling, support, and resources that address emotional, financial, and practical obstacles encountered during rehabilitation processes.
- Case manager: Case managers oversee and facilitate patients’ rehabilitation journey. They ensure effective communication among team members, manage care transitions smoothly, and help access necessary services for optimal care.
- Psychologist/psychiatrist: Psychologists and psychiatrists play an essential part in supporting team efforts by meeting patients’ mental health needs. Through counseling, therapy, and interventions, they help individuals cope with emotional strain and mental illness issues.
- Orthotist/prosthetist: These members of the rehabilitation team offer customized orthotic/prosthetic solutions. An orthotist designs, fabricates, and fits orthotic devices—supportive equipment for bones—to assist patients in improving mobility and functionality. A prosthetist does the same for prosthetic devices, which augment or replace damaged or missing body parts. Working closely with rehabilitation teams, they ensure proper fit and function are in place.
- Respiratory therapist: Respiratory therapists specialize in respiratory care for those experiencing difficulty with breathing. Their services may include helping improve lung function through exercises and managing chronic respiratory conditions.
- Dietitian/nutritionist: Dietitians and nutritionists assess patients’ nutritional needs and develop plans that support recovery and overall health while accommodating any special considerations related to a particular condition or circumstance. They are extremely helpful for patients with unique dietary and nutritional education needs, such as persons with diabetes, cystic fibrosis, Crohn disease, and more.
- Adaptive equipment specialist: This professional assesses the need for and provides adaptive equipment to help restore body functions to patients with disabilities. They also help patients who need an assistive device to perform activities they find challenging due to a health condition or limitation.
- Neuropsychologist: A neuropsychologist specializes in diagnosing and treating cognitive and behavioral issues related to brain injuries or neurological conditions, providing interventions designed to correct cognitive deficits and boost mental well-being.
Principles of Patient-Centered, Rehabilitation-Focused Care
Patient-centered, rehabilitation-focused care is an approach that places the patient at the forefront of their recovery journey. This has great value for community health, as it assists people in moving from an acute care hospital setting back home to lead meaningful lives (Stucki et al., 2005). An acute hospitalization is truly only a short time period, yet the process of rehabilitation can be ongoing, impacting the quality of the rest of the patient’s life. Effective rehabilitation emphasizes tailoring care plans, interventions, and communication to the individual needs, preferences, and goals of the patient. Table 36.1 displays a list of core principles of patient-centered, rehabilitation-focused care. By embracing these principles, health-care providers create an environment that promotes patient engagement, well-being, and successful rehabilitation outcomes
| Principle | Description |
|---|---|
| Individualized care |
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| Shared decision-making |
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| Empowerment and autonomy |
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| Goal setting |
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| Holistic approach |
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| Cultural sensitivity |
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| Effective communication |
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| Collaboration among health-care professionals |
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| Psychosocial support |
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| Patient education |
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| Respect for patient preferences |
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| Continuity of care |
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| Outcome-oriented care |
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| Regular assessment and evaluation |
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| Respect for dignity and privacy |
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The Nurse’s Role in Rehabilitative Care
The nurse’s role in rehabilitation nursing is multifaceted and integral to facilitating the recovery, well-being, and functional independence of patients undergoing rehabilitation. In this specialized field, nurses work collaboratively with an interdisciplinary team to provide comprehensive care that addresses the physical, psychological, emotional, and spiritual needs of patients (American Association of Rehabilitation Nurses, 2017). A rehabilitation nurse may work in a rehabilitation facility other than the patient’s home, such as in a long-term acute care (or simply “rehab”) center. Rehab centers serve the transition period following an acute hospitalization when a patient may still need skilled nursing care around the clock before they may return home (Figure 36.3). For example, a patient may be in postsurgery recovery but may still need help getting in and out of their wheelchair.
The nurse’s role in rehabilitation nursing includes many of the same elements as in home health nursing:
- assessment and care planning
- collaboration
- medication management
- physical care and functional rehabilitation
- psychosocial care
- communication
- documentation of all care
However, rehabilitation nurses must also assist with transition planning: helping patients to prepare for transitions from rehabilitation settings back to their homes or communities by coordinating the necessary resources, support, and education.
Rehabilitation Case Management
Rehabilitation case management plays an essential part in providing patients undergoing rehabilitation with comprehensive care, from coordinated assessments and planning through delivery of interventions and resources that help achieve their rehabilitation goals. Table 36.2 summarizes nursing activities related to the various roles of a rehabilitation case manager.
| Role | Nurse Activities |
|---|---|
| Advocate and planner |
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| Collaborator |
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| Coordinator |
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| Educator |
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Rehabilitation Specialties
Rehabilitation nursing encompasses a range of specialties that focus on addressing specific aspects of patients’ recovery, functional independence, and quality of life. Rehabilitation typically involves a team of specialists all working together for the good of the patient (O’Sullivan & Schmitz, 2019). Examples of these specialties include orthopedic rehabilitation, neurological rehabilitation (including stroke, spinal cord, and traumatic brain injury rehabilitation), pulmonary rehabilitation, geriatric rehabilitation, and pediatric rehabilitation.
Life-Stage Context
Rehabilitating Older Adults
Rehabilitation nurses must recognize that older patients frequently experience age-related functional decline. In these populations, rehabilitation programs that target improving mobility, balance, and ADLs can greatly increase quality of life. Older adults often present multiple chronic illnesses. Rehabilitation nurses must coordinate care and address polypharmacy concerns while considering all interplay of conditions when developing treatment plans. It is vitally important for older adult patients to undertake risk analysis to provide a safe rehabilitation environment. Understanding environmental and physiological factors that cause falls is one key for creating such an atmosphere. Many older adults may also experience cognitive impairments like dementia; rehabilitation nurses must tailor communication techniques as necessary to safely accommodate cognitive deficits and ensure patient well-being.
Stroke Recovery
Stroke recovery is an involved and multidimensional process that must address physical as well as psychological difficulties. Nurses play an integral part in treating their stroke patients’ individual issues, and they can aid the recovery process in myriad ways.
People who have been impacted by stroke typically experience physical, cognitive, social-emotional, and socioeconomic challenges. Some physical impairments may include weakness or paralysis on one side of their body (known as hemiparesis), changes to muscle tone, and issues with balance and coordination. Physical therapy plays an integral part of stroke recovery by improving mobility, strength, and motor control. Experiencing dysphagia, an increasingly prevalent risk after stroke, may impede nutrition and hydration, increasing the risks of aspiration pneumonia and complicating recovery efforts. Patients who experience stroke with aphasia can develop depression, frustration, and even suicidal ideation because of their inability to communicate clearly. Rehabilitation nurses help individuals adapt to these changes by finding ways to communicate and engage in meaningful activities.
Recovering from stroke is an interdisciplinary journey in which nurses, therapists, and psychologists all come together to help those who experienced stroke regain independence, enhance quality of life, and adapt to a new reality. It is important to assist patients in regaining functional independence in ADLs, such as dressing, grooming, and feeding themselves. Occupational therapy plays an invaluable role in providing adaptive techniques and strategies. Speech therapy helps people who have experienced stroke rebuild their skills to address aphasia as well as strengthen the muscles to safely swallow and eat.
Recovery from stroke can be emotionally exhausting for patients. Many experience depression, anxiety, frustration, and mood changes; these sudden changes to physical and cognitive capabilities, while simultaneously adapting to a new normal, can add another layer of emotional challenge. Patients impacted by stroke frequently experience fatigue, which may impede their participation in therapy sessions and daily tasks. Therefore, finding an equilibrium between rehabilitation efforts and rest is of utmost importance.
Medication management is another integral part of rehabilitation therapy. Patients who experienced stroke must often manage multiple medications for conditions like hypertension, diabetes, and anticoagulation; maintaining appropriate medication adherence is critical in avoiding future strokes and managing other health concerns.
Spinal Cord Rehabilitation
Spinal cord rehabilitation addresses the complex challenges faced by individuals experiencing spinal cord injuries (SCIs). An SCI may lead to various degrees of paralysis or loss of function depending on its level of severity and location on the body. Rehabilitation for such individuals aims at optimizing functional independence, improving quality of life, and offering support for physical, emotional, and psychosocial well-being. This type of rehabilitation is typically achieved through adaptive techniques, assistive devices, and mobility training programs.
Individuals living with SCIs often experience changes to sensation, including loss of sensation, altered perceptions, and neuropathic pain. Therefore, managing sensory changes and pain management are critical elements of rehabilitation. Spinal cord injuries may disrupt the autonomic nervous system’s control of bladder and bowel function, necessitating rehabilitation interventions to manage bladder and bowel control, prevent infections, and preserve skin integrity.
Depending on the severity of the spinal injury, respiratory function can also become compromised. Individuals having more serious wounds may require respiratory support such as breathing exercises and techniques designed to minimize complications related to breathing issues. Spasticity (involuntary muscle contractions) is common after an SCI and should be managed through medications, stretching exercises, and physical therapy to increase comfort and mobility.
Additionally, individuals with limited mobility are at an increased risk for pressure ulcers (bedsores). Proper skin care and preventive measures must be implemented to mitigate such complications. Many individuals with SCIs rely on wheelchairs or other assistive devices for mobility purposes; training in their safe use forms an integral component of rehabilitation.
Spinal cord injuries may lead to emotional challenges such as depression, anxiety, grief, and body image concerns; addressing these challenges may require counseling services, peer support groups, and other forms of psychosocial support. It may also be helpful for nurses to collaborate with rehab teams specializing in treating sexual health concerns associated with spinal injuries; these specialists can provide education about options for sexual activity and family planning. Spinal cord injuries often have an overwhelming effect on family and other caregivers of an affected individual, necessitating support and training to ensure a safe home environment for everyone involved in the process.
Spinal cord rehabilitation emphasizes enhancing functional independence for everyday activities such as dressing, bathing, and grooming. Occupational therapy assists individuals to redevelop the necessary self-care abilities needed for self-sufficiency. Reconnecting individuals with their communities and engaging them in recreational and social activities are also integral parts of spinal cord rehabilitation, helping promote social inclusion and foster feelings of belongingness and acceptance. Adaptive sports and recreational activities provide individuals with SCIs an avenue to maintain physical fitness, build self-confidence, and have fun. Rehabilitation nurses also work to evaluate individuals’ vocational goals and capabilities before providing necessary training and support to reintegrate them back into the workforce.
Cardiac and Pulmonary Rehabilitation
Cardiac and pulmonary rehabilitation programs are tailored to improve the health and well-being of those experiencing cardiac or lung conditions, respectively.
Cardiac rehabilitation programs focus on personalized exercises tailored specifically for individuals living with heart conditions. Balancing intensity with one’s cardiovascular fitness level and health status is integral to improving cardiac function and endurance. Education, lifestyle modifications, and medication administration each play key roles in cardiac rehabilitation programs. Cardiac rehabilitation programs provide essential education on medication usage, including potential side effects and the importance of sticking with prescribed regimens. Cardiac rehab programs also offer psychosocial support services, which offer counseling services, stress-management techniques, and support groups.
Patient education is integral to a cardiac rehabilitation program. Cardiac rehabilitation programs often offer nutritional advice regarding low-sodium diets and portion-control strategies, as well as ways to manage weight and blood sugar. It is also important to educate the patient on heart anatomy and function, cardiovascular system design and performance, and the effects of exercise. The patient should understand that these strategies all play a role in avoiding future adverse heart events.
Pulmonary rehabilitation aims at increasing lung capacity by means of breathing exercises and other methods that maximize oxygen exchange. Individuals living with lung conditions frequently experience shortness of breath and reduced exercise tolerance, making pulmonary rehabilitation programs an essential way of strengthening respiratory muscle strength and endurance. Pulmonary rehabilitation offers individuals who experience conditions like chronic obstructive pulmonary disease, asthma, and pulmonary fibrosis the tools needed to effectively manage symptoms, avoid exacerbations of their condition, and optimize lung function.
Many individuals living with lung conditions require oxygen therapy and inhaler medications. Pulmonary rehabilitation educates participants on energy conservation techniques such as safe storage, proper use, and delivery methods of inhalers and other tools for oxygen therapy. Pulmonary rehabilitation offers techniques for conserving energy and managing daily tasks without straining one’s respiratory system. Individuals living with lung conditions require techniques to clear mucus from their lungs and improve lung hygiene, including coughing and huffing techniques that work most effectively. Pulmonary rehabilitation includes instruction in these techniques as well as psychosocial support services for individuals needing rehabilitation services. Lung conditions can lead to feelings of isolation, anxiety, and depression. Pulmonary rehabilitation programs offer support and teach strategies that address the physical needs of a lung transplant as well as the psychosocial impact of lung disease.
Patient education around nutrition and dietary needs is critical for pulmonary rehabilitation too. Nutritional education centers on maintaining a healthy body weight and optimizing energy levels to support lung function. Nutritional strategies also play a crucial role in managing conditions like obesity-related hypoventilation.
Both cardiac and pulmonary rehabilitation programs emphasize education, support, lifestyle modifications, and lifestyle management services to maximize patients’ well-being and quality of life. These specialized rehabilitation approaches allow people to manage their conditions more easily while increasing functional capacity and leading healthier lives.
Assessment of Functional Ability
Functional ability assessment in rehabilitation is an integral part of the rehabilitation process. It entails accurately assessing patients’ physical, cognitive, and psychosocial capabilities to establish current levels of independence and potential areas for development. Assessments provide valuable data for creating personalized care plans with realistic rehabilitation goals in mind. Activities of daily living are daily self-care tasks performed by individuals, including bathing, dressing, grooming, eating, and toileting. Measuring how effectively patients complete ADLs on their own or with assistance allows us to determine their level of independence with self-care tasks.
An instrumental activity of daily living (IADL) is a more complicated task that contributes to an individual’s overall well-being and independence; they include preparing meals, managing medications and finances, and completing home chores. Assessing IADLs provides insight into a patient’s ability to function within both home and community environments. Evaluating a patient’s mobility and transfer abilities entails evaluating their capacity for safe movement from one location to the next: for example, moving between beds, chairs, toilets, and tables. Assessing mobility also allows health-care practitioners to determine any additional assistance, such as assistive devices, gait training, or strength-building interventions, that might be required for them.
Assessing a patient’s ability to walk and stand independently or with assistive devices can give valuable insights into their overall mobility and help identify areas for intervention to enhance balance, coordination, and walking ability. Evaluating cognitive abilities such as memory, attention, problem-solving, and decision-making is vital in treating brain injuries or cognitive impairments, especially among patients residing in care homes or residential facilities. Cognitive assessments help guide interventions designed to tackle any challenges to functional independence that might impact daily activities. Assessing a patient’s ability to communicate, either verbally or via alternative channels, helps establish whether the patient can effectively express needs, understand instructions, and interact with others.
Patients experiencing dysphagia require frequent assessments to ensure safe eating without aspiration; rehabilitation nurses can provide essential guidance for diet recommendations and interventions to minimize complications. Speaking and swallowing are helpful components of a respiratory assessment. Patients living with lung conditions benefit from having their lung function and endurance assessed to gauge the potential capacity for physical activity and exercise.
Consideration should also be given to the social supports, family dynamics, mental health issues, and emotional well-being of patients undergoing rehab therapy; these factors can influence a patient’s motivation, engagement in therapy, and overall rehabilitation outcomes. Assessing the living environment for accessibility and safety features serves to inform recommendations for modifications or assistive devices that facilitate functional independence at home.
Functional ability assessments provide health-care providers with baseline data that allow them to track patient progress. Regular reassessments enable health-care providers to adjust interventions and goals as patients’ abilities change over time. Including patients in goal setting helps ensure their rehabilitation plan reflects their preferences and values. Setting realistic and obtainable goals motivates patients to actively engage with rehabilitation activities. Interdisciplinary teams that may include nurses, PTs, occupational therapists, SLPs, and psychologists conduct functional ability assessments on patients to gain a comprehensive understanding of functional abilities and limitations so they can design rehabilitation interventions to promote independence while increasing overall quality of life for these individuals. For many years, the Functional Independence Measure has been the gold standard for assessing a patient’s function in rehabilitation; it is required by CMS. The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) is the assessment instrument that IRF providers use to collect patient assessment data for quality measure calculation and payment determination in accordance with the IRF Quality Reporting Program.