The Fabric of Rehabilitation Nursing
The Fabric of Rehabilitation Nursing is a graphical representation of the competency standards for rehabilitation nursing. This diagram portrays the relationship between the seven domains of nursing practice:
1. The Rehabilitative Approach
The rehabilitative approach relates to the manner in which nursing activities are performed, adopting a wellness model of care with the specific intent of facilitating the patient’s rehabilitation and discharge from the service. Adopting this approach nurses focus on the person’s abilities, to see possibilities rather than focusing on disabilities.
To contribute effectively to the facilitation of a person’s rehabilitation, nurses must possess a repertoire of interpersonal skills and techniques, from which to choose when approaching each nurse-patient interaction. The choice of specific skills and techniques is based upon an assessment of the patient in his/her context at that point in time, being mindful of the patient’s long term and short term goals. It also encompasses particular nursing activities that facilitate rehabilitation through the development of therapeutic relationships with individuals, and the creation of a rehabilitative milieu.
Generally, the rehabilitative approach is associated with the nurse’s ability to see ‘the big picture: to possess ‘a sense of that person’ or to possess ‘a sense of the whole’.
2. The teaching and coaching role
The rehabilitation nurse views every patient-nurse interaction as a teaching/learning opportunity. Predominantly teaching and coaching focuses on the development of self care and independence of the patient, however, the focus also extends to needs of the family, significant others and carers.
The rehabilitation nurse possesses a diverse range of teaching and coaching skills, resources and methods, and adapts these to the needs, readiness and style of the learner. Teaching and coaching are directed towards the promotion of self-determination of the patient and discharge from the rehabilitation service.
This may begin by teaching the patient and family to focus on abilities rather than disabilities.
3. Observation, assessment and interpretation
Observation, assessment and interpretation are core activities for the rehabilitation nurse in getting to know the patient.
The nurse continually gathers information and interprets it to inform every stage of all planned and unplanned patient-nurse interactions. Observation, assessment and interpretation facilitate the setting of goals and discharge planning with the patient.
Observation, assessment and interpretation also determine the plan of care—this includes the choice of intervention, the timing, duration and frequency of the intervention and the approach to use for the nursing response.
4. Administering and monitoring therapeutic interventions
Nurses contribute to the rehabilitation of their patients through a variety of independent therapeutic nursing activities, which are initiated in response to anticipated and unanticipated situations.
The nursing response is directed towards the promotion of the patient’s self-determination, the attainment of the patient’s goals and maximisation of the patient’s safety.
Nurses also contribute to the rehabilitation of their patients through active participation in allied health and medical interventions. This may relate to the collaborative assessment, planning, implementation and evaluation of interventions with the patient and family, allied health and/or medical staff; the continuation of allied health interventions; or the monitoring of the patient’s response to llied health and/or medical interventions.
5. Management of rapidly changing situations
The nurse must possess the necessary skills to effectively manage the variety of situations that have the potential to change rapidly.
The nature of the changing situation may be physiological, psychological, social or spiritual and may be related to the individual patient, family or significant others, a group of patients, or staff. The change may be desirable or adverse, and the nurse must accurately interpret the significance of all changes and respond appropriately.
Comprehensive and ongoing assessment will often identify the early warning signs of change and inform early intervention to prevent an adverse situation.
6. Management, advocacy and co-ordination role
By the virtue of their 24 hour responsibility for patient safety and well being, nurses assume the role of co-ordinator of patient care at an individual and ward level, as well as assuming responsibility for the management of the clinical unit.
Nurses do this via two-way communication within the organisational structures and health care systems in which they function. At the individual patient level, nurses coordinate the input from all members of the health care team, as well as liaising with family and significant others.
7. Monitoring and ensuring the quality of health care practices
Rehabilitation nurses monitor and actively participate in the pursuit of quality health care practices at the individual patient level through to the health care system level.