Download Competency Model for Professional Rehabilitation Nursing

Competency Model for Professional
Rehabilitation Nursing
Behavioral Scenario
for
Competency 2.2: Foster Self-Management
Christine Cave, RN MSN CRRN HFS
Copyright©2015, Association of Rehabilitation Nurses
Competency 2.2:
Foster Self-Management
Description/Scope: A collaborative approach that incorporates the
client’s self-efficacy, past experiences and health literacy to problem
solve and make decisions about his/her health care to achieve the
highest quality of life while living with a chronic illness and/or disability
Assesses clients for their
readiness to learn and their
existing knowledge of their
illness or disability
Participates in the goal
setting and development of
the plan of care with the
client, family and
interprofessional team that
includes self-care skills
Communicates with the
interprofessional team in
data collection
Participates in the evaluation
of the self-management plan
of care
Beginner Proficiency
Level Descriptors
Copyright©2015, Association of Rehabilitation Nurses
Behavioral Scenario
A new paraplegic patient staying in the rehabilitation unit is anxious
about his approaching day to be discharged home. His wife is with him
at the bedside. They request to see their nurse to ask questions about
the discharge plans. The nurse enters the room to meet with the patient
and his wife.
The patient’s wife pulls out a list written on her
notepad and begins asking several questions
about her husband’s needs for home. The
patient’s wife apologizes that she has so many
questions and tells the nurse how anxious she is
about her husband’s needs.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
The nurse stares at the patient and his wife and listens as the list of
questions are read aloud. The patient nods in agreement as his wife
describes concerns about skin care, mobility, intermittent
catheterization and a routine bowel program. The nurse interrupts the
patient’s wife when she is only read half of her list, “I’m very sorry, but
you’ll have to wait to ask these questions of the home health nurse.
Home health nurses provide nursing care in the home, I only provide
care in the hospital.”
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
Observations & Outcomes
1. The nurse attends to the patient and his wife when they call, but the nurse is not able to
contemplate the needs of the patient who is preparing to transition to a home environment. The
nurse is not proficient in listening to the patient’s concerns and working with the patient and
family to problem solve each care need. Instead the nurse becomes overwhelmed by the list and
passes on the responsibility of planning and teaching to the home health nurse.
2. Newly paraplegic patients require significant support and education to develop self-management
skills. As a result of not being proficient, the nurse misses out on the opportunity to play a vital role
in teaching patients and their families how to prevent complications related to spinal cord injury.
3. The nurse should use the list provided by the
patient’s wife to develop a teaching plan. The nurse
can recruit resources provided by the hospital and
from national spinal cord injury organizations to
promote independent living. Key areas of spinal cord
injury education include bowel and bladder
management, skin care and pressure ulcer
prevention, mobility and range of motion, and pain
management.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 - Proficient
The nurse takes a seat beside the patient and his wife and listens as the
entire list is read. The nurse makes a few notes while listening. When the
patient’s wife finishes, the nurse provides a confident reply, “I know this is
overwhelming for you both. You have asked all of the right questions. I
have several resources that I can give you to address your concerns.” The
nurse introduces a comprehensive booklet for new paraplegic patients.
The nurse schedules daily times to meet and teach the patient and his
wife how to perform self-catheterization and develop a home bowel
program. The nurse teaches the patient and his wife about skin care and
mobility and assesses their knowledge by asking them questions about
their learning. The nurse discussing positioning for pain control and how
to appropriately take pain medications. The nurse frequently checks in to
see how they are feeling about discharge and allows the patient to vent
his frustrations when he feels overwhelmed.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 – Proficient
Observations & Outcomes
1. The nurse takes the time to listen and validate the anxiety felt by the patient and his wife. The nurse
demonstrates an attentive and sympathetic demeanor. The nurse knows how overwhelming it is for
patients to adjust to a drastically new lifestyle and how paraplegia impacts the whole family.
2. The nurse provides supporting materials to teach the patient and his wife to manage toileting needs,
skin care, mobility and pain management. The nurse designs a teaching plan and sets goals for the
patient to be able to manage these personal needs independently. The nurse introduces concepts in
a simple and structured manner. The nurse breaks up the education in short incremental periods
over each day so that the new information is manageable. The nurse evaluates the patient’s and
wife’s learning by allowing them to demonstrate and “teach-back” the information.
3. To increase proficiency, the nurse can develop a standard
teaching plan for all paraplegics and their families who come
to the rehabilitation program. The standard plan may include
a weekly unit-based class offered to all spinal cord injured
patients.
Copyright©2015, Association of Rehabilitation Nurses
What Did You Observe?
How did the outcomes of this scenario differ?
Proficient Nurse
- Listens to the patient and
wife and validated feelings
- Develops a teaching plan to
ensure all concerns were
addressed
Non-Proficient Nurse
- Does not listen to the
patient and wife describe
their concerns
- Does not embrace the
opportunity to teach the
patient and wife to perform
self-care skills
- Schedules teaching periods
and allows for the patient
and wife to attain the skills
- Passes on responsibilities
and demonstrate and teach- of teaching to the home
back their learning
care nurse
Copyright©2015, Association of Rehabilitation Nurses
Takeaways
1.
2.
3.
The new nurse embraces the role as patient/family educator.
The nurse utilizes resources and develops a teaching plan to
ensure that the patient is prepared for discharge to the home
environment.
The patient demonstrates skills and knowledge learned from the
nurse’s teaching. The patient is able to perform as much of the
self-care skills independently as possible. The family is educated in
how to support and assure that these skills are successfully
performed.
The patient and wife are able to perform the skills of self-care in
the home safely and effectively. The transition to home is
frightening after a spinal cord injury with paraplegia. The nurse
evaluates that the patient/family are able to perform all of the
self-care skills before the day of discharge so that the transition to
home is smooth.
Copyright©2015, Association of Rehabilitation Nurses