Download Promote Health & Present Disability

Competency Model for Professional
Rehabilitation Nursing
Behavioral Scenario
for
Competency 2.1: Promote Health & Prevent Disability
Across the Life Span
Mary Ullrich, MSN, RN, CRRN &
Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN
Copyright©2015, Association of Rehabilitation Nurses
Competency 2.1:
Promote Health & Prevent Disability
Across the Life Span
Description/Scope: The use of risk reduction, harm prevention, and
health management promotion strategies, such as helmet safety,
transportation services, nutrition education and lifestyle modifications,
to promote and encourage wellness.
Assesses for common risks
with persons living with
DCIHM
Establishes goals for RPP
(Reducing Risk, Promoting
Health, Preventing Disability)
following established
rehabilitation protocols
Beginner Proficiency
Level Descriptors
Evaluates a person’s ability to
understand and engage in
strategies for RPP
Copyright©2015, Association of Rehabilitation Nurses
Behavioral Scenario
Sam is preparing for discharge from the inpatient rehab unit where she
has been treated for medical management of MS and declining
functional status. She will now need to use a wheelchair as her primary
mode of locomotion.
Being confined to a wheelchair at age 45 has
her feeling a bit anxious. Fortunately, her sister
will be able to stay with her a few weeks while
she learns how to adapt to her decreased
functional status.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
With Sam’s discharge day approaching, Sam’s nurse provided her
with information regarding her medications and reviewed self
administration of some of the meds. Knowing some of the long
term effects of decreased mobility, Sam’s nurse provided her
with patient education hand-outs regarding nutrition and skin
care.
The day before discharge, Sam’s nurse asked Sam if she had read
the hand-outs. Distracted with her own thoughts, Sam had stated
she had. When asked by the nurse if she had any questions, Sam
reported that she did not.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
Observations & Outcomes
1. Although the rehab nurse provided written educational information to Sam,
she failed to completely assess Sam’s risks for additional complications due to
the increased use of the wheelchair combined with the aging process.
2. In order to master the beginning level of
competency in this domain, the rehab nurse
should have thoroughly assessed Sam’s risk as
a middle-aged women with MS, helped her
establish some long-term goals to promote
health, and evaluated her understanding of the
materials provided for education.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 - Proficient
The nurse met with Sam to review educational hand-outs that were given earlier.
Due to her history with MS, Sam already knew much of what was in the handouts. The nurse then discussed with Sam long term goals for Sam’s health related
to aging with a disability. Information was also provided related to changes that
may occur within body systems due to the onset of menopause, and the nurse
encouraged Sam to discuss these issues with her primary healthcare provider as
symptoms presented. They also discussed risk reduction related to Sam’s
decreased function, resulting in the increased use of a wheelchair. The nurse
provided a peer counselor with MS who had also transitioned to wheelchair use
and who could provide additional tips for Sam about aging with MS and how to
prevent common problems.
When Sam’s sister arrived later in the shift, the nurse asked Sam to discuss with
her sister all they had talked about earlier in the day in order to verify Sam’s
understanding of the information. They discussed some of these issues at length,
and in the end decided a seated Yoga class just might be fun as well as
therapeutic.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 – Proficient
Observations & Outcomes
1. The proficient, experienced rehabilitation nurse went beyond
merely identifying a need for education. She provided education
and then followed up to evaluate the patient’s understanding,
using techniques such as teach-back, incorporating the family, and
peer counseling.
2. The result of the proficient nurse’s expertise was the patient and
family identifying additional ways to reduce risk of complications
and promote health.
Copyright©2015, Association of Rehabilitation Nurses
What Did You Observe?
How did the outcomes of this scenario differ?
Proficient Nurse
Non-Proficient Nurse
- Assessed the patient’s quality of - Identified the patient’s need for
life issues.
information based on the
- Identified the patient’s need to patient’s present medical status.
understand changes that may
impact her health and quality of
life as the result of aging with a
disability.
- Did not assist the patient with
formulating long-term goals.
- Did not assess knowledge of risk
reduction.
- Collaborated with the family in
teaching.
- Consulted with a peer counselor
to provide support for the
patient.
Copyright©2015, Association of Rehabilitation Nurses
Takeaways
Rehabilitation provide more than just care for patients
today. Assisting patients and families with knowing how
to prevent long term health complications and
understanding ways to work through changes in health
throughout the lifespan allows us the privilege of
enhancing the quality of life for our patients through
out their lifetimes.
Copyright©2015, Association of Rehabilitation Nurses