Rehabilitation

REHABILITATION NURSING

1. Rehabilitation nursing Jose amala anilda S M.SC(N) BCON

2. Introduction Tertiary prevention means disability limitation and rehabilitation. Tertiary prevention begins early in the period of recovery from illness. It consists of such activities as consistent and appropriate administration of medications to optimize therapeutic effects moving and positioning the patient to prevent complications of immobility and active and passive exercises to prevent disability, minimizing residual disability and helping the client learn to live productively with limitations. Disease I m pai r m ent D is abi l i t y Handicap

3. REHABI L ITATION Rehabilitation is the process of helping a person to reach the fullest physical, psychological, social, vocational, and educational potential consistent with his or her physiologic or anatomical impairment, environmental limitations, and desires and life plans.

4. According to WHO “ Rehabilitation is the combined and coordinated use of the medical, social, educational, and vocational measures for training and re-training the individual to the highest possible level of functional ability”.

5. REHABILITATION NURSING Rehabilitation nursing is directed toward the prevention of complications of disease or trauma and the maintenance or restoration of function . Important and essential part of comprehensive nursing. Rehabilitation nursing ideally starts at the moment a patient enter into the health care system. However, rehabilitation programme may take place in the special units of hospital or independent centre in the community.

6. Objectives of Rehabilitation Nursing There are 4 broad objectives of rehabilitation nursing: To restore affected abilities to the highest possible level of function. To prevent further disability/ handicap. To protect the person abilities. To assist the person / patient to use his or her abilities

7. Maximize the quality of life of the individual Address the individual`s specific needs. Assist the individual with adjusting to an altered lifestyle. Be directed toward promoting wellness and minimizing complications. Assist the individual in attaining the highest degree of function and self- sufficiency possible. Assist the individual to return to home and community. GOALS:

8. Principles Of Rehabilitation: Rehabilitation should begin during the initial contact with the patient. Restoring the patient to independent or to regain his pre-illness/pre-disability level of function in as short a time as possible. Maximising independence within the limits of the disability. He must be an active participant.

9. The activities of daily living are facilitated. The individual with a disability is encouraged to wear his clothing enhances self-esteem and dignity. Motivates the patient and helps him to attain social independence. Focus is on the needs of groups of people with specific condition Every patient has a right to the rehabilitation services.

10. Quality of life versus quantity of life: Rehabilitation focuses on continually improving the quality of the person`s life, not merely maintaining life itself. It focuses on making the life productive and returning optimum functioning of the body. Care versus cure: Rehabilitation gives importance to care and it is provided at the stage of treatment. When treatment is completed rehabilitation starts. Rehabilitation generally depends more on care, exercises, like skill training, acceptance of situation rather than on medication. ISSUES IN REHABILITATION:

11. High cost of interdisciplinary care versus long- term care: Rehabilitation is expensive. Success is sometimes seen as a return to productive employment. Patient with chronic illness needs long- term care whereas by rehabilitation may be the individual becomes so sufficiently independent that no caregiver is required.

12. Three moral principles serve as frameworks for medical ethic which can be followed during rehabilitation are: Respect for autonomy Beneficence Justice ETHICAL ISSUES IN REHABILITATION :

13. For rehabilitation, there are different types of models of team functioning. These are: Multidisciplinary rehabilitation team: Characterized by discipline- specific goals, clear boundaries between disciplines, and outcomes that are the sum of each discipline`s efforts. TYPES OF REHABILITATION TEAM:

14. Interdisciplinary rehabilitation team: Collaborates to identify individual`s goals and is characterized by a combination of expanded problem solving beyond discipline boundaries and discipline specific work toward goal attainment. Transdisciplinary rehabilitation team: Characterized by the blurring of boundaries between disciplines, as well as by cross-training and flexibility to minimize duplication of effort toward individual goal attainment.

15. Patients and their families Psychiatrists Rehabilitation psychologists Rehabilitation care coordinators Rehabilitation nurses Physical therapists Occupational therapists Recreational therapists Speech- language pathologists Registered dietitians Respiratory therapists Medical social workers Vocational case coordinators Child life specialists Chaplains Members of the health care team include

16. The various methods of rehabilitation are: Psychosocial therapy Behavior modification Problem- oriented medical record Social skills training Cognitive therapy Social empowerment Pragmatic approaches METHODS OF REHABILITATION:

17. The therapy emphasizes the desirability of moving from a secure psychological stage of development to a higher one in the manner that is suitable for the individual situations, the research recommended the sufferer to read books and poetry, see film and listen to song associated with his childhood. Psychosocial therapy:

18. The therapist needs some skills such as assessment, goal- setting, realistic program to achieve goal and learning suitable techniques. Therapy has developed its own specific therapeutic formats: The problem- oriented medical record Social skills training. Behavior modification:

19. It is a method of recording data about the health status of a patient in a problem- solving system, in an easily accessible way that encourages ongoing assessment and revision of the heath care plan in the health care team. The POMR will help the care provider in prioritizing the health problems . Problem- oriented medical record (POMR):

20. Social skills training aims at improving social skill of client. Lieberman identify three areas of skill training: Making suitable international exchanges, e.g. Eye contact, smile, propionate voice volume and appropriate length of speech. Conversational skill, e.g. asking suitable questions and making appropriate rejoinder. Problem- solving skills: covering areas of job interviewing, money management, management of medication and coping with difficult social circumstances, e.g. a hostile landlord. Social- skills training:

21. Cognitive therapy is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. It is base on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This method can be applicable in cases of depression, academic achievement, anxiety disorders, addictions and schizophrenia etc. by expressing their feelings. Cognitive therapy:

22. Social empowerment is a broad area of practice drawing upon social work and community development principles. Social empowerment is typically implemented at four following levels: The individual level- where the person values him/ herself and actively wants to participate in life. Family level Community level Social policies level impacting local and national level actions to promote social equity and inclusion of all persons. Social empowerment:

23. Rehabilitation needs to be supported by tangible social services. UK has been centered on the work of psychiatric day centers as focal point of spectrum of required services. Pragmatic approaches:

24. Community-based rehabilitation (CBR) was initiated by WHO following the Declaration of Alma-Ata in 1978 in an effort to enhance the quality of life for people with disabilities and their families; meet their basic needs; and ensure their inclusion and participation. CBR is implemented through the combined efforts of people with disabilities, their families and communities, and relevant government and non-government health, education, vocational, social and other services. COMMUNITY BASED REHABILITATION (CBR):

25. CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services" -WHO Definition

26. To identify all persons with disability in the community. To provide required rehabilitation service to disabled people. To create awareness about all issues related to disability. To transfer rehabilitations related skills to the community members. To mobilize available resources and raise funds to carry out the problem. To raise the level of community participation to an optimum level. To make the CBR program sustainable until the needs of the disabled people are adequately met To priorities service for disabled children. OBJECTIVES OF CBR:

27. Inclusion Participation Empowerment of local people Equity Raising awareness PRINCIPLES OF CBR

28. REHABILITATION COUNCIL OF INDIA: On enacted in September , 1992 the RCI act by parliament it became statutory body in 22 june 1993. 16 Categories of Professionals/ Personnel have been covered under the RCI Act as given below. Audiologists and Speech Therapists Clinical Psychologists Hearing and Ear Mould Technicians

29. Rehabilitation Engineers and Technicians Special Teachers for Educating and Training the Handicapped Vocational Counsellors, Employment Officers and Placement Officers Multi-purpose Rehabilitation Therapists, Technicians Speech Pathologists Rehabilitation Psychologists 10.Rehabilitation Social Workers

30. Rehabilitation Practitioners in Mental Retardation Orientation and Mobility Specialists 13.Community Based Rehabilitation Professionals 14.Rehabilitation Counsellors, Administrators 15.Prosthetists and Orthotists 16.Rehabilitation Workshop Managers

31. Psychiatric rehabilitation also known as psychosocial rehabilitation and sometimes simplified to psych rehab by providers, is the process of restoration of community functioning and well- being of an individual diagnosed in mental health or mental or emotional disorder and who may be considered to have a psychiatric disability. PSYCHOSOCIAL REHABILITATION (PSR)

32. To enable patients to achieve their optimal functioning To enable patients to live independently To empower patients to understand and manage their illness effectively. To encourage involvement of families in care. OBJECTIVES:

33. Ten essential elements that characterize the PSR approach: Individualization Hope Client- directed Focus on skills Strengths and abilities Environmentally specific Environmental supports Partnership approach Ongoing support Skills and supports in balance.

34. Psychiatric (Symptom management) Health and medical ( maintaining consistency of care) Housing( safe environment) Basic living skills( hygiene, meals, safety, planning, chores) Social( relationship, family, boundaries, communications and community integrations) Vocational and or educational( coping skills, motivation) Financial( personal budget) Community and legal(resources) PSYCHIATRIC REHABILITATION CONSISTS OF EIGHT MAIN AREAS:

35. Vocational planning Leisure counseling Enhancing social support systems Improving family relationship Addressing legal problems Parenting and child welfare issues Budgeting and financial planning Social skills training Stress management Relapse prevention POTENTIAL PSYCHOSOCIAL REHABILITATION ISSUES:

36. Pain management Polysubstance use Harm reduction Anger management Eating disorders Depression Anxiety and phobic disorder Trauma issues Grieving issues Sexual and gender identity issues Sexual dysfunction Adjustment to chronic illness.

37. Commonly there are four phases involved in the rehabilitation procedure, namely phase-1, phase-2, phase-3 and phase-4. There are different types of rehabilitation available for different types of disabilities . Neurological rehabilitation Cardiac rehabilitation Drug rehabilitation Alcohol rehabilitation Physical rehabilitation Medical rehabilitation Psychosocial rehabilitation Vocational rehabilitation Vestibular rehabilitation Stroke rehabilitation Educational rehabilitation TYPES OF REHABILITATION:

38. Rehabilitation and Prosthetic Services is responsible for the national policies and programs for medical rehabilitation, prosthetic and sensory aids services that promote the health, independence and quality of life for people with disabilities. Rehabilitation and Prosthetic Services is comprised of national programs for: Audiology and Speech Pathology; Blind Rehabilitation; Chiropractic Care; Physical Medicine and Rehabilitation; Prosthetic and Sensory Aids Service; and, Recreation Therapy. REHABILITATION SERVICES AND PROSTHETIC SERVICES

39. Special programs include Polytrauma /Traumatic Brain Injury (TBI) System of Care, Amputation System of Care, and Blind Rehabilitation Care Continuum . . Rehabilitation and Prosthetic Services is committed to providing the highest quality, comprehensive, interdisciplinary care; the most advanced medical devices and products that are commercially available; and, promoting advancements in rehabilitative care and evidence-based treatment. 

40. PSAS Clinical Services include Orthotics and Prosthetic Services, hearing aids and eyeglasses, and a wide range of comprehensive services and items including but not limited to: Sensory aids such as hearing and blind aids Mobility aids such as walkers and wheelchairs Communication and assistive devices Home respiratory therapy such as home oxygen services Recreational/rehabilitative equipment Surgical Implants Durable medical equipment Prosthetic item repairs

41. Recreation Therapy is a direct-care interdisciplinary service, whose aim is to improve and enrich bio-psycho-social functioning through active therapy and/or meaningful therapeutic activities to maintain or improve functional independence and life quality. Recreation Therapy Service provides an activity based patient centered service that integrates function, quality and meaning to one’s life through art, dance, music, and recreational activities. Recreation Therapy

42. Prosthesis or prosthetic implant is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or is a condition present at birth (congenital disorder). Prostheses are intended to restore the normal functions of the missing body part. Amputee rehabilitation is primarily coordinated by a physiatrist as part of a inter-disciplinary team consisting of physiatrists, prosthetics, nurses, physical therapists, and occupational therapists. PROSTHESIS

43. Prosthetic are made lightweight for better convenience for the amputee. Some of these materials include: Plastics: Polyethylene Polypropylene Acrylics Polyurethane Wood (early prosthetics) Rubber (early prosthetics) Lightweight metals: Titanium Aluminum Composites: Carbon fiber Prosthetic raw materials

44. It is a private organizations that pursue activities to relieve suffering, promote the interest of poor, protect the environment, provide basic social services or undertake community development. It is a organization is not for a profit, voluntary citizen group which is organized on a local, national, international level to address issues in support of the public good. ROLE OF VOLUNTARY ORGANIZATION IN REHABILITATION:

45. Community based rehabilitation Livelihood programme Securing social justice Awareness and advocacy Schemes and benefits of govt Imparting education Establishing infrastructure Areas of action:

46. Rehabilitation counseling is focused on helping people who have disabilities achieve their personal, career, and independent living goals through a counseling process. Rehabilitation Counselors can be found in private practice, in rehabilitation facilities, hospitals, universities, schools, government agencies, insurance companies and other organizations where people are being treated for congenital or acquired disabilities. ROLE OF GUIDANCE AND COUNSELING IN REHABILITATION

47. Training Evaluation Planning Personal counseling Case manager Follow along Support services Job placement Agency consultation Public relations. Roles of rehabilitation counselor:

48. Section 33 of the persons with disabilities (equal opportunities, protection of rights and full participation) act 1995 envisages three percent reservations for persons with disability in identified posts in government establishments. the employer`s contribution for employees state insurance (ESI) and employees provident fund (EPF) for 3 years, for employees with disabilities including visually impaired persons employed in the private sector on or after 01.04.2008 with a monthly salary up to Rs.25,000. WELFARE MEASURES FOR PERSONS WITH DISABILITES:

49. The mahatma Gandhi national rural employment guarantee act (MGNREGA) guarantees employment to rural household adults including persons with disabilities. Under national rural livelihood mission, a provision of 3% of total beneficiaries has been made for persons with disabilities. Indira gandhi national disability pension scheme (IGNDPS) under the national social assistance programme provides pension to BPL persons with severe or multiple disabilities between the age group of 18 to 79 yrs at Rs.300 P.M per beneficiary.

50. The other welfare measures are as follows: Scholarship to physically handicap for going to school. Admission quota for disables in schools and colleges. Seats are reserved for handicap in govt.services Separate employment exchange for handicap Handicap friendly environment in offices and hospitals, lifts, toilet, ramps, wheel chairs and porters. Seats are reserved for handicap persons in buses and transport. Special transport allowance to handicaps and concessional rail tickets with free attendants. Setting up of rehabilitation centers at district and PHC level. Availability of artificial limbs, appliances.

51. Rehabilitative nursing is not a specialty limited to the particular agencies or settings. It is a vital part of nursing in the patient`s home, the hospital emergency room, nursing home, clinic and all health care settings. Practitioner Care coordinator: Educator: Consultant: Researcher: ROLE OF A CHN IN REHABILITATION:

52. Rehabilitation is care that can help you get back, keep, or improve abilities that you need for daily life. These abilities may be physical, mental, and/or cognitive (thinking and learning). You may have lost them because of a disease or injury or as a side effect from a medical treatment. Rehabilitation can improve your daily life and functioning conclusion

53. Book references: Stanhope- Lancaster (2012) Textbook of Community Health Nursing, Mosby publishers. S. Kamalam (2013) , Essentials in community health nursing, concepts& practices , Jaypee brothers:New delhi Dash.B ,(2017) A comprehensive textbook of community health nursing , Jaypee brothers:New delhi Park.k (2017) preventive and social medicine. Bhanot publishers: jabalapur . Journal references: https://europepmc.org/abstract/med/25476072 https://journals.lww.com/ajpmr/Abstract/2017/07000/Community_Based rehabilitation. https://academic.oup.com/ageing/article-abstract/40/1/2/11682 https://europepmc.org/abstract/med/26300599 REFERENCES: