We believe that as a Rehabilitation Nursing Department, we should provide our patients with enough control over the health of their bodies and minds so that even after catastrophic disability, they may experience the highest possible quality of life.  To achieve such control, they must be provided with the proper tools.  These tools will come from an understanding of their bodies and minds, how they functioned before, how that function is now altered and how they can best handle these altered body and mind functions in a safe, informed manner.

We also believe that not only must the immediate maintenance of health and prevention of further deterioration be taken care of, but in addition that the long-range healthcare needs must be considered.

In considering our patients, their families or significant others must be taken into account, since they often provide direct healthcare for the patient and strongly influence the degree to which proper health regimens are carried out.  In addition, they play an important role in the patient’s acceptance of self within his or her altered physical and emotional state.  The family and/or significant other must therefore be provided with the same understanding of the disability and appropriate ways of dealing with it as is the patient.

The Magee Rehabilitation Nursing Department practices within a dynamic, therapeutic and supportive environment, collaborating with the interdisciplinary team to facilitate the achievement of the goals of rehabilitation.  The Rehabilitation Nurse utilizes the nursing process to achieve for patients those individualized, quality outcomes defined by the Standards of Rehabilitation Nursing Practice, Policy and Procedures of the Department of Nursing, hospital policy and the rehabilitation literature.

The major roles of the Rehabilitation Nurse in this setting include, but are not limited to:

• Teacher – preparing patient and family for future self-management and providing educational information for other team members and within the community.
• Care-Giver – coordinating all care-giving aimed at restoration and maintenance of function and prevention of complications and further functional loss.
• Patient Advocate/Case Manger – bridging the gap between medical and non-medical professionals, recognizing the long-term needs and rehabilitation potential of the patient.
• Consultant
• Researcher

Objectives   

In keeping with our Rehabilitation Nursing Philosophy, Magee strives to insure that every patient and his or her family receive the following:

General

• Consideration and respect during our intervention.
• Equality in the number of services provided.
• Care based upon a skilled assessment, plan, provision and evaluation and in keeping with the individual patient/family response.
• Care that is unique to the nursing profession, but that is coordinated with related healthcare services such as: case management; occupational and physical therapy; psychology and speech.
• Attention to particular patient/family information and circumstances in establishing discharge goals to facilitate return into the community.  These goals include, but are not limited to: durable equipment/supplies and community health referrals.

Specific

Providing the information and teaching the skill necessary for self-care.  If the patient’s physical limitations prevent him/her from acquiring the skill necessary for self-care, they can still use the information taught to direct their care.  The family, on the other hand, should always acquire proficiency in the skill as well as all relevant information.  This teaching includes the following areas:

• Bowel and Bladder Retraining – some anatomy and physiology skills required to care for changed excretory function, reasons why and complications (how to avoid them and what to do if they occur).
• Skin Care – maintenance of intactness, care of any present skin breakdown, care of possible skin breakdowns, etc.
• Activities of Daily Living in a Real Situation – ADL training provided at a time when the patient normally washes, dresses, grooms and eats.  (This practice in a real situation is most important for our population of stroke patients who, due to brain damage, need to learn through repetition and reference to past habitual activities.  With repetition, the time factor is decreased, making attempts at independence much more practical for all our patients.
• Medications – administration, drug actions, uses, side-effects.
• Diet – modifications of pre-morbid diet, based upon dictates of medical condition.
• Concurrent Medical Problems  (e.g., diabetes, hypertension, etc.) – provide an understanding of these conditions and proper health regimens to impede additional disability secondary to these.
• Emotional support to the patient and family.
• Skilled nursing care until such time as it can be provided for by the patient and/or family.
• Continued supervision (even after mastery of the skill), until discharge.
• Identification of healthcare resources available in the community.