Dynamic Role of the Nurse in Stroke Rehabilitation Nancy Boaro, BScN, MN, CNN(C), CRN(C) Advanced Practice Leader, Neuro Rehab Program Toronto Rehabilitation Institute Hello all. It’s a pleasure to be here to speak to you on the topic of Stroke rehabilitation Nursing. Before we begin, by a show of hands how many of you are nurses, PT etc.

Objectives Define the goal of rehab nursing Outline the roles of the rehab nurse Outline the competencies of the stroke rehab nurse Highlight areas for stroke rehab nursing intervention and interprofessional collaboration via case study Define the goal of rehab nursing Outline the roles of the rehab nurse Outline the competencies of the stroke rehab nurse Highlight areas for stroke rehab nursing intervention and interprofessional collaboration via case study

Goal of Rehabilitation Nursing Promote maximum functional ability Optimal health Adaptation to an altered lifestyle “Goal of rehabilitation nursing is to assist the patient to attain and to maintain optimum health as it is defined by the patient.” (Hoeman, 2002) “Goal of rehabilitation nursing is to assist the patient to attain and to maintain optimum health as it is defined by the patient.” Where the client is viewed as a whole person and yet different from the sum of physical, psychological, spiritual, and socio-economic parts. Unique, autonomous, responsible for their own state of health, ability to solve his/her problems.

The Multidimensional Role of The Stroke Rehabilitation Nurse Provider of Care (e.g., caregiver, direct and indirect delivery of care); Leader and collaborator (e.g., clients, families, community providers, interdisciplinary team, support staff); Educator and coach (e.g., wellness and prevention, self-care and advocacy skills); Client advocate (e.g., promoting the accessibility of rehabilitation services to all clients; community education; awareness of advocating rehabilitation services at local, provincial and national levels); Coordinator of Care (e.g., delegation, integration of knowledge of team information into comprehensive continuum of care)

Provider of Care Provides quality evidence based nursing Focuses on restoring & maintaining function and preventing complications Interacts therapeutically with clients and their support systems (ARN,1998, OARN, 1998) Provides quality evidence based nursing 24/7 Focuses on restoring & maintaining function and preventing complications Interacts therapeutically with clients and their support systems Head to toe assessment , Monitor VS Care provider: Focuses on restoring and maintaining function, preventing complications, and avoiding further functional loss. Interacts therapeutically with clients and their support systems.

Educator and Coach Wellness and prevention Self care Advocacy skills assesses their readiness to learn plans teaching times and strategies (uni-profession or interprofessional) Advocacy skills Consults with patients and/or families, to help them adapt to lifestyle changes. Modify stroke risk factors, chronic disease management, activity, weight loss etc. relaxation therapy stress reduction etc Teach self-care techniques and help them adapt to limitations and progress towards functional goals Documents the teaching-learning process, evaluates and validates it. CDM and risk modification

Leader and Collaborator Works with the team to establish goals to promote maximal patient independence. Collaborator Works with physicians, therapists, and other healthcare team members to solve problems and establish goals to promote maximal independence for clients with disabilities or chronic disabling conditions. Assertively communicates information and provides insight to others about the rehabilitation process and clients’ responses, reactions, needs and progress.

Rehab Nurse as Advocate Patient or unit / program based Accessibility of rehabilitation services Politically involved at all levels Patient / family level with clients re: patient centered needs, discharge etc Advocate for the patient, sensitive to their diverse needs. Promoting Accessibility of rehabilitation services to all clients i.e. accessibility issues that arise on unit or within programs or organization Community education Broader advocacy through OARN and CARN Committed to affordable, accessible, universal, accountable delivery of care. Accessibility advocacy within institution OARN and CARN

Rehab Nurse as Coordinator Uses holistic, interprofessional approach Identifies and measures functional goals for patients plan and guide care Brings together the expertise of health professionals and integrates that knowledge into a comprehensive plan of care. Taking a holistic approach, facilitates the design and implementation of the family’s individual plan of care Uses measurable functional goals to plan, coordinate, and evaluate ongoing client care Follows Rehabilitation Nursing Standards

CNA Rehabilitation Nursing Competencies CNA established national standards of practice and competencies for rehabilitation nursing in 2005 Recognized as a specialty practice with certification exam The Canadian Nurses Association (CNA) has established national standards of practice for rehabilitation nursing as a means for ensuring high quality nursing care. Specialty practice in which nurses focus on: Restoration/maintenance of health & well being Promotion of optimal functioning Maintenance of abilities Prevention of injuries

Rehabilitation Nursing Competencies Functional Health Patterns Discharge and Transition Mobility Sexuality Sleep and rest Sensory and Pain Nutrition, Elimination, Skin Integrity Cardiopulmonary Psychosocial adaptation Discharge and Transition Mobility Sexuality Sleep and rest Sensory and Pain Nutrition, Elimination, Skin Integrity Cardiopulmonary Psychosocial adaptation How does this look in the stroke rehab population?

Role of the Nurse in Rehabilitation Assesses Pre-existing and current status Physical, emotional, functional, social indicators Diagnostics Selects nursing interventions to enhance and support physical, psychological, and social functioning Collaborates Evaluates Patient/family response to interventions/plan of care

Rehabilitation Nursing Competencies Psychosocial Health Patterns Cultural Spiritual Motivation Stress response Coping Unresolved grief, anger Emotional fatigue Denial Self-perception Family structure Health beliefs Caregiver burden Family resources for coping Financial Emotional Physical environmental

Stroke Specific Rehabilitation Nursing Competencies Understands Risk factors for stroke Anatomy and pathophysiology of stroke Nursing interventions optimize function of client with stroke Recognizes Clinical manifestations of stroke Deficits of clients with stroke specific to stroke location Interprets laboratory values Understands Risk factors for stroke (HTN, diabetes, smoking etc) Anatomy and pathophysiology of stroke Nursing interventions optimize function of client with stroke Recognizes Clinical manifestations of stroke (dysphagia, aphasia, hemiplegia, etc) Deficits of clients with stroke specific to stroke location Interprets laboratory values (cholesterol, INR)

Case Study

Final Thoughts The scope of practice of a stroke rehab nurse is broad and dynamic Significant impact on patient’s rehabilitation experience and recovery Many opportunities for interprofessional collaboration to optimize patient outcomes The scope of practice of a stroke rehab nurse is broad and dynamic Significant impact on patient’s rehabilitation experience and recovery Many opportunities for interprofessional collaboration to optimize patient outcomes

Advanced Practice Leader Contact Information Nancy Boaro Advanced Practice Leader Neuro Rehab Program Toronto Rehab 416-597-3422 ext 3772 boaro.nancy@torontorehab.on.ca

QUESTIONS?