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 Evaluates a person’s ability to understand and engage in strategies for RPP Beginner Proficiency Level Descriptors 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. Copyright©2015, Association of Rehabilitation Nurses 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.

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 hand- outs. 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 - Assessed the patient’s quality of life issues. - Identified the patient’s need to understand changes that may impact her health and quality of life as the result of aging with a disability. - Collaborated with the family in teaching. - Consulted with a peer counselor to provide support for the patient. Non-Proficient Nurse - Identified the patient’s need for information based on the patient’s present medical status. - Did not assist the patient with formulating long-term goals. - Did not assess knowledge of risk reduction. 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