1. 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.

2. 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

3. 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.

4. 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)

5. 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.

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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?

12. 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

13. 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

14. 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)

15. Case Study

16. 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

17. Advanced Practice Leader
Contact Information
Nancy Boaro
Advanced Practice Leader
Neuro Rehab Program
Toronto Rehab
ext 3772

18. QUESTIONS?