1. REHABILITATION & THE OLDER ADULT A N SDL L ECTURE HEAL6011– Nursing Practice – The Older Adult

2. L EARNING OUTCOMES BTEOTLTLWBAT: Define rehabilitation. Explain why older adults differ to younger adults in rehabilitation. Explain what the nurses role is in rehabilitation. Discuss the differences between short-term & long- term goal setting. Identify ways in which to make goals achievable for the older adult. Identify potential ethical dilemmas that can occur in the rehabilitation setting.

3. BACKGROUND According to the World Health Organization (WHO), approximately 10% of the world’s population experience some form of disability or impairment. The vision outlined in the Disability and Rehabilitation WHO Action Plan 2006-2011, states that “All persons with disabilities (should) live in dignity, with equal rights and opportunities” (WHO, no date, p. 1). If you would like to have a look, here is the URL: http://www.who.int/disabilities/publications/dar_action_plan_200 6to2011.pdf

4. P HILOSOPHY OF REHABILITATION In any literature you may read regarding rehabilitation philosophy, one thing in common that they will all have is that they all sound similar! Hage & Prebola (2003) definition of rehabilitation is a nice basic one, and it states: Rehabilitation seeks to assist individuals with restoration of function and maintenance of health and has been described as aiding the individual to reach maximum physical, psychosocial, educational, vocational, and avocational potential consistent with the patient's abilities and limitations (in Buttaro et al, 2008, p. 90). See Mosby’s Nursing Consult).

5. G ERIATRIC R EHABILITATION Brown & Edwards states (in Lewis, 2008) that, interventions are focused on adapting to or recovering from disability. With proper training, assistive equipment and …personal care, the patient with disabilities can often live an independent life (p. 82).

6. It needs to be said that: “The (outcome) of rehabilitation depends upon the patient’s commitment to the objective and upon the nurse’s commitment to help the patient achieve…” -Routasalo, P., Arve, S., & Lauri, S. (2004). Geriatric rehabilitation nursing: Developing a model. International Journal of Nursing Practice, (10), 207-215.

7. O LDER ADULTS DIFFER FROM YOUNG ADULTS IN THE AREA OF REHAB DUE TO : 1. Most older adults having pre-existing conditions that may affect the rehabilitation potential. 2. Older adults may lose functioning because of inactivity and immobility. This is called de- conditioning and can result because of medical conditions, environmental barriers and lack of motivation.

8. A basic tenet of rehabilitation is a multidisciplinary approach to care. The members of this team not only include the patient and the patient’s family, but also would include: Nurses, Geriatricians (or general physicians, or even physiatrists [rehab specialists]), physiotherapists, Speech-language therapists, Occupational therapists, Dieticians, and Social workers.

9. N URSES ROLE IN REHABILITATION Rehabilitation nurses are highly skilled in the specialty of rehab and work 24/7 with their patients. Comprehensive nursing assessments are undertaken. Physical and functional assessments are undertaken to develop the patient’s plan of care and as a way to measure the patient’s progress during their term of rehab. “The key elements of the functional history include the patient’s ability to complete ADL’s (both currently and before the present illness) and the degree of assistance required. Information regarding the use of wheelchairs, walkers, canes, prosthetics, orthotics, and any other adaptive equipment, as well as accessibility within the patient’s home, is also important” (Hage & Prebola, in Buttaro, 2003).

10. GOAL SETTING IN THE REHABILITATION ENVIRONMENT Goals give the client something to work toward and achieve. They are a great motivational factor, however, when goal-setting, your goals should be achievable. Short-term goals enhance the process of rehab. Long-term goals should (aim for): reasonable functional improvement maintenance of existing abilities inhibit deterioration of condition prevent secondary complications

11. T HINKING EXERCISES Think of some examples of what some short-term and long-term goals may be in rehab. Apply your past nursing experiences to this question. What does it mean to enhance the process of rehab ?

12. H OW DO WE MAKE THESE GOALS WORK ? Be realistic Involve patient, family & healthcare team Allow for sufficient time to achieve the goals Provide a stimulating atmosphere that provides to overcome obstacles. One HUGE factor that all rehab nurses and students working in rehab units encounter is ethical dilemmas.

13. E THICS Not only do we have to preserve the dignity of the individual in rehab, but we also have to respect the patient’s autonomy in the choices that he/she makes at the outset of rehab and/or during the often long and painful process of rehabilitation. What ethical issues can you think of that you may encounter in the rehab unit? Look at the next slide for some issues that were brought up by the members of the American Association of Rehabilitation Nurses.

14. ETHICS Patients right to stop rehab; to determine when they have had enough. Use of restraints Do-Not-Resuscitate (DNR) orders Advanced directives (not legally binding in NZ) Management of clients who are disposed to self-destructive behaviours or suicidal gestures Issues related to healthcare reform and changes in how healthcare is allocated and delivered Confidentiality, security, and privacy of patient care Substance abuse Abused clients The nurse/client relationship – blurred professional boundaries Have a read of the article itself: http://www.rehabnurse.org/profresources/pethical.html

15. Here are some books in the WTK library that refer to the topic of rehabilitation nursing…