Rehabilitation Nursing: A Case Study

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Rehabilitation Nursing: A Case Study



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Using the AlterG Anti-Gravity Treadmill in the rehabilitation process allows patients to normalize gait patterns and return to movement in a fall-safe environment. Patients with balance deficits are at increased fall-risk, significantly affecting independence and quality of life. Lower body positive pressure training is an effective means to help these patients work on static and dynamic balance to regain function, increase stability and safety, and recapture their lives.

By using the Anti-Gravity Treadmill to provide accurate and metered doses of weight bearing therapy, these patients can progressively load painful limbs to decrease sensitivity and restore mobility. Hip surgical procedures like arthroscopic debridement and labral repairs may result in increased sensitivity at the hip joint for a period of time. The AlterG Anti-Gravity Treadmill can be used to introduce overground training earlier in the rehabilitation process to encourage proprioceptive retraining and to supplement cardiovascular training. Patients who suffer severe orthopedic trauma often have difficulty regaining movement and function. Limited by pain, fear, and weakness, they have a hard time trusting the injured extremity.

The Anti-Gravity Treadmill provides a safe, comfortable environment for these patients to regain mobility and regain their life. After a fibular stress fracture, patients are limited to weight bearing as tolerated to manage their pain and get moving again. With the AlterG Anti-Gravity Treadmill, regular movement can be maintained and replicated by unweighting to minimize pain. Patients can be deconditioned after a significant illness, surgery, or any period of inactivity. Resuming exercise can be challenging and frustrating, so starting at lower body weights can provide a safe, comfortable option to help these patients begin their journey back to health.

Lower body positive pressure decreases ground reaction forces with walking, minimizing stress and allowing for healing. The AlterG Anti-Gravity Treadmill can allow for safe, pain-free closed kinetic chain activities with decreased stress at the tibiofemoral joint. One fall can lead to a multiple disc herniation and the recovery from spinal injuries requires easy levels of movement while increasing independence. The AlterG Anti-Gravity provides an environment for body weight support and enables patients to start standing and closed-kinetic chain activities at easier levels. Lower extremity fracture rehabilitation is important to reduce the risk of morbidity. Optimizing the rehab process can improve patient quality of life and outcomes. Current weight bearing methods often result in patients placing loads greater than what is recommended on healing bone, likely resulting in persistent pain and altered gait patterns.

The AlterG Anti-Gravity Treadmill provides precise and accurate measures to ensure safe progression of lower extremity loading. Knee OA is the most common form of joint arthritis and can result in debilitating pain for sufferers. Loss of function and quality life can lead to devastating consequences for health and happiness. Lower body positive pressure training allows sufferers to perform functional activities like walking and squats with decreased joint compression forces.

Brain injuries are usually accompanied by decreased balance, loss of safety with ambulation, and increased fall-risk for patients. Lower body positive pressure training is an effective means to help these patients regain function, relearn proper movement, and recapture their lives. Regaining independence after any injury is essential in continued quality of life for the elderly. Early movement with the AlterG can allow therapy to begin in fall-safe environment. Minimizing fall risk and weight bearing progression is essential to the pelvic ring fracture healing process.

Weight bearing and a fall-safe environment are easily managed with the AlterG Anti-Gravity Treadmill. Patients with foot injuries, like fractures and plantar fascia tears, have difficulty with loading the injured limb because of stress to the healing tissue or instability of the deconditioned limb. Lower body positive pressure allows for the gradual reintroduction of body weight for a safer, less painful rehabilitation process. Those with cardiac conditions may have difficulty tolerating upright positions or exercise for extended periods.

Deconditioning can be counteracted in the AlterG Anti-Gravity Treadmill by allowing a user to start walking or standing at a fraction of his or her body weight. Load can be reintroduced gradually as cardiovascular condition improves. An undiagnosed stress fracture that leads to a weakened tibia can worsen the injury and create a situation where the patient is unable to be fully weight bearing. The AlterG Anti-Gravity Treadmill can be used to maintain strength and range of motion while wearing an orthopedic boot. Post-surgery, athletes recovering from hip injuries are quick to want to return to sport.

Using the AlterG Anti-Gravity Treadmill can provide a quicker return to sport while minimizing overuse and pain. Runners and other endurance athletes are concerned about taking too much time off activity for fear of losing cardiovascular conditioning. LBPP treadmills allow for earlier return to running with a safe, controlled progression. Fractures can occur through many high-impact physical activities and patients are often anxious to get moving again.

With the help of the Anti-Gravity Treadmill, individuals can get moving again while reducing the chance of additional injury. Early, safe, pain-free mobility is the key to a successful post-operative course for Total Hip Replacement patients. The challenge for these patients is the need to adhere to surgical precautions. Early post-operative mobilization for patients is important to prevent complications and improve functional mobility.

The AlterG Anti-Gravity Treadmill can encourage safe gait training and exercise in the early post-operative stages for patients under skilled nursing care. Total Knee Replacement patients often have difficulty with mobility post-operatively because of pain. Movement is necessary though to minimize the consequences that can occur from being immobilized too long, like increased scarring, joint stiffness, and muscle atrophy. The Anti-Gravity Treadmill can help these patients eliminate pain and encourage gain. A unicompartmental knee replacement after a very active lifestyle can leave an active individual anxious to return to activity.

The AlterG Anti-Gravity Treadmill allows for progressive weight bearing as tolerated to get moving again. The key for weight loss is balancing physical activity with nutrition. Energy expenditure must be consistently maintained above caloric intake if individuals are to reach their fitness goals. If someone has joint, muscle, or tendon pain, that can make exercise difficult. Just lighten the load with the AlterG and users will stay on the path to a healthier body. Following release to weight-bearing, incorporate de-weighting into rehabilitation protocol Develop a progressive return to activity Maintain fitness and function during rehabilitation.

Acetabular Fracture. Develop a normal gait pattern Increase strength and range of motion Strengthen mechanics in forward and retro walking. Increase mobility and functional skills in a safe environment Develop balance through minimally weight-bearing activities Normalize gait patterns. Acute Myocardial Infarction MI. Progress to more body weight as patient endurance improves. He may need to refer them to another floor to be seen by another healthcare professional such as a cardiologist to find out what is going on. Considering doing so, it helps nurses to understand their purpose and role in nursing in the healthcare setting.

Henderson believes that the unique function of the nurse is to help the person sick or well, in the performance of those activities contributing to health or its recovery to a peaceful death that he would do unaided if he had the strength, will or knowledge. In doing so will help him gain independence as quickly as possible Burggraf, The Scope or Level of theory The scope or level of theory used by Henderson was a grand theory. Peplau described nursing roles in seven different ways as a counselor, resource, teacher, counseling, surrogate, leader, and technical expert. As a home health nurse, my major nursing role was teacher focused on patient teaching.

In studying Registered Nursing one will find that they have to be compassionate and want to care for others. Registered Nurses assist physicians with suffering patients of any medical condition. They need to have bedside manner, and be able to prepare patients for surgery. Registered Nursing careers range anywhere from critical care, oncology, mental health, to an everyday school nurse. Cabral supports and enhances patient self-determination and follows the ANA code of ethics for nurses.

She serves as a resource for patients, families and staff in addressing ethical issues and directs them appropriately to the palliative care team and or Medical Center Chaplin. This course objective will provide trends and relevant information about health promotion. It makes nursing students to know and understand what is the purpose of the health promotion and caring. In this case, this course objective is necessary in nursing curriculum because it makes nurses or nursing students to encourage and empowering individual, families, groups, and communities to engage in immunization program, weight loss programs, or any other programs related with the health promotion. This includes awareness of nutritional needs, allowing them to express their spiritual affiliation, mutual respect with the patient, and open communication.

This allows decisions to be a shared experience. When decision-making is a joint process between the nurse and patient, superior patient care is achieved School of Medicine [University Of California Irvine], The role of the advanced nurse is to be a health care provider striving to reach health care goals for their patients. The current study suggests an explanation for these findings by describing gaps and inconsistencies in transitional care services that may contribute to poor outcomes for older adults in SNFs after they return home. Findings in the study do not account for differences in income, community support, primary care, and other factors that might contribute to poor outcomes.

However, our findings of gaps in transitional care services suggest that poor outcomes may be related to modifiable strategies for delivering care in SNFs. This finding also suggests the need to test the feasibility and effectiveness of evidence-based transitional care for SNF patients. Our finding, that one SNF with robust organizational structure and care-team interactions more effectively delivered transitional care services than two SNFs with limited organizational structure and care-team interactions, suggests two strategies for improving the way existing staff deliver transitional care.

The first strategy is to develop organizational structure in SNFs that supports staff members who deliver transitional care; for example, new procedures in SNFs for creating written self-care plans for patients to use at home. The second strategy is to develop interactions on patient care-teams that promote connections, information exchange and problem solving; for example, carefully listening to family caregivers to evaluate their understanding of new instructions for care at home. In two prior studies, transitional care services were associated with reductions in 30 day hospital readmissions of SNF patients [ 10 , 18 ].

Our findings potentially extend these studies and suggest that strengthened supports and training for staff who deliver transitional care are needed to reduce hospital readmissions after SNF patients return home. These findings suggest practical implications for policymakers and research. In , the U. Congress passed a value based purchasing program for SNFs, which will create penalties for SNFs based on Medicare reimbursement rates for care in SNFs to prevent avoidable re-hospitalizations of SNF patients 30 days after discharge [ 3 ].

A first step to improving transitional care, and potentially patient outcomes, might be to develop staff knowledge about care transitions, including training to help staff: a recognize that SNF patients are at risk for poor outcomes during transitions to home and b learn the importance of key transitional care steps for minimizing these risks [ 29 , 30 ]. With greater awareness, existing staff in SNFs may be receptive to the changes in workflow and additional steps needed to implement evidence-based transitional care interventions and prevent avoidable re-hospitalizations after patients return home [ 31 , 32 ].

Training materials in the Re-Engineered Discharge RED Toolkit are a useful starting point to develop new educational materials [ 9 , 10 , 32 ]; in particular, Tools 3 - 6 which describe transitional care services associated with reduced rates of hospital readmissions, such medication reconciliation, education strategies for assuring that patients understand new healthcare instructions, written transition plans for use at home, and calls or visits to patient homes after discharge [ 13 , 32 ].

The findings also suggest the need for new tools and procedures to plan patient transitions from the SNFs to home [ 9 , 18 ]. We found that staff in two SNFs delivered many transitional care services in the last 24 to 72 h of patient stays; this suggests the need to start transitional care services earlier and establish schedules to move staff stepwise through a process to prepare SNF patients and caregivers for discharge. Moreover, data are not currently available which describe ways that electronic medical records might be adapted in SNFs to support timely and collaborative work of physicians, social workers, nurses and rehabilitation therapists.

As financial pressures continue to reduce the average length of stay in SNFs, organizational supports, such as new tools in electronic medical records systems, will be important resources for improving the timeliness and number of team member contributions to transitional care services. New transitional care tools in electronic medical records systems may also be useful to managers and department heads in SNFs who oversee performance improvement and quality assurance in SNFs. The transitional care practice guidelines developed by the American Medical Directors Association includes tools that SNF managers might use to monitor the quality of transitional care services; for example, the frequency of caregiver inclusion in care plan meetings, hand-offs of clinical information to follow-up physicians, and post-discharge follow-up calls or visits [ 29 ].

Finally, our findings have implications for practice and research about patient- and family- centered care-teams in SNFs. Consistent with earlier studies [ 19 , 20 , 21 , 33 ], our findings suggest the need to cultivate formal and informal care-team interactions among physicians, nurses, rehabilitation therapists and social workers who directly prepare patients for transitions in care. Findings in this study extend earlier research by identifying strategies to engage family caregivers and establish their important roles on patient care-teams. For example, the findings suggest the need to ask questions about caregiver roles and responsibilities at home; to explain new information carefully, especially critical details in planning such as the expected day of discharge; and to make time for solving problems in groups with patients and their primary caregivers.

Training tools in the CONNECT for Better Falls Prevention in Nursing Homes study may help staff members recognize how their interactions with patients and primary caregivers influence the effectiveness of problem solving on patient care-teams [ 34 ]; in particular, role playing exercises in the CONNECT training tools are potentially helpful models, as they create opportunities for staff to practice giving and receiving feedback with each other and in simulated encounters with patients or primary caregivers. These findings come with several caveats. First, the limited number of SNFs studied may limit the transferability of the findings [ 35 , 36 ]. For example, differences in ownership in study SNFs may have contributed to the variations in transitional care services, organizational support and care-team interactions; quantitative studies with larger samples of SNFs are warranted to examine the relationship between facility-level factors e.

Second, our study was designed to closely examine how differences in organizational support and care-team interactions were related to the quality of transitional care in three SNFs; it was not designed to study how differences in the needs of patients and primary caregivers — within the same SNF — may have influenced the quality of transitional care.

Additional research may be needed to evaluate the relationship between SNF patient factors, such as health literacy and perceived social support, and the outcomes of transitional care services. Third, SNF staff members were aware that the study focused on transitional care, which may have influenced their behavior and introduced bias into the data. However, this limitation was attenuated by the design for data collection and analysis, which included triangulation of data in the analysis that were collected from multiple sources e.

Finally, the study did not examine patient outcomes at home. Despite these caveats, the study permitted prolonged and in-depth data collection in three diverse SNFs; it also facilitated a description of practical strategies to train and support existing staff in SNFs that deliver transitional care. Existing staff members can effectively deliver evidence-based transitional care services with appropriate organizational structure and care team interactions; research is needed to determine the influence of transitional care interventions on patient outcomes after SNF discharge.

A written, informed consent procedure was used with all study participants, including use of a plain language statement of study procedures and risks. Individuals who provided study data signed an informed consent. Data supporting study findings are contained in the manuscript. Some data will not be made available as publication of the documents, field notes and interview transcripts from the case studies would compromise the confidentiality of study participants.

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