Rehabilitation Nurses Research Articles

Personalised discharge care planning for postmyocardial infarction patients through the use of the Personalised Patient Education Protocol - implementing theory into practice.

This study aims to evaluate the service impact of the integration of an evidence-based instrument - the Personalised Patient Education Protocol - into an existing postmyocardial infarction care pathway. Recent research indicates that while better patient health outcomes can be achieved when care planning is personalised, delivery staff feel less satisfied and less confident in its provision. To achieve a shift to personalised care, innovations are needed to enable an effective transition for staff. A service evaluation using a patient survey and nurse interviews. A longitudinal patient survey measured changes in patient illness beliefs, cardiac diet and exercise self-efficacy, anxiety, depression and quality of life study of a patient cohort of 74. Paired t-tests analysed the effects before and after the implementation of the Personalised Patient Education Protocol. Cardiac rehabilitation nurses who implemented the Personalised Patient Education Protocol were interviewed and a patient survey identified perceptions of the usefulness of the service innovation. Analysis of change from baseline to three months results showed statistically significant changes in Illness Belief component 'Understanding' and the Dartmouth Quality of Life 'General Health'. The integration of the Personalised Patient Education Protocol into the existing discharge process identified service improvements for cardiac nurse training and care pathway delivery, while patients identified the level and frequency of their use of the protocol following discharge. The introduction of the Personalised Patient Education Protocol succeeded in increasing patient engagement, facilitated a more patient-centred service by enabling practitioners to systematically provide personalised patient education, and gave patients a postdischarge structure to better follow-up their illness concerns with health professionals in the community. Integration of the Personalised Patient Education Protocol into an existing postmyocardial infarction care pathway enabled nurses to systematically respond to individual patients' illness beliefs and expectations.

Taking Care of the Squeaky Wheel: Joint Replacement Long-term Issues

•We provide history and physical examination priorities for patients with postarthroplasty issues. •Intrinsic causes of joint pain postarthroplasty that may initiate patient complaints are discussed. •Origins of pain extrinsic to the joint prosthesis that may cause patient complaints are explored. •We provide tips for managing the postarthroplasty patient with joint issues. Laurel Short, MSN, FNP-C, is a Physical Medicine and Rehabilitation Nurse Practitioner in Overland Park, KS. She can be reached at . Department Editor Laurel Halloran, PhD, APRN, would like to hear your ideas for future columns, can be reached at .

Abstract NS9: ARN Professional Rehabilitation Nurse Competency Model: Application to Stroke Care

As the nursing profession continues to become more specialized, there have been more models developed to define specific practice areas. Rehabilitation nursing is practiced in diverse settings along the healthcare continuum with clients who have experienced a disability/chronic illness, such as stroke. No framework was noted in the literature that defined the necessary competencies of the rehabilitation nurse Purpose: To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical practice. Method: An Association of Rehabilitation Nurses’ (ARN) task force was convened, conducted a literature review and participated in “brainstorming” that yielded four domains of professional practice: nurse-led evidence-based interventions; promotion of health and successful living, leadership, and interprofessional practice; and essential role competencies. The competencies were further defined into three levels of proficiency: beginner, intermediate, and advanced (ARN, 2014). Results: Model is a circle with professional rehabilitation nurse at the center surrounded by four domains and the role competencies, separated by broken lines illustrating the crossover of knowledge and skills represented in each domain. This practice Model can be used to inform stroke care in various settings across the healthcare continuum; and competencies such as facilitating safe and effective care transitions can be used in plan for the stroke survivor and caregiver. Facilitating the stroke survivor’s transition to the right level of care is an essential rehabilitation nurse competency and promotes better outcomes (Camicia et al., 2014). Using competencies, such as interventions based on best evidence, are essential in managing stroke sequela: neurogenic bladder, dysphagia, hemiplegia, etc. The Model can also be used to address the caregiver role and frame the assessment to determine education, community resource, and support needs. Conclusion: ARN Rehabilitation Professional Nurse Competency Model reflects diversity of rehabilitation nursing in the current healthcare arena; and is an efficacious tool which can assist rehabilitation nurses at various levels to provide optimum stroke care and contribute to best practice.

Effectiveness of physical rehabilitation on clinical outcomes of patients following stroke

Background and purpose Stroke is a leading cause of gait impairment, resulting in long-term disability among adults, and frequently results in impaired mobility or motor function. More than half of the people with stroke are not able to walk, and walking impairments are still present among them due to abnormal muscle control, muscle weakness, abnormal muscle tone, abnormal muscle activation patterns, and altered energy expenditure, mostly affecting the paretic side. Thus, the purpose of the current study was to examine the effectiveness of using combined gait training and treadmill walking technique on selected clinical outcomes of patients with stroke.Patients and methods A quasi-experimental design was used to test the research hypotheses. A convenience sample of 50 adult patients with stroke were recruited.Setting This study was conducted in the outpatient clinics of neurology and physiotherapy unites at Shebin El Kom City, Menoufia University Hospital, Menoufia Governorate.Tools Interviewing Questionnaire, the Barthel Index, the Simplified Stroke Rehabilitation Assessment of Movement Scale, the Berg Balance Scale, the Oxford Scale, and the Modified Ashworth Scale were used to collect data.Results There was a statistically significant improvement in voluntary movement of subscale scores of the upper and lower limb and basic mobility after intervention. There was a statistically significant improvement in the mean scores of activities of daily living and body balance after intervention. There was a statistically significant improvement in the mean score of muscle tone and muscle strength after intervention.Conclusion Combined gait training and treadmill walking technique is effective in improving clinical outcomes in patients with stroke.Recommendation Rehabilitation nurses should be encouraged to implement the combined gait training and treadmill walking technique as a routine practice in rehabilitation facilities for patients with stroke.

Evaluating Status of Global Indices of Age-Friendly City In Tehran Metropolis (AFC)

Abstract OBJECTIVES: This study aims to assess the global indices of age-friendly city in Tehran, which have been developed by World Health Organization. Finally, the design solutions carried out based on the successful works in other countries will be presented for city of Tehran. MATERIALS AND METHODS: In the present study, World Health Organization’s standard questionnaire was duplicated in 110 copies and given to urban designers and planners, rehabilitation specialists, doctors, nurses, and other aging-related professionals and experts. Then, the resulting data were imported into SPSS22 software and analyzed using descriptive and inferential statistics. FINDINGS: The results indicated that, among 8 indices of age-friendly city including open spaces and buildings, transportation, housing, social participation, respect and social inclusion of the elderly, citizen participation and employment of the elderly, communication and information facilities, as well as health and local services, transportation factor had a more favorable condition in Tehran for the elderly and citizen participation and employment index was very inappropriate for them. CONCLUSION: It can be said that urban designers and researchers should deal with the planning of housing and buildings’ open spaces in a more detailed manner in their future works and pursue more accurate plans and programs in this regard. This study aims to only evaluate the mentioned issue, and special and detailed research is expected to be conducted on these two subjects in the future.

Cardiac Rehabilitation Nurse Clinics

Cardiac Rehabilitation Nurse Clinics

Nursing diagnoses of functional capacity in Parkinson's disease: a cross-mapping study

Aim: To carry out a cross mapping of the nursing diagnoses not standardized with the NANDA International classification system, present in the fields “Activity/Sleep” and “safety/protection” and related to the functional capacity of patients with Parkinson's disease in a rehabilitation program. Method: a descriptive study with documentary research for the realization of a cross-mapping study. Simple random sample of 67 medical records and 335 nursing registers, from March 2009 to April 2013. Results: Of the 93 terms of the nursing language, 15 NANDA International standardized diagnostics emerged from the cross mapping. The most mapped terms were “Impaired physical mobility” (22%) and “risk of falling” (11%). For “Impaired physical mobility”seven defining characteristics were mapped. Two terms of nursing language could not be mapped through the taxonomy. Conclusion: The cross mapping identified the standardized diagnostics related to the NANDA International. This enables the universalization and consolidation of the role of nurses in Parkinson's disease rehabilitation.

Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices.

Rehabilitation nurses know the impact of injury on function, independence, and quality of life, complicated by age-related changes associated with decreased strength, endurance, reserve, frailty, and social and financial resources. Multidisciplinary teams are essential to provide expert, age specific health care delivery to this vulnerable population across settings of care. The purpose of this article is to apply level of evidence rating scales to identify the best practice interventions to prevent falls on rehabilitation units. The evidence supports the importance of determining specific risk factors and initiating multifactorial fall risk factors tailored to the individual. Yet, little evidence exists for single interventions, universal fall prevention strategies, and population-specific fall prevention strategies. A review of the literature confirms the effectiveness of many fall prevention practices and interventions remains insufficient. Of particular concern are rehabilitation units in hospitals that have higher fall rates compared to other acute units.

Effect of progressive relaxation exercises on fatigue and sleep quality in patients with chronic obstructive lung disease (COPD)

ObjectiveThis research was conducted to investigate the effect of Progressive Muscle Relaxation Technique on fatigue and sleep quality in patients with COPD. This research was performed as a single-group pretest/post-test pretrial model. MethodsThe study was conducted with 45 patients who met the research criteria and agreed to participate in the study. A Personal Information Form was used as a data collection tool, Fatigue Severity Scale was used for measuring fatigue, and the Pittsburgh Sleep Quality Index was used for evaluating the sleep quality. ResultsIt was determined that PMRT decreased patients' fatigue level and improved their sleep quality, patients' fatigue level increased as their sleep quality decreased. ConclusionProgressive relaxation exercises programs represent effective therapeutic intervention approaches for relieving COPD-associated fatigue and sleep quality. PMRT programs will extend the scope of the rehabilitation nurses' work, as it is an important course of COPD patients' continuity nursing.

The Competency Model for Professional Rehabilitation Nursing.

Rehabilitation nursing is practiced in various settings along the healthcare continuum. No framework is noted in the literature that defines the necessary competencies of the rehabilitation nurse. To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical and educational practice. A seven-member Association of Rehabilitation Nurses (ARN) task force was convened; conducted a literature review, reviewed current and historical ARN documents, including the Strategic Plan, and developed a Competency Model for Professional Rehabilitation Nursing practice. The Competency Model for Professional Rehabilitation Nursing delineates four domains of rehabilitation nursing practice and essential role competencies. The Competency Model for Professional Rehabilitation Nursing addresses this diverse specialty practice in the current healthcare arena. This framework can be used to guide nurses practicing at different levels of proficiency in various settings. The Competency Model can be used as a structure for staff orientation, evaluation tools, clinical ladder components, role descriptions and rehabilitation nursing courses.

Meanings of Falls and Prevention of Falls According to Rehabilitation Nurses: A Qualitative Descriptive Study.

Guided by Friedemann's theoretical framework, this survey explored the meaning of a fall of an institutionalized older adult or fall prevention to rehabilitation registered nurses and whether the experience changed the nurse's practice. Qualitative, descriptive survey. A convenience sample of 742 rehabilitation nurses was asked to describe these experiences and the impact on their practice. Themes discovered related to the meaning of a fall include negative feelings (incongruence) and positive feelings (congruence). Themes related to the meaning of preventing a fall include positive feelings (congruence). Practice change themes emerged from both the experience of a fall and fall prevention. Practice change themes were drawn to Friedemann's (1995) process dimensions. Nurses' experiences and meanings of falls uncovered negative and positive feelings about these falls. New findings of this study were the positive feelings expressed by nurses, when there was no injury or when a fall was prevented.

Development of Professionalism and Performance Accountability for Sustained FIM Accuracy Improvement.

Rehabilitation nurses have essential responsibility for detailed Functional Independence Measure (FIM) documentation and accurate scoring. The goal of this performance improvement project was to improve individual FIM accuracy and establish and maintain a FIM accuracy standard. Case Study. This performance improvement project was implemented in a 20-bed CARF-accredited Midwestern acute care hospital inpatient rehabilitation unit. Improved individual and overall RN FIM scoring accuracy, with increased length of stay and case mix index. Concurrent FIM scoring and documentation review holds staff accountable and allows for timely revisions following discrepancy identification. Leadership supports for concurrent FIM audits, utilization of available technology, transparent reporting of results, and individual accountability lead to sustained improvement in FIM scoring accuracy. Accurate FIM documentation and scoring drive appropriate length of stay and case mix group assignment. Assessment competence enhances nursing engagement, confidence, and process accountability.

The effectiveness of self instructional module on cardiac rehabilitation

ObjectiveNurses play a strong role in helping patients reduce their risk for disease and make informed lifestyle changes. Reliability of the nurses is critical for them to serve as role models and educators. The aim of the present study was to improve nurse knowledge of post-myocardial infarction rehabilitation at selected hospitals in Indore through a newly designed self-instructional module. MethodsSixty cardiac center staff nurses were administered a questionnaire, a pre-test on cardiac care and the self-instructional module. Five days after the nurses were administered the module, a post-test was given to assess the gain in knowledge on in post-myocardial infarction cardiac rehabilitation. ResultsThe mean pre-test score was 8.27 ± 4.40 but increased to 23.18 ± 3.69 in the post-test following administration of the self-instructional module. The change in score was statistically significant (P < 0.0001) indicating that the self-instructional module was instrumental in increasing knowledge of post-myocardial infarction rehabilitation. ConclusionsThe results of this study highlight the need for continuing education of nurses in cardiac rehabilitation. Self-instructional modules are a useful tool for furthering nurse education.

Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation

A previous study reported a 45% incidence of falling among allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients during hospitalisation. We investigated balance and physical function in allo-HSCT patients. Thirty patients (18 men and 12 women) who underwent allo-HSCT between February 2013 and September 2014 were included in this study. Patients were evaluated for up to 3 weeks before and 7 weeks after transplantation. Balance was evaluated using the Timed Up and Go test (TUG) and length of centre of pressure (CoP). Physical function was assessed using hand-grip strength, knee-extensor strength tests, and the 6min walk test (6MWT). TUG and length of CoP were significantly increased following HSCT (P<0.01). Hand-grip strength, knee-extensor strength, and the 6MWT score decreased significantly after allo-HSCT (P<0.01). TUG and length of CoP were negatively correlated with hand grip and knee-extensor strength (P≤0.05). The allo-HSCT patients in this study had worsened dynamic and static movements of the CoP after transplantation as well as decline of physical function. Rehabilitation staff, nurses, and physicians should recognize the decreased balance function of patients who have undergone allo-HSCT.

Information Needs of Family Caregivers of People With Dementia.

Understanding caregiver needs is essential when caring for people with dementia. The aim of this study was to identify family caregivers' information needs as perceived by home care workers and the caregivers themselves. This study used a descriptive survey design and convenience sampling. The two groups of care providers were given a list of 48 items and asked to choose caregivers' top 10 information needs. Group 1 (n=33 unpaid family caregivers) identified dealing with behavior changes and group 2 (n=59 paid home care workers) identified providing personal care as most important. While differences between these groups emerged, both care providers chose more items related to needing help for the care recipient, than items related to needing help for the caregivers themselves, e.g., support group. These information needs can be used by rehabilitation nurses and other healthcare professionals to develop educational materials and supportive interventions.

Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility.

The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (±8.2). The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. Mean GDS was 7.60 (±2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p=.043). A negative correlations between GDS and MMSE (p=.029), GDS and BI (p=.049), and GDS and AIS (p<.0001) were found. The occurrence of depressive symptoms in older adults after stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects.

Current Situation and Training Strategy of Rehabilitation Nurses in China

Current Situation and Training Strategy of Rehabilitation Nurses in China

Self-perceived Burden in the Young and Middle-aged Inpatients with Stroke: A Cross-sectional Survey.

The aims of this study are to explore the prevalence and the features of self-perceived burden (SPB) in the young and middle-aged inpatients with stroke and to identify predictors of SPB. A cross-sectional survey. One hundred fifty-five patients were recruited from the Neural Medical and Neural Comprehensive wards of a comprehensive hospital in Chengdu city from January to April 2013. Data consisted of survey interviews, medical records, and a series of questionnaires a week after the patients' hospitalization. Relevant statistical analyses were conducted using SPSS 16.0. We found SPB was a prevalent experience among young and middle-aged inpatients with stroke. The exploratory analyses (independent samples t tests or one-way ANOVAs) indicated that significant influencing factors of SPB were marital status, self-care ability, caregivers' health, knowledge of the illness, and monthly income. Moreover, patients' SPB scores were positively and significantly correlated with anxiety and depression, but they were negatively and significantly associated with social support and quality of life. A multiple stepwise regression analysis revealed that social support score and knowledge of the illness significantly predicted SPB. The present study indicates that SPB is a prevalent inner feeling among young and middle-aged inpatients with stroke in China and that it is associated with an array of variables, including social support, quality of life, distressful mood, and several demographic characteristics. The findings of this study may help rehabilitation nurses plan and implement health education, effectively and efficiently use healthcare resources, so as to better care the young and middle-aged stroke patients as well as promote their rehabilitation.

Understanding Work-related Musculoskeletal Injuries in Rehabilitation from a Nursing Perspective

The incidence and prevalence of work-related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context-specific patterns of nursing injuries. Using a cross-sectional descriptive research design, 58 rehabilitation nurses participated in this study. Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit. Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication. Nursing input is critical in understanding and reducing context-specific work-related musculoskeletal injuries. Further research that includes nursing voices is advocated. Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.

Determinants of Health-Related Quality of Life in Taiwanese Middle-Aged Women Stroke Survivors.

Female stroke victims have a higher survival rate and experience a greater loss of quality of life than do male stroke victims. The aim of this study was to evaluate the determinants of health-related quality of life in middle-aged women stroke survivors. This study is a cross-sectional design. This cross-sectional research uses a descriptive, prospective, and correlational study design to investigate the associations between latent variables. Participants included women stroke survivors, aged 45-65 years, who were patients at a medical center in Taiwan. Participants completed an interview and a six-part questionnaire comprising the Short-Form Health Survey (SF-36), National Institutes of Health Stroke Scale, Modified Rankin Scale, Burden Scale, Chinese Health Questionnaire, and five items that pertain to the survivor's cognitive appraisal of coping. Structural equation modeling (SEM), with the use of the partial least squares (PLS) method, was used to examine the proposed conceptual model. A total of 48 dyad samples (48 female stroke survivors, mean age = 55.29; 48 caregivers, mean age = 42.71) participated in the study. Overall, women's physical functioning (PF; stroke severity), cognitive appraisal of coping, and caregiver's psychosocial functioning were the predictors, explaining 43.3% of the variance in women's health-related quality of life. We found that female stroke survivors' level of stroke severity and negative appraisal-impact of stroke are significant predictors of the stroke survivor's quality of life. In addition to assisting women in their PF rehabilitation, rehabilitation nurses also should help to develop survivors' self-care confidence as a means to avoid the recurrence of stroke.