Rehabilitation Grand Rounds

NURS 441- Nursing Process in Rehabilitation

Purpose of Assignment
To provide the student an opportunity to integrate previous knowledge from the sciences
to the care of a client with a physical disability. Also, to provide the student with an opportunity
to demonstrate critical thinking and independent judgments in managing care of a client with a
physical disability.
Student Approach to Assignment
Throughout my rehabilitation clinical, I cared for the same patient. This allowed me to
observe her from the time she was admitted to three days prior to her discharge date. Through the
care I provided and observations made, I was able to see how impactful the rehabilitation
experience was on her health. Also, because this was more of an observational clinical than acute
care, I was able to gain a better understanding of the responsibilities of different care providers
such as occupational, physical, and recreational therapy.
Reason for Inclusion of the Assignment in the Portfolio
This assignment is included in the portfolio because it highlights the care that I gave to a patient
in a non-acute care setting and demonstrates my understanding of inter-professional
collaboration and the effects it has on patient care.
Critical Thinking
Uses decision-making skills in making clinical or professional judgements
Example: In my concept map, one of the interventions listed was change in time that
pain medication was given. The patient was not able to do all her therapy because she
was in pain. I recommended to the physical therapist and nurse that we change her
time to get Percocet from 0600 to 0800. This resulted in a higher compliance with
therapy because the medication was lasting throughout her morning therapy when
given later.
Engages in creative problem solving.
Example: In this presentation I discussed the assistive aids my patient used to help her
complete activities of daily living and be independent. My patient was right handed.
She fractured her right humerus which was in a sling, and her right femur which she
had surgery for nail fixations. She had to adapt to using her left hand only and learn to
bear weight on her right leg to be able to walk. Assistive devices such as elastic shoe
laces, a shoe funnel, a reacher, and sock aid were all creative ways to help her
problem solve completing daily activities of living. She used these aids to dress
herself independently.

 Nursing Practice
Performs therapeutic interventions that incorporate principles of quality management
and proper safety techniques based upon assessment findings.
Example: In this oral presentation I discussed how with green safety status the patient
needed assistance with transferring from bed to wheelchair or wheelchair to
bathroom, etc. I always ensured I asked for help transferring the patient because she
was a 2 person assist at first due to her non-weight bearing on the right extremity.
When her leg got sore I discussed how I used ice and a rolled up towel placed under
the right leg to relieve pressure and pain.
Demonstrates an awareness of complementary modalities and their usefulness in
promoting health.

Example: I demonstrated awareness of complementary modalities and their

usefulness in promoting health by discussing the use diaphragmatic breathing and
praying. My patient exhibited a lot of anxiety that was affecting her ability to do
exercises in rehab. The patient was very religious so praying before standing with deep
breathing really made a difference in her abilities.
Establishes and/or utilizes outcome measures to evaluate the effectiveness of care.
Example: Through this oral presentation I had to discuss the progress my patient
made through her rehab experience. Her goal upon admission was that she would
leave being able to go to the bathroom. Changing to a white safety status (being able
to go to the bathroom unsupervised) is evidence that she met this outcome.
Communication
Expresses oneself and communicates effectively with diverse groups and disciplines using
a variety of media in a variety of contexts
Example: In this oral presentation, I discussed the exercises and activities done by
physical, occupational, and recreational therapy. I also discussed the assistive devices
used such as: wheel chair, walker, Wii, sock aid, reacher, shoe funnel, elastic shoe
laces, etc.
Teaching
Provides relevant and sensitive health education information and counseling to patients,
and families, in a variety of situations and setting
Example: In this oral presentation, I discussed how a neuropsychology consult was
initiated by occupational therapy to assess the patients anxiety after the therapist and
I had a discussion about the patients anxiety interfering with therapy. The
neuropsychologist recommended the patient do diaphragmatic breathing and praying
through therapies. I then reinforced this teaching throughout all her therapies and
constantly reminded her to do these alternative interventions, especially before
standing. Re-teaching was very effective because with anxiety the patient would get

flustered easily, but re-teaching and telling her it will help her to relax would quickly
cause her to relax and think about what she was doing.
Research
Shares research findings with colleagues.
Example: In my presentation I included research about the physical therapy needed to
recover from a femoral shaft fracture. It discussed the results of patient swho
underwent physical therapy versus those who did not. The research article I chose
identified home modifications that needed to be made such as moved rugs and access
to essential things since these patients go home in either a wheel chair or with a
walker.
Professionalism
Differentiates between general, institutional and specialty specific standards of practice
to guide nursing care.
Example: In my presentation I discussed my assessment of the capabilities of my
patient. I then stated specific exercises and activities the different disciplines
performed with my patient and the purpose of them. For example, physical therapy
did more lower body exercises such as walking; whereas, occupational therapy did a
lot of arm exercises to strengthen her left arm to be able to use it for independence. I
also discussed the colored safety bands which is an institutional standard of practice
to prevent falls; however fall risk prevention is a general standard amongst all
hospitals and acute care settings. Specialty specific standards focus on the nursing
process to manage adult clients' adjustment to a physical disability which is not
always the case in an acute care setting. Throughout the presentation I explained how
the different therapies worked together to get the patient to be independent while
healing her disability.
Culture
Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle and age.
Example: In the presentation I discussed how my patients religion was used as an
alternative intervention for her anxiety. We taught her to say a prayer and clear her
head before standing up to reduce her anxiety. This had a positive outcome and great
improvement was noticed with her standing. Her lifestyle was discussed as it is
focused on her use and selling of the Reliv supplemental products which impacts her
health. One last thing that was mentioned was her osteoporosis and being an older (68
year old) woman increases your chance for osteoporosis. She takes her supplements
to help with this disease process.