Dynamic Role of the Nurse in Stroke Rehabilitation

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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

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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

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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)

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The Multidimensional Role of The Stroke
Rehabilitation Nurse
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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)

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Educator and Coach

• Wellness and prevention
• Self care
• assesses their readiness to learn
• plans teaching times and strategies
  (uni-profession or interprofessional)
• Advocacy skills

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Leader and Collaborator

• Works with the team to establish goals to promote
  maximal patient independence.

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Rehab Nurse as Advocate

• Patient or unit / program based
• Accessibility of rehabilitation services
• Politically involved at all levels

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Rehab Nurse as Coordinator

• Uses holistic, interprofessional approach
• Identifies and measures functional goals for
  patients
• plan and guide care

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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

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Rehabilitation Nursing CompetenciesFunctional
Health Patterns

• Discharge and Transition
• Mobility
• Sexuality
• Sleep and rest
• Sensory and Pain
• Nutrition, Elimination, Skin Integrity
• Cardiopulmonary
• Psychosocial adaptation

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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

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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

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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

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Case Study

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Final Thoughts

• The scope of practice of a stroke rehab nurse is
  broad and dynamic
• Significant impact on patients rehabilitation
  experience and recovery
• Many opportunities for interprofessional
  collaboration to optimize patient outcomes

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Contact Information

• Nancy Boaro
• Advanced Practice Leader
• Neuro Rehab Program
• Toronto Rehab
• 416-597-3422 ext 3772
• boaro.nancy_at_torontorehab.on.ca

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QUESTIONS?