Transcript Provide Client and Caregiver Education in Relation to Disability

Competency Model for Professional
Rehabilitation Nursing
Behavioral Scenario
for
Competency 1.3: Provide Client and Caregiver Education in
Relation to Disability, Chronic Illness, and Health
Management (DCIHM)
Kristen L. Mauk, PhD, DNP, CRRN, GCNS-BC, GNP-BC, ACHPN, FAAN &
Kim Maas, BSN, CRRN, CBIS
Copyright©2015, Association of Rehabilitation Nurses
Competency 1.3:
Provide Client and Caregiver Education in Relation to
Disability, Chronic Illness, and Health Management (DCIHM)
Description/Scope: Uses the nursing process to provide DCIHM to provide
education for individuals, families, interdisciplinary teams, and communities.
Areas of education include but are not limited to ADL management, mobility,
communication, safety, and disease management.
Assesses/determines learning
needs and readiness to learn of
the client and caregiver for
DCIHM “literacy”
Supports established goals for
the client and caregiver
Utilizes standard rehabilitation
education related to DCIHM
Utilizes “teach-back” to
evaluate client and family
learning
Beginner Proficiency
Level Descriptors
Copyright©2015, Association of Rehabilitation Nurses
Behavioral Scenario
A nurse enters the room of a patient that is due to be discharged the next
day. The patient is a 37 year old male who was in a motor vehicle accident
and sustained a traumatic brain injury and multiple fractures. The fractures
are since healed and he has full weight-bearing; however, the
psychoemotional effects of his brain injury are still apparent.
His wife is at the bedside and expressing concerns
about his upcoming discharge. His wife reports that
she runs a daycare in the home and this is their only
income at this time. She is concerned about her
husband’s continued irritability and verbal outbursts
when too much environmental stimulation is
present. They also have a son of their own, and the
patient has been verbally aggressive with him as
well. The patient is currently on Cymbalta daily.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
The nurse continues to walk into the room with little eye contact with patient and
wife. She approaches the bedside and discusses the need to finish up discharge
paperwork. She explains that she needs to get this done before the next shift
comes in so he is ready to be discharged at the hospital’s stated discharge time.
The patient’s wife expresses concerns about her husband’s irritability again. The
nurse brings her computer near them and goes over the last team conference
notes. The notes conclude with the team agreeing that the patient has met his
goals and is ready to go home. The nurse also states that the physician says it is
time for the patient to be discharged. His wife nods and acknowledges the note,
but starts to get tearful and express her doubts of being able to manage
everything at home while working. The nurse tells her not to worry and that her
husband would not be going home if the team didn't think they were both ready.
The nurse then says that she needs to check on another patient and she will be
back soon to finish up the paperwork.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
Observations & Outcomes
1. The nurse does review the last team notes to assist in reassuring the patient's wife he is ready to
go home. She does this by acknowledging he has reached his goals for inpatient rehab.
2. However, the nurse is not proficient in addressing the concerns about overstimulation and
irritability. She does not attempt to educate the wife on ways to decrease stimulation to assist in
making home transition easier. She also does not address the medications he is on and whether or
not they can be adjusted. The nurse is too concerned with getting her paperwork done.
3. The nurse needs to increase her proficiency in providing
education to her patients by using principles of patientcentered care and therapeutic listening. She should have
realized that the wife was asking for help and reassurance
and that this presented a teachable moment. By failing to
educate the wife about common behaviors, how to
control the environment to minimize stimulation, the
medication regimen, and strategies to cope with
behaviors, the nurse is not helping the patient and family
to have the best outcomes after discharge.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 - Proficient
The nurse says to the wife, “I understand that this is an adjustment in
getting ready to take your husband home after his brain injury. Let’s talk
about your specific concerns”. The nurse listens carefully to the wife
and then states that she will be back with some written information
about managing behavior after brain injury and the contact number for
a support group in the area. The nurse returns with this information
and takes time with the wife to role play a scenario in which the patient
loses his temper in front of their son. She demonstrates the best
strategies for handling this behavior and repeats the scenario for the
wife to demonstrate “teach-back”. The nurse also discusses other
options for the wife that might be more feasible than running a daycare in their home, and some choices for respite for her. After their
educational session, the wife says, “I feel so much better now. I think I
just needed to have more information. It looks like I need to make some
changes on how I handle things”.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 – Proficient
Observations & Outcomes
1. The nurse at a beginning level of proficiency considered the patient’s wife and her goals for
discharge. The nurse was able to determine that the wife needed additional education in several
areas. She used standard educational tools and methods including a brochure and support group
information, the teach-back method via role-playing to handle difficult behaviors, and discussion
about medications.
2. The nurse also demonstrated some intermediate competencies in that she individualized the
educational plan and provided tailored education. To further increase her proficiency level, this
nurse could have adapted the plan of care in advance to include the needed teaching versus waiting
until just before discharge.
3. An expert rehab nurse would have anticipated long-term
needs of this patient and family, provided consultation ahead
of time to determine the wife’s fears and concerns, and
modified educational materials to meet the wife’s needs.
Copyright©2015, Association of Rehabilitation Nurses
What Did You Observe?
How did the outcomes of this scenario differ?
Proficient Nurse
- Took time to listen to the
wife’s concerns and tailored
her educational plan
accordingly
Non-Proficient Nurse
- Focused on finishing her
documentation above
listening to the wife’s
concerns
- Used the teach-back method - Provided minimal education
to help the wife practice new that was not tailored to the
skills
patient/wife’s needs
- Used her rehab knowledge to - Did not share the needed
educate the wife about
knowledge for this patient
behavior, environmental
before discharge
control, and medications
-
-
Copyright©2015, Association of Rehabilitation Nurses
Takeaways
• The new rehab nurse should demonstrate at least a
beginning proficiency level in this competency by listening to
the patient and family goals prior to discharge and providing
needed education.
• Establishing a tailored educational plan takes prior planning.
• Rehabilitation nurses can foster more positive patient
outcomes through appropriate education that is based on
current standards and includes the items that family members
and patients both want and need to know for a successful
home transition.
Copyright©2015, Association of Rehabilitation Nurses