PRESENTEDBY,

UMADEVI.K
1ST YEAR MSc NURSING
OXFORD COLLEGE OF NURSING
BENGALURU
 AMBULATORY CARE

 ACUTE AND CRITICAL CARE

 HOME HEALTH CARE

 LONG TERM CARE

 The word patient comes from the Latin word
patiens, originally meant “one who suffers”.
verb, patior, meaning “I am suffering” The
patient is most often ill or injured and in need of
treatment by a physician, advanced practice
registered nurse or other health
careprovider.patient is one whom needs
care,attention and support from healthcare
professionals and family.
 Care in hospital is the attention or
watchful oversight o supervision and attentive
assistance or treatment for the needed by the
nurse or other heath care professional and
health care setting is a place of organized
systems of medical care, including prepaid
group medical practices, collective group
insurance-covered, fee-per-service medical
care, and community clinics organized and run
by non-profit or profit-making organizations.
 As an increasing proportion of
population and with the shift in disease
patterns from acute illnesses to chronic
illnesses,the traditional disease management
and care focus of the health care professions
has expanded.The health care focus must
center more on prevention,health promotion
and management of chronic conditionsthan
in previous times.

 It is the ability to walk from place to place
with or without assistance.

 In ambulation Individual is able to walk at least

10 feet outside the parallel bars with
supervision or physical assistance from only
one person
 Ambulatory care is a personal health care
consultation, treatment or intervention using
advanced medical technology or procedures
delivered on an outpatient basis (i.e. where the
patient’s stay at the hospital or clinic, from the
time of registration to discharge
 Ambulatory health care is provided for the
patients in the community or in hospital
settings.
 0 Non functional

 patient cannot ambulate,ambulates in parallel bars

only,or requires supervision or physical assistance
from more than 1 person to ambulate

 1 Ambulator –dependent dependent for physical

 assistance

 patient requires manual contacts of no more than

one person during ambulation.manual contacts are
continuos and necessary to support body weight
 patient requires manual contacts of no more
than one person during ambulation.manual
condact consists of continuos or intermittent
light touch for assistance
 3 Ambulator –dependant for supervision
 patient can physically ambulate on level
surfaces without manual condact with
another person but for safety requires stand
by guarding

 4Ambulatory – independent level

 patient can ambulate independently on level
surfaces but requires supervision

 5Ambulator – independent

 patient can ambulate independently on non

level and level surfaces,stairs and inclines
 Ambulatory care nursing includes those
clinical,management,educational ,and research
activities provided by registered nurse for and with
individuals who seeks care and assistance with
health maintainence and or health promotion. -
AAACN

 AMBULATORY CARE
SETTINGS
 SITES
 HOSPITAL
EMERGENCY
DPT COMMUNITY
OUTREACH
PROGRAMME

CARDIAC
REHABILITAT
ION AMBULATORY
CENTRES HEALTH
CARE STUDENT
SETTINGS HEALTH
CENTRES

AMBULATOR
Y CARE
CENTRES
MEDICAL
CLINICS
 Providing direct patient care
 Conducting patient intake screenings
 Treating patients with acute or chronic illnesses or
emergency conditions
 Reffering patients to other agencies for additional
services
 Teaching patients self care activities
 Offering health education programmes that promote
health maintainence
 Nurses also work as clinical managers,direct the
operation of clinics and supervise other health team
members
 Providing advice and emotional support to patients
family members.
 Teach patients and their families how to manage their illness or injury,
including post-treatment home care needs, diet and exercise
programs, and self-administration of medication and physical
therapy
 counseling to family members of critically ill patients

 RNs work to promote general health by educating the public on

various warning signs and symptoms of disease and where to go for
help
 RNs also might run general health screening or immunization
clinics, blood drives, and public seminars on various conditions.

 Some ambulatory care nurses are involved in telehealth, providing

care and advice through electronic communications media such as
videoconferencing or the internet
 Research in ambulatory care is needed for
many reasons;
 To help to develop new models of nursing
care delivary
 To develop standards of client care
 To create both performanceimprovement
programmes and nursing intensity systems to
determine the number and types of nursing
personals needed

 ACUTE CARE HOSPITALS

 An acute care hospital is a healthcare facility that

offers patient care services of a limited duration to
diagnose and/or treat an injury or short-term
illness. Services include medical and surgical
inpatient services and
outpatient diagnostic services.
PROFIT
HOSPITALS– receives local, HEALTHAGENCIES
state and federal gov support Eg: Hospitals that
arechurch
eg: army,navy, and public affliated,hospitals
treating
health services etc
specialities such a
cancer
FOR PROFIT HOSPITALS MAGNETHOSPITALS
Goal is business to generate profit, Designation is given to
hosptals
Owned privately by large corporations that have
reputation for
providing
excellent
Or by single owners. nursing care and good
medical Outcomes
Eg:clients who require
organ transplantation
Care after serious injury
are Cared in this institutions
 PROFESSINAL SERVICES SUPPORT SERVICES

 MEDICAL STAFF
 PRIVATE OR GROUP PRACTICE PHYSICIANS ADMINISTRATION

 NURSING SERVICE BIOMEDICAL ENGINEERING DEPARTMENT

 PHARMACY
 PHARMACISTS AND TECHNICIANS BUSSINESS DEPARTMENTS

 REHABILITATION SERVICES CENTRAL SERVICE/MATERIAL MANGMT DPT



 PHYSICAL THERAPISTS, DIETARY DEPARTMENT

 OCCUPATIONAL THERAPISTS,  LABORATORY
LAUNDRY

 MEDICAL RECORDS DPT
 HUMAN RESOURCE DPT

 VOLUNTEER SERVICES
CENTRAL SERVICE/MATERIAL
MANGMT DPT

 DEVOLOPMENT/COMMUNITY
RELATIONS

 DIETARY DEPARTMENT

 ENVORONMENTAL SERVICES
PROVIDER OF DIRECT CARE

RESEARCHE EDUCATOR MANAGER

R
 Critically ill patients are defined as those patients
who are at high risk for actual or pot
 ential life-threatening healthproblems.

 Critical care is a term used to describe “the care of

patients who are extremely ill and whose clinical
condition is unstable or potentially unstable”.

 Critical care nursing is the field of nursing with a

focus on the utmost care of the critically ill or
unstable patients
 Damages
 general(injury),special(all losses and
expenses),emotional,punitive
 Eg:
 INTENTIONAL TORTS
 Civil wrong committed againt a person or persons
property
 Assault
 Eg:Threatening a pt with an injection.
 Battery
 Eg:Forcing a patient to ambulate
 Falseimprisonment
 Eg:Refusing to allow a patient to leave against
medical advice
.
Invasion of privacy
 Eg:Taking unauthorized pictures of the
patient,releasing confidential information to
others without consent.
 Defamation
 Use of adverse language that affectsones
reputation.
 Eg:falsely accusing staff members in frontof
others,making false chart entries about patients
life style
 It includes;
 INFECTIOUS HAZARDS
 HIV exposure
 Viral hepatitis exposure
 MUSCULOSKELETAL INJURIES
 Occupational back injury(back pain)
 CHEMICAL HAZARDS
 Skin irritants,eye irritants,antineoplastic
agents etc
 NOISE

 Sources of noise includes;

 Ventilators
 suction machines
 telephones
 infusion pumps
 doors
 staff conversations
 monitor alarms
 Effects;
 Prolonged exposure can cause hearing loss and mental irritability
 CHEMICAL DEPENDANCY

 Without healthy coping skills; a nurse may secretly turn to drugs or

alcohol for emotional and spiritual support. Drugs that are abused
commonly include cocaine, alcohol, narcotics and tranquilizers.
 INFORMED CONSENT
 DURABLE POWER OF ATTORNEY FOR HEALTH
CARE
 DO NOT RESUSCITATE ISSUES
 LIVING WILLS
 WITHDRAWAL OF ORDINARY CARE MEASURES
 DOCUMENTATION
 Acute and Critical Care Expert Panel was
established IN 2009 to inform health policy and
influence relevant issues related to acute and
critical care. Members of the panel have
diverse areas of expertise to provide leadership
and expert opinion on a variety of issues. The
panel facilitates networking, and fosters research
and scholarship between members. It also
promotes exchange of information and ideas
with other nursing and professional groups
 critical care nurses:

 Respect and support the right of the patient.

 Help the patient obtain necessarycare.

 Respect the values, beliefs and rights ofthe

patient.
 Support the decisions of the patient or
designated surrogate, or transfer care to an
equally qualified critical care nurse.
 Intercede for patients who cannot speak for
themselves in situations that require immediate
action.
 Monitor and safeguard the quality of care the
patient receives.
 Act as a liaison between the patient, the patient's
family and other healthcare professionals
 Critical care nurses work in a wide variety of settings, filling
many roles including bedside clinicians, nurse educators,
nurse researchers, nurse managers, clinical nurse
specialists and nurse practitioners a particular specialty.
 The CNS is responsible for the identification, intervention and
management of clinical problems to improve care for patients
and families.
 They provide direct patient care, including assessing,
diagnosing, planning and prescribing pharmacological and
nonpharmacological treatment of health problems.
 CNS in the critical care setting focus on making clinical
decisions related to complex patient care. Their activities
include risk appraisal, interpretation of diagnostic tests and
providing treatment, which may include prescribing
medication.
 Home Care (also referred to as domiciliary care or
social care)is health care or supportive care
provided in the patient's home by health care
professionals (often referred to as home health
care or formal care)
 Home Health Nursing is about patients receiving
nursing care in their home. Home health nurses have
a new environment every day and face many
challenges. Patients are going home from the
hospital with more acute problems and the home
health nurse must rise to the occasion.
 A Home Health Care Nurse works with patients
in their homes. These nurses mainly work with
the elderly, but sometimes work with younger
children who have developmental or mobility
issues. A Home Health Care Nurse is great for
people that would rather work outside of a
hospital.
 The Home Healthcare Nurses Association
(HHNA) is a national professional nursing
organization of members involved in home
health care and hospice nursing practice,
education, administration and research.
HHNA provides leadership and a unified voice so
that home care and hospice nurses may improve
their specialty and influence public policy as it
relates to home care and hospice
 The HHNA’s predecessor organization was
founded in 1993 by the JB Lippincott Company
with the vision of providing a forum for members
to discuss and refine professional, educational
and conceptual aspects of the home healthcare
nursing practice as a specialty.
 The HHNA is committed to improving the
specialty of home care and hospice nursing and
influencing public policy as it relates to home care
and hospice. HHNA is a forum that recruits and
brings together energized home care and hospice
nurses who want to become leaders in their field
and enable them to speak out in a unified voice.
 Develop the specialty of home care and hospice
nursing
 Foster excellence in the practice of home care
and hospice nursing
 Promote high standards of patient care in home
care and hospice
Provide an organized and unified voice among the
home care and hospice nursing profession
 Disseminate and exchange information with
those involved in the home care and hospice
nursing specialties
 Honor and select the top home care and hospices nurses across the
country.
 Learn about changes in laws or regulations which impact your work.
 Establish home health and hospice care best practices.
 A subscription to Caring Magazine, the only publication received by the
entire home care and hospice community as well as all U.S. hospitals and
physicians who serve the home care community.
 Receive the Home Healthcare Nurse Journal and keep up to date on new
protocols, best practices, and clinical and therapeutic advances.
 The National Association for Home Care &
Hospice is the nation's largest trade association
representing the interests and concerns of home
care agencies, hospices, and home care aide
organizations.
 Professionals providing home care include:
 licenced practical nurses,
 Registered nurses,
 Home Care Aids, and
 Social workers.
 Rehabilitation services are providedby:
 Physical therapists,
 Occupational therapists,
 Speech therapist pathologists and Dietitians.
 Home care aides are trained to provide non-custodial
care, such as helping with dressing, bathing, getting in
and out of bed, and using the toilet. They may also
prepare meals.
 Home care aims to make it possible for people to remain at
home rather than use residential, long-term, or institutional-
based nursing care. Home care providers render services in the
client's own home. These services may include some
combination of professional health care services and life
assistance services. Professional home health services could
include medical or psychological assessment, wound care,
medication teaching, pain
management, disease education and management,
physical therapy, speech therapy, or occupational therapy. Life
assistance services include help with daily tasks such as meal
preparation, medication reminders, laundry, light
housekeeping, errands, shopping, transportation, and
companionship. Home care is often an integral component of
the post-hospitalization recovery process, especially during the
initial weeks after discharge when the patient still requires some
level of regular physical assistance.
 To prepare for early hospital discharge and possible need for
follow up care in home,discharge planning begins with patients
admission.

 COMMUNITY RESOURCES AND REFERRALS

 Home health nurses and public health nurses act as case

managers.after assessing patients needs they may refer to the other
team members.

 Home health care nurse is responsible for providing information about

various resources.resource booklet should be provided for the patient
which includes the resources available in the
community.



 Nurse should review the patients referral form to contavt the

reffering agency if the purpose for the referral is unclear
 Call the patient and obtain permission and schedule the time for
visit.
 Ask permission before entering the house and explain the
purpose of referral.

 CONDUCTING A HOME VISIT
 Whenever the nurse makes a visit,the agency should know the
nurses schedule and locations of the visits.
 Initiate the visit in which the patient is evaluated and a plan of
carevis established
 Determine the needs for future visits such as current health
status,home environment,level of self care abilities ,mental
status etc
 Learn a cellular phone with thetelephone
numbers of the agency ,police and
emergency services
 Let the agency know your daily scheduleand
telephone numbers of your patients
 Know where the patient lives
 Schedule visit only in dayhours
 When making visits in crime areas visitwith
another person
 AMBULATORYSETTINGS
 Ambulatory health care is provided for the patients
both in community and hospital settings.types of
agencies includes medical clinics,ambulatory care
units,mental health centres,student health centres etc

 OCCUPATIONAL HEALTHPROGRAMMES
 Occupational nurses work in industrial setting or they
may serve as consultants on a limited or part time
basis
 The occupational health nurses works in several ways
and provide direct care to the employers who
becomes ill or injured and conduct health education
programmes .
 Some school nurse programmes provide community
care.physical examinations are performed by
advanced practice nurses who then diagnose and treat
students and families for acute and chronic
illnesses.nurse act as care
provider.consultant.educator and counselor.
 CARE FORHOMELESS
 Homeless have difficulty in affording or gaining acess
to health care.they will experience high rates of
trauma,tuberculosis and other communicable
diseases.community health nurses who works with
homeless shoulb be patient,non judgemental and
understanding.nursing interventions are aimed at
obtaining health care services for homeless.
 A home health care nurse helps to
 care for the elderly, disabled, chronically ill or
mentally impaired.
 Daily tasks for a home health care nurse can include
administering medication,
 checking on patients'status,
 performing routine procedures and
 helping administer treatments that patients need.
Some home health care nurses will also provide for the
basic needs of patients, helping them to bathe or providing
nutritious meals. At times, they must also provide support
to patient's family members and other caretakers,
instructing them on how best to care for the patient and
providing emotional support.
 The roles of the home care rehabilitation nurse include,
but are not limited to, those outlined below.
 Practitioner
 Serves as a clinical resource for those involved in
rehabilitation nursing practice and in the care of clients with
a complex chronic illness, a disabling condition, or both
 Acts as a resource during a crisis that is aggravated by a
chronic illness or a disabling condition
 Assesses the appropriateness of a client's admission to, and
the delivery of rehabilitation services in, the home
environment
 Provides assistance with discharge planning to ensure a
smooth transition into the community or, when appropriate,
 Collaborates with the interdisciplinary team in the
management of the team function in the home
environment
 Helps the client and the client's family adapt to
changes in lifestyle necessitated by the disabling
condition
 Implements rehabilitation nursing care based on
scientific knowledge, home care standards, and
rehabilitation principles that are appropriate to the
home care environment
 Care coordinator
 Acts as a member of the interdisciplinary
healthcare team and promotes the coordination of
client care
 Coordinates the activities of rehabilitation
professionals; integrates the knowledge and skills
of various rehabilitation disciplines into a
comprehensive continuum of care
 Facilitates the design and implementation of the
plan of care for clients who are chronically ill or who
have disabling conditions
 Advocate
 Advocates for clients and their families or
caregivers
 Teaches clients and their families or caregivers to
advocate for themselves
 Facilitates the client’s transition from the
hospital to the home and the community
 Furthers an understanding of home care-based
rehabilitation issues among people in the community
and among those in government who are in a position
to deal with issues related to this patient population
 Educator
 Provides education for clients and their families
 Provides staff orientation and guides staff
development, both at the professional and the
paraprofessional levels, in the area of rehabilitation
home care
 Provides rehabilitation-focused continuing
education programs
 Develops policies and procedures that are
specific to rehabilitation home care
 Develops educational materials designed to help
clients and their family members become
knowledgeable consumers in the healthcare
 Consultant
 Identifies clients and families who could benefit
from rehabilitation home care services
 Serves as a liaison with third-party payers and
justifies the use of funds for rehabilitation home care
 Serves as a resource for rehabilitation nurses and as
a process consultant to staff in the home care setting
 Promotes rehabilitation nursing services to
community health professionals and to the
community at large areas
 Researcher
 Participates in research involving home care
clients and their families
 Participates in the analysis and dissemination of
evaluative data that may have an impact on clients
and their families
 Incorporates evaluative data into nursing practice
 Long-term care is a variety of services that
includes medical and non-medical care to people
who have a chronic illness or disability. Long-
term care helps meet health or personal needs.
Most long-term care is to assist people with
support services such as activities of daily living
like dressing, bathing, and using the bathroom.
Long-term care can be provided at home, in the
community, in assisted living or in nursing
homes.
 Long-Term Care Nurse
 A Long-Term Care Nurse cares for patients
who have a disability or illness in need of
extended care. Many of their patients live in
long-term care facilities, rehabilitation centers,
or nursing homes
 WhatIs Long Term Care?
 When a person requires someone else to help
him with his physical or emotional needs over an
extended period of time, this is long-term care
EG:WALKING,BATHING,DRESSING etc
 Temporary long term care (need for carefor
only weeks or months)
 Rehabilitation from a hospital stay
 Recovery from illness
 Recovery from injury
 Recovery from surgery
 Terminal medical condition
 Ongoing long term care (need for carefor
many months or years)
 Chronic medical conditions
 Chronic severe pain
 Permanent disabilities
 Dementia
 Ongoing need for help with activities ofdaily
living
 Need for supervision
 SUBACUTE OR TRANSITIONAL CARE
 For people who require ongoing care or
recovery for an acute conditionbut donot
need to receive the services on an acute
hospital unit.
 ASSISTED LIVING FACILITY
 A form of housing that provide 24 hr
staffing,meals,supervision of
medications,personal assistance care.
 ADULT DAYCARE
 A day time programme for people who typically have
the same level of impairments as nursing home
residants but who receive care in the community
usually family members.the client is transported to the
center and receives structured
activities,meals,personal care assistance, and health
care supervision.
 HOME CARE
 For community based people who are home bound
and who need caregiving assistance or
specialtreatments.
 For people who r terminally ill and in need of
care.this care can b provided in the home or in a
day hospital setting.care of dying is common
experience in long term care.caring behaviours of
staff at the time of death,allowing family to be
involved with the resident and providing spiritual
support are important and valued nursing
functions.
 Long-term care services may beprovided in
any of the following settings:
 In the home of therecipient
 In the home of a family member or friend of the
recipient
 At an adult day serviceslocation
 In an assisted living facility or board-and-
care home
 In a hospice facility
 In a nursing home
 Residants of LTCFs can be of any age,although most of
them are older adults.The risk of being in an LTCFs
increases with each decade of life:average age of resiants
is 82yrs.Women outnumber men ratio is 3:1.
 Most residents have conditions that impair their selfcae
capacity or require interventions that they cannot perform
independently.About one half have progressive cognitive
impairment,such as alzheimers
disease,arthritis,cardiovascular disease,impaired
vision,impaired hearing or combination of
illnesses.Most residents need assistancewith atleast
several ADL.Although most residents spend
remainder of their lives in the facility,an increasing
number do recover ,have restored function and
return to the community.
 According to federal regulations a reggisterd
nurse must be on dutyatleast 8 consecutive hours
per day,7 days a week and a full time director of
nursing must be on staff if the facility has more
than60 beds.The propotion ofnursing staff is not
stated,although it is required that “the facility to
provide 24 hour nursing services which are
sufficient to meet otal nursing care needs”.
 Health care plans such as health insurance plans,
Medicare, Medicaid and the Veterans
Administration. They are used primarily to
differentiate care provided by medical specialists as
opposed to care provided by aides, volunteers, family
or friends.
 A patient receiving skilled care in a nursing home
from Medicare not only receives care from skilled
providers such as nurses, therapists or doctors but
also receives care from custodial
providers such as aides. This care usually
consists of help with bathing, dressing,
ambulating , toileting,
 ASSESMENT
 Nurse hav to assess residents within the first 14
days of admission and atleast annually there
after;residants are to be reassed whenever thereis
change in their status.


 CARE PLANNNG
 Regulations require that a careplan be written for
each resident within 7 days after completion of
assessment.care plan is a interdisciplinary one
and is the blue blue print for nursing actions.
 CAREGIVING

 Nurses performs selected roles,such as administering

medications and treatments and they may be involved in
total care activities.
 NURSE have to make the residants to face many
adjustments;

 ROUTINES ANDSCHEDULES


 ENVIRONMENT

 PEOPLE
 INDEPENDENCE

 COMMUNICATION
 Proper communication helps the nurse for identifying and
obtaining timely treatment of complications and new health
problems and also nurse must make sure that physicians
learn of changes in residants condition in a timely manner.
 Provide the physician with complete information that can
aid in medical decision making.
 Eg: current and usual vital signs,clinical
manifestations etc
 Avoid making diagniosis.report th clinical
manifestations and allow \physicaian to make
medical judgement.
 Take order directly from the physician
 If there is anything wrong in the order question the
physician.

 MANAGEMENT
 Nurse performs some management functions such as:
 Delegatingassignments
 Supervising otherstaffs
 Evaluatingperformance
 Implementing disciplinaryactions
 Completingreports
 Reviewing and auditing records
 Communicating needs to other departments
 Handling complaints
 Ordering supplies
 Communicating with regulatory agencies.

 DEFINITION
 “Rehabilitation is a interdisciplinary speciality that
supports a dynamic process of helping an individual
to achieve a life that is as independence and self
fulfilling as or vocational areas of functionaing”

 REHABILITATION NURSING
 Rehabilitation nursing is defined as the diagnosis and
treatment of human responses of individuals and
groups to actual or potential health problems relative
to altered functional ability and lifestyle
 TO assist the individual who has a disability or
chronic illness in restoring maintaining and
promoting his or her maximal health
 To achieve maximam level of functioning and self
sufficiency in all spheres of
life;physical,mental,social,emotional,educational,voca
tional,and economic.
 To manage chronic illness and disability
 Physicalreconditioning
Strength
 Restoration offunction
 Stressreduction
 Patient and familyeducation
 Attending Physician
The physician, who is either a physiatrist
(rehabilitation medicine) or a neurologist, will
provide medical management and coordinate
your rehabilitation program provided by the
treatment team.
 Case Manager
Your case manager will help you and your family
cope with the recovery process, as well as
understand your rehabilitation program. The case
manager serves as your liaison among your team of
treatment professionals, your family, your insurance
carrier, and resources in the community.
 Nurse
The nurses and nursing ass istants provide direct
personal care. Using the nursing process the
nurse is responsible for planning the nursing
care necessary in your rehabilitation program.
Your nurse
also shares a key role in patient and family
educ ation.
 PhysicalTherapist
The physicaltherapist will help you develop
strength and
coordination to improve your function.
Pt will
work with therapist to become more independ
ent with
bed mobility, wheelchair mobility and, if
appropriate, walking.
 Occupational Therapist
The occupational therapist works to coordinate your physical
and mental abilities with the activities of daily living. Your
therapist will teach special skills and if needed, provide
adaptive equipment to allow you to be as independent as
possible in your self-care. The therapist will also work with you
if you have any problems with sensation, coordination,
balance, thinking, and visual perception.
 Speech/Language Pathologist
Communication, swallowing, and thinking are skills our
speech/language pathologist address. Difficulties in these
areas may affect all other areas of your rehabilitation.
Through practice, teaching new techniques and strategies, our
speech/language pathologist can help you improve your
communications.
 Dietitian
Dietitian is responsible for evaluating, developing and
implementing a plan to meet your nutritional needs.
Nutrition is a very important part of recovery process.

 Neuropsychologist
A neuropsyc hologist may be ask tosee by attending
physician. By concentrating onpsychological needs, the
neuropsychologist may contribute to rehabilitation
program. Through psychological testing andcounseling,
and family will better understand the type of injury that have
sustained. As continue through recovery, this
professional may beworking with in the area of thinking
and behavioral retraining.

 Patient &Family
 Actively participate in the rehabilitation
process so that they can achieve the
best outcome possible.
 Social Worker
 Provides support and counseling as needed for the
patient and their family, and facilitates a safe and
effective discharge plan.
 Rehabilitation Assistant
 Works under the supervision of the Physiotherapist
and/or Occupational Therapist to provide individual or
group therapy programs.
 RespiratoryTherapist
 Evaluates, treats and cares for patients with breathing
disorders

 Physiatrists

 are the main medical doctor on the rehabilitation
team. A physiatrist is either an M.D. (Medical Doctor) or
D.O. (Doctor of Osteopathic Medicine) with a specialty in
physical medicine and rehabilitation. The physiatrist
assesses patients at admission to rehabilitation and
directs the patient's medical care, monitoring the course
of rehabilitation to help the patient attain optimal function.
 According to the needs, the rehabilitation programs are
divided in various types. are as follows:
 Occupational Rehabilitation: This particular type of
Rehabilitation is for those victims who do have lost some
important skills after they have met with a paralytic stroke or any
unfortunate major accident. We have to perform these skills
everyday in our life, without which it is impossible to survive.
Skills like writing, reading, cooking food etc. We lose this skill if
our brain is injured; therefore victims lose interest in
communicating with other people.
For this type of patients, doctor advises to visit occupational
therapist. This particular therapist helps you to do regular
physical exercises, meditation to make your muscle strong.
The patient is given special care by their counselor and
psychologist.
 Physical Rehabilitation: This sort of rehabilitation is used for patients who have
suffered from bone and muscle injuries. The physiotherapist helps a lot in giving
the right exercise regime to strengthen the muscles of back neck, shoulder,
etc. This injury can happen due to accidents,
sports, etc. A lot of treatment and technology is available in physical
rehabilitation. The recovery time differs from person to person and so does the
type of injury. The patients have to follow religiously the given exercise patterns.

 Aquatic Rehabilitation: This is a new trend in rehabilitation yet it is a successful
in treating problems in joints. The therapists treat the patients by giving
various water exercises like swimming, water
aerobics, etc. This helps in giving strength, flexibility and mobility to the
muscles of legs. Many patients with arthritis, joint pain, and paralytic stroke are
treated with help of this rehabilitation. The program is
customized according to an individual's needs and he or she is treated to
recover from the injury so that he or she has a normal life.
 .
 OTHER TYPES;

 Above Knee Amputation Rehabilitation

 Orthopedic Rehabilitation
 Shoulder Injury Rehabilitation
 Spinal Cord Injury Rehabilitation
 Pain Management Rehabilitation
 Pelvic Floor Rehabilitation
 Post Polio Rehabilitation
 Patellar Tendonitis Rehabilitation

 Hip Replacement Rehabilitation

 Knee Injury Rehabilitation
 Post Surgical Rehabilitation

Aquatic Rehabilitation
 Pulmonary Rehabilitation
 Rehabilitation For Depression
 Outpatient Rehabilitation Programs
 Paraplegia Rehabilitation
 Parkinson Rehabilitation
 Rehabilitation services are provided in a variety of settings,depending on
thearrayand intensity of services that are required.
 Individuals with an impairment thatminimally impacts functional ability
may be able to receive rehabilitation services in an outpatient settings
 More complex impairments may require servicesthat can be provided in the
home setting or in day care treatment programme
 Individuals with impairments that affect multiple functional abilities may
require period of inpatient rehabilitation services in either a subacute or acute
rehabilitation seting
 Acute rehabilitation may be provided in free standing rehabilitation
hospitals or ondedicated unit within hospitals
 Subacute rehabilitation may be provided in long term care facilities or on
dedicated units within hospitals.
 Medicare rehab clients includes;

 Stroke
 Spinalcord injury
 Congenital deformity
 Amputation
 Major multiple trauma
 Fracture of femur
 Brain injury
 Rheumatoid arthritis
 Burns etc
 Recent research suggests that obesity and excess weight can influence cancer survival
and recurrence. Given the increasing rate of obesity and an aging population more
susceptible to cancer, there is mounting concern about obesity’s role in fueling tumor
growth. At an IOM workshop, experts presented the latest evidence on the obesity-
cancer link and the possible mechanisms underlying that link, as well as potential
interventions to mitigate the effects of obesity on cancer, and research and policy
measures needed to counter the expected rise of cancer incidence and mortality due to
an increasingly overweight and older population.

 Washington University researchers trace pediatric tumors to stem cells in
developing brain
(07/10/2012) - Stem cells that come from a specific part of the developing brain help fuel
the growth of brain tumors caused by an inherited condition, researchers at Washington
University School of Medicine in St. Louis report. Scientists showed in mice that disabling
a gene linked to a common pediatric tumor disorder, neurofibromatosis type 1 (NF1),
made stem cells from one part of the brain proliferate rapidly. But the same genetic deficit
had no effect on stem cells from another brain region. The Washington University School
of Medicine is home to the Alvin J. Siteman Cancer Center.


 Our healthcare system is large and complex with many
stakeholders. ALL stakeholders will benefit from a transformed health
care system in which nurses play a much larger role.This is a very big
issue. This really goes to the heart of whether health
reform can reach its potential for the good of
society.Establishing the workforce we need – and using it productively
- - will enhance delivery, improve outcomes, and help contain
costs.Improving delivery of care will help not only patients but also
payers and providers.Nurses are in the main stream of service to both
advantaged and disadvantaged clients.Nurses play a crucial role in
delivering health care.Ambulatory care nursing is the fastest growing
areas of nursing speciality practice.Ambulatory nurses are not only
expert clinicians but also expert communicators.Aging nurses
arenretiring or leaving critical care.Young or new nurses must step up
to meet the exiting challenges of critical care nursing.
 “No man, not even a doctor, ever gives any other definition
of what a nurse should be than this - 'devoted and
obedient'. This definition would do just as well for a
porter. It might even do for a horse. It would not do for a
policeman”

 Nursing is an art: and if it is to be made an art, it requires
an exclusive devotion as hard a preparation, as any
painter's or sculptor's work; for what is the having to do
with dead canvas or dead marble, compared with having to
do with the living body, the temple of God's spirit? It is
one of the Fine Arts: I had almost said, the finest of Fine
Arts. ~Florence Nightingale


 TEXT BOOK OF MEDICAL SURGICAL NURSING-JOYCE M BLACK-7TH
EDITION-ELSEVIER PUBLICATION-2005-PAGE NO:121 – 189

 CRITICAL CARE NURSING-2ND EDITION-JOHN M CLOCHESY-W.B
SAUNDERS COMPANY PUBLISHERS,PAGE NO: 28 – 35,1996
 CRITICAL CARE NSG-PATRICIA GONCE MORTON,DORRIE.K.FONTAINE
 SUZANNE .C .SMELTER,MSN-LIPPINCOTT WILLIAMS AND WILKINS
PUBLISHER
 SPAG:6-25- 10TH EDITION-2004

 WWW.MEDICARE.GOV.IN
 WWW.DISCOVERNSG.IN
 WWW.LONGTERMCARE.LINKNET

 CANADIAN JOURNAL OF RESEARCH
 NURSING TIMES –MARCH 30-2012
 WWW.PUBMED.COM
 JOURNAL OF NURSE OLDER PEOPLE 2012

