PRESENTED BY,

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.
 GOVERNMENT SPONSERED VOLUNTARY OR NOT-FOR-
PROFIT
HOSPITALS – receives local, HEALTH AGENCIES
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 MAGNET HOSPITALS
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

RESEARCHER EDUCATOR MANAGER

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

 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
 False imprisonment
 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 affects ones
reputation.
 Eg:falsely accusing staff members in front of
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 necessary care.

 Respect the values, beliefs and rights of the

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 provided by:
 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 the telephone
numbers of the agency ,police and
emergency services
 Let the agency know your daily schedule and
telephone numbers of your patients
 Know where the patient lives
 Schedule visit only in day hours
 When making visits in crime areas visit with
another person
 AMBULATORY SETTINGS
 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 HEALTH PROGRAMMES
 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 FOR HOMELESS
 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
 What Is 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 care for
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 care for
many months or years)
 Chronic medical conditions
 Chronic severe pain
 Permanent disabilities
 Dementia
 Ongoing need for help with activities of daily
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 DAY CARE
 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 be provided in
any of the following settings:
 In the home of the recipient
 In the home of a family member or friend of
the recipient
 At an adult day services location
 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 assistance with 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 AND SCHEDULES



 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:
 Delegating assignments
 Supervising other staffs
 Evaluating performance
 Implementing disciplinary actions
 Completing reports
 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
 Physical reconditioning
Strength
 Restoration of function
 Stress reduction
 Patient and family education
 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 assistants 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 education.
 PhysicalTherapist
The physical therapist will help you develop
strength and coordination to improve your
function. Pt will work with therapist to become
more independent 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 neuropsychologist may be ask to see by attending
physician. By concentrating on psychological needs, the
neuropsychologist may contribute to rehabilitation
program. Through psychological testing and counseling,
and family will better understand the type of injury that
have sustained. As continue through recovery, this
professional may be working 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.
 Respiratory Therapist
 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
PUBLISHERS
 PAG: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

