Understanding disability and how the philosophy of rehabilitation nursing can be integrated into practice is used to promote quality nursing care. This chapter covers the philosophy of rehabilitation nursing as an approach to patient- and family-centered care. The International Classification of Function (ICF) will also be discussed.

In this chapter, rehabilitation nurses will master the core competencies of this specialty practice. This chapter briefly reviews the Rehabilitation Nursing Competency Model, with an emphasis on the beginner level competencies.

The philosophy of rehabilitation nursing can be applied across settings to promote holistic patient/client/family care. The benefit of applying rehabilitation nursing concepts across environments to the patient, family, and community will be explored.

This chapter presents three models of interdisciplinary teams. The various team members—including physicians, therapists, nurses, social workers, and others—are described.

Setting patient-centered goals that are mutually established with the interprofessional team is an essential rehabilitation nursing skill. This chapter will teach participants the components of a team goal and how to write appropriate interprofessional goals.

The brain is a major organ in the central nervous system (CNS). In this chapter, brain development, cell structure, nerve integration, and fluid and blood supply to and from the brain are discussed as important elements to explore prior to learning about structural and functional neuroanatomy.

Protected within the skull, the brain is responsible for controlling voluntary movements, memory, problem-solving, creativity, and speech. It receives its information through the five senses and interprets these messages through relay of nerve impulses out to the spinal cord, muscles, and many organs within the body. This chapter will outline the major functional structures that provide this innervation.

Structures deep within the brain provide important functions of coordination of movement, perception, and vital functions. They also mediate autonomic and endocrine functions while stimulating or inhibiting emotional responses that influence pleasure, pain, and physical movement. This chapter will present an overview of these important brain structures and how they bridge information from the brain back to the spinal cord.

The spinal or vertebral column is a flexible bony structure that supports and protects the spinal cord. This chapter will present an overview of the importance of proper alignment of the spine as it connects to ligaments and tendons along with housing the spinal cord and nerve root openings to innervate muscles and internal organs.

As the second major organ in the central nervous system (CNS), the spinal cord, or medulla spinalis, connects the brain to the rest of the body. It is important for clinicians to understand how the spinal cord assists the brain with optimal body function and movement. Discussion of each of the four main spinal cord regions, with associated anterior and posterior spinal nerve root function, along with upper and lower motor neuron pathways, will be presented.

The spinal cord nerve root pathways relay messages (outside the brain and spinal cord) to organs and the periphery of the body through what is called the peripheral nervous system (PNS). This system houses both voluntary (somatic) and involuntary (autonomic) system branches. It is important for clinicians to understand normal pathophysiology of both to understand how organs act in times of stress or rest. This chapter will review the twelve cranial nerves and thirty-one pairs of spinal cord nerves within the PNS, along with related functions, both voluntary and involuntary, within the human body.

Normal nerve impulse control and innervation is important for healthy function of the spinal cord and brain. The treating clinician must have a good understanding of the components of a comprehensive neurofunctional examination to determine this status for a patient. In addition to determining level of consciousness and verbal responses, the clinician must be able to demonstrate how to evaluate motor responses such as muscle strength, muscle tone, posture, reflexes, movement, sensation, and coordination. This chapter will present a quick overview of how to perform a simple motor and sensory examination to determine optimal spinal cord function.

This chapter will discuss principles of body mechanics. Use of proper body mechanics during lifting, carrying, pushing, pulling will be discussed and demonstrated with a focus on safety of the patient and caregiver.

This chapter will discuss how to transfer patients of varying levels of functional mobility. Instruction on how to properly set up the patient and guard them for safety during the transfer will be discussed and demonstrated.

This chapter will discuss how to safely ambulate patients of varying levels of functional mobility. A review of commonly used ambulation aids and their applications will be discussed and demonstrated.

This chapter will review functional scales that are commonly used in rehabilitation settings. The Functional Independence Measure (FIM), Barthel Index, and Katz Index will be discussed. Scoring and standard interpretation of these tests will be reviewed.

Rehabilitation providers who understand the various tools and scales to measure function can conduct more accurate assessments. Common tools used in the various post-acute care settings will be described. The importance of accurately measuring function in post-acute care delivery to detect improvement as a result of rehabilitation care will be discussed.

Rehabilitation providers need to understand scales used to measure function in rehabilitation patients. Choosing the most appropriate tool is a learned skill. This chapter briefly reviews common functional assessment tools used with rehabilitation patients.

Functional items from the CARE Tool are used in post-acute care delivery to measure quality. Scoring the CARE Tool items and their impact on rehabilitation outcomes and care delivery for rehabilitation patients will be discussed.

Rehabilitation professionals who understand the regulations that guide practice in post-acute care in the U.S. are better able to influence health policy and local or agency processes. The historical context for the current regulations will be discussed. This chapter covers current regulations and payment policy that govern post-acute care.

Rehabilitation professionals need to recognize how current policy, such as the IMPACT Act and emerging policies, affect their practice. This chapter briefly reviews the IMPACT Act and how this post-acute care reform may impact the patient’s rehabilitation process.

The IMPACT Act of 2014 will result in significant reform to post-acute care delivery. Issues such as access to care, interpretation of data, and the future influence of current practice on care delivery are reviewed for their impact on post-acute rehabilitation.

Health care professionals who understand the theory that underlies how people learn are better able to develop and deliver education to patients/residents and caregivers. Foundational teaching-learning theory and models of learning will be discussed. This chapter covers different learning styles and adult learning principles.

Teaching patients/residents and caregivers at the right time can result in more effective learning. Assessing readiness to learn and the optimal timing for educational delivery will be discussed.

Health care professionals need to facilitate learning to improve health and prevent complications from disabling conditions. This chapter reviews evidence-based teaching strategies (e.g., motivational interviewing, the teach-back method) to promote effective learning. The result of effective learning and the impact on patient/resident and caregiver health will be discussed.

Case management is an effective means to improve the quality of transitions during the discharge planning and transition of individuals with disabling conditions across the continuum of care. The role of the case manager and a brief overview of models will be described.

The rehabilitation nurse has a breadth of skill to assess the need for and explore resources to facilitate care transitions. This chapter explores the resources to optimize care transitions. Community, personal, and professional resources to assist with discharge planning and community reintegration are described.

This chapter presents information on how nurses can influence care transitions through providing input into case management, discharge planning, and community reintegration. The various leadership competencies for rehab nurses to impact care transitions for persons with disability and/or chronic illness are described.

Rehabilitation nurses need to understand how quality is measured and reported. This chapter briefly reviews federal quality measurement efforts and reporting requirements for post-acute care settings (inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies).

Continuous quality improvement is necessary to advance rehabilitation nursing practice and provide high-value care. The rehabilitation nurse collaborates with other professionals to improve care delivery. This chapter reviews models and tools for performance improvement.

Rehabilitation nurses need to understand how the quality of rehabilitation care is measured and reimbursed to optimize the effectiveness of their care delivery. This chapter covers a variety of reimbursement and insurance models, utilization management and review, and the regulatory oversight related to payment.

Culture is complex. Rehabilitation providers need to understand what comprises a culture. Factors associated with culture, such as the preferred cultural values, beliefs, worldview, and practices of health care, are described. This chapter covers the definitions and concepts that are relevant to culture.

Rehabilitation providers need to recognize their own conscious and unconscious biases about cultures different from their own. This chapter briefly explores sources of bias and identifies strategies to increase self-awareness.

Health care providers can utilize their knowledge, skills, and behaviors to optimize the provision of culturally congruent care. Factors that contribute to the provision of culturally competent care are described.

Rehabilitation nurses are held to high ethical standards of practice. This chapter covers basic ethical principles and the ANA Code of Ethics for Nurses that help guide practice.

Rehabilitation nurses should be familiar with several types of advance directives in order to uphold patient autonomy in decision-making. Strategies for making difficult decisions in ethical dilemmas are covered here using case examples.

This last chapter of the ethics course encourages participants to analyze their own ethical decision-making process using several case scenarios. This interactive portion of the course will present several real-life dilemmas encountered by nurses across various rehabilitation settings.