Competency Model for Professional Rehabilitation Nursing

Competency Model for Professional Rehabilitation Nursing

Competency Model for Professional Rehabilitation Nursing Behavioral Scenario for Competency 3.4: Empower Clients to Self-Advocate Mary Ullrich, MSN, RN, CRRN & Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, ACHPN, GNP-BC, FAAN Copyright2015, Association of Rehabilitation Nurses Competency 3.4: Empower Clients to Self-Advocate Description/Scope: Client advocacy is the safeguarding of a clients

autonomy, acting on behalf of the client, and empowering the client through education, collaboration, and support for individuals living with chronic illness and/or disability (DCIHM). Beginner Proficiency Level Descriptors Copyright2015, Association of Rehabilitation Nurses Behavioral Scenario Fred is a 76 year old male who has been on the rehabilitation unit for a left middle cerebral artery (MCA) stroke (CVA). He has been progressing quite well with self-care and mobility issues; however, he remains NPO due to dysphagia. He currently has a nasogastric tube in place and has worked hard with the Speech Language Pathologist to

improve his ability to eat again. In Team Conference today a discharge date for the following week was set. It was determined Fred would require a G-tube placed for nutritional prior to going home, as Fred has not made enough progress in swallowing safely. After the Team Conference, the physician spoke to Fred about G-tube placement and the reasons why it was determined this intervention is required. Copyright2015, Association of Rehabilitation Nurses Path 1 Not Proficient Sally, Freds primary nurse, entered Freds room after the physician spoke to him about G-tube placement. Sally indicated she wanted to

start soon with education for Fred and his wife regarding the use and care of the G-tube. At that point, Fred informed Sally he had no intention of having the tube placed. Sally stated that although she respects and understands Freds feelings regarding this, the issue is really out of everyones hands because, ethically speaking, eating is harmful to him right now and it is the teams responsibility to keep him safe. Later in the shift, Sally saw Freds wife entering the unit for her daily visit with Fred. Sally told the wife it was important for Fred to have the Gtube and could she please talk Fred into having the procedure done. Copyright2015, Association of Rehabilitation Nurses Path 1 Not Proficient Observations & Outcomes

1. The novice nurse understood the patients need for autonomy, but quickly denied him his right to decision-making through informed consent. 2. The novice nurse also attempted to solicit Freds wife in talking him out of the decision he had made without understanding that Freds wife deserved information and education as well. 3. The not-proficient nurse in this case did not initiate consultation with team members who could provide additional education and information, thus failing to empower Freds decision-making. Copyright2015, Association of Rehabilitation Nurses Path 2 - Proficient

The proficient nurse first asked Fred why he was opposed to having the G-tube placed. Fred stated life was not worth living if he could not taste and swallow his food. The nurse provided additional information to Fred that he could still continue speech therapy and that patients often progress enough to later have the G-tube removed. The speech therapist and the clinical nurse specialist were asked to provide additional education to Fred and his wife. However, Fred was still adamant that he did not want a G-tube. Acknowledging Freds right to make that decision, the nurse contacted the patients care team for a discussion. Members of the team presented information to Fred and his wife regarding the health effects of Freds decision. The nurse anticipated discourse within the nursing and therapy teams regarding the potential that Fred might discharge home without a G-tube. She contacted a member of the Ethics Committee to discuss the ethical principle of autonomy with the clinicians in regards to Freds situation.

The following week, Fred discharged home without the G-tube. Copyright2015, Association of Rehabilitation Nurses Path 2 Proficient Observations & Outcomes 1. 2. 3. 4. The proficient nurse allowed the patient to verbalize his reasons for not wanting the G-tube. This allowed her to provide the appropriate interventions for Fred and his wife for informed decision making.

In this case, the nurse recognized the value of additional team members and knew which persons should be incorporated into the POC. She appropriately made the contacts and followed through with the interprofessional team to communicate Freds wishes. The proficient nurse also anticipated difficulty with acceptance of Freds decision from her colleagues and arranged education and discussion of their feelings regarding Freds decision. Although the outcome of this scenario was still Freds refusal of G-tube placement, the proficient nurse assured that his decision was both informed and supported. Copyright2015, Association of Rehabilitation Nurses What Did You Observe? How did the outcomes of this scenario differ?

Copyright2015, Association of Rehabilitation Nurses Takeaways The beauty of rehabilitation is in the team approach to assisting the patient to attain a quality of life that is self-determined. When ethical issues arise in the care of our patients, it is critical to work as a team to support and empower clients toward self-advocacy. This is done through education and collaboration. Support in the form of discussion and education to the team members is also vital to their ability to support the patient in his decision. Copyright2015, Association of Rehabilitation Nurses

Recently Viewed Presentations

  • 9/5/17 Warm-up #7 Write out the sentences. Use

    9/5/17 Warm-up #7 Write out the sentences. Use

    The decision (which is what we read) was written by Justice Brennan. It said that burning the American flag wasn't encouraged, but it was protected by the First Amendment as a form of freedom of Speech. ... Janelle felt great...
  • Semi-Hydroponics - Annual Orchid Show Feb 3

    Semi-Hydroponics - Annual Orchid Show Feb 3

    Semi-Hydroponics is a method of growing plants without soil, moss, or bark. Instead, an inorganic, porous medium transports water and fertilizer to the roots by capillary action. Benefits of Semi-Hydroponics. Requires only one type of potting media.
  • HALLIBURTON COMPAMY - Bauer College of Business

    HALLIBURTON COMPAMY - Bauer College of Business

    HALLIBURTON COMPAMY RISK MANAGEMENT FUNCTIONS Presentation for University of Houston, Bauer College of Business March 23, 2006 Agenda Halliburton Company Information Risk Management & Insurance Programs Project Case Study Enterprise Risk Management HALLIBURTON COMPANY Revenues - $20,994,000,000 Employees - approx....
  • Ilmselt maailma kige hullem esitlus Demonstratsioon mida mitte

    Ilmselt maailma kige hullem esitlus Demonstratsioon mida mitte

    Microsoft PowerPoint is unable to open the requested file. This could be because your file is corrupted and/or this is an unsupported file type. Do you wish to retry or cancel? Disk is unformatted. Click "yes" to format your disk...
  • Blood Pressure Control

    Blood Pressure Control

    Mechanisms of Aldosterone Secretion. Renin-angiotensin mechanism: decreased blood pressure stimulates kidneys to release renin, triggers formation of angiotensin II, a potent stimulator of aldosterone release . Plasma concentration of K+: Increased K+ directly influences the zona glomerulosa cells to release...
  • Simple Tips for FSOs - University of Central Florida

    Simple Tips for FSOs - University of Central Florida

    Ten Simple Tips (that give a Big Bang!) for fsos. FISWG. 26 September 2012. Helen MacDonald. L-3 Communications. These are really simple tips, and are probably most suitable for those of us who work for smaller facilities, don't have corporate...
  • Introduction to Multimedia - Gunadarma

    Introduction to Multimedia - Gunadarma

    Multimedia Design Use Effective Cropping and Image Placement Uncropped image Most of the trees and part of the building are cropped, emphasizing the student Avoid Hyphenation and Underlines Underlined and hyphenated Clear Summary Navigational structures: Linear Hierarchical Non-Linear Composite Storyboarding...
  • Programmation Orienté Objet applications au language Java

    Programmation Orienté Objet applications au language Java

    Programmation des simulations par événements discrets. Années 70 : développement par Xérox du premier systéme Fenêtres Icônes et souris. Développement par Apple des premiers Mac. Années 80: Développement des ordinateurs personels. Intérêt pour les interfaces graphiques. Apparition du Eiffel, C++...