Re: Nursing rehab

[Corey Ali]

Title: Nursing rehab

For some reason, this entire concept really bothers me.  I truly believe that the term "Nursing rehab" should be just that: a nursing rehabilitation program, not a program done only by just a few aides.    Maybe this is due to the fact that in most of the facilities I've worked in, a large number of the residents were in some stage of dementia.  For the patients coming off acute rehab, I guess it's fine to have one or two aides work with them for a set number of minutes each day.  However, since the program is "Rehabilitation" and most of these folks are demented, this isn't going to work too well with LTC residents.        Nursing, as a professionally provided services, just like physical therapy, should be providing this service around the clock.  Therefore, if you have Polly Patient who needs to be taught how to rise at the toilet, pivot to toilet, and seat herself, it needs to be done around the clock.  If you are working with someone for eating skills, or communication skills, or just figuring out how to dress themselves with one arm handicapped from a CVA, it needs to be practiced each time it is done until it is routine, and done without the resident having to think about it.        Carol Maher, long one of my very respected writers, stated the following: " First of all, start with a few of the programs--ambulation, range of motion and eating, maybe.  Provide an inservice with stations for each restorative program and teach the CNAs how to do basic restorative techniques.  Have licensed staff attend the same inservice, but also provide an inservice just for licensed staff to teach them how to identify residents who could benefit from the program, how to care plan for a restorative nursing program and also how to communicate the program to the CNAs and document the resident's progress in their weekly/monthly charting.  We have developed a simple flow sheet that is part of the CNA documentation record.  The licensed nurse enters the restorative program on the CNA flow sheet.  The flow sheet has an area for the CNA to enter his/her initials signifying that the program was done and also has an area to enter the number of minutes that the program took that day.  It has an area for each shift each day so the minutes can be totalled for the 24 hours.  "   This is a real nursing rehab program, and it is essentially effortless.  It has always worked well for me when I've been allowed to implement it.  I can NOT figure out why so many nursing facilities are shooting them selves in the foot financially by making this a program only done by special staff at specific times.  Those people must be hired and paid for IN ADITION to the staff already on the floor, and trained.  They may need a specific inservice each time a person is added to the nursing rehab program, but usually not.  The therapy approaches are usually the  same and all that is needed is to know what the problem is and the goal once the actual inservice is done.   Corey ----- Original Message ----- From: Kathy Archibald To: [EMAIL PROTECTED] Sent: Monday, April 05, 2004 5:50 PM Subject: Re: Nursing rehab Holly, it helped us when we differentiated between floor CNAs and Restorative Nurse Aides.  We finally sent two of our best CNAs (after we advertised for the position) to Good Samaritan in Washington state (we are in Idaho) for a weeklong course they provide on restorative nursing.  They came back with training and best of all, specific programs including forms, guidelines etc.  It was a great investment, and I recommend Good Sam for this program.  I have 2 other CNAs that alternate so we cover 7 days a week, try to have 2 staff on because they are more efficient usually with 2 RNAs at time.  Sometimes I rely on floor CNAs but am always disappointed because, honestly, they just don't have 'ownership' of the program.  Like someone else said, we focus on basic restorative nursing program, ROM, ambulation, ADL self care, restorative dining etc.  Good Luck! Kathy Archibald RN Living Center Supervisor FAX 1-208-547-2790 Voice 1-208-547-2771 email [EMAIL PROTECTED] Important Notice:  This communication, including any attachments, may contain information that may be confidential or privileged and is intended solely for the entity or individual to whom it is addressed.  If you are NOT the intended recipient, you must delete this message and attachments and are hereby notified that any disclosure, copying, or distribution of this message is strictly prohibited.  Nothing in this email, including any attachment, is to be a legally binding signature. ----- Original Message ----- From: carol maher To: [EMAIL PROTECTED] Sent: Monday, April 05, 2004 2:00 PM Subject: Re: Nursing rehab Holly, First of all, start with a few of the programs--ambulation, range of motion and eating, maybe.  Provide an inservice with stations for each restorative program and teach the CNAs how to do basic restorative techniques.  Have licensed staff attend the same inservice, but also provide an inservice just for licensed staff to teach them how to identify residents who could benefit from the program, how to care plan for a restorative nursing program and also how to communicate the program to the CNAs and document the resident's progress in their weekly/monthly charting.  We have developed a simple flow sheet that is part of the CNA documentation record.  The licensed nurse enters the restorative program on the CNA flow sheet.  The flow sheet has an area for the CNA to enter his/her initials signifying that the program was done and also has an area to enter the number of minutes that the program took that day.  It has an area for each shift each day so the minutes can be totalled for the 24 hours.  Therapy helps by assisting the licensed nurses with establishing goals for the care plan.   Most of the residents are at least screened by therapy to determine if skilled therapy is needed, if not , then can help set goals for restorative nursing program. -----Original Message----- From: Holly McGran <[EMAIL PROTECTED]> Sent: Apr 5, 2004 11:02 AM To: [EMAIL PROTECTED] Subject: Nursing rehab         We are having the hardest time getting our nursing rehab/restorative nursing program off the ground. It has become a very complicated system of everyone questioning whether or not it is nursing rehab; CNAs not documenting or not understanding the minute concept. Difficulties communicating to the CNAs what goals are nursing rehab and to document on those and not the others that are not nursing rehab etc. etc. and what we end up with is the vast amount of our MDSs with -0 for this section. Does anybody have any ideas/best practices or input on how to get a handle on this. I would appreciate anything….thank you in advance. Holly McGran  /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/