Role of the Nurse on the Rehabilitation Team
Role of the Nurse on the Rehabilitation Team
Physical rehabilitation is the area of healthcare that most exemplifies the concept of a team approach. It is the position of the Association of Rehabilitation Nurses (ARN) that the use of collaborative effort through a team delivery model offers the most comprehensive rehabilitation care. The rehabilitation nurse, easily accessible to individuals, families, team members and other concerned parties, and by virtue of specialized education, expertise, and interest in caring for individuals with chronic illness and disabilities, is considered the most qualified team leader and a key partner in a successful rehabilitation program. We believe that the outcome of rehabilitation is maximized when the rehabilitation nurse takes a leadership role and collaborates with rehabilitation team members.
Current Status:
Rehabilitation is a continuous process. Clients are rehabilitated through the leadership of the comprehensive approach to care provided by the rehabilitation nurse. Rehabilitation nurses are leaders who specialize in assisting individuals affected by chronic illness and disability to maximize their health through health restoration, maintenance, and promotion. The rehabilitation nurse functions as a care provider and coordinator as they partner with the client, caregiver, and the other rehabilitation specialists to solve problems and promote clients' maximal independence. Rehabilitation nurses are particularly skilled at working with others to adapt ongoing care to the constant changes in healthcare and to resources available to achieve timely outcomes. The function and role of team leader and care coordinator is reflected throughout all activities of the rehabilitation nurse.
Rehabilitation Team
The collaborative rehabilitation team model facilitates care in a coordinated and cost-effective manner. The team is composed of professionals from various disciplines that differ in educational preparation, professional expectations, and responsibilities. Each team members bring a unique perspective and individual expertise, but works collaboratively balancing the physical, psychological, emotional, spiritual, social, and vocational needs and preferences to achieve optimal outcomes. The rehabilitation team members involved depend on many factors, including the client's need, resources, and insurance coverage for services. The team members may include, but is not limited to, the following members:
Client
Family members/Caregivers
Rehabilitation Nurse
Physiatrist
Primary Care Physician
Social Worker
Physical Therapist
Occupational Therapist
Speech/Language Pathologist
Psychiatrist
Psychologist/ Neuropsychologist
Recreation Therapist/Childlife Therapist
Audiologist
Dietitian
Vocational Therapist
Case Manager
Respiratory Therapist
Spiritual Care Counselor
Home Health Nurses/Staff
The Rehabilitation Team Meeting
A collaborative rehabilitation team success depends on effective communication which includes team meetings that may be held periodically depending on the setting and needs. Topics included at team meetings include such items as the following:
Client and caregiver’s short- and long-term goals
Client's plan of care
Client's progress
Barriers/complications that may affect the plan
Length of stay
Client and caregiver education needs
Discharge planning/Transitions
Position Statement
The nurse’s role in the rehabilitation team should be as a leader and a key partner in the rehabilitation process for individuals with disease or trauma. As stated by ANAs Position Statement Role of Registered Nurse “nurses are a vital part of any effort to design, implement, and evaluate care coordination systems within and among institutions, organizations, and communities. Care coordination has long been recognized as a traditional strength of the nursing profession, regardless of the care setting. Due to the overall coordination and integration of adaptive techniques, the nurse is in a key position to provide input and assessment of all aspects of healthcare and adaption.
Nurses Role in the Rehabilitation Team
The rehabilitation nurse should:
Provide holistic, well-rounded care to the client and caregiver
Establish collaborative goals with the rehabilitation team and implement interventions that result in the best possible outcome to meet the needs of the client and caregiver
Maintain a strong commitment to the rehabilitation team
Participate in the rehabilitation team process at team conferences and other team meetings and offer input into team decision making
Communicate effectively and interact in a manner that facilitates the group process and team building
Reinforce the care provided by other team members
Coordinate team activities
Evaluate the effectiveness of the treatment plan on an ongoing basis
Advocate for the client and caregiver
Act as a resource to the rehabilitation team possessing the specialized knowledge and clinical skills necessary to provide care for people with physical disability and chronic illness
Provide teaching for rehabilitation team members and reinforce the teaching done by specialists in rehabilitation and other healthcare disciplines
Updated by the Continuing Education Provider Unit in 2024.
References:
Association of Rehabilitation Nurse. The Rehabilitation Staff Nurse Role Description (Brochure).
Association of Rehabilitation Nurses. Rehabilitation Nurses make a difference (Brochure).
Association of Rehabilitation Nurses (2014). ARN Competency Model for Professional Rehabilitation Nursing. Chicago, IL: Author.
Association of Rehabilitation Nurses (2014). Standards & Scope of Rehabilitation Nursing Practice (6th Ed.). Chicago, IL.
Hoeman, S.P. (2008). Rehabilitation Nursing: Prevention, Intervention, and Outcomes (Rehabilitation Nursing: Process & Application (4th Ed.). Mosby Elsevier in St. Louis, Mo. ISBN-13: 978-0323045551
Mauk, K.L. (2011). Rehabilitation Nursing: A Contemporary Approach to Practice: A Contemporary Approach to Practice (1st Ed.). Jones & Bartlett Learning. ISBN-13: 978-1449634476
Vaughn, S. (Ed.) (2019). The Specialty Practice of Rehabilitation Nursing, A Core Curriculum (8th Ed.). Association of Rehabilitation Nursing. Chicago, IL ISBN-10: 0990025411
