1. Competency Model for Professional Rehabilitation Nursing Behavioral Scenario for Competency 2.2: Foster Self-Management Christine Cave, RN MSN CRRN HFS Copyright©2015, Association of Rehabilitation Nurses

2. Competency 2.2: Foster Self-Management Description/Scope: A collaborative approach that incorporates the client’s self-efficacy, past experiences and health literacy to problem solve and make decisions about his/her health care to achieve the highest quality of life while living with a chronic illness and/or disability Assesses clients for their readiness to learn and their existing knowledge of their illness or disability Participates in the goal setting and development of the plan of care with the client, family and interprofessional team that includes self-care skills Communicates with the interprofessional team in data collection Participates in the evaluation of the self-management plan of care Beginner Proficiency Level Descriptors Copyright©2015, Association of Rehabilitation Nurses

3. Behavioral Scenario A new paraplegic patient staying in the rehabilitation unit is anxious about his approaching day to be discharged home. His wife is with him at the bedside. They request to see their nurse to ask questions about the discharge plans. The nurse enters the room to meet with the patient and his wife. The patient’s wife pulls out a list written on her notepad and begins asking several questions about her husband’s needs for home. The patient’s wife apologizes that she has so many questions and tells the nurse how anxious she is about her husband’s needs. Copyright©2015, Association of Rehabilitation Nurses

4. Path 1 – Not Proficient The nurse stares at the patient and his wife and listens as the list of questions are read aloud. The patient nods in agreement as his wife describes concerns about skin care, mobility, intermittent catheterization and a routine bowel program. The nurse interrupts the patient’s wife when she is only read half of her list, “I’m very sorry, but you’ll have to wait to ask these questions of the home health nurse. Home health nurses provide nursing care in the home, I only provide care in the hospital.” Copyright©2015, Association of Rehabilitation Nurses

5. Path 1 – Not Proficient Observations & Outcomes 1.The nurse attends to the patient and his wife when they call, but the nurse is not able to contemplate the needs of the patient who is preparing to transition to a home environment. The nurse is not proficient in listening to the patient’s concerns and working with the patient and family to problem solve each care need. Instead the nurse becomes overwhelmed by the list and passes on the responsibility of planning and teaching to the home health nurse. 2.Newly paraplegic patients require significant support and education to develop self-management skills. As a result of not being proficient, the nurse misses out on the opportunity to play a vital role in teaching patients and their families how to prevent complications related to spinal cord injury. 3.The nurse should use the list provided by the patient’s wife to develop a teaching plan. The nurse can recruit resources provided by the hospital and from national spinal cord injury organizations to promote independent living. Key areas of spinal cord injury education include bowel and bladder management, skin care and pressure ulcer prevention, mobility and range of motion, and pain management. Copyright©2015, Association of Rehabilitation Nurses

6. Path 2 - Proficient The nurse takes a seat beside the patient and his wife and listens as the entire list is read. The nurse makes a few notes while listening. When the patient’s wife finishes, the nurse provides a confident reply, “I know this is overwhelming for you both. You have asked all of the right questions. I have several resources that I can give you to address your concerns.” The nurse introduces a comprehensive booklet for new paraplegic patients. The nurse schedules daily times to meet and teach the patient and his wife how to perform self-catheterization and develop a home bowel program. The nurse teaches the patient and his wife about skin care and mobility and assesses their knowledge by asking them questions about their learning. The nurse discussing positioning for pain control and how to appropriately take pain medications. The nurse frequently checks in to see how they are feeling about discharge and allows the patient to vent his frustrations when he feels overwhelmed. Copyright©2015, Association of Rehabilitation Nurses

7. Path 2 – Proficient Observations & Outcomes 1.The nurse takes the time to listen and validate the anxiety felt by the patient and his wife. The nurse demonstrates an attentive and sympathetic demeanor. The nurse knows how overwhelming it is for patients to adjust to a drastically new lifestyle and how paraplegia impacts the whole family. 2.The nurse provides supporting materials to teach the patient and his wife to manage toileting needs, skin care, mobility and pain management. The nurse designs a teaching plan and sets goals for the patient to be able to manage these personal needs independently. The nurse introduces concepts in a simple and structured manner. The nurse breaks up the education in short incremental periods over each day so that the new information is manageable. The nurse evaluates the patient’s and wife’s learning by allowing them to demonstrate and “teach-back” the information. 3.To increase proficiency, the nurse can develop a standard teaching plan for all paraplegics and their families who come to the rehabilitation program. The standard plan may include a weekly unit-based class offered to all spinal cord injured patients. Copyright©2015, Association of Rehabilitation Nurses

8. What Did You Observe? How did the outcomes of this scenario differ? Proficient Nurse - Listens to the patient and wife and validated feelings - Develops a teaching plan to ensure all concerns were addressed - Schedules teaching periods and allows for the patient and wife to attain the skills and demonstrate and teach- back their learning Non-Proficient Nurse - Does not listen to the patient and wife describe their concerns - Does not embrace the opportunity to teach the patient and wife to perform self-care skills - Passes on responsibilities of teaching to the home care nurse Copyright©2015, Association of Rehabilitation Nurses

9. Takeaways Copyright©2015, Association of Rehabilitation Nurses 1.The new nurse embraces the role as patient/family educator. The nurse utilizes resources and develops a teaching plan to ensure that the patient is prepared for discharge to the home environment. 2.The patient demonstrates skills and knowledge learned from the nurse’s teaching. The patient is able to perform as much of the self-care skills independently as possible. The family is educated in how to support and assure that these skills are successfully performed. 3.The patient and wife are able to perform the skills of self-care in the home safely and effectively. The transition to home is frightening after a spinal cord injury with paraplegia. The nurse evaluates that the patient/family are able to perform all of the self-care skills before the day of discharge so that the transition to home is smooth.