Principles Of Rehabilitation

In this essay I will discuss theoretical principals of rehabilitation of a particular patient I cared for while on clinical placement. It will focus on the role of the multidisciplinary team involved in this rehabilitation process post acute myocardial infarction and the education and support given to the patient and her family during the discharge planning process. Also I will be including statistics and evidence of pathophysiology. The National Service Framework for Older People (Department of Health, 2001) sets out eight standards including standard three about intermediate care services that promote independence and provide effective rehabilitation services. Active rehabilitation is seen to reduce the risks of hospital readmission, increase the likelihood of discharge from hospital, and prevent older people being placed in long-term residential care.

The aim of this essay is to analyse the rehabilitation process and understand the principles of rehabilitation for nursing practice. This will be achieved based on the reason for the patient's admission. Discussion on the patient's rehabilitation needs, the rehabilitation members who were involved in relation to the phase of cardiac rehabilitation that was used. The goal of the rehabilitation is to help the patient achieve optimal function again. The common goals for the rehab include: improved independence in the performance of basic activities of daily living such as grooming, dressing, hygiene and feeding, laundry and housekeeping tasks, meal planning, grocery shopping and community mobility. Also to provide the patient with education to help prevent another stroke. To abide by the Nursing and Midwifery council (NMC) code of Professional Conduct (2002) on confidentiality the patient will be referred to as Amanda. Amanda was a 56 years old lady, who lived with her husband. She had four children. She smoked 20-30 cigarettes a day for the 25 years and drinks alcohol occasionally. Her past medical histories were diabetes, chest pain and systemic hypertension.

Coronary heart disease (CHD) is the major cause of death in the UK and the survivors of acute myocardial infarction are at high risk of mortality. It is responsible for more than 110,000 deaths in England in 1998 including41,000 under the age of 75 Department of Health (2000). It can be seen from Amanda lifestyle that there was a possibility of her developing coronary heart disease. The term coronary heart disease refers to the symptoms of coronary occlusion caused by atherosclerosis" NT (1994,pg. 5). There are several factors considered to contribute to CHD. Cigarette smoking, obesity, person's sex, diabetes mellitus, exertional chest pain and age for women over the age of 55 were among the factors considered to contribute to CHD which might lead to acute myocardial infarction. Coronary heart disease alone is the most common cause of death in the UK, accounting for 1 in 4 deaths in men and 1 in 5 deaths in women (British Heart Foundation 1998).

Amanda was admitted from Cardiac Care Unit (CCU) to medical ward following a suspected myocardial infarction. Myocardial infarction is a "pathological term used to describe the death of a portion of heart muscle" Jones and West (1995,pg7). This in order words occurs when a coronary artery blocks completely resulting to death of the dependent muscle. The infarction can involve any part of the heart, but it commonly affects the left ventricle NT (1994,pg.7). On admission during assessment, Amanda was in pain, discomfort, anxious and restless. Amanda was on pain relief during the acute phase which was intravenous (iv) diamorphine. Her skin was also pale and clammy. This according to Hand (2001,pg.49) is as a result of peripheral vasoconstriction as the body diverts the blood supply towards the vital organs, the brain and the heart. Several blood tests and electrocardiograph (ECG) were carried out. Other signs of distress and her history of chest pain, systemic hypertension were used to prove the provisional diagnosis of myocardial infarction that was made earlier.

Cardiac Rehabilitation programme is offered to patients post myocardial infarction. Rehabilitation is defined by the Royal College of Nursing RCN, (2000,pg.3) as re-enablement which means "helping people adapt to changes in their life circumstances." Cardiac rehabilitation is defined by Jowcett and Thompson 1996 cited in Noy (1998,pg.1033) as "the process by which patients with coronary heart disease are enabled to achieve their optimal physical, emotional, social and economic status". Furthermore, it is also defined by the World Health Organisation WHO, (1993) cited in the National Service Framework for coronary heart disease DOH, (2000,pg.3) as the "sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they (people) may, by their own efforts preserve or resume when lost, as normal a place as possible in the community". Rehabilitation is a complex activity that requires contributions from many members of the healthcare team. Rehabilitation is a planned, goal-directed activity that requires assessment and re-assessment using standardised measures to monitor progress. It must include patients and their families and friends.

Cardiac rehabilitation programme is structured to be either hospital based, community based or home based. It was recommended by WHO, (1993) that cardiac rehabilitation should start at the time of coronary heart disease, or as soon as possible following admission with acute event from phase one. The cardiac rehabilitation programme consist of four phases Coats et al (1995,pg.153-156). Phase one (in-patient stay) starts from when a patient is in coronary care unit or in a medical ward until the patient is discharged from the hospital. Its contents are reassurance, involving partner and friends, providing information and education. It also includes risk factor assessment, mobilization and discharge planning.

Phase two (immediate post-discharge) involves post discharge fellow-up which can be through telephone or home visits whereby deterioration or non compliance with treatment will be identified. Further assessments and inverstigation are also made and more education.Phase three (intermediate outpatient) constitutes of prescribed individual exercise which is based on clinical status, risk stratification, and assessment of previous physical activity and future needs. It also includes