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RCN Critical Care Forum News and Issues Joint Position Statement RCN Critical Care and Rehabilitation Nursing Forums A growing interest and concern over long-term outcomes for critical care patients, and a conviction of the value of early rehabilitation strategies, has prompted the RCN Critical Care Forum and the RCN Rehabilitation Nursing Forum to work together on a joint position statement. The Forums strongly support the need for proactive rehabilitation. The continuum of rehabilitation stretches from the critical care areas to the patient's home. Though members of both the Critical Care and Rehabilitation Nursing Forums meet patients at differing ends of this continuum, there are a number of areas of common ground and belief. The position statement highlights these joint principles for practice. Both forums: view rehabilitation as a complex enabling process with physical, psychological and social components; see rehabilitation as client-centred, using creative ways of maintaining and restoring function and independence; respect, promote and value patients' capacity to choosefor themselves. We recognize the ethical dilemmas raised in respecting client choice, and promote the use of health education to facilitate informed decision-making. We contribute as equal members of a multidisciplinary team in searching for and negotiating solutions affirm the importance of initiating rehabilitation strategies early in critical illness (Scott Lea & Costello 1997); support and encourage the use of systematic reviews, research and clinical audit to provide high- quality, clinically effective rehabilitation (Sinclair & Dickenson 1998) promote rehabilitation as a key rolefor all registered nurses (RCN Rehabilitation Forum 1995) To identify the nurse's role in proactive rehabilitation, it is useful to consider the continuum of rehabilitation in four stages: Stage 1 The goals of rehabilitation are maintaining life and preventing loss of function. This includes promoting stability and supporting failing organs and prevention of complications from immobility such as pressure sores and loss of muscle mass and tone. Stage 2 Enabling patients to use the function and abilities they have; beginning to establish normal activities such as getting up and enabling patients to make choices. With speech therapists, establishing alternative forms of communication and planning rehabilitation so that family members can be actively involved. Stage 3 In a specialized rehabilitation centre and Stage 4 in the community, involve a more active programme of rehabilitation, with the focus on enabling the patient to return home. Rehabilitation is about being positive, searching for those things the patient can do for themselves and enabling their practice. Rehabilitation is a philosophy of care which should underpin all aspects of health care. Nurses are in an ideal position to adopt this approach as they have close and continuing (often 24-hour) contact with patients both in the acute and chronic setting. REFERENCES 1. Scott Lea G. Costello R 1997Developing an intensive care continuing: incorporating rehabilitation services in critical care Dimensions of Critical Care 16(1):40-46 2. Sinclair A, Dickenson E 1998 EffectivePractice in Rehabilitation. King's Fund, London 3. RCN Rehabilitation Forum 1995 Statement of Aims. Royal College of Nursing, London BIBLIOGRAPHY SeedhouseD 1988ethics:The Heartof Health Care John Wiley, Chichester Diana Kingston Critical Care Nursing Forum and Addenbrooke's NHS Trust, Cambridge, UK Sally Davis Rehabilitation Forum and Rivermead Rehabilitation Centre, Oxford, UK Do you have examples from your clinical experience of creative rehabilitation in a critical care area? Or problems and dilemmas? Please write to Diana Kingston, RCN Critical Care Forum, c/o Royal College of Nursing, 20 Cowendish Square, London WIMOAB, UK © 1999 Harcourt Publishers Ltd Intensive and Critical Care Nursing (1999) 15, 127-130 129

Joint position statement: RCN critical care and rehabilitation nursing forums

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RCN Critical Care Forum News and Issues

Joint Position Statement

RCN Critical Care and Rehabilitation Nursing Forums

A growing interest and concern over long-term outcomes for critical care patients, and a conviction of the value of early rehabilitation strategies, has prompted the RCN Critical Care Forum and the RCN Rehabilitation Nursing Forum to work together on a joint position statement.

The Forums strongly support the need for proactive rehabilitation.

The continuum of rehabilitation stretches from the critical care areas to the patient's home. Though members of both the Critical Care and Rehabilitation Nursing Forums meet patients at differing ends of this continuum, there are a number of areas of common ground and belief. The position statement highlights these joint principles for practice. Both forums:

• view rehabilitation as a complex enabling process with physical, psychological and social components;

• see rehabilitation as client-centred, using creative ways of maintaining and restoring function and independence;

• respect, promote and value patients' capacity to choose for themselves. We recognize the ethical dilemmas raised in respecting client choice, and promote the use of health education to facilitate informed decision-making. We contribute as equal members of a multidisciplinary team in searching for and negotiating solutions

• affirm the importance of initiating rehabilitation strategies early in critical illness (Scott Lea & Costello 1997);

• support and encourage the use of systematic reviews, research and clinical audit to provide high- quality, clinically effective rehabilitation (Sinclair & Dickenson 1998)

• promote rehabilitation as a key role for all registered nurses (RCN Rehabilitation Forum 1995)

To identify the nurse's role in proactive rehabilitation, it is useful to consider the continuum of rehabilitation in four stages:

Stage 1 The goals of rehabilitation are maintaining life and preventing loss of function. This includes promoting stability and supporting failing organs and prevention of complications from immobility such as pressure

sores and loss of muscle mass and tone. Stage 2 Enabling patients to use the function and abilities they have; beginning to establish normal activities such as getting up and enabling patients to make choices. With speech therapists, establishing alternative forms of communication and planning rehabilitation so that family members can be actively involved. Stage 3 In a specialized rehabilitation centre and Stage 4 in the community, involve a more active programme of rehabilitation, with the focus on enabling the patient to return home.

Rehabilitation is about being positive, searching for those things the patient can do for themselves and enabling their practice. Rehabilitation is a philosophy of care which should underpin all aspects of health care. Nurses are in an ideal position to adopt this approach as they have close and continuing (often 24-hour) contact with patients both in the acute and chronic setting.

REFERENCES 1. Scott Lea G. Costello R 1997 Developing an intensive

care continuing: incorporating rehabilitation services in critical care Dimensions of Critical Care 16(1): 40-46

2. Sinclair A, Dickenson E 1998 Effective Practice in Rehabilitation. King's Fund, London

3. RCN Rehabilitation Forum 1995 Statement of Aims. Royal College of Nursing, London

BIBLIOGRAPHY Seedhouse D 1988 ethics: The Heart of Health Care John Wiley,

Chichester

Diana Kingston Critical Care Nursing Forum and Addenbrooke's

NHS Trust, Cambridge, UK Sally Davis

Rehabilitation Forum and Rivermead Rehabilitation Centre, Oxford, UK

Do you have examples from your clinical experience of creative rehabilitation in a critical care area? Or problems and dilemmas? Please write to Diana Kingston, RCN Critical Care Forum, c /o Royal College of Nursing, 20 Cowendish Square, London WIMOAB, UK

© 1999 H a r c o u r t Pub l i shers L td Intensive and Critical Care Nursing (1999) 15 , 127 -130 129