Rehabilitation Team
Transdisciplinary Approach: AnAtypical Strategy for ImprovingOutcomes in Rehabilitative andLong-Term Acute Care Settings
Carolyn Reilly, MN RN CCRN
In the rehabilitation and long-term acute care settings, anatypical strategy has emerged in the past few years wherebythe central focus is on improving patient care through a teamapproach in which responsibilities are shared and the normalboundaries of the healthcare professions blurred. This articleprovides a conceptual analysis of this unique, transdisciplinary approach to care delivery. Differentiation between interdisciplinary, multidisciplinary, and transdisciplinary techniques is provided through case scenarios. Defining attributes,necessary antecedents, and the many possible positive outcomes from the transdisciplinary approach to practice is discussed. This concept analysis defines for the rehabilitation or
In an era ofhealthcare redesign, several novel approaches todelivering high-quality care at a reduced cost have emerged. Using clinical guidelines, Carelvlaps'", or pathways is one approach whereby populations of patients that consume significant resources are identified, and standardized plans of care aredeveloped. Other design changes include decentralization ofservices, skill mix changes.and shared governance. In the rehabilitation and long-term acute care settings, an atypical strategy called transdisciplinary approach (TA) recently has beendeveloped, whereby the central focus is to improve patient carethrough a team approach, in which responsibilities are sharedand the normal boundaries of the various healthcare professionsare blurred. The case scenario that follows introduces this newconcept within a facility that combines the rigors of rehabilitative practices with acute and sometimes critical care in a longterm acute care setting.
Case scenario: Mr. C was transferred to a long-term acutecare facility at 2 pm on a Thursday afternoon. His admissionwas coordinated among the team members assigned to his care,so that an arena assessment could occur. In his room, his assigned nurse, certified nursing assistant (CNA), and respiratory therapist made himcomfortable and oriented him to his room.Mr. C was dependent upon mechanical ventilation and had experienced cardiac arrhythmias throughout his hospitalization atthe transferring facility. Consequently, the caregivers initiatedmechanical ventilation on a portable ventilator and established
216 Rehabilitation Nursing s Volume 26, Number 6· Nov/Dec 2001
Keywordstransdisciplinary approach, concept analysis
long-term acute care nurse a method that can be used to redesign care delivery, to promote improved patient outcomes,and to achieve a cohesive team environment.
Carolyn Reilly is the director of quality and risk management at Tahoe Pacific Hospital in Sparks, NV, and a doctoral student at the University of Nebraska Medical Center.Her research interests include transdisciplinary care, outcome management, and acuity measurement with the chronically ill population. Address correspondence to CarolynReilly, 2385 E. Prater Way, Suite 101, Sparks, NV 89434, email [email protected].
telemetry monitoring. His daughter was given a welcome packet and some basic information about visiting hours, cafeteria location, and facilities.
Although the team had hoped to complete an arena assessment, whereby all disciplines would jointly complete one comprehensive assessment, Theresa, Mr. C's primary nurse, suggested that he was too fatigued from the transfer and would bebetter served by a limited assessment that would meet immediate needs, followed by a more formalized assessment the nextday. The team concurred and an initial assessment was completed only by Theresa and Allen, the respiratory therapist.
The next morning, Joe, Mr.C's physical therapist, helped himto the bedside commode with Theresa and Monica, Mr.C's CNA.Joe was able to assess Mr. C's balance, strength, and coordination while offering suggestions in proper body mechanics during transfer to Monica, who was still in orientation. Throughoutthe morning, the other team members worked together to meetMr.C's needs and complete a thorough assessment.
In the afternoon, Sheri, the case manager, facilitated a teamconference with the patient and his daughter to develop thetreatment plan. Among the other team members attending wereMr.C's primary physician and his physiatrist. At this conference,specific barriers to discharge were identified and a plan developed to meet Mr.C's needs. Sheri then reviewed all documentation with the team members and summarized the plan of treatment and discharge.
Mr. C's daughter wasencouraged to bring to his room somefamiliar items from his home to help himto feel more comfortable.Joe askedthat she also bring sweatpants and a shirt so thatMr. C could dress every day. Allen and Lisa, the speech languagepathologist,discussedwith Mr.C his need for a speakingvalvefor his tracheostomyand developeda schedulefor its use.Mary, theclinical nutritionist, discussed Mr.C's nutritional needs,and the team discussed at length tube feeding goals, initiationof a boweland bladderprotocol,and the timingof swallow evaluations. Specific short-andlong-termgoalsfor recovery wereestablishedwith Mr.C and the finalplan of care and interventionswere documented on the chart for weekly review and progressrecording.
Transdisciplinary approachFirst proposed as a model for educating children with cere
bral palsy, transdisciplinary approach (TA)has become a model of healthcare delivery in new settings. Currently,the term isused to describe care approaches used in the management ofchronic illnesses (vanEijk & de Haan, 1998) and as a practicemodel for nurse practitioners(Hartwig & Landis, 1999).It hasbeen suggestedfor use in home care application(Sherry, 1994),in rehabilitationfacilities (Rosenet al., 1998),and in long-termacute care facilities (e.g., LifeCare Management Holdings Facilities of Plano, TX).
TAholds particularpromisefor improvinghealthcaredelivery and team cohesiveness within the subspecialtiesof rehabilitativecare and long-termacute care. These two areas, more sothan any other healthcare sector, rely upon teamwork amongseveral disciplines to coordinate and provide patient care. TAoffersa uniqueapproachto facilitatingthis cooperationand hasthe promise of improved patient outcomes through the synergism of teamworkand role blending.
Giventhe vagueunderstandingof the term transdisciplinary(it is often confused with multidisciplinary and interdisciplinary), a linguistic strategy known as concept analysis is usedhere to explain the TAconcept.Foremost, the purposebehindaconcept analysis is to examineand describe the idea and its usein current language(Walker & Avant, 1995).Toaccomplishthistask, all definitions of the term(s) are considered, defining attributesare identified,case scenariosare generatedto help clarify true and contrary cases, and antecedents and consequencesare identified.Thus, the purposes of this particular analysisareto define and clarify the meaningof TA and to discuss the benefitsof employing TAin acutecareand rehabilitative settings. Finally, a conceptualmodelof care withTAas the nuclearprocessfrom which positiveoutcomesemanate is presented.
Uses of the conceptTodevelop theTAconcept, several processes anddatasources
wereused.Definitions weretakenfromdictionaries andfromtheliterature.A searchwas made of the electronicdatabasesMEDLINE, CINARL, and HealthSTAR, using the Medical SubjectHeadings(MeSH)term transdisciplinary. References fromjournal articles found in this search led to additionalreviewand researcharticles.Finally, discussions withmultiplehealthcarediscipline colleagues who work within a transdisciplinary model
helped ground the concept and reaffirm the defining attributesdetailedin the literature.
The onlyformaldefinition of thetermtransdisciplinary foundin any dictionaryof the Englishlanguagewas in Merriam-Webster (1999), which (incorrectly) defined transdisciplinary as interdisciplinary (1999). Therootwordstrans- and discipline wereresearchedfor their variedmeanings that couldbe appliedto theconcept.The New 040rd Dictionary ofEnglish (OxfordUniversity, 1998)listed trans- as the prefixfor across,beyond,on or totheother side,from theLatin trans meaningacross. A chemistrydefinition fordenoting molecules withtransarrangements of substituents was also listedbut is not applicablefor this discussion.Synonymsincludethrough, surpassing, and transcending.
The word discipline, from Middle English with origins inOld French and Latin (Frenchfrom Latin disciplina [i.e., teaching or learning], and discipulus [i.e., pupil]) first appeared inthe 13th century. It has several definitions, including (a) punishment; (b) obsolete: instruction; (c) a field of study; and (d)training that corrects,molds, or perfects the mental faculties ormoralcharacter(Merriam-Webster, 1999). TheNew 040rd Dictionary ofEnglish (OxfordUniversity, 1998)furtherdefinesdiscipline as "a branchof knowledge, typicallyone studiedin high-·er education." Therefore, an apt definition for TA, combiningthe root definitionsof trans- and discipline, would be "The delivery of care transcendingthe normal boundaries of a specificfield of study."
In the literature, the termtransdisciplinary canbe tracedto theearly 1970sas a teammodelfor educating childrenwithcerebralpalsy(Rosenetal.,1998). In this, andin morerecentusesas a teamapproachfor healthcare delivery, several principles are describedas core to TA.Foremostis that care is deliveredbased upon patient needs rather than on staff trainingor job descriptions. Further,teamrecommendations arebasedon the patient'sgoals,andnot on team members' expertise. Finally,the ultimate goal is topromoteintegrated assessment andto develop a unifiedtreatmentplan that is executed by all team members (Haig et al., 1994;Hartwig& Landis, 1999;Sherry,1994;Rosen et al., 1998).
The definition of terms often is made clearer by listingantonymsor definingterms that contradict the term or describeits opposite. In this analysis, transdisciplinary can be directlyopposed to the terms multidisciplinary and interdisciplinary. Inthemultidisciplinary teamapproach, therolesof eachteammember are clearly definedand communicationis relativelylimited.Differentdisciplineswork with the same client, yet functionindependently. Each conducts his or her own discipline-specificassessmentand formulates discipline-specific goals. The resultsare then shared at team meetings (Rosen et al., 1998).With theinterdisciplinary team approach,team membersengagein problem solvingand care deliveryfrom their discipline (Lamorey&Ryan, 1998). Recommendationsare a result of group decisionmaking that may include problem solving beyond an individual's particular knowledgebase (Hartwig & Landis, 1999).
Defining attributes of TATo further differentiatetransdisciplinaryfrom interdiscipli
nary or multidisciplinary, defining attributes have been takenfrom the literature. Walkerand Avant(1995) describe defining
Rehabilitation Nursing s Volume 26, Number 6· NovlDec 2001 217
Transdisciplinary Approach
attributes as characteristics of the concept that appear repeatedly in the literature (Walker & Avant, 1995). The literature delineates five premises as needing to be met before TA is possible. They are role extension, role enrichment, role expansion,role release, and role support.
Role extension is a process whereby one's own disciplinespecific knowledge is continually increased (Woodruff & MeGonigel, 1988). It is essential that each team member understandshis or her individual role and responsibilities, as well as those ofother team members. "Feeling secure in one's role and knowingthat individual contributions are facilitating positive patient outcomes are essential components in creating an environment whereeach discipline is comfortable collaborating with the other"(Akhavain, Amaral, Murphy, & Nehlingerr, 1999, p. 2). Further,"having the security in one's own role leads to the resolution ofrole, turf, and status issues" (Lamorey & Ryan, 1998, p. 325).
The definition ofterms often is made clearer by listing
antonyms or defining terms that contradict theterm or describe its opposite. In this analysis,
transdisciplinary can be directly opposedto the terms multidisciplinary and
interdisciplinary.
Role enrichment is being aware and knowledgeable of the other disciplines represented on the team (Woodruff & McGonigel,1988).Although healthcarepersonnel recognize and appreciate thevarious other professionals, the level of role enrichment to whichthe defining attribute refers is only achieved through team communication, coordination of care, and a high degree of collaboration. Team members are encouraged to communicate, collectivelyplan and implement assessments, discuss results, and develop integrated treatment goals during team meetings (Rosen et al., 1998).
It is through team meetings that the third critical attribute,role expansion, is expressed. Here, each member of a disciplineeducates the others regarding his or her own expertise (Lamorey& Ryan, 1998). Knowledge is shared as team members teacheach other to make specific judgments and decisions about interventions that transcend the boundaries of traditional roles(Lamorey & Ryan).
The fourth critical characteristic, role release, is reported extensively in the literature. Incorporating the skills acquired fromother disciplines blurs the traditional discipline boundaries (Lyon& Lyon, 1980). Although a model case is presented later in thisarticle, a simple example would be that of a speech-languagepathologist (SLP) who helps a client to sit more comfortably fortherapy by applying proper body mechanics principles learnedfrom his or her physical therapy colleagues. In this example, theclient's comfort is the primary objective (beyond that of discipline-specific goals such as mastering swallowing techniques),the healthcare provider assumed responsibility for the task andhelped the client meet a goal by applying techniques learnedfrom another discipline.
218 Rehabilitation Nursing > Volume 26, Number 6· Nov/Dec 2001
Role support, the last defining attribute, would be evident ifthe physical therapist should walk by at just the moment the SLPwas helping the patient to a more comfortable position and gavethe SLP feedback on how he or she was instructing the patientabout body mechanics. Support of, and feedback to, others aboutthe implementation of a particular skill are the hallmarks of rolesupport (Woodruff & McGonigel, 1988).
Several other common themes are evident in the literature, including transdisciplinary play assessment, arena assessment, andprimary care providers. Although repeatedly addressed in thissubspecialty of literature, these themes would need to be refinedto be regarded as defining attributes in a healthcare delivery model. In particular, the arena assessment mentioned in the initialcase scenario can be readily adapted to the healthcare environment, in that one primary provider conducts the initial client assessment, with all other disciplines observing, adding, or questioning as needed. This approach limits the number of times thepatient is required to answer the same question or demonstratethe same activity or skill, and is considered the best for detectinganomalies because of its thoroughness and differing perspectivesof several specialties (Smith, 1997).
Transdisciplinary casesListed below are several true and invented cases to demon
strate the TA concept. The model case provides an example ofTA use, with each of its necessary defining characteristics. Theborderline case is an example of a situation where some, but notall, of the critical attributes are present. A related case modelsrelated concepts but does not have any of the critical attributes.Finally, a contrary case is presented that is a clear example ofwhat TA is not (Walker & Avant, 1995).
A model case of transdisciplinary approach: A physicaltherapist enters a patient's room where a family member is helping the patient try to drink juice. The therapist, immediately noticing the patient coughs after each sip, remembers from a recentcare teaming conference that the patient was to have thickenedliquids only, using the chin-tuck swallowing technique. The therapist praises the family member for giving assistance and suggests that the patient would tolerate the liquid better if it werethickened; the thickener is added to the juice by the therapist,who returns it to the family member and explains the principlesof the chin-tuck swallowing technique to both patient and family member. The therapist remains in the room to verify that thepatient is swallowing the juice without choking or aspirating.
Discussion. In this model case, the therapist models role release by identifying a need and providing intervention, basedupon previous role enrichment and expansion. Role extensionis assumed through the therapist's calm and competent manner.Further role expansion is evident as the therapist instructs thefamily member in helping the patient. Finally, role support isevident as the therapist remains in the room to support the family member in this delivery of care.
Borderline case: The dietitian and the nurse confer aboutMr. Jones's nutritional intake in the past 48 hours. The dietitian notes that the intake is well below what is required andasks the nurse to encourage the taking of supplements betweenmeals.
Discussion. In this case, role enrichment is demonstratedthrough the communication and consultation between the nurseand the dietitian. Perhapsevena mutualplan can be inferred;however,no role expansion,release, or support is obvious.The intervention to be undertaken by the nurse is within her job description and is not an expansion of what she knows and practices.
Related case: The RN and CNA discuss the plan of care fortheir patient load that day. The nurse assigns the giving of bathsand the taking of vital signs to the CNA; she takes responsibility to complete all assessments, give medications, and changedressings. They cooperate in getting all of the patients out of bedfor meals.
Discussion. Althoughthisscenariois a nicedescription of communication and teamwork, it is not transdisciplinary care planning. Both the CNA and the nurse are actingwithin their scopeofpractice. One criticismof TA is that there may be some role confusion, with the potential of breaching legal scopes of practice.This author does not advocate that, nor is it supported by any literature cited. All initiativesto transcend usual discipline boundaries are undertaken within legitimate scopes of practice. In thisparticular case, circumstancesthat might be changed to better reflectTAandremainwithin thepermissible scopeofpractice, wouldhave the CNA assist with gait training learned from a physicaltherapist, or help withreminiscenceactivities duringpersonalcare,as learned from a certifiedtherapeutic recreation specialist.
Contrary case: An internist was assessing Mr. Jones's phys-:ical condition when Mr. Jones suddenly vomited approximately300 cc of dark brownfluid.The physician immediatelycalledforthe nurse, ordered NPO (nothing by mouth) for the patient, andordered that the emesis be cultured for occult blood.
Discussion. In this classicexample, the physicianfails to meetthe patient's immediate need, which is assistance with personalhygiene and medication to prevent further emesis. The physician acts within his traditional scope of practice and expects thenurse to act within her own scope of practice. There is no collaboration, no role enrichment, expansion, release, or support.
Antecedents of transdisciplinary approach"Collaboration flourishes in an atmosphere where there is a
high level of trust among the disciplines.'(Akhavain et al., 1999,p. 2). Trust is a crucial antecedent for collaboration and TA.Pikeet al. (1993) described how team members can readily assumeaccountability and responsibility for patient care when trust andrespect for individualperspectives are part of the team's culture.Further, developing an environment of trust and mutual respectrequires that individuals abandon antiquated notions of a hierarchy that are rooted in intellectual superiority (Evans, 1994).
Consequences of transdisciplinary approachSeveral positive consequences ofTA are described in the lit
erature. These include (a) increased professional knowledge andskills through collaborationamong team members, (b) increasedmutual respect and professional growth among team members,(c) shared responsibilitiesfor problem solving and decisionmaking' (d) more equal distribution of responsibilities,among teammembers, and (e) a more integrated holistic view of the clientshared by team members (Ryan-Vincek,Tuesday-Heathfield,&
Lamorey, 1995). Negative consequences of TA that are identified in the literature include ambiguous role definitions, liability questions concerning indirect integrated therapy, and inequitable delineation of work responsibilities (Geiger, Bradley,Rocks, & Croce, 1986).Both negativeand positiveconsequencescan result from team TA, depending upon the managerial support and spirit of the organization in which it is attempted.
Empirical!clinical referentsThe finalstep in the conceptanalysisis to determinethe empir
ical referents. WalkerandAvant(1995,p. 46) advisethatempiricalreferents "areclassesorcategories of actualphenomenathatbytheirexistenceor presencedemonstratethe occurrenceof theconceptitself."Further,in manycasesthe empiricalreferentsare identicaltothe criticalattributes. This is so withTA.
To verify that the fiverolechanges (extension,enrichment,expansion' release,and support)were the operationalrepresentationofTA, the author interviewedstaffmembers from each disciplinein a long-termacute care facilitythatpromotes a transdisciplinaryteam environment.The staffinterviewedrepresentedmany disciplines including nursing (RN, LVN, CNA), respiratory therapy,physicaltherapy, occupational therapy, recreational therapy, speechpathology,and medicine. Three questions were asked:
1. What is transdisciplinary team approach?2. Did you have any training into this approach prior to
working in this position?3. How is transdisciplinary different from interdisciplinary
or multidisciplinary care?Responses wereconsistent across disciplines andincluded "com
munication," "it's everybody's job;' ''we workoutsideof our expertise;' ''workingtogethertowards onepatientgoal,notdiscipline-specific goal;'"everyoneworks forthegoodofthepatient, blendingroles;,and ''bestinterests of thepatientcomefirst" Noneof the respondentshad formaltraining inTAoutside oftheirpresentjobs,although afewsaid theyhad read about it in theirrespective professionaljournals.Only the physician couldnot clearlyiteratethe differences betweentrans-, inter-, andmultidisciplinary team approaches. (Thephysician,whoisnotin theemployof thefacility, couldnotdefinetransdisciplinaryandstatedit wasnotan important concept.)
The literature has no reports of empirical research related topatient perceptions or outcomes from TA, although studies haveevaluated the staff's responsiveness and acceptance of TA.Figure 1 shows a working conceptual framework for measuring outcomes of patients who are chronically critically ill. Theseare typically older persons who have recovered from life-threatening crises but remain critically ill, with exacerbations of underlying chronic disease or complications of their primary illnesses (Daly, Phelps, & Rudy, 1991).The model presents TA ascentral to positive outcomes in this patient population within along-term acute care environment.
Several patient outcomes are listed that could be analyzed,such as cost, length of stay,hope, satisfaction, functional status,
Rehabilitation Nursing s Volume26, Number6 • NovlDec2001 219
Transdisciplinary Approach
Figure 1. Conceptual Framework for Patient Outcomes Measurement
Patient outcomes• Ventilator time • Patient satisfaction• LOS • Hope• Disposition • Quality of life• Mortality • Motivation• FIM improvement • Costs• Recidivism • Depression
Patient Care Services
Care pro!der outcomes• Employee satisfaction• Physician satisfaction• Employee proficiency• Job stress
Care system outcomes• Hospital profitability• Employee retention• Employee productivity
depression, recidivism, and mortality. The overriding hypothesis of the framework is that specific patient, care provider, andsystem outcomes are enhanced by a patient care delivery modelin which the transdisciplinary process has a core, pivotal position. Research is currently under way investigating the model andspecifically the role TA shares in improving outcomes of this vulnerable population.
ConclusionLamorey and Ryan (1998, p. 310) propose that "successful
professionals team together to pursue holistic solutions to thechallenges that threaten to overwhelm families, schools, clinics,and community agencies." Transdisciplinary is one team approach that should be scrutinized as a possible effective meansof care delivery in the ever-changingand complex world of healthcare. Specifically, in the specialties of long-term acute care andrehabilitative care, TA can foster a more cohesive team amongthe many professional disciplines caring for patients with complex problems. By providing TA focused upon meeting the
220 Rehabilitation Nursing> Volume 26, Number 6· Nov/Dec 2001
patient's immediate needs regardless of the health professional's specialty or job description, improved outcomes for patient,care provider and the health facility can be achieved.
ReferencesAkhavain, P., Amaral, D., Murphy, M., & Nehlingerr, K.C. (1999). Collab
orative practice: A nursing perspective of the psychiatric interdisciplinary treatment team. Holistic Nursing Practice, 13(2), I-II.
Daly, BJ., Phelps, C., & Rudy, E.B. (1991). A nurse-managed special careunit. Journal ofNursing Administration, 21(7/8), 31-38.
Evans, J. (1994). The role of the nurse manager in creating an environmentfor collaborative practice. Holistic Nursing Practice, 8(3), 22-31.
Geiger, W.L., Bradley, R.H., Rocks, S.L., & Croce, R. (1986). Commentary. Physical and Occupational Therapy in Pediatrics, 6,16-21.
Haig, AJ., Nagy, A., LeBreck, D.B., Ashenbach, D., Collins, S., Hansen,G., & Putnam, J. (1994). Patient-oriented rehabilitative planning in asingle visit: First year review of the quick program. Archives of Physical Medicine and Rehabilitation, 75, 172-176.
Hartwig, M.S., & Landis, BJ. (1999). The Arkansas AHEC model of community-oriented primary care. Holistic Nursing Practice, 13(4),28-37.
continued on page 244
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244 Rehabilitation Nursing' Volume 26, Number 6' NovlDec 2001
Transdisciplinary Approachcontinuedfrom page 220
Lamorey, S., & Ryan, S. (1998). From contention to implementation: Acomparison of team practices and recommended practices across servicedelivery models. Infant- Toddler Intervention, 8(4), 309-331.
Lyon, S., & Lyon, G. (1980). Team functioning and staff development: Arole release approach to providing integrated educational services for severely handicapped students. Journal ofthe Association for the SeverelyHandicapped, 5(3), 250-263.
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Oxford University. (1998). The New Oxford Dictionary ofEnglish. Oxford,England: Oxford University Press.
Reilly, C.M. (2000). Doctoral Research Studies. University of NebraskaMedical Center, College of Nursing.
Rosen, c., Miller, A.C., Cate, LM.P., Bicchieris, S., Gordon, R.M., &Daniele, R. (1998). Team approaches to treating children with disabilities: A comparison. Archives ofPhysical Medicine & Rehabilitation, 79,430-434.
Ryan-Vincek, S., Tuesday-Heathfield, L., & Lamorey, S. (1995). From the.ory to practice: A pilot study of team members' perspectives on transdisciplinary service delivery. Infant-Toddler Intervention, 5,153-176.
Sherry, D. (1994). Reinventing homecare. Homecare Nursing, 12(5),8.Smith, D.L. (1997). Tele-assessment: A model for developmental assess
ment of high-risk infants using a televideo network. Infant Young Children, 9(4),58-61.
van Eijk, 1., & de Haan, M. (1998). Care ofthe chronically ill: The future ofhealthcare professionals and their patients. Patient Education and Counseling, 35, 233-240.
Walker, L.O., & Avant, K.C. (1995). Strategies for theory construction innursing (3rd ed.). Norwalk, CT: Appleton & Lange.
Woodruff, G., & McGonigel, M. (1988). The transdisciplinary model. In 1.Jordan, J. Gallagher, P. Huttinger, & M. Karnes (Eds.), Early childhoodspecial education: Birth to three. Reston, VA: Council for ExceptionalChildren.
Continuing education (CE) articles discuss current trends and issues affectingrehabilitation nursing. This CE offering(code number RNC-185) will provide 1contact hour to those who read this articleand complete the application form on page251. This independent study offering is ap-propriate for all rehabilitation nurses. By reading this article, the learner will achieve the following objectives:1. Differentiate between the interdisciplinary, multidisci
plinary, and transdisciplinary approaches.2. Identify the five defining attributes of transdisciplinary
care.3. Identify positive consequences of, or benefits from, ap
plying the transdisciplinary approach to the healthcareenvironment.