Assistant in Nursing Extended Orientation Program – Rehabilitation Services

(AiN)

Janet Trotta 2014.

Brief Introduction to Rehabilitation Services and your role

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Welcome to rehabilitation services

> Fire exit> Toilets> Tea and coffee facilities> Mobile phones> Respectful classroom behaviours> Todays session

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Inpatient Rehabilitation Services are committed to

This is a shared responsibility

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> Staff Development Opportunities

> My role• Background• Role • Support

> Educational opportunities at HRC• Ward based in-service • HRC Nursing in-service • Capacity to attend education through RAH and

TQEH (? Cost associated for causals) • Moodle education

Artist in residence art groups Other disciplines Grand rounds and forums etc.

Staff Development Department & staff development consultant role

Janet Trotta Staff Development ConsultantHRC

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Our history

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> Started life as an infectious diseases hospital – • Opened & first patients 7th October 1932 • Collect overflow patients from RAH in Australia's first large

scale poliomyelitis epidemic (1930’s)• ”Metropolitan Infectious Diseases Hospital (MIDH) ” • Polio, scarlet fever, measles and diphtheria.

> By 1945 mass immunisations decreased new outbreaks considerably. The number of immunisations to disease grew

> Also – there were new drugs to combat illness - penicillin

Hampstead Rehabilitation Centre - History

Diphtheria Polio Scarlet fever

Whooping cough Measles

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> Focus changed to convalescence for lasting effects of disease. Became known as “Northfield wards”

• Predominantly polio • Came under the annex of RAH

> With time, people requiring convalescence from other long term chronic health problems also came to Northfield

> Large scale review commenced in 1970’s

> 1980s Northfield wards closed doors to clients with infectious disease. Became Hampstead Rehabilitation Centre - a modern progressive centre for rehabilitation and extended care

> Affiliated with St Margaret's Rehabilitation Centre

Hampstead Rehabilitation Centre - Progress

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> Provides a range of services for people requiring rehabilitation, including but not limited to:

• Post medical illness• Following surgical intervention.• Post trauma, • after orthopaedic and spinal injury• In association with health problems associated with aging

Nursing role is Rehabilitation Focused• Subacute presentations • Patient centred Individualised care• Goal focused

Predominant nursing care issues revolve around: independence, education, quality of life, safety, mobility, continence, skin integrity, wound care

• Discharge and community focus and liaison

Our services

Psychosocial support

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Reception area

Main part of the Hospital

Seminar room

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Outpatients Department OPD spinal & brain injured clients • Podiatry• X-ray• Botox clinic• Wound clinics

Educator office

Spinal Injury Unit (SIU, 2CD)• spinal cord injury• no admission age

limitation• Services: SA, Northern

Territory, parts of NSW & a small section of Victoria

• does not take people with a bony fracture where there is no neurological loss

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Brain Injury Rehabilitation unit –(BIRU, 2B)• people with an acquired

brain injury, (generally traumatic brain injury)

• average presentation is male, in the 40s, often attributable to MVA assault, or

drug abuse. • Clientele often have

physical and cognitive deficit.

• Focus: developing independence for placement (not always home)

• potential for unpredictable behaviour and aggression within this unit

Orthopaedic, Amputee and Burns rehabilitation unit–(OABRU, 2A)• specialist inpatient rehabilitation service for people following orthopaedic

surgery (trauma or joint replacement), amputation or burns• assists with the provision of prosthetic limbs. • focuses on assisting optimum level of functioning post surgery or injury &

assists with developing independent living skills

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Stroke rehabilitation unit–(Ward 1C )• post CVA and also those

with neurological deficits, Guillain-Barre syndrome, Multiple Sclerosis, or people who are deconditioned after surgery etc.

• focuses on assessing and developing independence as well as assisting clients to relearn or find new ways of doing activities or functions lost as a result of the Stroke

General rehabilitation unit–(Ward 1D)• general medical rehabilitation with diverse group of clientele • No set age range for admission, ages have ranged from 30 – 90. • Most clientele come present with multiple complex co-morbidities. • Predominant nursing issues are as diverse as the client group.

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State-wide rehabilitation service plan 2009 - 2017

Integrated inpatient, outpatient and ambulatory services. HRC = HUB in hub and spoke model

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PAST

FUTURE

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Your Role

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> Understand what is expected of you as an AiN

• Familiarise yourself with your job and person specifications

• Understand exactly which duties come under the remit of the AiN

• Understand the core values and philosophies of rehabilitation services

> Know where you can get help if needed

Your role

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> Your job specification outlines the expectations for you as an AiN. Read all of this and become familiar with it

> Carry it to work with you, at least to begin with. • You cannot assume that others will always know

what you can and cant do • You need to be sure you are performing within

your scope of practice.

Your role – job specification

Your role – in a nutshell To provide routine care as delegated and supervised by the RN and perform tasks

• Considered standard and unchanging• With expected predictable results • With minimal potential for risk

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The Assistant in Nursing:

> Reports to the Nurse Clinical Services Coordinators ( CSC / Level 3) on a ward level and the Nurse Management Facilitators form an administrative focus ( NMF / Level 3)

> Works under the direct supervision of a Registered Nurse

> Works with workplace supervisor or preceptor

> Maintains cooperative and productive working relationships within all members of the health care team

Reporting/Working Relationships

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The adoption of this new role may hold challenges for you:

> Confusion about your role > Feelings of inadequacy or “just not

coping”> Pressure from University and

working commitments may build-up> Adoption of the role may take time> Expectations from clinical staff may

be foreign to your experiences…

Support Systems

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Support Systems

There are a number of alternatives for support open to you:

> Peer support from other AiN’s within rehabilitation services > Support from the ward preceptors / mentors> Support from your ward L2 nurses and the CSC for clinical issues or staff issues> Support from the AiN Program Coordinator for some issues & debriefing > The Nurse Management Facilitators ( available on all shift but predominantly after hours> The staff development consultant

The RAH endorses a respectful behaviours framework for all employees and service users.

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Employee Assistance Program – RAH

· Access-OCAR

45 Wakefield Street Adelaide SA 5000  

ph: 1300 667 700 (free call)

· Converge

174 Pulteney Street Adelaide SA 5000

ph: 1800 337 068 (free call)

More information available: http://intra.sahs.sa.gov.au/sahs/our_organisation/adelaide_health_service/eap.jsp

Support Systems

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Things you should know

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> Know the

> emergency procedures & roles:

• Emergency assistance

Code Black

Know where the emergency trolley & equipment is on any ward you work in

Know where the emergency trolley & equipment is on any ward you work in

All emergencies

In a calm rationale way state• nature and location of the

emergency• who you are• answer any specific

questions

Emergencies

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Consider your

> Personal security

• Wear identification at all times• Walking grounds / parking etc.• Security of belongings

Personal equipment & accessories Car safety

> Security of the workplace

• Security of keys etc.• Report concerns / unusual events• Personal Protective equipment

Security

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Consider your

> Client safety

• Clients personal equipment & accessories

• HRC / ST Margaret's Equipment – report issues or potentially unsafe equipment

• SLS reporting : Cleints, staff and near miss or hazards

• Client Confidentiality • Report concerns or unusual

events

Security

Patient risk assessment (i.e. falls, pressure injury, general risk factors in a rehabilitation environment )

Address issues and SPEAK UP IF CONCERNED

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> Please make sure you wear full uniform

> Present to work every day: clean and with a tidy appearance

> Hair should be pulled back

> No earrings, rings jewellery – why? (wedding rings allowed)

> Please make sure you wear your identification badge.

Uniform code

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> Never use or carry your mobile phone when in active client based care provision. It is like any other personal item or activity, it should only be used on allocated breaks

No Mobile Phones!

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If you wish to arrange parking payment options – please see Haile Elkins - 82221643.

If parking on site in an ad hoc way you have the option of paying > daily rate (up to $13 day) > or a weekly pass ($38 p/week).

> weekly tickets available from auto pay stations.

The user presses the information button and the control room will talk them through the process.

Parking Arrangements

Contracted hours Fortnightly deductions Pre-tax Post tax deduction

0-25 per fortnight $6.69 $7.36

More than 25 less than 48 per fortnight

$12.95 $14.22

More than 48 per fortnight $19.63 $21.59

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Please:

> Be punctual

> Arrive with enough time to ensure you are ready to work from the shift start time

> to and from breaks > (reputations are easily gained / lost in a workplace)

> Always let someone know if you need to leave the ward (communicate)

> Call in to report you will be off if you are sick or have personal issues that prevent you from coming to work

Professionalism

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HRC supports partnering with consumers

• Safety • Comfort• Dignity• Respect • Choice• Advocacy • Client centered approaches • Quality best practice care provision • Admission to discharge • Focus on factors that are central to

ensuring a positive outcome for the client• OWI (Organization wide instruction)

A rehabilitation framework. While on shift at HRC

The patient comes first

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The RAH HRC has policy and procedure or OWI’s to guide all of the common processes within the organisation.

This allows for > Consistency> Evaluation of care and processes within the organisation> Guidance to new and existing staff’> risk of missing important things> Quality service for all

Your care

provision

OWI – what is it, why is it there?

If you would like to have a look, ask the staff to advise you on location in the first instance . It can be tricky manoeuvring around the intranet

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As this is a rehabilitation setting there may be “extra” things to consider

• Independence• Self care• Optimal functioning• Client Choice and participation• Multidisciplinary teams• Assessment of functioning • Risk management • The clients perspectives• least restrictive options / promote

“normalisation”• Liaison, networking, referral and other

services• Breaking down stigma and discrimination• Different ways of caring

What about rehab?

The Client

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What is a multidisciplinary team?

A group of professionals working together for the common good of the client.

The team may consist of any relevant professional who has important input that will benefit the client’s current treatment and future wellbeing.

Multidisciplinary teams can have varied membership but may include

Medical officer PsychiatristNursing staff Special therapistPsychologist Speech pathologistSocial worker Case managerOccupational therapist Dietician Physiotherapist

Multidisciplinary team approaches

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The goals of rehabilitation nursing are

(Australasian Rehabilitation Nurses’ Association, 2002)

Rehabilitation Nursing

• the maximisation of self-determination;• the restoration of function; and• the optimisation of lifestyle choices for their clients.

Tell me in your own words what this means to you?

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Rehabilitation Nursing Professional body for Rehabilitation Nursing in Australia

ARNA : Australasian Rehabilitation Nurses

Association Inc

http://www.arna.com.au/

=

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Important considerations !

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The checklist

We need evidence of your successful completion of Basic Life supportMedication CompetenciesManual Handling.

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> To work to your relevant scope of practice> To work within the professional guidelines of your

profession - if you are unaware of these – please ask! > To provide safe and efficient quality care for patients> To seek support and assistance if unable to meet clinical

requirements> To provide a physically safe and culturally sensitive

environment for consumers and staff> To observe and communicate respectfully within the team

and others> To work ethically and safely> To respect therapeutic relationships and professional

boundaries at all times- if you are unaware of these – please ask!

The role of the staff member at HRC

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Just a reminder …

> Your scope of practice is different to others on the unit

Don’t let others coerce you into doing things that are outside your scope

Don’t fall into a false sense of security that you can do things outside your scope and “it will be okay” or “I was helping out on a busy day” or that you won’t get caught out

It could end your career before you begin

Using this time wisely

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Any questions

For your attention