Competency Model for Professional Rehabilitation Nursing

1. Competency Model for Professional Rehabilitation Nursing Behavioral Scenario for Competency 1.1: Use Supportive Technology for Improving Quality of Life for Persons with Disability. Rebecca S. Koszalinski, PhD, RN, CRRN, CMSRN

2. Competency 1.1 Use Supportive Technology for Improving Quality of Life for Persons with Disability Description/Scope: Use of appropriate technology that improves self-management in Persons with Disability and/or Chronic Illness Beginner Proficiency Level Descriptors

3. Behavioral Scenario A nurse enters a patient room to administer medications and quickly notices that the patient is in distress. Due to tremor, the patient requires an assistive high technology spoon to eat. She is having difficulty placing the spoon securely in her hand. The nurse watches the patient repeatedly pick up the spoon, try to place it in her hand and then drop it to the tray. The patient is clearly frustrated.

4. Path 1 – Not Proficient • The nurse continues to watch out of the corner of her eye as she prepares medications. She approaches the patient and follows the rights of medication administration. Then, she administers the medications to the patient. The nurse walks back to her cart and quickly documents the medication pass. She pauses for a moment at the door and asks if the patient is done with her tray. The patient looks up with tears in her eyes and asks for assistance. The nurse states, “Sorry, I don’t know how to use that spoon. I could send in an aide or you could wait until your therapist comes to your room. Just do what you can until then.” The nurse turns and leaves before the patient can respond.

5. Path 1 – Not Proficient Observations & Outcomes • The nurse is proficient in noting that the patient is not able to properly place the spoon. The nurse is also proficient in conducting a proper medication pass. However, the nurse is not proficient in using the patient’s high-tech assistive technology. The patient is unable to eat her lunch and is told to wait for someone else to help. This may result in the patient not meeting nutritional needs for the day. • Understanding how to use technology is integral to quality care in the rehabilitation population. Patients are encouraged to challenge themselves so that they may reach the highest level of rehabilitation possible for each person. Technology may be used to enhance patient rehabilitation. The consequences of failing to learn how to use patient assistive technology is that the patients may not be able to reach their highest level of desired rehabilitation. It also supports a pervasive continuation of nursing knowledge deficit regarding patient needs. This patient should be nurtured in her efforts to feed herself. • The nurse should learn how to use patient assistive technology proficiently so that the patient’s needs are met. This can be done by working with the patient and therapists to provide optimal support.

6. Path 2 - Proficient • The nurse continues to watch out of the corner of her eye as she prepares medications. She approaches the patient and follows the rights of medication administration. Then, she administers the medications to the patient. The nurse walks back to her cart and quickly documents the medication pass. She pauses for a moment and states, “You are really having trouble with that spoon. Could I help?” The patient looks up with tears in her eyes and says, “Yes, please. The therapist showed me how but I can’t make it work.” The nurse states, “Ok, I am not really familiar with this particular supportive technology so I’d like you to tell me what you know about it.” The patient states that the therapist also left some information about how the spoon stabilizes tremor and a link to a short video.

7. Path 2 - Proficient • The nurse pulls a chair near the patient so she can sit at the patient’s level and says, “Let’s look at the information, pull up the video and see if we can figure this out.” Once they have discovered how to use the assistive technology, they briefly discuss the patient’s care plan and all other needs the patient has for that shift. At the end of the conversation, the nurse states she will check in regularly and leaves to document the outcome of the nurse led intervention using assistive technology.

8. Path 2 – ProficientObservations & Outcomes • The nurse is exhibiting the use of technology in the plan of care, is demonstrating competent use of technology in the care of a patient and is documenting the outcomes of using a supportive technology nurse-led intervention. • Positive outcomes include meeting the patient’s dietary needs and assistance in the use of supportive technology. The patient is also recognized as a unique and caring individual, is able to participate in the care plan and may feel empowered. The nurse is more aware of how to best care for the patient. • In order to increase proficiency levels, the nurse can continue to assess and anticipate the patient’s needs for supportive technology, establish goals with the inter-professional team for the use of technology in the plan of care, tailor the technology to the needs of the patient, and continue to evaluate the effectiveness of the supportive technology.

9. What Did You Observe? How did the outcomes of this scenario differ?

10. Takeaways • The new nurse should embrace technology for the benefit of the patient. This will impact the patient through meeting her needs. It will also impact the team as important information is shared with other nurses and team members so that optimal care is provided. • The patient may require additional assistance in using supportive technology. Supporting her may result in a more positive healing experience and increased likelihood that the patient will continue to use the supportive technology after discharge. • Transition of care may be better facilitated when everyone on the care team is aware of patient needs and preferences.