Pediatric rehabilitation nurses play an essential role in the care of children on the Comprehensive Inpatient Rehabilitation Unit (CIRU) at Children’s Healthcare of Atlanta. With a commitment to improve the quality of life for children and adolescents with disabilities, rehab nurses partner with members of an interdisciplinary team of healthcare providers to help children reach their maximum potential.

The patient care delivery system practiced on the CIRU is Relationship Base Care (RBC), which establishes a therapeutic relationship between the rehab nurse, the patient, and the family. With RBC, each patient is assigned a primary rehab nurse on the day of admission. The primary rehab nurse determines and prioritizes the needs of the patient and family in order to establish an individual plan of care.

This plan of care is specific to the needs of the patient and is communicated to other members of the interdisciplinary team. Partners with the primary rehab nurse in the care of the patient can include physical therapists, occupational therapists, speech therapists, music therapists, recreation therapists, child-life specialists, teachers, chaplains, nutritionists, social workers, case managers, respiratory therapists, and especially physicians. 
      

On the CIRU, the primary rehab nurse and interdisciplinary team members conduct weekly meetings to discuss progress with patient goals, patient and caregiver education, length of stay, and patient rehab plans for after discharge. The primary rehab nurse often works in collaboration with other team members on patient and caregiver education.

For example, with bladder management for a wheelchair-bound spinal cord injury patient, the primary rehab nurse partners with the occupational therapist with activities of daily living and positioning, as well as the physical therapist on the wheelchair transfers and positioning. Anticipatory guidance is needed as the child’s developmental needs will change as they grow though life’s stages.

Developmental needs must be addressed both during the hospitalization and in the future. Teens have special activities, such as music group, geared to their interests. Play is an important part of therapy. The primary rehab nurses often read to their patients, play games with their patients, and provide care and comfort at night to promote sleep. Rehab therapy can be very hard work for patients and caregivers. As such, promotion of proper rest for the patient and caregiver is imperative to promote healing and recovery.

Education is incorporated into the daily care based on individual patient needs. Evaluating the caregiver’s emotional readiness and how they learn best plays a major role in the approach to caregiver education. Discharge education is initiated on the day of admission for every patient. To better prepare the caregiver to care for their child at home, upon completion of caregiver education, the primary rehab nurse and interdisciplinary team members conduct “rooming in” time for the caregiver for 24 hours to 48 hours.

During this time, the caregiver demonstrates mastery in providing all patient care needs under the constant supervision and support of the primary rehab nurse and interdisciplinary team.

This important caregiver training validates medication administration, bladder management, bowel management, tube feeding and GT care, tracheotomy care and ventilator care, splint application, patient positioning, and wound care. Caregivers are also able to verbalize signs and symptoms of infection and shock, and manage patient agitation. Patient care during this time is done with medical equipment ordered for the patient’s home after discharge. Examples of this include feeding pumps, suction machines, ventilators, pulse ox monitors, and wound care machines.

On the CIRU, the primary rehab nurse actively participates in several interdisciplinary groups. This promotes collaboration between the primary rehab nurse and members of the therapy team. Two key unit-based committees are the Spinal Cord Committee and the Brain Injury Committee. These two committees have recently accomplished the development of care pathways for pediatric spinal cord injury and pediatric brain injuries, which guide the interdisciplinary care throughout the patient’s admission.

By having these pathways, the primary rehab nurses and therapy team know what each other is working on and can therefore work together to reach goals. For example, when a patient is learning bladder management and how to self-catheterize, the primary rehab nurse and occupational therapist work together to help the patient with the procedure and positioning.

On the CIRU, there is a large emphasis placed on teamwork and on how, as an interdisciplinary team, we can provide the best and most consistent care for our patients. Another key CIRU interdisciplinary team is the Patient Safety & Quality Committee. This unit-based committee provides education and monitoring on patient safety and quality outcomes. In 2008, the CIRU interdisciplinary team exceeded its goal in patient falls, resulting in a 43-percent reduction rate. This accomplishment is a direct result of team collaboration and diligent caregiver education.            
              
To ensure consistency and standardization of care delivery, annual rehabilitation education is given to all members of the interdisciplinary team. Staff education is a vital component on the CIRU. These annual rehab competencies include rehab nursing care, occupational therapy, physical therapy, speech therapy, and respiratory therapy. Another annual staff competency on the CIRU is Crisis Prevention Intervention (CPI).


With this education, team members learn how to best handle an escalation or outburst of an agitated patient. On the CIRU, one of our main admitting diagnoses are traumatic and non-traumatic brain injuries. Patients with these diagnoses can be very agitated, creating safety concerns for themselves and the caregiver. CPI training educates the staff on preventing and minimizing aggressive and disruptive patient behavior.

The Children’s CIRU knows what it takes to rebuild the everyday skills that matter most. We treat and involve the whole family to heal the physical and emotional needs of every child, adolescent, and young adult. Our approach to pediatric rehabilitative therapy focuses on rebuilding skills in as normal a way as possible. Using everyday activities as the basis for therapy is more motivating for the patient, enabling them to work hard and reach their potential.

Our rehabilitation philosophy is to help assure that each child, adolescent, and young adult regains and maintains those important aspects of life. Children’s Healthcare of Atlanta is one of only a few hospitals nationwide that is Commission on Accreditation of Rehabilitation Facilities-certified in pediatric rehabilitation.

As pediatric rehab nurses on the CIRU our success can be measured by stories when our patients return to visit. So many children continue to improve after their inpatient admission. Years later, we may recognize the caregiver, but the children have changed so very much. Many caregivers have shared that the CIRU is a place of hope and miracles. What contributes to this hope is the upbeat and positive attitude of all members of our interdisciplinary team.

Our team rejoices with every small advance, yet we provide a soft shoulder and a warm hug when needed. Caring for our patients involves so much more than physical care. Emotional care is also critical. Together, rehab nurses and therapists promote a healing environment where each child can heal and reach their maximum potential.

— Lisa Richard, RN, is the manager of clinical operations in the Comprehensive Inpatient Rehabilitation Unit at Children's Healthcare of Atlanta. Teryl Ellis, RN, Heather Hammond, RN, Lisa Robertson, RN, and Margaret Williams, RN, are members of Comprehensive Inpatient Rehabilitation Unit. Questions and comments can be directed to editorial@therapytimes.com.