Competency Model for Professional
Rehabilitation Nursing
Behavioral Scenario
for
Competency 1.2: Implement Nursing and Interprofessional
Interventions Based on Best Evidence to Manage the
Client’s Disability and/or Chronic Illness
Rebecca S. Koszalinski PhD, RN, CRRN, CMSRN
Copyright©2015, Association of Rehabilitation Nurses
Competency 1.2: Implement Nursing and Interprofessional
Interventions Based on Best Evidence to Manage the
Client’s Disability and/or Chronic Illness
Description/Scope: Use of evidence-based interventions to
manage common disabilities and chronic illness, such as TBI,
stroke, SCI, amputation, neuromuscular disorders, etc.
Beginner Proficiency
Level Descriptors
Uses established
guidelines to assess an
individual’s function
and health
management needs
Follows an established
plan of care (POC) with
the client and family
Documents responses
to standard
interventions
Copyright©2015, Association of Rehabilitation Nurses
Behavioral Scenario
A nurse enters the room of a patient who is completing his rehabilitation locally
so he can be near his family. He suffered Mild Traumatic Brain Injury (MTBI) in
military service when his jeep flipped and he was thrown. His family members,
who are greatly involved in his plan of care, say that he seems “different”. The
patient is generally cooperative, but is anxious to leave the facility. He also
frequently exhibits impulsive behaviors.
Additionally, his vestibular system is affected so that he
sometimes experiences dizziness. He is identified as a
fall risk in his personalized plan of care. A gait belt is
supposed to be worn at all times (except when
sleeping) and he should always wear non-slip socks
when out of bed. The nurse from the last shift reported
that he was “belligerent”. She adds that the patient
wants to get up to use the restroom instead of using
the urinal hanging on his side rail.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
The nurse introduces himself to the patient as the patient fidgets in his bed.
Suddenly the patient blurts out, “I need to get up right now”. Before the nurse can
respond, the patient throws his blankets off and swings his legs out of the bed. The
nurse quickly steps forward to block the patient as the patient lurches to his feet.
The nurse instinctively grabs the patient’s arm and attempts to steer the patient to
the restroom. However, the patient is not wearing a gait belt or non-slip socks. As a
result of these safety errors, the patient slips and falls to the floor. Further injury
occurs when the nurse tries to pull the patient back to his feet and is subsequently
pulled to the floor. The nurse reports a mild back strain and leaves to have it
examined after the patient is safely back in bed. The plan of care is not updated and
the nurse leaves the facility before completing the required documentation.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
Observations & Outcomes
1. The nurse did not know and did not follow established evidence-based guidelines for working
safely and competently with patients who are fall risks and/or have experienced MTBI. As a result,
both the patient and nurse were at risk for injury.
2. The impacts/consequences of not being proficient include further injury to the patient and a
potential setback in the patient’s progress , which could require additional time and costs. The
nurse could suffer injury, resulting in diagnostic tests, unanticipated time off work and temporary
loss of full pay. The nurse could be disciplined for not being aware of safety measures, using
ineffective communication, poor body mechanics and limited critical thinking skills. Lastly, the
nurse could suffer permanent disability.
3. Steps to achieve beginner proficiency include becoming
aware of resources and guidelines, such as the Agency
for Healthcare Research and Quality (AHRQ) National
Clearinghouse Guidelines, so that the nurse can
anticipate care needs in the rehabilitation population.
Other resources include the individualized plan of
care, supervisors and colleagues.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 - Proficient
The nurse introduces himself to the patient as the patient fidgets in his
bed. As he introduces himself, the nurse assesses the patient and quickly
notes agitation. Suddenly the patient blurts out, “I need to get up right
now!” The nurse is knowledgeable about the Agency for Healthcare
Research and Quality (AHRQ) National Clearinghouse Guidelines for best
practices and so is aware of how to work with a patient with increased fall
risk and MTBI. The nurse continues to speak calmly to the patient while
reaching for the non-slip socks on the side table and the gait belt on the
chair. This action and calm communication provides both clear direction
and reassurance to the patient. Once both safety measures are properly
applied, the nurse skillfully assists the patient to the restroom and the
patient successfully uses the toilet. The nurse then documents the nurseled intervention including the patient’s success. This new information is
added to the individualized plan of care.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 – Proficient
Observations & Outcomes
1.
2.
3.
The behaviors that this nurse is exhibiting display competence, confidence, and proficiency. The nurse sets
limits and provides clear direction for the patient in order to alleviate the patient’s agitation and stress.
The nurse appreciates the report of the patient being “belligerent” but does not simply accept this second
hand assessment. Instead, this nurse looks for the source of his agitation and learns that the patient wants
to void independently and in the restroom. This nurse demonstrates critical thinking and therefore is able
to safely and successfully assist the patient.
The positive outcomes of being proficient include patient safety, patient empowerment and clear nursepatient communication.
The nurse may continue to increase proficiency by engaging in
best practices in the facility and by using insight and creativity to
identify gaps in assessment strategies. The nurse can collaborate
with clients, patients, family and the interprofessional team to
develop a plan of care with attainable rehabilitation goals, and
evaluate and document clients responses to interventions. Lastly,
the nurse can continue to adjust the plan of care as needed for
best outcomes.
Copyright©2015, Association of Rehabilitation Nurses
What Did You Observe?
How did the outcomes of this scenario differ?
Proficient Nurse
- Proactively assessed the
situation
- Safely employed best
practices to maximize
outcome and minimize risk
- Empowered the patient
with calm and clear
communication
Non-Proficient Nurse
- Reacted to the situation
with intuition instead of
insight
- Did not know and did not
use evidence-based best
practices
- Greatly increased risk for
injury to both patient and
nurse
Copyright©2015, Association of Rehabilitation Nurses
Takeaways
1. Evidenced-based practice should strongly inform nursing
practice. For the beginning nurse in particular, the use of
evidenced-based practice helps to increase proficiency
through the development and use of critical thinking skills.
2. Understanding and following the plan of care helps to
ensure that care is consistent and can result in better
outcomes for the patient.
3. Documenting all interventions and patient responses to
those interventions keeps the interprofessional team on
the same page. This can facilitate smoother care
transitions and optimize an individualized plan of care.
Copyright©2015, Association of Rehabilitation Nurses