A registered Nurse will be assigned and dedicated her role to improving the quality of life for the patients. She will assist patients in transitioning from hospital or rehabilitation center to home.
- Assessment and evaluation of patient abilities
- During the first visit, the rehabilitation nurse will assess the patient’s abilities, including:
- Appropriate use of adaptive equipment
- Medication compliance
- Pain management
- Mobility
- Safety
- Self-care and health education
- Individual tolerance for exercise and activity
- Nutrition
- Bowel and bladder management
- After gaining information from this assessment, the nurse will work with to create a care plan that best meets the patient’s individual needs.
- Set goals to achieve the highest level of independence
- Holistic approach to care
- Coordination with physician
- Support for patient and caregivers
- Patient and caregiver education
