Psychiatric Rehabilitation
Psychiatric Rehabilitation
Psychiatric Rehabilitation
INTRODUCTION
Psychiatric rehabilitation program is a service designed to teach or restore
skills necessary for recovery from mental illness. This program offers group and
individual services for those who have experienced multiple serious episodes of
mental illness. The services focus on psychosocial support, healthy living
practices, residential support, community activities, medication management and
teamwork. Many patients report improved symptom management and better life
skills after participation in the PRP Program.
The difficulties with living with a longer-term mental health problem can mean
that you can't be discharged home, but you may have to spend some time in a
specialist rehabilitation service.
The service will try to help patient recover, while accepting that he or she may still
have serious difficulties which need continuing help and support.
Inpatient rehabilitation
Community rehabilitation
. These services support people who have made the move from a rehabilitation
unit to some form of supported accommodation, but who require ongoing
support with their day-to-day lives, both social and personal.
The community rehabilitation team can give more specialised support than the
more general community mental health teams.
The team will continue the work of the rehabilitation unit. They will work with
patient to update your care plan and make sure that it progresses. They will
support him or her with managing medication, looking after the patient home,
and doing any activities the patient may want to get involved with,
The team will involve the patient carer(s) or family (if appropriate) to help them
have the understanding and support the patient need.
Each designed to address specific ranges of issues. What they all have in
common is their primary goals: To help individuals recover from illness, injury,
surgery, stroke, cardiac events or other medical issues and regain functional
abilities and independence lost to these events. Here we'll outline
Physical Therapy
This type of rehabilitation therapy works to improve movement dysfunction.
Therapists work with patients to restore movement, strength, stability and/or
functional ability and reduce pain via targeted exercise and a range of other
treatment methods.
Occupational Therapy
Speech Therapy
Respiratory Therapy
Used to aid patients who have breathing disorders or difficulties, this form of
rehabilitation therapy works to help them decrease respiratory distress, maintain
open airways and, when necessary, learn how to use inhalers and supplemental
oxygen properly
Cognitive Rehabilitation
Music Therapy:
address the cognitive, speech/language, physical, and psychosocial needs of a
patient, using Neurologic Music Therapy techniques.
Spasticity Management :
addresses the impairment of one's mobility, positioning, comfort, care and ability
to perform activities of daily living.
Vestibular Therapy:
a form of therapy designed to help patients with complaints of falls, dizziness,
vertigo, sense of imbalance, disequilibrium, motion sensitivity and balance
disorders.
Aquatic Therapy:
combines traditional exercise with the water's buoyancy to enhance and accelerate
the rehabilitation process.
ASSESSMENT OF PATIENT DURING
REHABILITATION
A functional assessment
A resource assessment
Involving the client in the interview means facilitating the client's active
participation in completing each of the tasks that are part of doing a rehabilitation
assessment. Client involvement increases the client's ownership of the
rehabilitation assessment. An important ingredient of the assessment process is the
interpersonal skill of the person conducting the assessment (Anthony, Pierce, &
Cohen, 1980). Several practitioner skills serve to involve the client in the
assessment.
1. Orienting; orienting means that the practitioner describes the task, the
purpose of the task, and the roles of both the practitioner and client.
Reinforcement Surveys
Understanding what “motivates” an individual is a key step in designing
effective rehabilitation treatment. Treatment may require a considerable investment
of the client’s time and energy before its rewards and benefits are fully realized.
This delay can be bridged by providing intermediate rewards at each step, raising
the value of the rewards as more and more steps are successfully accomplished.
Each of the four surveys included in this assortment gathers the information to
identify possible rewards. One is an open-ended questionnaire; the others are
closed-ended rating scales. Each includes a different set of possibly rewarding
objects and activities.
The AIPSS is a role play test of the examinee's cognitive and behavioral
skills to solve interpersonal problems. These are situations between two people in
which one person hinders the other from obtaining a desired goal. The second
person must determine the nature of the problem, decide on some appropriate
solution, and then perform the solution the solution in a socially appropriate and
effective manner.
Most existing instruments lack many of the characteristics that would make
the instrument most useful for psychiatric rehabilitation assessment. Although
increasing numbers of psychiatric assessment instruments are focusing on skill and
resource assessments as opposed to a symptom and pathological focus, these
instruments are still limited in their clinical application. The most obvious
limitation is their lack of environmental specificity.
The rehabilitation staff nurse also performs various roles in the inter-disciplinary
rehabilitation team. The role of the nurse changes based on the specific need of the
patient at the time.
1. Teacher:
a. Shares information about the disease processes underlying disabilities
and teaches nursing techniques to help clients and their families
develop the self-care skills necessary to move toward wellness on the
illness-wellness continuum
b. Prepares clients and their families for future self-management and
decision-making responsibilities by fostering clients' independence
and goal achievement
c. Reinforces the teaching done by specialists in rehabilitation and other
healthcare disciplines, provides resource materials for clients'
changing needs, and provides on-going patient education after
discharge
d. Provides in-service education for healthcare team members and
members of the community regarding the prevention of disabilities
2. Caregiver:
a. Assesses the physical, psychological, sociocultural, and spiritual
dimensions of clients and their families, as well as their educational
and discharge needs in order to formulate nursing diagnoses
b. Plans nursing care while acknowledging that rehabilitation nursing is
practiced within a dynamic, therapeutic, and supportive relationship
that is constantly changing, as nurses and clients influence one
another
c. Implements a plan of care by providing nursing care and education
directly or through ancillary personnel, as needed, to maintain and
restore function and prevent complications and further loss
d. Evaluates the nursing care that is being provided and modifies the
plan, as needed, to achieve measurable goals and objectives
3. Mental Health Counseling:
Because addiction is both a physical and psychological health issue,
substance abuse nurses need training and experience in general medical care
and mental health. They must understand the psychological issues that
contribute to addiction so they can help patients work through these
problems and reduce the risk of relapse.
They must also know what psychological issues arise when patients
attempt to conquer their addictions so they can help patients create strategies
for coping with the impact of starting a new life. For example, patients
sometimes suffer from anxiety, depression, mood swings and even thoughts
of suicide when going through withdrawal from the drug.
4. Collaborator:
a. Develops goals, in collaboration with clients, their families, and the
rehabilitation team, that are oriented to wellness behavior and are
reality based and that encourage socialization with others, and
promote maximal independence for patients with disabilities or
chronic disabling conditions
b. Participates in the interdisciplinary team process at team conferences
and other team meetings and offers input into team decision making
c. Intervenes with team members and other healthcare professionals to
ensure that the optimal opportunity for recovery is made available to
the client, the most significant member of the rehabilitation team
d. Collaborates with team members to achieve cost-effective care by
utilizing appropriate clinical measures to meet emergent physical,
psychosocial, and spiritual situations
5. Physical Care:
Patients going through drug rehab can suffer devastating physical
symptoms such as withdrawal, which is caused by the body's response to
going without a substance it's depended on for so long. During withdrawal,
patients might suffer from everything from nausea and vomiting to
sleeplessness. In addition, patients addicted to painkillers might see a
recurrence of their pain when they cease taking the drug.
Substance abuse nurses must be prepared for these physical effects,
and must administer treatments to ease the symptoms so patients can
concentrate on breaking their addictions. The physical effects are sometimes
so severe that patients return to drugs to ease the discomfort, something
nurses can help prevent by helping them manage their symptoms.
6. Patient Education:
7. Client Advocate:
a. Actively listens, reflects, and guides clients and their families through
the stages of the grieving process to mourn the loss of abilities and
roles while also "instilling hope"
b. Advocates for policies and services that promote the quality of life for
individuals with disabilities and participates in activities that will
positively influence the community's awareness of disabilities
c. Contributes to a safe and therapeutic environment and supports
activities that promote the clients' return of function and prevent
complications or chronic illness
d. Intervenes on behalf of clients to ensure that medical professionals
and nonmedical professionals work to maximize clients' success when
they return to work or school
PSYCHOEDUCATION
Many individuals who have a mental health condition know little or nothing about
the condition they have been diagnosed with, what they might expect from therapy,
or the positive and negative effects of any medications they may be prescribed.
Literature on these topics given to them by medical professionals may be
confusing or otherwise difficult to comprehend and thus of little help.
Offered in both individual and group formats, psychoeducation can benefit the
individual diagnosed, parents and other family members, and caregivers and
friends. It is not an approach to treatment in itself but represents an important early
step in treatment, as it offers those individuals involved in a person’s care
information on both how to offer support and how to maintain their own emotional
health and overall well-being and provides them with the opportunity to develop a
thorough understanding of the mental health concern(s) affecting their loved one.
Participating in psychoeducation may have a positive impact on quality of life.
USEFULNESS OF PSYCHOEDUCATION
Support
This is one of the basic and most important roles of family members during
rehabilitation. Family members provide emotional, psychological and social
support to patient undergoing rehabilitation programme. Family supports also
help patients deal with issue of self esteem related to their condition. Good family
support also improves the patient’s chances of having a positive oputcome.
Encouragement
This is needed during rehabilitation programme. Family constantly
encourages the patient in their rehabilitation programmes. They encourage them
to go for their rehabilitation therapy, encourage them to use their medication,
encourage them to visit their rehab centres etc.
Positive attitudes.
Another role of family members is to be a source of positive attitude to the
client. This will serve as an inspiration. It will inspire patients’ commitment to
recovery and help them adapt to new physical challenges or limitation
Working and in hand with professionals
Educators
In some cases, families have become especially knowledgeable and may even
know more than many professionals, particularly about the aspects of their own
relative’s illness. This knowledge is an important resource in the rehabilitation
process. For example, they know their family member’s reaction to life stresses,
strengths and weaknesses and reactions to the illness and to the interventions of
the mental health system. This family knowledge is an important addition to the
knowledge professionals gain from their experience with their experience with
their client.
Families also need to educate professionals about how they experience the
mental illness of their family member and to confront the negative beliefs some
professionals hold towards families.
However, while playing their roles and caring for their relatives during
rehabilitation, the family members might experience some emotional derailment
like feeling of burden, loneliness, depression etc. hence, a need for them to join
support groups during this course.
REHABILITATION SERVICES
Psychiatric rehabilitation is also known as psychosocial rehabilitation, it
seeks to effect changes in a person's environment and in a person's ability to deal
with his/her environment, so as to facilitate improvement in symptoms or
personal distress and life outcomes. These services often "combine
pharmacologic treatment (often required for program admission), independent
living and social skills training, psychological support to clients and their families,
housing, vocational rehabilitation and employment, social support and network
enhancement and access to leisure activities. Psychiatric rehabilitation promotes
recovery, full community integration, and improved quality of life for persons who
have been diagnosed with any mental health condition that seriously impairs
their ability to lead meaningful lives. Psychiatric rehabilitation services are
collaborative, person-directed and individualised. It promotes recovery, full
community integration, and improved quality of life for persons who have been
diagnosed with any mental health condition that seriously impairs their ability to
lead meaningful lives.
- respect for the client wherever they are in the recovery process.
- emphasizing the importance for the client to develop social support networks.
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- Basic Living Skills (personal hygiene or personal care, preparing and sharing
meals, home and travel safety and skills, goal and life planning,chores and group
decision-making, shopping and appointments)
1. The individual experiences symptoms that meet the diagnostic criteria for a
diagnosis from Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or
International Classification of Diseases (ICD) for psychiatric outpatient treatment
covered by his plan.
Enabling recovery for people with complex mental health needs - a template for
rehabilitation services. Published by the Royal College of Psychiatrists' Faculty of
Rehabilitation and Social Psychiatry, edited by Drs Paul Wolfson, Frank Holloway
and Helen Killaspy.