ABSTRACT
As part of routine clinical activities there is an expectation that nurses undertake and participate in health promotion/rehabilitation activities. Studies suggest that intervention/strategies aiding recovery are sparse (Jones et al., 2003; Robinson et al., 2006). This intervention should be viewed as an integral part of most care activities rather than as a separate and ‘add on’ activity (Jones et al., 2003). Rehabilitation should start as early as possible, even if it means within the intensive care unit (ICU) (Gutenbrunner et al., 2007). Anecdotal evidence within acute/critical care suggests that health promotional activities are usually limited by their unstructured, haphazard, ad hoc approaches, and are far more likely to be opportunistic and limited to information-giving. This may be influenced by the critical nature of the patient’s history and the perceived lack of time. Today, in most wards discharge planning starts with admission, although this may inevitably become a paper exercise. Although the need for physical rehabilitation is well established substantive evidence to guide rehabilitation services is lacking (Baker and Mansfield, 2008). Health promotion can start before the onset of critical illness (where possible) as some patients undergo planned treatment that will make them acutely or critically ill afterwards. So, pre-planned visits to a critical care unit (by ward nurses) or pre-assessment clinic can provide health promotion opportunities both before and after treatment. Due to the severity of their illness, patients may not have the capacity or desire to be involved in rehabilitation. The nurse must set priorities that place immediate physical and psychological safety above rehabilitation. However, once the patient has passed the ‘critical phase’ of their illness and are assessed as competent (Chapter 41) rehabilitation should begin/resume. Opportunities for health promotion/rehabilitation within critical care exist, but are often missed, possibly resulting in some patients feeling unprepared for discharge to general wards. This particular chapter will discuss rehabilitation in relation to the acutely ill. Particular emphasis is made on creating a culture to enable this to happen. Strategies to help achieve this will also be discussed.
