Community Based Rehabilitation (CBR)

Part 1
The portfolio will discuss on Community Based Rehabilitation (CBR) as a service which is offered by Western Health. The portfolio also explains the roles and responsibilities of the nurses in Community Based Rehabilitation settings and explains how the preceptor nurse prepares, support and empower patients, family members and the carers. It will also discuss how preceptor nurse prepare students for professional skills and knowledge development.
Community Based Rehabilitation in Western Health Hospital aims to help clients and their carers to meet their maximum potential, self care management and independence. They provide an individualized, goal oriented, short term, therapy program and they emphasis on self management and patient education. The therapy program is provided to individual/group or both depending on the therapy sessions established goals. Rehabilitation is done at hospital or at home but in most cases the procedures are performed in the centre. This program is free and interpreters are always available when required. It is offered to clients who require rehabilitation for:
● Neurological conditions such as stroke, epilepsy
● Musculoskeletal conditions.
● Clients who are falling or have a high risk of falling.
● Age related changes where there has been a significant acute change in function.
● Chronic pain which focuses on self care management.
● Alcohol withdrawal
Western Health Community Based Rehabilitation is offered in two locations Sunshine hospital and The Williamstown hospital (Artefact1) where clients are required to go to the nearest location. They open on Monday to Thursday from 8AM to 6PM and on Friday they open from 8AM to 4.30pm. Clients who have been referred to Community Based Rehabilitation services, their referrals should include the following
● Patient details such as address date of birth and contact phone numbers.
● The reason for referral.
● Relevant past clinical details for the client.
● List of medication that the client is currently taking.
● Any risks to clients or staff.
● Contact details for the person who wrote the referral.
When the referral is received by any of the hospital staff, he or she is supposed to contact the client to organize on their first appointment or discuss a more convince service to meet the client’s needs.
Part 2
The main objective of a nurse is to help individuals with a disability and/or chronic illness to get and maintain a maximum function. Their role is to help the client to readjust to a modified lifestyle and at the same time provide a therapeutic environment for clients, their families and their carers development.
Rehabilitation staff nurse design and implement treatment strategies that are based on scientific nursing theory in relation to self care and that promote physical, psychosocial, and spiritual health. They work with inpatient and outpatient settings that can be found in an extent of acute to sub acute rehabilitation facilities.
CBR nurses shares information concerning the client condition and teach the nursing techniques in order to help clients and their families develop the self care management skills which are required to move toward wellness on the illness wellness continuum. They also act as a resource and a role model for nursing staff and students and are involved in activities such as nursing committees and professional organizations that advocate the advancement of nursing care and the development of professional skills and knowledge for rehabilitation nursing.
Community nurses assist clients in performing the recommended exercises that may help them to improve their conditions and give instruction to the students on how to help the patients who are not able to perform their exercises.
Nutrition is vital when it comes to patient’s recovery. Working with patients to increase their knowledge of nutrition and access to healthy foods provides better nutrition care which directly improves patients’ outcomes after hospital stays (Jess, 2016).
In medical settings, patient safety is a major concern. There has been an increase in the number of individuals seeking for rehabilitative care for their medical conditions or they are referred to rehabilitation specialists with increasingly complex medical conditions. The issue of patient safety in the rehabilitation setting takes on added importance. Therefore, patient safety, cognitive biases, systems thinking, and quality improvement must be applied to the rehabilitation medicine.
The care provided by rehabilitation professionals is usually safe, but unfortunate events do happen. Some of the frequent antagonist events such as fall related event, pain and soreness associated with muscle injury, infection due to medical care ,wound infection, decubitus ulcer, hospital acquired pneumonia are the most commonly seen in the clinical practices. For efficiency delivery of therapeutic measures with rehabilitative and health care services a system that both prevents error from occurring is most important while considering for time sensitive and result oriented improvement of the disability associated with specific disease.
Western Health introduced the Nintendo Wii in Williamstown and Sunshine hospitals for patient rehabilitation. The Nintendo Wii technology is used as a therapeutic technique to challenge patients’ physical, cognitive and visual recovery (Vic, 2016).
Community Therapy Services available in Western hospital include:
● Allied Health Assistants
● Clinical psychology
● Community Integration and Leisure
● Dietetics
● Hydrotherapy
● Neuropsychology
● Nursing
● Occupational Therapy
● Physiotherapy
● Podiatry
● Rehabilitation Consultant
● Social Work
● Speech Pathology
The rehabilitation personnel include physiotherapists, occupational therapists, speech therapists, audiologists, mobility trainers, prosthetists or orthotists, medical and paramedical personnel. Their main focus is on how they can be of benefit to people with different impairments. CBR personnel must understand their role and responsibilities in order to deliver great services and meet clients’ needs.
Therapist usually treats clients at the Centre but limited therapies are performed at home or they can be combined. The length of the Community Based Rehabilitation is discussed between the professional, client, relatives and carers. This depends on the client’s goals and capability.
Community Based Rehabilitation tends to promote, support and implement rehabilitation activities at the community level and promote referrals for clients in order to access more specialized rehabilitation services.
Preceptor nurses provide support and assistance to the patient on how to utilise the new skills and knowledge at home and in the community after he or she returns. They also visit the clients at home and encouraging them to continue rehabilitation activities as required.
The preceptor nurse assesses the client and his or her family on some basic information before planning for rehabilitation and starting activities. This helps to determine the needs and priorities for the client. They also review client past medical records, observing the individual, perform a basic physical examination of the individual and through discussions with the individual, family members and involved health professionals or services helps to obtain accurate information.
Community Based Rehabilitation preceptor is responsible in linking up individuals with a self help group who shares the same similarities. These groups help the clients to share ideas and information between themselves and the professionals which encourage mutual understanding and collaboration.
Nursing students are prepared to provide nursing care disregarding of the patient’s illness. Preceptor nurse provides education, such as clinical placements, strengthen knowledge and skills in mental health nursing students and new staffs. They act as a role model and assist in professional skills and knowledge development.
CBR nurses distribute booklets and manuals to the clients, relatives and carers depending on their condition. These resources provide valuable information for the wider community as well as the many different services and sectors involved in rehabilitation activities (Khasnabis, C., Heinicke, K. , Achu K, & et Al, 2010).
The preceptor nurse builds basic skills, address mobility issues, provide training to the clients and relatives in order to reduce safety risks in moving freely from place to place especially to patients who have falling problem, provide the necessary tools to client, provide communication devices, advocating for reasonable accessibility, and empower the client to advocate for themselves.
Nurses are responsible in determining the interests and needs, developing social skills and friendships, advocate for them, educating family members on how to develop their social network and provide assistive technology as needed to reintegrate into society.
The preceptors should respect client, beliefs, values and interests in relation to the world of nature, promoting empathy and relationships to non-human beings (Tahmineh, 2015).
The preceptor nurse is responsible in checking whether the referred client is eligible for Community Based Rehabilitation. They usually check the following details.
● Whether the client is 16 years old and above.
● Whether the client has achieved rehabilitation goals who require short term multidisciplinary team involvement.
● Whether the Client is medically stable.
● Whether the client is consent and motivated in participating in therapy and whether the client is able to understand the nature of service and is able to and agreeable to participate in therapy. They must be able to attend multiple therapy sessions, attend during work hours and access the facilities centres.
● Check whether they Resides in the following catchment areas: Cities of Brimbank, Hobsons Bay & Maribyrnong.
The clinicians check and review clients details to confirm whether they should be treated through Community Based Rehabilitation. The following are the patients who are not eligible in CBR.
● If the client is eligible for funded therapy. If they are qualified for TAC or Work cover or DVA funding for a single discipline only. They are also responsible for checking whether the client reside in HLC or receive services through a high care home care package, if that is the case they recommend private services to the patient.
● Need for equipment or a home modification is determined by the preceptor nurse.
Part 3
The main objective of community health nursing is to support, protect and preserve the health of the public. Community health nursing are involved in promotion of healthy lifestyle, disease prevention and health problems, provision of direct care, educate the community about managing chronic conditions and making healthy choices, evaluate a community’s delivery of patient care and wellness projects, enact health and wellness programs, conduct research in order to improve healthcare (Roden,2016).
Nurses and health professionals works without rest in order to care for their patients in a progressive complicated, inefficient and stressful setting. The design, enticement and the culture on the systems they operate in is not properly coordinated in order to assist them in meeting the client requirements. A healthcare system that promotes learning usually acknowledge a learning healthcare system that acknowledge a decree to focus on the person is one where patients and their families are the main drivers of the learning process design and operation. In case a patient, their families and other careers and the population are entirely involved, this results in an improvement in active care, health care experience and financial results. Both patients and clinicians are required to be involved in complex situations for perfect care. Nurses provide data and guidance depending on their science knowledge and possible results in the treatment and intervention choices. They assist patients in choosing the right therapy program choice. They also involve patients and families in decision making process for their therapy sessions. This helps to reduce pain and discomfort and encourage physical health and emotional health improved.
CRB is also equipped with exercise equipments (Artefact3) where the nurses assist the patients to complete their prescribed exercises. They also involve patients’ families in this process so that they can gain knowledge on how they will be helping them to perform some exercises in the future.
Families play an important role in caring for individuals who require assistance due to illness and/or disability. However, if they are not offered adequate support their own health and wellbeing can be compromised. They are usually given moral support and they are also taught how they will take care of the patient and first and foremost, they are encouraged to take care of themselves especially taking time for resting.
The caregivers also require support and empowerment in order to reduce negative outcomes and maximize the care they provide to the patients. This has received considerable attention in recent policy initiatives since the carers are the one who spends most of the time with the patients (Kristine, Kokorelias, Monique & Jill, 2019).
Community Based Rehabilitation nurses support, prepare and empower clients, their relatives and carers in order to deliver great care to them. Nurses prepares the client, their families and carers for future self care management and decision making responsibilities by promoting clients’ independence and goal achievement.
Patient education has long been deliberated to be a major component of rehabilitation nursing care. Community nurses educate patients, relatives and carers on the condition and the processes that will be involved in the therapy program. They also provide them with handbook, manual or brochure which they can refer to (Artefact4). The relatives and carers are given manual that guide them to help patients once they leave the health facilities such as how they can feed them and prevent choking while swallowing (Artefact5).
Patient centered care correlate with a patient’s ability to undertake personal health maintenance and adhere to complex treatment or therapy regimens. Improvement in patient engagement helps to boost better patient experience, health, and quality of life and better economic outcomes, but in most cases patient and family participation in care decisions is limited and the professionals and nurses mostly makes decisions concerning the patient program. Therefore, patient engagement and interaction with the practitioners is required in order to deliver great Community Based Rehabilitation service. The willingness of the patient helps to boost their recovery and positive response is recorded. Patient and the family members are given options on the therapy program and they are able to choose the one they fill that will benefit them through assistance from the nurses when choosing the therapy program and the session’s arrangement.
Communication is crucial when it comes to delivery of health care services in Community Based Rehabilitation. Nurse keeps communication active between them, patients and their families. This helps them to collect useful information. This helps to motivate patients and can promote certain health behaviors and adherence to treatment regimens by drawing out the patient’s motivation for change (Smith, Saunders, & Stuckhardt, 2013). Through communication preceptor nurse is also able to understand the history of the patient condition and gather information on whether there is someone in the family who has or had the same condition. This helps to determine the cause of the client condition.
Nurses also follow up with the patients once they have completed their therapy program. This helps to determine whether the client requires more sessions from the facility or at home and whether the therapy program was successful. The follow up also helps to support the patient and the family members by showing them that they are not alone in this journey.
Preceptor nurse develops goals, in collaboration with clients, their relatives and carers. These goals are oriented to wellness behavior and are reality based and that encourages socialization with others, and promote maximal independence for patients with disabilities or chronic disabling conditions. They actively listen, reflect, 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. They also act as an intermediary between clients and medical professionals in order to maximize clients’ success when they return to work or school (ARN, 2015).
Community Based Rehabilitation nurses prepares clients and their families for future self care management and decision making responsibilities by fostering clients’ independence and goal achievement. The family members and carers are couched on how they will take care of the patient once their therapy program is completed.
Patients’ recovery process and their response to the recommended and implemented therapy program are boosted by their family members, carers and the nurses. Their engagement helps to understand more about the patients and relatives are also able to gain more knowledge concerning the condition and the program recommended.
Nurses solve conflict and also calm the patient and family members down when they have doubts concerning the procedure and the program. They explain to them the processes that must be followed in Community Based Rehabilitation and the program recommended and to be implemented and how they will be helpful to the patient and the family members. They also ensure that patient safety is kept as the first priority.
In conclusion, family members and carers are very important in ensuring that the patients are able to respond positively to the therapy program which is being conducted and they are able to recover from their conditions. There must be collaboration between the patients, family members and the carers and the Clinicians and the professional health workers.
Part 4
Context and situation
During my time in Sunshine hospital Community Based Rehabilitation, an incident occurred while checking a patient vitals, his respiration was high (30 beat per minute) and the normal range is between 12 and 20 beats per minute, it is referred to as rapid, shallow breathing. This was an emergency case and my first action was to call code where the professionals came and treated him. Before they arrived I requested the patient to take breath, we were doing this together. After the patient was stable, we notified the family about the incident and let them know that he is now steady.
My thoughts, feelings, and concerns
I was tense but I was able to control myself. I felt that I have taken the right professional procedure and I was able to act immediately. My concern is that my preceptor nurse could have been there with me but I felt that she had seen my capability and how I have gained professional skills and I can handle a patient by myself.
Identified areas for professional development
I was able to gain self control skills where I was able to react after the incident rather than freaking out. I was also able to implement my professional skills that I had gained earlier. I developed professional procedures by following the correct process during an emergency incident.
Impact on my future career
The incident helped me to realise that I have Attained my personal and my course objectives. This opened a room for me in Sunshine hospital where I can be recruited. I was also able to showcase my responsibilities and my professional skills and knowledge which will help me to be trusted and relied on by my preceptor nurse, patient and their family.
ARN (2015) What Does A Rehabilitation Staff Nurse Do?
Khasnabis, C. , Heinicke, K. , Achu K, & et Al (2010). Community-Based Rehabilitation: CBR Guidelines. Geneva: the World Health Organization; Rehabilitation.
scoping review
Kristina, M., Monique, A. & Jill, I. (2019) Towards a universal model of family centered care: a scoping review
Jess, W. (2016) Nutrition plays big role in patient outcomes retrieved from
Roden, J. (2016) Australian rural, remote and urban community nurses’ health promotion role and function
Tahmineh, M. (2015) The Role of Community-BasedRehabilitation in Poverty Reduction
Vic (2016) Patients game for rehabilitation retrieved from
Smith, M. Saunders, R. & Stuckhardt, L. (2013) 7 Engaging Patients, Families, and Communities

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