Focus of Rehabilitation
Disability can occur at any age and may result from an acute in-cident, such as stroke or trauma, or from the progression of a chronic condition, such as arthritis or multiple sclerosis. A per-son with disability experiences many losses, including loss of function, independence, social role, status, and income. A patient and his or her family members experience a range of emotional reactions to these losses. The reactions may progress from disor-ganization and confusion to denial of the disability, grief over the lost function or body part, depression, anger, and, finally, accep-tance of the disability. The reactions may subside over time and may recur at a later time, especially if chronic illness is progres-sive and results in increasing losses. Not all patients experience all of the stages, although most do exhibit grief. Patients who exhibit grief should not be blithely encouraged to “cheer up.” The nurse should show a willingness to listen to the patient talk about the disability and should understand that grief, anger, regret, and re-sentment are all part of the healing process. See the accompany-ing Gerontologic Considerations box for concerns unique to older adults.
The patient’s preexisting coping abilities play an important role in the adaptation process: one patient may be particularly in-dependent and determined, while another may be dependent and seem to lack personal power. One goal of rehabilitation is to help the patient gain a positive self-image through effective coping. The nurse must recognize different coping abilities and identify when the patient is not coping well or not adjusting to the dis-ability (Nursing Research Profile 11-1). The patient and family may benefit from participating in a support group or talking with a mental health professional to achieve this goal.
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