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  1. Camicia, Michelle MSN, CRRN, CCM, NEA-BC, FAHA

Article Content

I have the privilege to lead an amazing team of rehabilitation nurses toward excellence in clinical outcomes and care experience in this era in health care that is focused on accountable care, pay-for-performance, and public reporting of quality outcome data. Every day, I am inspired with what my team has achieved in producing industry-leading results, and I am often asked what contributes to our success. My assessment indicates that it is attributed to how our nursing team embraces their ethical obligation to implement evidence-informed practice. Evidence-informed practice integrates empirical evidence and ways of knowing with what Watson (2009) describes as the "esthetic" or intuitive ways of knowing.


The study of nursing phenomena and the resulting nursing science has evolved tremendously over the past several decades. We now have a body of evidence for practice in preventing catheter-acquired urinary tract infections, hospital-acquired pressure ulcers, falls, and other complications associated with debilitating conditions. This evidence is readily available to nurses through publications such as the Association of Rehabilitation Nurses' (ARN) Rehabilitation Nursing Interventions for Common Challenges: An Evidence-Based Approach (2nd ed.) (ARN, 2017a). This publication includes five essential steps for evidence-based nursing care and highlights 17 common focus areas of rehabilitation nursing, including the available scientific evidence on bowel, bladder, skin management, pain, dysphagia, nutrition, and mobility. In addition, the annual conference of the ARN provides state-of-the-science content to inform rehabilitation nursing practice. Nurses may read quality improvement and research studies published in the Rehabilitation Nursing Journal and receive education from their employer, continuing education programs, and training via professional education.


Rehabilitation nurses have been leaders in producing the evidence for many quality indicators, which has resulted in improved quality of life, the appropriate use of healthcare resources, and reduction of avoidable complications. For example, we know that we must attend to the needs of caregivers in addition to our patients and view the patient in the context of their family system in providing patient- and family-centered care (Bakas et al., 2014). We know that the patient's experience of care is improved when nurses demonstrate authentic caring behaviors (Brewer & Watson, 2015).


The American Nurses Association's (ANA) Code of Ethics for Nurses (ANA, 2015a) articulates what society should expect from nurses and the nursing community with regard to professional practice. This includes Provision 4: "The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care". In addition, nurses are guided by the ANA's Scope and Standards of Practice (ANA, 2015b) in clinical decision-making, which includes Standard 7 (The registered nurse practices ethically) and Standard 13 (The registered nurse integrates evidence and research findings into practice). It is an ethic of nursing to do what is best for the patient. Nursing practice that is informed by evidence fulfills this responsibility. It is a core competency of rehabilitation nurses to "implement nursing and interprofessional interventions based on best evidence to manage the client's disability and/or chronic illness" (Vaughn et al., 2016). According to LaSala (2009), nurses who are morally accountable make informed, reasonable judgments based on what is right, and they act accordingly. In essence, if I know that implementing falls prevention strategies, such as hourly rounding, reduces fall and thus harm to patients, it is my moral imperative to implement such rounds. Nurse leaders must ensure staff have the necessary resources of staffing, education/information, and support to enable evidence-informed practice.


Recently, I witnessed how our professional ethos to share evidence-informed practices with others in the healthcare continuum benefits patient care and clinical outcomes. Rehabilitation nurses have consulted with our nursing colleagues in the acute care setting on how to reduce catheter-acquired urinary tract infections, hospital-acquired pressure ulcers, patient falls, and in providing patient- and family-centered care. They have applied their expertise in helping to establish the plan of care for patients with complex behaviors and have provided consultation on bowel management and other clinical challenges for patients with spinal cord injuries. It is a true joy to witness the attainment of the ARN (2017b) strategic goal to "utilize evidence-based rehabilitation nursing interventions in all levels of the post-acute care continuum." It is an ethical imperative that we contribute to the advancement of health for our communities by striving to achieve the vision of the ARN: "To improve healthcare delivery through the integration of rehabilitation nursing concepts across the continuum of care".


We have many resources available to inform our practice. Thank you for fulfilling your professional responsibility in keeping current with the evidence. I hope you find this edition of Rehabilitation Nursing informative.


Let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but) how can I provide for this right thing to be always done? (Florence Nightingale, Notes on Nursing)




American Nurses Association. (2015a). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application (2nd ed.). Silver Spring, MD: Author. [Context Link]


American Nurses Association. (2015b). Nursing: Scope and standards of practice. Silver Spring, MD: Author. [Context Link]


Association of Rehabilitation Nurses. (2017a). Rehabilitation nursing interventions for common challenges: An evidence-based approach (2nd ed.). Association of Rehabilitation Nurses. [Context Link]


Association of Rehabilitation Nurses. (2017b). The ARN strategic plan. Retreived from http://www.rehabnurse.org/about/content/ARN-Strategic-Plan.html[Context Link]


Bakas T., Clark P. C., Kelly-Hayes M., King R. B., Lutz B. J., & Miller E. L. & American Heart Association Council on Cardiovascular and Stroke Nursing and the Stroke Council. (2014). Evidence for stroke family caregiver and dyad interventions: A statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke, 45(9), 2836-2852. doi:10.1161/str.0000000000000033 [Context Link]


Brewer B. B., & Watson J. (2015). Evaluation of authentic human caring professional practices. Journal of Nursing Administration, 45(12), 622-627. doi:10.1097/nna.0000000000000275 [Context Link]


LaSala C. A. (2009). Moral accountability and integrity in nursing practice. Nursing Clinics of North America, 44(4), 423-434. doi:10.1016/j.cnur.2009.07.006 [Context Link]


Vaughn S., Mauk K. L., Jacelon C. S., Larsen P. D., Rye J., Wintersgill W., [horizontal ellipsis] Dufresne D. (2016). The competency model for professional rehabilitation nursing. Rehabilitation Nursing, 41(1), 33-44. doi:10.1002/rnj.225 [Context Link]


Watson J. (2009). Caring science and human caring theory: Transforming personal and professional practices of nursing and health care. Journal of Health and Human Services Administration, 31(4), 466-482. [Context Link]