Rehabilitation in the Acute Setting

This subject is not offered in 2016.

170 hours

Graduate level knowledge of the health care system and professional role consistent with a bachelor program in a health care science. Students enrolling in this subject are highly recommended to be working within the intensive care setting.

For the purposes of considering request for Reasonable Adjustments under the Disability Standards for Education (Cwth 2005), and Student Support and Engagement Policy, academic requirements for this subject are articulated in the Subject Overview, Learning Outcomes, Assessment and Generic Skills sections of this entry.

It is University policy to take all reasonable steps to minimise the impact of disability upon academic study, and reasonable adjustments will be made to enhance a student's participation in the University's programs. Students who feel their disability may impact on meeting the requirements of this subject are encouraged to discuss this matter with a Faculty Student Adviser and Student Equity and Disability Support: http://services.unimelb.edu.au/disability

This online subject provides students with the opportunity to build a deep understanding of the safe and effective application of rehabilitation principles to meet the health needs of individuals with critical illness. Attention is focused primarily on the assessment and rehabilitation of individuals within the intensive care setting and consideration on planning for reintegration back into the community. This subject will provide a problem based approach to enable students with an opportunity to extend their understanding of advanced anatomy, physiology, pathology, assessment and treatment in relation to ICU rehabilitation. The emphasis in this subject is the application of clinical reasoning and evidence-based practice in the safe and effective assessment and rehabilitation of individuals within the intensive care setting and consideration post intensive care on their ongoing management. Consideration will also be given to the rights of individuals and impact of team management processes in providing rehabilitation within the acute setting.

All students will complete four modules within this subject.

All students will complete a Foundational module that will explore anatomy, physiology and pathology which may affect the different body systems in particular the cardiovascular, respiratory and musculoskeletal systems. The implications of impairment in these systems will be considered in conjunction with the monitoring (lines and attachments) that may be seen with individuals who are critically unwell. At the end of this module students will also have an understanding of the legacy of post intensive care syndrome and the burden of survivorship on the physical, cognitive and mental health of survivors and also the impact on the mental health of family.

Students will then choose two from four modules that best meets their learning interests and/or practice needs. These modules are:

1. Rehabilitation in the Intensive Care Setting module comprises the study of non-volitional and volitional rehabilitation strategies including consideration of safety, exercise prescription, delivery methods and evaluation of the program

2. Rehabilitation considerations post intensive care module addresses rehabilitation, exercise prescription, delivery and the evaluation of exercise programs in the ward and community setting.

3. Outcome Measures across the continuum module focuses on outcome measures which can be utilised to measure impairment, activity limitations and participation restriction in line with the International Classification of Functioning framework. Course content will include specific development of the performance and interpretation of measurements and consideration of the clinimetric properties of outcomes.

4. Culture Change and Implementation module covers the analyses of cultural factors that enable and restrict the implementation of rehabilitation in acute settings. Leadership and management theory will be used as a basis for designing and negotiating barriers to implementation of mobility and rehabilitation protocols into acute setting such as intensive and critical care settings.

The final integration module will be completed by all students and will focus on the application of rehabilitation theory to practice with an understanding of the needs of the individual within the ICU and community settings. Students will integrate and apply their learning from the previous three modules into context specific applications. They will select appropriate outcome measures and critically review literature to solve contextually relevant rehabilitation challenges demonstrating in-depth understanding of the complexity of the medical stability of the patient and choice of rehabilitation strategies.

The curriculum is designed around three elements that provide both horizontal and vertical integration throughout the program. These elements are: rehabilitation theory and practice, evidence and innovation and clinical practice in context.

Rehabilitation Theory and Practice:
1. Demonstrate knowledge of the impact of post intensive care syndrome and physiological factors which need to be evaluated to determine the appropriateness to commence rehabilitation
2. Apply knowledge of pathophysiology and anatomy to justify assessment techniques and propose an appropriate and safe physiotherapy management plan for patients who are critically unwell
3. Propose and justify safe and effective physiotherapy interventions to manage patients who are critically unwell
4. Explain and justify the choice of appropriate outcome measures to evaluate the efficacy of rehabilitation interventions provided

Evidence and Innovation
5. Identify, critically appraise and evaluate the current research knowledge in relation to rehabilitation and outcome measurement in the management of the critically unwell
6. Investigate and evaluate new technologies and innovations which can be utilised to enable rehabilitation and measurement of efficacy in individuals who are critically unwell

Clinical Practice in Context
7. Recognise and respond to personal, cultural and environmental factors that can influence the ability to undertake rehabilitation in the ICU setting
8. Reflect on the principles of clinical decision making and integrate knowledge of pathophysiology, anatomy and assessment to individualise rehabilitation within the ICU setting

• Contribution to online discussions throughout term, 10%
• Critical Appraisal assignment – 1,000 words due week 3, 20%
• Reflective portfolio – 1,500 words due week 8, 20%
• Written assignment – 2,000 words due week 9, 50%

Students will have access to electronic copies of prescribed readings.

The following texts are also essential for this subject.
Stevens RD, Hart N, Herridge (2014): Textbook of Post-ICU Medicine: The legacy of critical care
Bersten AD and Soni N (2013): Oh’s Intensive Care Manual 7th Edition. Publisher: Butterworth-Heinemann

This subject is not available as a breadth subject.

On completion of this subject students will have had the opportunity to develop the skills associated with:

• Applying knowledge and reasoning skills to complex problems in a range of contexts
• Effective oral and written communication skills
• Inquiry and creative solutions to challenges in their practice context
• Awareness of and appropriate responsiveness to the social and cultural diversity in their practice and ensuring cultural safety for rehabilitation consumers and workers from diverse linguistic and cultural backgrounds
• Self-assurance and confidence in their knowledge, yet flexible, adaptable and aware of their limitations