Where in the World Is Rehabilitation Nursing?
CARF International has been accrediting organizations and programs outside of North America since 1996. One of the great lessons learned was that the field of rehabilitation nursing is alive and well in North America and almost nonexistent in other parts of the world.
The integral part that rehabilitation nursing plays in interdisciplinary rehabilitation may be taken for granted in some organizations. However, when one is exposed to an interdisciplinary model where there is no rehabilitation nursing or it is an intuitive process by some general nurses, it becomes evident that, without this key group, results and the durability of those results become lost. Such is the unfortunate state of many countries that have not been able to see the value of rehabilitation nursing.
The Association of Rehabilitation Nurses has been a member of CARF’s International Advisory Council for a number of years and has shared incredible resources and key individuals from their leadership to assist CARF in our work with international providers (http://www.carf.org/Resources/IACResources/).
In countries that are developing their rehabilitation presence, such as China, the need for multiple levels of training and education is critical. One of the articles in this issue discusses the value of educating Chinese nurses about rehabilitation, demonstrating that knowledge does increase with a structured educational program. In China, the basic nursing education is there, but the emphasis is on technical tasks and the role of the nurse to carry out physician orders. Because of extreme shortages and the values embraced in Chinese culture, families play roles that in Western cultures nurses and nursing assistants would be performing. So, when a rehab nurse is not interacting with that family member, many of the critical components of teaching and follow-through with techniques learned in therapy are missing. The role of the nurse in comparison to physicians and therapists is somewhat diminished because the philosophy and therapeutic approach is not part of their core curriculum. Leadership, autonomy, team building, and assertiveness are not generally taught in nurse’s basic training in China. Thus, introducing core competencies that we use here in the United States requires a paradigm shift that is not always supported by the Chinese health system. The positive aspect of this challenge is that the nurses working in rehabilitation settings are like sponges for new information. They are eager to learn and have more training in the concepts of rehabilitation nursing. However, finding the resources and expertise to make this happen remains a challenge.
Another difference from North America is evident in areas of the Middle East where the work force is extremely diverse. Workers in rehabilitation come from 40 to 50 different countries. Many nurses are recruited from India and the Philippines. The patient population in Middle Eastern facilities may be homogeneous, but the workforce is diverse.