1. Rehabilitation evaluation: Comprehensive rehabilitation evaluation is conducted for patients, including physical dysfunction, cognitive impairment, emotional and psychological state, social adaptability, etc. To provide a basis for the follow-up rehabilitation plan.
2. Make a rehabilitation plan: according to the evaluation results, make a personalized rehabilitation plan with rehabilitation doctors, physiotherapists, occupational therapists and speech pathologists.
3. Implement rehabilitation intervention: including but not limited to physical function training, respiratory function training, activities of daily living training, stress nursing, pain management, guidance on the use of assistive devices, cardiopulmonary rehabilitation, nerve rehabilitation, etc.
4. Monitor the progress of the disease: pay close attention to the patient's rehabilitation process, monitor the change of disease symptoms, the degree of functional recovery and possible complications, and adjust the treatment plan in time.
5. Health education and consultation: instruct patients and their families how to carry out daily care, including diet conditioning, wound care, drug management, etc. And provide psychological support and guidance for a healthy lifestyle.
6. Community rehabilitation and continuing care: After the patient is discharged from the hospital, the rehabilitation nurse may also participate in the community rehabilitation work, assist in formulating the family care plan, and ensure that the patient can get effective rehabilitation treatment at home.
7. Cooperation and communication: Cooperate closely with other medical staff, report the patient's rehabilitation progress in time, and ensure the continuity and effectiveness of the whole rehabilitation process.