Can Rehabilitation have a Negative Impact?

If experiencing sudden or gradual loss of functions and becoming increasingly disabled, most people will need individually adapted support, as well as help to deal with the consequences their disability entails.

In this case, rehabilitation is an important and very crucial factor in the effort to preserve, develop, and restore previous or new functions so that the individual client achieves or regains the greatest possible independence, equality, and meaningfulness in everyday life.

For precisely these positive reasons, rehabilitation has gained increasing acceptance in the health and care sector and is incorporated into many everyday care tasks.

Purpose of Rehabilitation

In practice, the increased focus on rehabilitation means that, when the need arises, a collaborative process is started between a client, relatives, and care providers. The purpose of the process is, as stated, to enable the client to maintain as much independence as possible.

The rehabilitative efforts also help to ensure that we, as a society, have the resources to support everyone who has a need, by preserving as much of the client's independence as possible, and thus ensuring that the client needs less help from public healthcare service providers in the long run.

An example of a classic rehabilitation course could be a client who, due to wear and tear on his hips, can no longer put on socks himself. With rehabilitation and training in using an appropriate aid, the aim is to allow the client to regain the ability to perform the task independently, allowing staff to use the saved time elsewhere. Meanwhile, the client becomes more independent of outside help which increases their quality of life.

Rehabilitation also has a third purpose, namely, to protect the working environment of nursing and health personnel. The more the client can do independently, the more he or she can assist, and the less straining a given task such as patient transfer is for caregivers. We often hear this referred to as utilizing the client's functions.

In this way, there are many benefits to rehabilitation. However, in the efforts to make clients as independent as possible, challenges often arise as the increased focus on rehabilitation can have negative consequences for both staff and the client or patient.

Rehabilitation for Better or Worse

Today, rehabilitation is such a widespread concept that it is intertwined in the vast majority of care situations. This is called ‘everyday rehabilitation’ - where the client must utilize his or her own functions to cope with everyday activities and can incorporate everything from toilet visits to cooking lunch or turning over in bed.

Very often, this type of rehabilitation has to fit into a daily routine that is already filled with other demanding care tasks. In this way, rehabilitation becomes just another task for carers to perform.

In some cases, everyday rehabilitation can have negative consequences for clients in the form of a lack of energy and depleted energy levels. To illustrate this, I will bring a new example into play; A client, who has had a blood clot in the brain and has been paralysed on one side, is quickly exhausted due to the cognitive damage, and the paralysis has made it difficult to turn over in bed. The rehabilitative efforts, therefore, focus on the client being able to turn over with the help of friction-reducing aids such as slide sheets.

The consequence for the client may, in this case, be that when the transfer is complete, the client has used up their energy for the day, and do not have the energy to train other skills, to participate in their other therapy programs, or to be social with relatives.

Simultaneously, because everyday rehabilitation does not have a set time on its own, staff might sometimes need to skip it at times when they are very busy. This can consequently result in the client losing his remaining functions more quickly as the rehabilitative effort is not performed routinely.

Staff Faced with Dilemma

Recent year’s increased focus on rehabilitation can also have consequences for the staff. 

Continuing with the example above, the client is provided with aids based on the fact that he or she must participate when being turned and transferred in bed. But the client has had a bad night and has not been able to sleep.

This means that the client cannot actively participate when being turned, and the staff is therefore in a situation where they have to turn the client over on the side without having the right aids available. This puts staff in an ethical dilemma, where they are forced to choose between their own work health and safety and the client's rehabilitation.

In practice, however, it can be difficult for the staff in the specific situation either to not perform a care task or to have to insist and demand participation from the client that he or she does not have the energy to deliver. This also risks damaging the relationship between staff and client.

As such, even though rehabilitation is of great importance, it can result in negative consequences for caregivers and clients. To overcome this challenge, it is important to evaluate whether rehabilitation should be incorporated into the client’s daily routine or if it should be reserved for other times. This is up to an individual evaluation of the client’s functions, energy and resources as well as the caregiver’s work health and safety.