1. Rehabilitation and Restorative Nursing Care
Chapter 41
Rehabilitation and Restorative Nursing Care
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2. Disability Body function can be affected by:
Disease, injury, and surgery
Birth injuries and birth defects
Often more than one function is lost.
Losses are temporary or permanent.
A disability is any lost, absent, or impaired physical or mental function.
An acute problem has a short course.
A chronic problem has a long course.
Activities of daily living (ADL) —the activities usually done during a normal day in a person’s life—can be hard or seem impossible to a person.
Some persons cannot work. Others cannot care for children or family.
With an acute problem, recovery is complete. A fracture is an example of an acute problem.
Chronic problems are controlled—not cured—with treatment. Diabetes and arthritis are chronic health problems.
Review Box 41-1 on p. 636.
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3. Disability (Cont’d) Disabilities are short-term or long-term.
The degree of disability affects how much function is possible.
Goals of health care:
To prevent and reduce the degree of disability
To help the person adjust
Rehabilitation is the process of restoring the person to his or her highest possible level of physical, psychological, social, and economic function.
The focus of rehabilitation is on improving abilities.
When improved function is not possible, the goal is to prevent further loss of function.
The person may depend totally or in part on others for basic needs.
A focus on improving abilities promotes function at the highest level of independence.
Preventing loss of function helps the person maintain the best possible quality of life.
Some nursing center residents have physical disabilities.
Rehabilitation may continue in the home, the community setting, or some persons may require nursing center care.
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4. Restorative Nursing Restorative nursing programs:
Help maintain the highest level of function
Prevent unnecessary decline in function
Many persons need restorative nursing and rehabilitation.
Both focus on the whole person.
A restorative aide is a nursing assistant with special training in restorative nursing and rehabilitation skills.
Required training varies among states.
Restorative nursing care is care that helps persons regain health, strength, and independence.
With progressive illnesses, the person becomes more and more disabled.
Often it is hard to separate restorative nursing and rehabilitation. In many centers, they mean the same thing.
Restorative nursing may involve measures that promote self-care, elimination, positioning, mobility, communication, and cognitive function.
Usually nursing assistants are promoted to restorative aide positions. Those chosen have excellent work ethics, job performance, and skills.
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5. Rehabilitation and the Whole Person
The person needs to adjust physically, psychologically, socially, and economically.
Abilities are stressed.
Complications are prevented.
Rehabilitation takes longer in older persons than in other age groups. Factors include:
Changes from aging affect healing, mobility, vision, hearing, and other functions.
Chronic health problems can slow recovery.
Older persons are at risk for injuries.
Rehabilitation programs for older persons usually are slower paced.
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6. Physical Rehabilitation
Physical aspects
Rehabilitation starts when the person first seeks health care.
Complications are prevented.
The following measures are needed:
Good alignment
Turning and re-positioning
Range-of-motion (ROM) exercises and supportive devices
Good skin care
Complications can occur from bedrest, a long illness, or recovery from surgery or injury.
Bowel and bladder problems are prevented.
Contractures and pressure ulcers are prevented.
Self-help devices are often needed. Equipment is changed, made, or bought to meet the person’s needs.
Physical and occupational therapies are common for musculo-skeletal and nervous system problems. If possible, persons needing wheelchairs learn wheelchair transfers.
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7. Physical Aspects Some persons need bladder training.
Some need bowel training.
Self-care is a major goal.
The health team evaluates the person’s ability to perform activities of daily living (ADL).
Persons may need assistance with:
Mobility
Nutrition/swallowing
Communication
Mechanical ventilation
A prosthesis is an artificial replacement for a missing body part. The goal is for the device to be like the missing body part in function and appearance.
Difficulty swallowing may occur after a stroke. When possible, the person learns exercises to improve swallowing.
Speech therapy and communication devices are helpful.
See Focus on Communication: Communication on p. 638.
Some persons are weaned from the ventilator. Other persons must learn to live with life-long mechanical ventilation (Chapter 25, p. 432).
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8. Psychological, Social, and Economic Aspects
Psychological and social aspects
A disability can affect function and appearance.
Self-esteem and relationships may suffer.
The person may:
Feel unwhole, useless, unattractive, unclean, or undesirable
Deny the disability
Expect therapy to correct the problem
Be depressed, angry, and hostile
Successful rehabilitation depends on the person’s attitude.
The focus is on abilities and strengths.
Spiritual support helps some persons.
Economic aspects are addressed.
The person must accept his or her limits and be motivated.
Despair and frustration are common. Remind persons of their progress. Give support, reassurance, and encouragement.
Review Focus on Communication: Psychological and Social Aspects on p. 639.
Persons are assessed for work skills, work history, interests, and talents. A job skill may be restored or a new one learned. The goal is for the person to become gainfully employed.
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9. The Rehabilitation Team
Rehabilitation is a team effort.
The person is the key team member.
The family, doctor, nursing team, and other health team members help the person set goals and plan care.
Your role
Every part of your job focuses on promoting the person’s independence.
Preventing decline in function also is a goal.
The team meets often. Changes in the rehabilitation plan are made as needed.
The person and family attend the meetings when possible.
Families provide support and encouragement. Often they help with care when the person returns home.
Review Box 41-2 on p. 639.
Review Focus on Communication: Your Role on p. 639.
Review Teamwork and Time Management: Your Role on p. 640.
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10. Rehabilitation Programs and Services
Rehabilitation begins when the person first needs health care.
Common rehabilitation programs include:
Cardiac rehabilitation
Brain injury rehabilitation
Spinal cord rehabilitation
Stroke rehabilitation
Respiratory rehabilitation
Musculo-skeletal rehabilitation
Rehabilitation for complex medical and surgical conditions, including wound care, diabetes, burns, etc.
Home care agencies also provide rehabilitation services. So do some assisted living residences (see Chapter 42) and adult day care centers.
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11. Rehabilitation
The rehabilitation process may continue after the person leaves the hospital.
OBRA requires that nursing centers provide rehabilitation services needed by the person.
The center must provide services required by a person’s comprehensive care plan.
There are agencies for persons who are blind or deaf, have intellectual disabilities (formerly called mental retardation), are physically disabled, have speech problems, are mentally ill, and have problems with substance abuse.
If not provided by center staff, the service is obtained from another source. For example, a center does not have a speech therapist. Instead, the service is obtained from a hospital or other agency.
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12. Quality of Life
Successful rehabilitation and restorative care improve the person’s quality of life.
Promoting quality of life helps the person’s attitude.
The more the person can do alone, the better his or her quality of life.
What you can do:
Protect the right to privacy.
Encourage personal choice.
Protect the right to be free from abuse and mistreatment.
Learn to deal with your anger and frustration.
Encourage activities.
Provide a safe setting.
Show patience, understanding, and sensitivity.
The goal is independence to the greatest extent possible. To promote independence:
Focus on what the person can do.
Offer support and encouragement.
Remain patient. Do not rush the person.
Resist the urge to do things for the person that he or she can do. This hinders the person’s ability to regain function. Remind the family to resist as well.
Encourage the person to use self-help devices as needed.
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