Chapter 38 Rehabilitation and Restorative Nursing Care Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

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. Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Disability (cont’d)  A disability is any lost, absent, or impaired physical or mental function.  Causes are: Acute—short course; recovery is complete. Acute—short course; recovery is complete. Chronic—long course; problem is controlled–not cured- with treatment. Chronic—long course; problem is controlled–not cured- with treatment.  The person may depend totally or in part on others for basic needs. The degree of disability affects how much function is possible. The degree of disability affects how much function is possible.  Goals of health care are: Prevent and reduce the degree of disability. Prevent and reduce the degree of disability. Help the person adjust. Help the person adjust. Slide 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Rehabilitation  Rehabilitation is the process of restoring the person to his or her highest possible level of physical, psychological, social, and economic function.  The focus is on improving abilities. The goal may be to return to work. The goal may be to return to work. Another goal is self-care. Another goal is self-care.  Improved function is sometimes not possible. Then the goal is to prevent further loss of function. Then the goal is to prevent further loss of function.  Some persons return home after rehabilitation. The process may continue in home or community settings. The process may continue in home or community settings. Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Restorative nursing care is care that helps persons regain health, strength, and independence.  Restorative nursing programs:  Help maintain the highest level of function  Prevent unnecessary decline in function  Involve measures that promote: Self-care Self-care Elimination Elimination Positioning Positioning Mobility Mobility Communication Communication Cognitive function Cognitive function Slide 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Restorative Nursing

Restorative Nursing (cont’d)  A restorative aide is a nursing assistant with special training in restorative nursing and rehabilitation skills.  These aides assist the nursing and health teams as needed.  Required training varies among states. Slide 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Rehabilitation and the Whole Person  A disability has physical, psychological, and social effects.  The person needs to adjust physically, psychologically, socially, and economically.  Abilities are stressed.  Complications are prevented. Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Rehabilitation and the Whole Person (cont’d)  Physical aspects  Rehabilitation starts when the person first seeks health care.  Complications are prevented. Bowel and bladder problems are prevented. Bowel and bladder problems are prevented. Contractures and pressure ulcers are prevented. Contractures and pressure ulcers are prevented. Slide 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 The following may be needed: Good alignment, turning, and re-positioning Good alignment, turning, and re-positioning Range-of-motion exercises Range-of-motion exercises Supportive devices Supportive devices Good skin care Good skin care Bladder training Bladder training Bowel training Bowel training Assistance with activities of daily living (ADL) Assistance with activities of daily living (ADL) Self-help devices Self-help devices Crutches or a walker, cane, or brace Crutches or a walker, cane, or brace Physical and occupational therapies Physical and occupational therapies A prosthesis A prosthesis Assistance with nutritional needs Assistance with nutritional needs Speech therapy and communication devices Speech therapy and communication devices Mechanical ventilation Mechanical ventilation Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Rehabilitation and the Whole Person (cont’d)

 Psychological and social aspects  A disability can affect function and appearance. Self-esteem and relationships may suffer. Self-esteem and relationships may suffer.  The person may deny the disability.  The person may expect therapy to correct the problem.  Successful rehabilitation depends on the person’s attitude.  The focus is on abilities and strengths.  Psychological and social needs are part of the care plan.  Spiritual support helps some persons.  Economic aspects  The goal is for the person to become gainfully employed. Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Rehabilitation and the Whole Person (cont’d)

The Rehabilitation Team  Rehabilitation is a team effort.  The person is the key team member.  The family, doctor, and nursing and health teams help the person set goals and plan care.  The focus is on regaining function and independence.  Families provide support and encouragement.  Often, they help with home care.  Your job focuses on promoting the person’s independence.  Preventing decline in function also is a goal. Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Rehabilitation Programs and Services  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 Slide 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Rehabilitation Programs and Services (cont’d)  The rehabilitation process may continue after hospital discharge.  The person may transfer to a nursing center or to a rehabilitation agency.  Home care agencies, some assisted living residences, and some adult day-care centers also provide rehabilitation services. Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Successful rehabilitation and restorative care improve quality of life.  The more the person can do alone, the better his or her quality of life. To promote quality of life:  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. Slide 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Quality of Life