Chapter 38 Rehabilitation and Restorative Nursing Care

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. Activities of daily living are hard or seem impossible. Some persons cannot work. Others cannot care for children or family.

Disability (cont’d) A disability is any lost, absent, or impaired physical or mental function. Causes are: Acute—short course; recovery is complete. 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. Goals of health care are: Prevent and reduce the degree of disability. Help the person adjust. Review the contents of Box 38-1 on p. 641 in the Textbook. A fracture is an acute problem. The person has a cast and crutches are used until the bone heals. Diabetes and arthritis are chronic health problems. A spinal cord injury is long-term if paralysis results.

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. Another goal is self-care. Improved function is sometimes not possible. 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. A focus on improving abilities promotes function at the highest level of independence. Preventing further loss of function helps the person maintain the best possible quality of life. Review the Focus on Long-Term Care and Home Care: Rehabilitation and Restorative Nursing Care Box on p. 641 in the Textbook.

Restorative Nursing 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 Elimination Positioning Mobility Communication Cognitive function Persons who are weak and cannot perform daily functions need restorative nursing care. With progressive illnesses, the person becomes more and more disabled. Many persons need restorative nursing and rehabilitation. Both focus on the whole person.

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. If there are no state requirements, the agency provides needed training.

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. Complications can cause further disability. Review the Focus on Children and Older Persons: Rehabilitation and the Whole Person Box on p. 641 in the Textbook.

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. Contractures and pressure injuries are prevented. Complications can occur from bedrest, a long illness, or recovery from surgery or injury.

Rehabilitation and the Whole Person (cont’d) The following may be needed: Good alignment, turning, and re-positioning Range-of-motion exercises Supportive devices Good skin care Bladder training Bowel training Assistance with activities of daily living (ADL) Self-help devices Crutches or a walker, cane, or brace Physical and occupational therapies A prosthesis Assistance with nutritional needs Speech therapy and communication devices Mechanical ventilation Some persons need bladder training. The method depends on the person’s problems, abilities, and needs. Some need bowel training. Control of bowel movements and regular elimination are goals. The health team evaluates the person’s ability to perform ADL. The need for self-help devices is considered. Physical and occupational therapies are common for musculo-skeletal and nervous system problems. 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. The person may need a dysphagia diet. When possible, exercises are taught to improve swallowing. Weaning from a ventilator may take many weeks. Some persons learn to live with life-long mechanical ventilation.

Rehabilitation and the Whole Person (cont’d) Psychological and social aspects A disability can affect function and appearance. 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. The person may feel unwhole, useless, unattractive, unclean, or undesirable. 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 the Focus on Communication: Psychological and Social Aspects Box on p. 644 in the Textbook. The person is assessed for work skills, work history, interests, and talents. A job skill may be restored or a new one learned.

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. The team meets often to discuss the person’s progress. The rehabilitation plan is changed as needed. The person and family attend the meetings when possible. Review the measures in Box 38-2 on p. 645 in the Textbook. Review the Focus on Communication: Your Role Box on p. 645 in the Textbook. Review the Teamwork and Time Management: Your Role Box on p. 645 in the Textbook.

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 Rehabilitation begins when the person first needs health care.

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. Review the Focus on Children and Older Persons: Rehabilitation Programs and Services Box on p. 646 in the Textbook. Review the Focus on Long-Term Care and Home Care: Rehabilitation Programs and Services Box on p. 646 in the Textbook.

Quality of Life 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. The goal is independence to the greatest extent possible. A hopeful and winning outlook is needed. Privacy protects dignity and promotes self-respect. Allow and encourage persons to control their lives to the extent possible. Personal choice is important in planning care. No one can shout, scream, or yell at the person. Nor can they call the person names. They cannot hit or strike the person. Unkind remarks are not allowed. Report signs of abuse or mistreatment to the nurse. The nurse can suggest ways to help you control or express your feelings. Provide support and reassurance. Stress the person’s abilities and strengths.