Restorative Care Chapter 21

21-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Restorative Care  Takes place in many types of health care settings. Acute care Home health care Outpatient clinics Long-term care facilities

21-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Restorative Care  Focus is on quality of life.  Return the client to normal functional ability. Adapt activities and lifestyle to resume family and work roles.

21-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Restorative Care  Rehabilitate (two components) To restore to a normal or optimal state of health and constructive activity by medical, physical, and psychological therapy

21-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Rehabilitate  To prepare a disabled or disadvantaged person for employment by vocational counseling or training

21-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Restorative Care  Functional Ability Physical, cognitive,and emotional skills required to perform activities of daily living.

21-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends in Restorative Nursing Care  World War I Need to help disabled veterans readapt their lives and be vocationally productive.

21-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends in Restorative Nursing Care  Social Security Act of 1935 provided restorative services to the American public.  Epidemics of poliomyelitis in1930s and 1940s stimulated study in restorative care.  Sister Kenney, 1941, changed the method of treating polio.

21-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends in Restorative Nursing Care  World War II Antibiotic therapy Long-term rehabilitation Separate veterans’ rehabilitation centers

21-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends in Restorative Nursing Care  Post World War II  Dr. Howard Rusk Civilian rehabilitation programs Importance of good nursing care -Frequent voiding programs -Use of footboards and pillows for positioning

21-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends in Restorative Nursing Care  1960s Research in cardiac rehabilitation Rehabilitation for neurological injuries Rehabilitation nursing recognized as a specialization

21-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Trends in Restorative Nursing Care  1970s Rehabilitation Act of 1973 Americans with Disabilities Act of 1990 Association of Rehabilitation Nurses (ARN)

21-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Classification of Terms  Disability  Impairment  Handicap

21-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Types of Restorative Settings  Home Health Care  Ambulatory Clinics  Transition Hospitals  Acute Care Hospitals  Inpatient Rehabilitation Centers  Subacute Units in Skilled Nursing Long- Term Care Settings

21-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Life Span Considerations in Restorative Care  Nurses must have a clear understanding of the growth and development needs in all age groups in order to deliver effective, compassionate care.

21-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Children  Cerebral palsy  Congenital conditions  Sports injuries, falls, accidents

21-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Young Adults and Middle Age  Common Injuries War injuries Work-related injuries Motor vehicle or recreational accidents  Rehabilitation Recovering functional ability Family and work role adaptations

21-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Late Middle Age and Older Adults  Hospice care  Cardiac rehabilitation  Ambulatory infusion clinics  Asthma or chronic obstructive lung disease

21-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Acuity Level of Restorative Care Clients  Acuity classification Client care continuum from highly dependent on complex nursing care to independent in self-care

21-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Acuity Continuum of Care

21-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. High Technology Advancements and Acuity Level  Increased ability to stabilize critically injured people in the field.  Increased knowledge and use of technology in the intensive care unit.

21-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Aging and Acuity Level  Increasing numbers of people aged 85 and over with two or more comorbidities, which complicate and slow return to previous level of function

21-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Theory and Restorative Care  Orem’s Self-Care Model (1959) Self-esteem Independence Overcoming deficits

21-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Prevent complications of immobility Blood clots Skin ulcers Pneumonia Muscle atrophy Joint contractures  Prevent worsening of functional ability

21-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Promote Optimum Functional Ability Assessment of skills needed for self-care -Factors influencing client’s performance A variety of assistive aids, exercises, and tasks broken into small steps

21-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Use of an assistive aid for out-of-reach items.

21-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Include Client and Family on the Team Conveys respect for the individual. Allows the client to communicate and express personal viewpoints. Fosters understanding between health care providers and the client.

21-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Teach Client Rationale and Skills of Self Care Gives client the knowledge base to perform skills correctly and safely. Allows client to make adjustments in lifestyle. Teaching considers client’s physical as well as cognitive abilities.

21-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  View the Client Holistically Functional abilities Financial resources Social, family, and work roles Psychological, spiritual, social resources

21-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Integrate Client into the Community Requires extensive preparation and planning. Requires a support system in the community.

21-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Philosophy and Principles of Restorative Nursing Care  Advocate for Quality of Life Defined by each individual. Some capacity of independence. A sense of purpose, dignity, and self- respect.

21-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Interdisciplinary Team  Physician or Physiatrist  Restorative Nurse Specialist  Therapists  Nutritionist  Clergy  Social Worker  Vocational Counselor

21-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Roles of the Restorative Nurse  Educator  Caregiver  Coordinator  Client Advocate  Researcher  Life Care Planner

21-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Nursing Process in Restorative Care  May require months or years for goals to be met.  Comorbidities may complicate or slow progress.  Goals must often be defined in small steps to show progress.  Reevaluation must be done periodically.

21-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Nursing Process in Restorative Care  Assessment Primary injury or disease Comorbidities and/or complications Limitations of self-care activities and mobility

21-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Functional Ability Tests and Scales Barthel Index Functional Independence Measurement (FIM)

21-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Nursing Process in Restorative Care  Nursing Diagnoses Frequently Used in Restorative Care Self-Care Deficit Activity Intolerance Bowel Incontinence Caregiver Role Strain Disturbed Body Image Risk for Impaired Skin Integrity

21-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Nursing Process in Restorative Care  Outcomes Identification Validates and quantifies the work of restorative nursing care. Goals and outcomes need to be broken down into smaller steps. Funding sources (Medicare) require documentation and evaluation of outcomes.

21-39 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Nursing Process in Restorative Care  Plan of Care Direct nursing actions Client and family teaching

21-40 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Types of Restorative Care Nursing Interventions  Assistive Cough  Progressive Mobility  Self-Catheterization  Bowel and Bladder Training  Skin Checks and Pressure Relief Activities  Assistive Devices for Dressing, Grooming, and Eating

21-41 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Documentation and Restorative Care  Computer generated charting systems focus on the functional skills of the client. The Minimum Data Set-Post Acute Care (MDS-PAC) is an eight-page form required by Medicare. Evaluates client’s functional ability at stated periods.

21-42 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation and Revision of Plan of Care  Performed every three to seven days.  Weekly care conference includes client and family.  Changes to goals and plans are mutually agreed upon.

21-43 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transitions Between Settings of Care: Discharge Planning  The social worker and nurse work together with the client and family toward transition to either a care facility or to the home setting.

21-44 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transitions Between Settings of Care: Discharge Planning  Written care plan, referral, and phone call prepared by the nurse. Medication schedule Assistive equipment Self-care skills, functional abilities Client and caregiver understanding of skills

21-45 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Written Care Plan, Referral, and Phone Call by the Nurse Areas needing further instruction Information about family members Safety issues and potential physical barriers to entry

21-46 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transitions Between Settings of Care: Discharge Planning  Preparation of Client and Family Relocation Stress Syndrome -Loss of familiar routine -Loss of relationships with current health team members -Uncertainty about the new environment -Concerns about ultimate prognosis for recovery

21-47 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transitions Between Settings of Care: Discharge Planning  Caregiver Strain Unprepared, unwilling, or elderly caregiver with his or her own health issues Feelings of being overwhelmed on the part of both client and caregiver

21-48 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Caregiver Strain  Caregiver experiences signs and symptoms of apprehension, fatigue, isolation, frustration, and depression.

21-49 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Transitions Between Settings of Care: Discharge Planning  Case Management and Restorative Care Ensures continuity of care for the restorative client with complex long-term needs. Coordinates community services and equipment needed at home. Usually done by a certified rehabilitation nurse (CCRN) or an advanced practice rehabilitation nurse.

21-50 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Improvement Issues in Restorative Nursing Care  Quality improvement in restorative care is evaluated by professional standards, current scientific knowledge, client outcomes, and cost effectiveness.

21-51 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Quality Improvement Issues in Restorative Nursing Care  Standards of care published by the Association of Rehabilitation Nurses.