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

Chapter 38Chapter 38

Rehabilitation and Rehabilitation and Restorative Nursing CareRestorative Nursing Care

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

DisabilityDisability

Body function can be affected by:Body function can be affected by: Disease, injury, and surgeryDisease, injury, and surgery Birth injuries and birth defects Birth injuries and birth defects

Often, more than one function is lost.Often, more than one function is lost. Losses are temporary or permanent.Losses are temporary or permanent.

The whole person is affectedThe whole person is affected

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Disability (cont’d)Disability (cont’d) A disability is any lost, absent, or impaired A disability is any lost, absent, or impaired

physical or mental function.physical or mental function. Causes are:Causes are:

• Acute—short course; recovery is complete ie fractureAcute—short course; recovery is complete ie fracture• Chronic—long course; problem is controlled–not Chronic—long course; problem is controlled–not

cured-with treatment ie stroke, spinal cord injurycured-with treatment ie stroke, spinal cord injury The person may depend totally or in part on The person may depend totally or in part on

others for basic needs.others for basic needs.• The degree of disability affects how many functions are The degree of disability affects how many functions are

lost and how much function is possiblelost and how much function is possible Goals of health care are: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.


RehabilitationRehabilitation

Rehabilitation is the process of restoring the Rehabilitation is the process of restoring the person to his or her highest possible level of person to his or her highest possible level of physical, psychological, social, and economic physical, psychological, social, and economic function. function. OBRA required to provide!!!OBRA required to provide!!! The focus is on improving abilities and what the The focus is on improving abilities and what the

patient can dopatient can do..• 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 possibleImproved 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.Some persons return home after rehabilitation.• The process may continue in home or community The process may continue in home or community

settings. Assessment is done by rehab team.settings. Assessment is done by rehab team.


Restorative nursing care is care that helps Restorative nursing care is care that helps persons regain health, strength, and persons regain health, strength, and independence.independence.

Restorative nursing programs:Restorative nursing programs: Help maintain the highest level of functionHelp maintain the highest level of function Prevent unnecessary decline in functionPrevent unnecessary decline in function Involve measures that promote:Involve measures that promote:

• Self-careSelf-care• EliminationElimination• PositioningPositioning• MobilityMobility• CommunicationCommunication• Cognitive functionCognitive function


Restorative NursingRestorative Nursing

Restorative Nursing (cont’d)Restorative Nursing (cont’d)

A restorative aide is a nursing assistant with A restorative aide is a nursing assistant with special training in restorative nursing and special training in restorative nursing and rehabilitation skills.rehabilitation skills. These aides assist the nursing and health teams These aides assist the nursing and health teams

as needed.as needed. Required training varies among states.Required training varies among states.


Rehabilitation andRehabilitation andthe Whole Personthe Whole Person

A disability has physical, psychological, and A disability has physical, psychological, and social effects.social effects. The person needs to adjust physically, The person needs to adjust physically,

psychologically, socially, and economically.psychologically, socially, and economically. Abilities are stressed.Abilities are stressed. Complications are prevented.Complications are prevented.


Rehabilitation andRehabilitation andthe Whole Person (cont’d)the Whole Person (cont’d)

Physical aspectsPhysical aspects Rehabilitation starts when the person first seeks Rehabilitation starts when the person first seeks

health care.health care. Complications are prevented.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.


The following may be needed:The following may be needed:• Good alignment, turning, and re-positioningGood alignment, turning, and re-positioning• Range-of-motion exercisesRange-of-motion exercises• Supportive devices Supportive devices • Good skin careGood skin care• Bladder trainingBladder training• Bowel trainingBowel training• Assistance with activities of daily living (ADL)Assistance with activities of daily living (ADL)• Self-help devices (ie wrists disabilities)Self-help devices (ie wrists disabilities)• Crutches or a walker, cane, or brace Crutches or a walker, cane, or brace • Physical and occupational therapiesPhysical and occupational therapies• A prosthesis-artificial replacement for a missing partA prosthesis-artificial replacement for a missing part• Assistance with nutritional needsAssistance with nutritional needs• Speech therapy and communication devices ie aphasiaSpeech therapy and communication devices ie aphasia• Mechanical ventilationMechanical ventilation



Psychological and social aspectsPsychological and social aspects A disability can affect function and appearance.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 deny the disability. The person may expect therapy to correct the problem.The person may expect therapy to correct the problem. Successful rehabilitation depends on the person’s attitude.Successful rehabilitation depends on the person’s attitude. The focus is on abilities and strengths.The focus is on abilities and strengths. Psychological and social needs are part of the care planPsychological and social needs are part of the care plan.. Spiritual support helps some persons.Spiritual support helps some persons.

Economic aspectsEconomic aspects The goal is for the person to become gainfully employed.The goal is for the person to become gainfully employed.



The Rehabilitation TeamThe Rehabilitation Team Rehabilitation is a team effort.Rehabilitation is a team effort.

The person is the key team member.The person is the key team member. The family, doctor, and nursing and health teams The family, doctor, and nursing and health teams

help the person set goals and plan care.help the person set goals and plan care. The focus is on regaining function and The focus is on regaining function and

independence-allow time to complete tasksindependence-allow time to complete tasks Families provide support and encouragement.Families provide support and encouragement.

Often, they help with home care. Often, they help with home care. Your job focuses on promoting the person’s Your job focuses on promoting the person’s

independence.independence. Preventing decline in function also is a goal.Preventing decline in function also is a goal.


Rehabilitation ProgramsRehabilitation Programsand Servicesand Services

Common rehabilitation programs include:Common rehabilitation programs include: Cardiac rehabilitationCardiac rehabilitation Brain injury rehabilitationBrain injury rehabilitation Spinal cord rehabilitationSpinal cord rehabilitation Stroke rehabilitation Stroke rehabilitation Respiratory rehabilitationRespiratory rehabilitation Musculo-skeletal rehabilitationMusculo-skeletal rehabilitation Rehabilitation for complex medical and surgical Rehabilitation for complex medical and surgical

conditionsconditions


Rehabilitation ProgramsRehabilitation Programsand Services (cont’d)and Services (cont’d)

The rehabilitation process may continue after The rehabilitation process may continue after hospital discharge.hospital discharge. The person may transfer to a nursing center or to The person may transfer to a nursing center or to

a rehabilitation agency.a rehabilitation agency. Home care agencies, some assisted living Home care agencies, some assisted living

residences, and some adult day-care centers residences, and some adult day-care centers also provide rehabilitation services.also provide rehabilitation services.

The patient may need both rehab and restorative The patient may need both rehab and restorative carecare


Successful rehabilitation and restorative care Successful rehabilitation and restorative care improve quality of life.improve quality of life.

The more the person can do alone, the better his The more the person can do alone, the better his or her quality of life. To promote quality of life:or her quality of life. To promote quality of life:

Protect the right to privacy.Protect the right to privacy. Encourage personal choice.Encourage personal choice. Protect the right to be free from abuse and Protect the right to be free from abuse and

mistreatment.mistreatment. Learn to deal with your anger and frustration.Learn to deal with your anger and frustration. Encourage activities.Encourage activities. Provide a safe setting.Provide a safe setting. Show patience, understanding, and sensitivity.Show patience, understanding, and sensitivity.


Quality of LifeQuality of Life

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