Rehabilitation and Rehabilitation and Restorative CareRestorative Care

NCOA

Chapter 18 (4th ed)

Pati L.H. Cox, RN, BSN, M.Ed.

Rolla Technical Center

IntroductionIntroduction

The goal of nursing care is to assist the O.A. back to health and allow them to return home.

OBRA of 1990 regulates care with MDS and “emphasizes restorative care as a major priority of care” Anderson, pg. 304

Concepts

The Nurse’s Role

Goals

Developing Goals

Implementation

Assessment of Goals

Clinical Implications

Rehabilitative vs. Rehabilitative vs. RestorativeRestorative

Rehabilitative Restorative

Goal – To assist people to obtain highest level of independent function (functional)

X X

Team or holistic approach X X

Assists with living environment, resources available

X

Implemented when rehab goal met or no further improvement noted.

X

Short term intensive strengthening training X

Continues with care over long period of time X

Ambulation, personal care, feeding, toileting X

FocusFocus

Maximize the abilities and functions of the older adult to ensure the highest level of independence and quality of life

The Nurse’s RoleThe Nurse’s Role

•Bedside Caregiver•Educator•Counselor•Advocate•Case Manager•Researcher

Goals Goals Rehabilitative & RestorativeRehabilitative & Restorative

• Provide direction• Behavioral outcome• Solution to problem • Realistic• Focus – highest level of independence within

limits of injury• Must look at

– Physical changes– Psychological changes– Functional changes

Changes affecting Restorative Changes affecting Restorative CareCare

Physical34%

Functional33%

Psychological33%

Physical ChangesPhysical Changes

• These changes must be considered:– Musculoskeletal– Cardiovascular– Respiratory– Renal and Digestive Tract– Consciousness and mental status– Perceptual

Functional ChangesFunctional Changes

• Result from impact of social & environmental situations– Inability to negotiate stairs @ home– Functional problems from chronic diseases– Physical changes resulting in limited ROM,

strength, endurance– Inability to consume appropriate diet– Inability to perform ADL’s

Psychological ChangesPsychological Changes

•Well-being = motivation•Self Esteem & positive self

image = critical factors in developing motivation for restorative program

Developing GoalsDeveloping Goals

• Assessment• LPN works with RN

to analyze data • Prioritize

rehabilitative & restorative goals

ImplementationImplementation

• Maintenance of Joint Function

• Active Exercise• Bladder Continence• Appropriate Sexual

Expression• Psychosocial and

Spiritual Well-Being

• Restorative Goals specific for O.A=– Improvement of

Function– Delay of

Deterioration– Accommodation of

dysfunction– Comfort in the dying

process

Clinical ImplicationsClinical ImplicationsRehabilitative & Restorative CareRehabilitative & Restorative Care

• Walking Program– Excellent Foot Care & well fitting shoes– Crutch walking– For those without assistive devices

• Continence Training– Should not use foley catheter for effective bladder

management– Regular schedules imp.

• Feeding and Self-Feeding Program• Self Promoting Behaviors & ADL’s