In-Service Training Series

RESTORATIVE CAREIn-Service Training Series

RESTORATIVE CAREYOUR CHOICE SENIOR CARE

The Road Back A skills update

This training is designed to provide nurses, caregivers, and nursing assistants with an understanding of the potential for impairment in functional abilities in elders. 2

ObjectivesYOUR CHOICE SENIOR CAREDescribe the shift in focus from custodial to restorative care List the 4 goals of restorative nursing careList 6 programs that are included in restorative nursingList 5 negative consequences of a lack of restorative careDiscuss ways restorative care can be incorporated into daily routineDiscuss ways to help motivate the client to reach goals

These objectives will aid the caregiver in understanding the importance of restorative care and the potential decline in overall health and quality of life that supports independence, dignity and self-esteem for elders. 3

IntroductionYOUR CHOICE SENIOR CARERestorative nursing care promotes quality of life that supports independence, dignity, and self-esteem. The goal of restorative care is to maintain or regain physical function.

The goal of restorative care is to maintain or regain physical function. 4

Custodial CareRestorative CareYOUR CHOICE SENIOR CAREBefore 1975 the focus of care for long term care clients was custodial. Custodial care focused on keeping clients comfortable until their death. There was little anticipation that they would ever regain independence or be discharged to home. Restorative nursing care ensures that every client has the opportunity to function at his highest level by maintaining or regaining independence. The goal is to maintain or regain physical function. Custodial vs. Restorative Care

Custodial care was focused on keeping clients comfortable before they died. In contrast, the goal of restorative care is to maintain or regain physical function. 5

Purpose of Restorative Nursing CareYOUR CHOICE SENIOR CAREEnsuring that every client has the opportunity to function at his highest level by maintaining or regaining independence in activities of daily living (ADL). Restoring independence in functioning ability for short-term care clients following a cerebral vascular accident (CVA), heart attack (MI), or after hip or knee replacement surgery. Restorative nursing is necessary to maintain or attain the highest quality of life possible for long term care clients that have chronic health problems.

The goals of restorative care are to make sure that ALL clients can function at the highest level possible. Short term clients may need help restoring independence after a surgery and those clients who are long term require assistance maintaining or regaining independence as much as possible. 6

Goals of Restorative Nursing CareYOUR CHOICE SENIOR CAREPrevent complications that can develop from inactivityMaintain or regain independence with mobilityMaintain or increase the clients level of functioning in activities of daily living (ADL)Maintain or regain continence of bowel and bladderRestore meaning, self-esteem, and dignity to life

Unlike custodial care which focused solely on keeping clients comfortable until death, restorative care is designed to promote independence and a better quality of life for as long as possible. The goal of restorative care is to maintain and/or regain physical function. 7

Complications as a Result of InactivityYOUR CHOICE SENIOR CAREThere are several complications that can occur as a result of inactivity. The next 3 slides explain these complications.

If you dont use it, you lose it!

Lets look at some of the complications that can occur from a lack of activity. As they say, if you dont use it, you lose it! 8

Complications as a result of inactivityYOUR CHOICE SENIOR CARELoss of strength Strength is lost at a rate of 5% per day with inactivity. Elders are slower to regain strength once it is lost. Pneumonia is a major hazard to elders that are inactive. This is due to diminished respiratory effort and pooling of secretions. Blood clots can form in the lower extremities because the blood vessels have lost elasticity and the leg muscles arent squeezing the venous blood and keeping it moving back toward the heart.

Inactivity can cause many problems for elders. Loss of strength is extremely detrimental because elders have a more difficult time regaining strength once it is lost. Pneumonia and blood clots are serious health issues that can result as a person becomes inactive. 9

Complications as a result of inactivitycontinuedYOUR CHOICE SENIOR CAREPressure ulcers can easily form because tissue is squeezed between bed and the clients bones, closing blood vessels that normally feed oxygen and nutrients to tissue cells, causing them to starve and die. Contractures or stretching of muscles can lead to permanent crippling and loss of ability to ambulate (move).Loss of calcium that leads to osteoporosis increases when weight bearing exercise, such as walking, does not occur.

More complications that occur as a result of inactivity are pressure ulcers, contractures, and a loss of calcium. It is important for elders to maintain activities such as weight bearing exercise so they remain strong and healthy and have a better quality of life. 10

Complications as a result of inactivitycontinuedYOUR CHOICE SENIOR CAREKidney stones can form as a result of calcium loss from the bones. The lost calcium accumulates in the kidneys.Bladder infections can occur with inactivity because of incomplete emptying of the bladder while on bed rest. Constipation is a common result of inactivity and weakened abdominal muscles.

When a person becomes inactive, kidney stones can form when calcium is lost from the bones and accumulates in the kidneys. Also when a person is on bed rest, they may not always completely empty their bladder. This can cause bladder infections. Constipation is another side effect of inactivity due to weakened abdominal muscles. 11

IDP TEAM

Interdisciplinary Planning TeamThe Interdisciplinary Planning Team, or IDP Team, is responsible for planning the care that is needed. They are also responsible for determining who will carry out various aspects of the Activities of Daily Living (ADL) plan. There are 8 members of this team. YOUR CHOICE SENIOR CARE

The interdisciplinary team is also known as the IDP team. They determine the Activities of Daily Living, or ADL care plan and who will carry out parts of the ADL care plan. 12

IDP Team Members: together they develop the ADL Plan of CareYOUR CHOICE SENIOR CAREPhysical Therapist- recommends ROM (range of motion) and ambulatory exercises. Occupational Therapist- promotes independence with bathing, feeding, and dressing. Dietician-establishes nutrition and hydration goalsSocial Worker- develops a discharge plan for each clientPhysician- reviews recommendations of other IDP team members and prescribes care activities accordingly. Speech Therapist- assesses speech, hearing, and swallowing ability and recommends food texturesNurse- coordinates the development and implementation of the ADL plan based on recommendations and physicians ordersCaregiver-has the primary responsibility of implementing the ADL care plan.

As a caregiver employed by Your Choice Senior Care, you are responsible for implementing the care plan developed by the IDP Team. 13

Restorative Care Plans follow the nursing processYOUR CHOICE SENIOR CAREThe 4 aspects of the nursing process that are used when developing a clients ADL plan of care are:ASSESSMENTPLANNINGIMPLEMENTATIONandEVALUATION.

Restorative nursing care follows the nursing process and includes assessment of the client, planning for their care, implementation of the plan, and evaluation of how the elder is doing on the plan. Lets look at these 4 aspects of the nursing process in more detail. 14

ASSESSMENT:The first step in the nursing process when creating a restorative care plan is assessment of the client. ASSESSMENTDetermines the ability of the client to perform the restorative activity.Establishes a baseline from which to measure future ability.Determines how much help the client will need.Gives insight into why the client cannot perform the task, whether there is a physical or mental deficit. YOUR CHOICE SENIOR CARE

Assessment is one of the 4 aspects of the nursing process that is used when developing an ADL care plan. It is vital to assess the person to determine a starting point for care. 15

PlanningPlanning is the 2nd step in the nursing process when developing a care plan. PLANNINGFocuses on clients ability maintain or improve functional ability.Develops short and long term goals. These must be measurable to determine progress.Involves the client in the planning. This makes it more likely that the client will participate willingly in the restorative activities. YOUR CHOICE SENIOR CARE

Planning is the 2nd aspect of the nursing process. Planning short and long term measurable goals will make it easier to determine whether a person is making progress in improving functional ability. By involving the elder, the team increases the likelihood of the elder participating in activities willingly. 16

ImplementationImplementation is the 3rd aspect of the nursing process that is used when developing a care plan. IMPLEMENTATIONShort term goals are worked on first.A written plan ensures that it is specific for that client, and that there will be consistency in approach among all caregivers.

YOUR CHOICE SENIOR CARE

Implementation is the 3rd aspect of the nursing process that is used. It is important to have a written plan so that care givers are consistent in working with a client on their goals. 17

EvaluationEvaluation is the 4th, and last step in the nursing process when developing a care plan. EVALUATIONMust be done on an on-going basis to determine whether the plan is appropriate for the clients abilities.

Identifies progress toward goals. YOUR CHOICE SENIOR CARE

The final step in the nursing process when developing a plan of care is evaluation. Without evaluating progress, there is no way of knowing if the plan is appropriate. 18

Programs included in restorative care: The programs listed on the right are included in restorative nursing care. We will discuss each one in this presentation. Range of Motion (ROM)AmbulationTransfersActivities of Daily Living (ADL)DiningBowel and bladder

YOUR CHOICE SENIOR CARE

The 6 programs included in restorative care are Range of Motion (ROM), Ambulation, Transfers, Activities of Daily Living (ADL), Dining, and Bowel and bladder.

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ROMRange of Motion involves movement of joints and soft tissue. ROM, or range of motion, exercises move each body part through its whole potential range of motion. YOUR CHOICE SENIOR CARE

One program included in restorative care is range of motion exercises. 20

YOUR CHOICE SENIOR CAREThere are 4 ways of performing range of motion (ROM) activities. Passive range of motion (PROM): The caregiver does the movement for the client. This prevents muscle and joint contractures, but DOES NOT maintain strength. Active-assistive range of motion (AAROM): The restorative caregiver assists the client with doing the full ROM. This helps the client gain strength, and to eventually be able to do the ROM activities alone. Active range of motion (AROM): The client does the same full range of motion independently. This not only maintains full ROM but also retains muscle strength. Functional Activities for ROM: The client engages in these as he rolls over in bed, sits up, dresses, etc.

The 4 ways of performing range of motion activities provide for varying levels of independence. 21

YOUR CHOICE SENIOR CAREAs a caregiver, you need to know how to perform range of motion (ROM) activities. Make sure you understand how to do the ROM exercises.

Find out if there are specific instructions for clients with special problems.

Never do passive ROM for a resident who can actively participate.

Be sure to give the client time to perform the ROM activity by -moving an inflamed joint slowly through pain-free -always explain what you plan to do and how the resident can participate -remove any obstacles that could impede motion -remember your own body mechanics; keep your back safe!

As a caregiver, it can be difficult to watch a client you care about struggle with a task. Do not do things for them that they can do themselves. It is important for maintaining their strength and independence. 22

AmbulationAmbulation, like range of motion activities, is one of the 4 parts of restorative nursing care. AMBULATIONFactors to keep in mind:Clients need to maintain/regain independence with walkingTeach clients to walk with assistive devicesAsk how far a client can walk safelyKnow whether you need another staff member to assist with ambulation

YOUR CHOICE SENIOR CARE

Range of motion and ambulation are 2 of the 6 programs included in restorative care. Caregivers should know how far a client can safely walk and whether another staff member is needed for assistance. 23

TransfersTransfers are a program that is included in restorative nursing. Transfers help maintain/retain independence with self-transfer between bed, chair, and toilet. YOUR CHOICE SENIOR CARE

The 3rd program in restorative care is Transfers. 24

ADL- Activities of Daily LivingADL is a part of restorative care. ADL, or activities of daily living, help maintain/retain independence with bathing, dressing, and grooming. ADL encourage clients to do as much as possible for themselves.

Although watching a client you care about struggle, it is important that they do as much as possible independently. YOUR CHOICE SENIOR CARE

Activities of daily living are a part of restorative care as well. Again, it is important to allow clients to do as much as possible on their own. 25

DiningDining is a program included in restorative care. Dining Helps maintain/regain independence with self-feeding.Provides necessary supervision/cueing with eating.Limit distractions to enable the client to concentrate on the mechanics of eating. Monitor intake of food and fluid to prevent weight loss and dehydration.Promote safety to prevent choking or aspiration. YOUR CHOICE SENIOR CARE

Some assistance with feeding may be part of the restorative care plan. Be sure to allow the client to be as independent as possible. 26

Bowel and BladderBowel and bladder programs are a part of restorative care. Bowel and bladder programsPromote continencePrevent skin breakdownPrevent infectionPromote dignity and quality of life. YOUR CHOICE SENIOR CARE

Bowel and bladder programs are an important aspect of restorative care. 27

The caregiver is an important professional on the IDP team. As the primary person who implements the plan it is imperative that caregivers know how to incorporate restorative care into their daily routine. YOUR CHOICE SENIOR CAREIncorporating Restorative Nursing into a Caregivers Daily Routine of Care

Caregivers role in restorative care programs:YOUR CHOICE SENIOR CAREROM- passive or active exercises can be included with A.M./P.M. care. Encourage the client to do exercise routines while you are doing other tasks in their room Ambulation- park their wheelchair and encourage them to walk to the toilet and back, walk to their place at the dining table, and to walk with/without assistive devices to activities as orderedTransfers-assist/supervise client with transfers in and out of bed to chair, wheelchair, commode, shower chairADL-supervise, cue, encourage clients to participate in self care with bathing, grooming, dressing, mouth careDining-cue, monitor, encourage eating in a safe, quiet environmentBowel and bladder-choose the type of program that seems appropriate: prompted toileting (based on clients schedule),n scheduled toileting (habit training every 2 hours while awake), or check and change program (results in client being clean, dry, and odor free)

The caregivers role in these 6 programs of restorative nursing are important for a client to maintain/regain independence. The caregiver is a professional and should know how to participate in these programs effectively. 29

Tips on ways to encourage and motivate clients to reach their goals:Have a positive attitudeBuild a relationship of trust with the clientMinimize distractions so the client can focus (T.V., phone, radio)Be patientEncourage client control by giving choicesProvide positive reinforcementMake sure client has assistive devices in place (hearing aids, clean glasses, dentures)Involve family or significant others. Ask them about how the client coped with challenges in the past. Ask what worked best in helping the client reach goals. YOUR CHOICE SENIOR CARE

In order for clients to reach the goals of their restorative care plan, they need assistance from the caregiver. The caregiver, as you remember is the primary person on the IDP team who is responsible for implementing the plan. These helpful tips are ways that the caregiver can effectively do their job of encouraging and motivating the client. By praising the client about small improvements, you will help them remain motivated and continue to strive for independence. 30

In conclusion, restorative nursing care must be a priority when giving care. With patience, encouragement, and assistance the road to restoration can lead to independence, dignity, and hope. An informed caregiver is an important part of this care. YOUR CHOICE SENIOR CAREConclusion

In conclusion, restorative nursing care must be a priority when giving care. With patience, encouragement, and assistance the road to restoration can lead to independence, dignity, and hope. An informed caregiver is an important part of this care.

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SummaryYOUR CHOICE SENIOR CARERestorative care focuses on maintaining or regaining physical function.Custodial care focused on safe comfortable care until death.The IDP team develops the ADL plan of care. 4 aspects of the nursing process used in developing a restorative care plan are assessment, planning, implementation, and evaluation.Dieticians establish nutrition and hydration goals.Speech therapists assess speech and swallowing ability and recommends food texture.Social workers develop discharge plansOccupational therapy promotes independence with bathing dressing, feedingAssistive devices are things like walkers, reachers, sippy cups.Physical therapy recommends ROM and ambulation exercises. Caregivers are primarily responsible for implementing the ADL plan of care.

Carefully review this summary prior to taking the quiz. 32