restorative care chapter 21. 21-2 copyright 2004 by delmar learning, a division of thomson learning,...
TRANSCRIPT
Restorative Care
Chapter 21
21-2Copyright 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
21-3Copyright 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.
21-4Copyright 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
21-5Copyright 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
21-6Copyright 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.
21-7Copyright 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.
21-8Copyright 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.
21-9Copyright 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
21-10Copyright 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
21-11Copyright 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
21-12Copyright 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)
21-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Classification of Terms
Disability Impairment Handicap
21-14Copyright 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
21-15Copyright 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.
21-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Children
Cerebral palsy Congenital conditions Sports injuries, falls, accidents
21-17Copyright 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
21-18Copyright 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
21-19Copyright 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
21-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Acuity Continuum of Care
21-21Copyright 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.
21-22Copyright 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
21-23Copyright 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
21-24Copyright 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
21-25Copyright 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
21-26Copyright 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.
21-27Copyright 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.
21-28Copyright 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.
21-29Copyright 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
21-30Copyright 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.
21-31Copyright 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.
21-32Copyright 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
21-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Roles of the Restorative Nurse
Educator Caregiver Coordinator Client Advocate Researcher Life Care Planner
21-34Copyright 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.
21-35Copyright 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
21-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Assessment
Functional Ability Tests and Scales• Barthel Index• Functional Independence Measurement
(FIM)
21-37Copyright 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
21-38Copyright 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.
21-39Copyright 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
21-40Copyright 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
21-41Copyright 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.
21-42Copyright 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.
21-43Copyright 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.
21-44Copyright 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
21-45Copyright 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
21-46Copyright 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
21-47Copyright 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
21-48Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Caregiver Strain
Caregiver experiences signs and symptoms of apprehension, fatigue, isolation, frustration, and depression.
21-49Copyright 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.
21-50Copyright 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.
21-51Copyright 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.