Chapter Eighteen

1. Chapter Eighteen Rehabilitation and Restorative Care

2. Understanding Rehabilitation and Restorative Concepts • Rehabilitation • The process of teaching individuals to achieve their highest level of independent function • Used by older adults for strokes and arthritis • Rehabilitation care is multidisciplinary • Initiated after an extensive assessment • Health-care team works with person and his or her family to develop goals

3. Understanding Rehabilitation and Restorative Concepts • Rehabilitation • Determination of care environment determined by family support, environmental safety, insurance reimbursement, access to rehabilitation team • Restorative care • Initiated after individual has reached rehabilitation goals • Nursing staff assists individual as needed • Allow person plenty of time to complete task

4. Nursing Roles • Bedside caregiver • Provide direct care until older adult is able to perform self-care • Provide positive reinforcement, encouragement, hope

5. Nursing Roles • Educator • Provide information to older adults and their families about disability, treatment, and management • Education plan includes health measures to obtain and retain function

6. Nursing Roles • Counselor • Assist older adults in solving and effectively coping with their problems • Ongoing process that requires supportive behaviors

7. Nursing Roles • Advocate • Use your influence and power to bring about positive changes for older adult and his or her family • Case manager • Work with health-care team as central figure • Resolve actual problems and prevent potential problems

8. Nursing Roles • Researcher • Work with nurse researcher to gather data to improve rehabilitation and restorative care

9. Goals of Rehabilitation and Restorative Concepts • A goal is a written statement of desired outcomes • Strategies are developed to reach the goal • Goals provide direction • Individual is assessed to determine realistic goals • Changes must be noted in three areas • Physical, functional, and psychological

10. Goals of Rehabilitation and Restorative Concepts • Physical changes • Identify changes in health status as well as current health issues • Functional changes • Result from changes in social and environmental situations • Psychological changes • Important to identify because of impact on motivation

11. Developing Goals • Complete full nursing assessment with RN • Physical assessment • Functional assessment • Mental assessment • Spiritual assessment • Analyze information as team and prioritize goals • Follow principles of holistic nursing care

12. Implementing Goals • Maintenance of joints • Prevention of deformities • Active exercise • Improve function and performance • Bladder continence • Initiate bladder training programs when appropriate

13. Implementing Goals • Bowel continence • Initiate bowel training programs when appropriate • Appropriate sexual expression • Build in time for partners to have privacy • Offer sense of touch • Psychological and spiritual well-being • Communication, increase in self-esteem and self-concept

14. Assessment of Goals • Goals are assessed at intervals • Progress towards goals is documented • Goals specific to elderly population • Improvement of function • Live independently, perform ADLs and IADLs, have self-care capabilities

15. Assessment of Goals • Goals specific to elderly population (cont.) • Delay of deterioration • Prevent decline in abilities • Include physical and psychological • Accommodation of dysfunction • Assist person in dealing with his or her dysfunction • Nurse must listen attentively and actively

16. Assessment of Goals • Goals specific to elderly population (cont.) • Comfort in the dying process • Provide comfort measures and palliative care

17. Clinical Implications • Walking programs • Walking is excellent physical activity for older adults • Good foot care is important • Develop walking programs incorporating assistive devices as needed • Walk 20–30 minutes three times a week

18. Clinical Implications • Continence training • Indwelling catheter IS NOT effective bladder management • Establish regular time schedule for emptying bladder • Increase person’s fiber and fluid intake • Enemas should be used only in emergencies

19. Clinical Implications • Feeding and self-feeding programs • Nasogastric feedings may be needed initially • Manual assistance is maintained until person can self-feed • Self-promoting behaviors • Allow time for person to independently perform personal care • Assistive devices may be needed