Caring for Older Adults Holistically, 4th Edition Chapter Eighteen Rehabilitation and Restorative Care

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition Nursing Roles  Bedside caregiver  Provide direct care until older adult is able to perform self-care  Provide positive reinforcement, encouragement, hope

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition Nursing Roles  Counselor  Assist older adults in solving and effectively coping with their problems  Ongoing process that requires supportive behaviors

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition Nursing Roles  Researcher  Work with nurse researcher to gather data to improve rehabilitation and restorative care

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition Implementing Goals  Maintenance of joints  Prevention of deformities  Active exercise  Improve function and performance  Bladder continence  Initiate bladder training programs when appropriate

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition Assessment of Goals  Goals specific to elderly population (cont.)  Comfort in the dying process  Provide comfort measures and palliative care

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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

Caring for Older Adults Holistically, 4th Edition 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