1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 48 Rehabilitation and Restorative Services

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Compare and contrast rehabilitation and restorative care. Identify five members of the interdisciplinary team.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe the role of the nursing assistant in rehabilitation. Describe the principles of rehabilitation and restorative care. List the elements of successful rehabilitation/restorative care.

4. Copyright © 2008 Delmar Learning. All rights reserved. Objectives List six complications resulting from inactivity. Describe four perceptual deficits. Describe four approaches used for restorative programs. List the guidelines for implementing restorative programs.

5. Copyright © 2008 Delmar Learning. All rights reserved. Introduction to Rehabilitation and Restorative Care Rehabilitation refers to a process in which the patient is assisted in reaching an optimal level of ability.

6. Copyright © 2008 Delmar Learning. All rights reserved. Introduction to Rehabilitation and Restorative Care This means the health care team is concerned with helping the patient be the best he or she can be physically, mentally, and emotionally.

7. Copyright © 2008 Delmar Learning. All rights reserved. Reasons for Rehabilitation/Restorative Care A person may need rehabilitation because of a disability. A disability exists –When a person has an impairment that affects his or her ability to perform an activity that a person of the same age would normally be able to perform.

8. Copyright © 2008 Delmar Learning. All rights reserved. Reasons for Rehabilitation/Restorative Care A handicap exists –If a disability limits or prevents a person from fulfilling a role that is normal for that person.

9. Copyright © 2008 Delmar Learning. All rights reserved. Reasons for Rehabilitation/Restorative Care Rehabilitation and restorative care –Teach persons with disabilities new ways of doing routine tasks, such as dressing or bathing.

10. Copyright © 2008 Delmar Learning. All rights reserved. Reasons for Rehabilitation/Restorative Care The programs help patients become as independent as possible Patients with severely limiting conditions such as tetraplegia –Are taught how to verbally direct staff in their care to accomplish the results they want

11. Copyright © 2008 Delmar Learning. All rights reserved. The Interdisciplinary Health Care Team Physicians who specialize in rehabilitation are called physiatrists. Nurses and nursing assistants who work in rehabilitation receive additional training and education. Many other disciplines may be involved in the rehabilitation process.

12. Copyright © 2008 Delmar Learning. All rights reserved. The Role of the Nursing Assistant in Rehabilitation Nursing assistant help with: –Procedures to prevent complications –Mobility skills –Bathing and personal care procedures –Bowel and bladder training programs –Maintaining the patients’ nutritional status –Programs to increase the patients’ independence

13. Copyright © 2008 Delmar Learning. All rights reserved. Principles of Rehabilitation Four principles: –Treatment begins as soon as possible –Stress the patient’s ability, not disability –Activity strengthens and inactivity weakens –Treat the whole person

14. Copyright © 2008 Delmar Learning. All rights reserved. Rehabilitation versus Restorative Nursing Care Rehabilitation and restorative nursing complement each other –They are not competing programs or services

15. Copyright © 2008 Delmar Learning. All rights reserved. Rehabilitation versus Restorative Nursing Care Following the restorative program reinforces what the therapists are teaching –So the patient masters the skill more quickly –This is called restoration

16. Copyright © 2008 Delmar Learning. All rights reserved. Complications from Inactivity People with disabilities may be unable to move about at will. Inactivity or immobility can result in numerous complications affecting the body systems.

17. Copyright © 2008 Delmar Learning. All rights reserved. Activities of Daily Living One purpose of restorative care –To increase the patient’s physical abilities These include mobility skills and the ability to carry out activities of daily living (ADLs)

18. Copyright © 2008 Delmar Learning. All rights reserved. Activities of Daily Living These tasks or skills are taught to us as children. Healthy adults do them automatically. If a patient cannot complete any or all of the ADLs –A self-care deficit exists

19. Copyright © 2008 Delmar Learning. All rights reserved. Restorative Programs If a patient has the potential to relearn an ADL and is motivated to try: –A restorative program is planned. Restorative programs are sometimes called retraining programs or ADL programs.

20. Copyright © 2008 Delmar Learning. All rights reserved. Restorative Programs Make the task part of the regular routine so it is purposeful. Avoid making it look like “busy work.”

21. Copyright © 2008 Delmar Learning. All rights reserved. Restorative Programs Use the restorative care plan approaches each time the task must be done. Some tasks must be done many times each day.

22. Copyright © 2008 Delmar Learning. All rights reserved. Restorative Programs When all staff use the same care plan approaches –Patient masters the task much faster. Do the task at the normal time of day the task should be done.

23. Copyright © 2008 Delmar Learning. All rights reserved. Approaches Used in Restorative Programs It is important that the same approach be used consistently in terms of: –Setup –Verbal cues –Hand-over-hand techniques –Demonstration

24. Copyright © 2008 Delmar Learning. All rights reserved. Adaptive Devices Adaptive devices change the way the tasks are done –Enabling the patient to perform the skill independently –Refer to Figure 48 – 11

25. Copyright © 2008 Delmar Learning. All rights reserved. Adaptive Devices

26. Copyright © 2008 Delmar Learning. All rights reserved. Adaptive Devices Care plan will provide instructions in the types of devices used by patients. Your role: –To make sure the device is clean, available, and used by the patient. –You may need to work on the skill with the patient when he or she is learning to use the device.

27. Copyright © 2008 Delmar Learning. All rights reserved. Communication Use the restorative philosophy when communicating with the patient. Avoid statements such as, “You can’t use your right hand.”

28. Copyright © 2008 Delmar Learning. All rights reserved. Communication Instead say, “You can use your left hand.” Allow the patient to struggle a little, but intervene before it progresses to the point of frustration.

29. Copyright © 2008 Delmar Learning. All rights reserved. The Restorative Environment All patients benefit from living in an environment that attempts to improve their quality of life. The interdisciplinary team can help promote this environment.

30. Copyright © 2008 Delmar Learning. All rights reserved. The Restorative Environment Compliment the patient for making progress –Even if his or her gains are small.

31. Copyright © 2008 Delmar Learning. All rights reserved. The Restorative Environment It is better for the resident to complete part of a task than it is for you to perform the task. Allow the patient to do what he or she can –Then finish the task without complaint

32. Copyright © 2008 Delmar Learning. All rights reserved. The Restorative Environment Avoid making the patient feel like a failure because he or she could not finish the task.