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

Caring for Older Adults Holistically, 4th EditionCaring for Older Adults Holistically, 4th Edition

Chapter EighteenChapter Eighteen

Rehabilitation and Restorative Care


Understanding Rehabilitation and Understanding Rehabilitation and Restorative ConceptsRestorative 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


Understanding Rehabilitation and Understanding Rehabilitation and Restorative ConceptsRestorative 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


Nursing RolesNursing Roles

Bedside caregiver Provide direct care until older adult is able to

perform self-care Provide positive reinforcement, encouragement,

hope



Educator Provide information to older adults and their

families about disability, treatment, and management

Education plan includes health measures to obtain and retain function



Counselor Assist older adults in solving and effectively coping

with their problems Ongoing process that requires supportive

behaviors



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



Researcher Work with nurse researcher to gather data to

improve rehabilitation and restorative care


Goals of Rehabilitation and Restorative Goals of Rehabilitation and Restorative ConceptsConcepts 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


Goals of Rehabilitation and Restorative Goals of Rehabilitation and Restorative ConceptsConcepts 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


Developing GoalsDeveloping 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


Implementing GoalsImplementing Goals

Maintenance of joints Prevention of deformities

Active exercise Improve function and performance

Bladder continence Initiate bladder training programs when

appropriate


Implementing GoalsImplementing 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


Assessment of GoalsAssessment 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



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



Goals specific to elderly population (cont.) Comfort in the dying process

Provide comfort measures and palliative care


Clinical ImplicationsClinical 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



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



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

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