Unit 20
Restorative Care
Restorative nursing is person-centered nursing care designed to improve or maintain the functional ability of residents, so they can achieve their highest level of well-being possible. It is a different way of looking at the care that is regularly given.
Restorative nursing is more than just a plan of care. It is a way of looking at the individual’s care and identifying what:
Does that person do?
Can that person do?
Will that person do?
A restorative program helps residents practice activities of daily living to improve, or at least maintain, overall functioning.
You have most likely heard the phrase, “If you don’t use it, you lose it.” or "Activity strengthens and inactivity weakens." Restorative nursing can prevent functional decline in residents. However, the benefits may extend beyond preventing decline. Restorative nursing can also improve residents’ functional ability.
What are examples of restorative care?
The most common restorative care activities are walking, passive and active range of motion, and dressing/grooming, but there are
15 complete restorative programs in all. They are:
ADLs, Ambulation/Falls, Transfers, Bed Mobility, Range of Motion, Locomotion, Brace/Splint, Amputation/Prosthesis, Dressing/Personal Hygiene, Eating/Swallowing, Incontinence, Communication, Medication Self-administration, and Ostomy Care.
In the following pages and videos we will explore the main types.
A restorative aide is another class that is available at Allied for further learning or if you choose to work as an RA - Restorative Aide. While there may be a restorative aide where you work, it is still your responsibility to follow their own care plan for restorative care.
Range of Motion:
Range of motion (ROM) refers to how far you can move or stretch a part of your body, such as a joint or a muscle. It's different for each of us. For example, some people can do complete splits, but others can't: their joints aren't loose and their muscles won't lengthen as far.
Active and Passive Range of Motion
Active Range of Motion (AROM). This is the space in which you move a part of your body by using your muscles. You make the effort without outside help. For example, lifting your arms above your head to stretch the muscles happens within your active range of motion.
Passive Range of Motion (PROM). This is the space in which a part of your body can move when someone or something is creating the movement, such as a C.N.A or physical therapist. You're not the one engaging the muscles you would normally use to start the movement and do the work. You should never perform PROM on the neck.
Be careful to do them gently, so as not to injure the resident. PROM should not be done on the neck. Never force any part of the body to move. Use smooth movements with no jerking or bouncing of the joint and always support either side of the joint. Example if doing range of motion on an elbow hold the arm between the wrist and the elbow and the area of the arm beneath the armpit and above the elbow.
Below is an example of a restorative care plan and a restorative flow chart.
This is a type of documentation you might use when charting the restorative care you have assisted a resident to perform. A sample of a restorative plan of care for Mrs. Rose is listed below. Look at the restorative care plan and then look at the flow chart to get an idea of what your responsibility for Mrs. Rose and for documentation might look like.
The restorative care plan for Mrs. Rose might be something like this:
Mrs. Rose experienced a prolonged illness with hospitalization resulting in weakness. After completing physical therapy Mrs Rose is released on a restorative program to increase and maintain her strength. This plan includes ambulation, active range of motion and small group exercises.
Ambulation: Time expectation 15 min q time.
Mrs. Rose is to Ambulate 4 times a day 75 feet each time with a gait belt and 1 assist.
Provide opportunities for rest approximately half way through the ambulation.
Provide encouragement and education for why this activity is important
Remind Mrs. Rose to keep her head up and posture as straight as possible taking full steps.
Ensure non slip shoes are worn during ambulation.
Active range of motion for Mrs. Rose: Feet
While in bed for 8 days in the hospital, Mrs. Rose began to develop early stages of foot drop the care plan states:
Active ROM with oversight and encouragement to feet bilaterally BID
Dorsiflex - 3 sets of 5 repetitions
Rotation - 3 sets of 5 repetitions
Small Group Exercises - no more than 8 residents to a group.
Upper body active ROM including 3 sets of 5 repetitions of flexations and extensions as well as adductions and abductions. Group exercises for 20 min 5 days a week.
Restorative Chair Exercises
Points to remember
*Important Points
*Keeping the resident mobile, offering fluids for hydration and frequent repositioning is important for many reasons including prevention of constipation, osteoporosis, contractures, and pressure ulcers. The old adage "an ounce of prevention is worth a pound of cure" hold true here.
*Before starting ambulation with your resident check to ensure your resident has on non-skid footwear, proper fitting clothing (do not want them letting go of the walker to pull up on their pants etc...), the correct walker, cane or gait belt, hearing aides so they can hear you encourage and coach, and clean glasses for safety.
The most important action for you to do every day when assisting your resident with a prosthesis is to look at the skin and inspect it for redness, blisters and wounds. The stump of an amputation site does not have as many nerve endings and skin breakdown can occur quickly without the resident knowing. If there is a wound the device cannot be used.
When performing PROM stop if the resident expresses pain, you see a wound on the joint, or the resident becomes stressed, asks you to stop or becomes frustrated.