CHAPTER 38 REHABILITATION AND ESTORATIVE NURSING CARE DISABILITY

CHAPTER 38 REHABILITATION AND ESTORATIVE NURSING CARE

DISABILITY Body function can be affected by: Disease, injury, and surgery Birth injuries and birth defects Often, more than one function is lost. Losses are temporary or permanent.

DISABILITY (CONT’D) A disability is any lost, absent, or impaired physical or mental function. Causes are: Acute—short course; recovery is complete. Chronic—long course; problem is controlled–not cured-with treatment. The person may depend totally or in part on others for basic needs. The degree of disability affects how much function is possible. Goals of health care are: Prevent and reduce the degree of disability. Help the person adjust.

REHABILITATION Rehabilitation is the process of restoring the person to his or her highest possible level of physical, psychological, social, and economic function. The focus is on improving abilities. The goal may be to return to work. Another goal is self-care. Improved function is sometimes not possible. Then the goal is to prevent further loss of function. Some persons return home after rehabilitation. The process may continue in home or community settings.

RESTORATIVE NURSING Restorative nursing care is care that helps persons regain health, strength, and independence. Restorative nursing programs: Help maintain the highest level of function Prevent unnecessary decline in function Involve measures that promote: Self-care Elimination Positioning Mobility Communication Cognitive function

RESTORATIVE NURSING (CONT’D) A restorative aide is a nursing assistant with special training in restorative nursing and rehabilitation skills. These aides assist the nursing and health teams as needed. Required training varies among states.

REHABILITATION AND THE WHOLE PERSON A disability has physical, psychological, and social effects. The person needs to adjust physically, psychologically, socially, and economically. Abilities are stressed. Complications are prevented.

REHABILITATION AND THE WHOLE PERSON (CONT’D) Physical aspects Rehabilitation starts when the person first seeks health care. Complications are prevented. Bowel and bladder problems are prevented. Contractures and pressure injuries are prevented.

REHABILITATION AND THE WHOLE PERSON (CONT’D) The following may be needed: Good alignment, turning, and re-positioning Range-of-motion exercises Supportive devices Good skin care Bladder training Bowel training Assistance with activities of daily living (ADL) Self-help devices Crutches or a walker, cane, or brace Physical and occupational therapies A prosthesis Assistance with nutritional needs Speech therapy and communication devices Mechanical ventilation

REHABILITATION AND THE WHOLE PERSON (CONT’D) Psychological and social aspects A disability can affect function and appearance. Self-esteem and relationships may suffer. The person may deny the disability. The person may expect therapy to correct the problem. Successful rehabilitation depends on the person’s attitude. The focus is on abilities and strengths. Psychological and social needs are part of the care plan. Spiritual support helps some persons. Economic aspects The goal is for the person to become gainfully employed.

THE REHABILITATION TEAM Rehabilitation is a team effort. The person is the key team member. The family, doctor, and nursing and health teams help the person set goals and plan care. The focus is on regaining function and independence. Families provide support and encouragement. Often, they help with home care. Your job focuses on promoting the person’s independence. Preventing decline in function also is a goal.

REHABILITATION PROGRAMS AND SERVICES Common rehabilitation programs include: Cardiac rehabilitation Brain injury rehabilitation Spinal cord rehabilitation Stroke rehabilitation Respiratory rehabilitation Musculo-skeletal rehabilitation Rehabilitation for complex medical and surgical conditions

REHABILITATION PROGRAMS AND SERVICES (CONT’D) The rehabilitation process may continue after hospital discharge. The person may transfer to a nursing center or to a rehabilitation agency. Home care agencies, some assisted living residences, and some adult day-care centers also provide rehabilitation services.

QUALITY OF LIFE Successful rehabilitation and restorative care improve quality of life. The more the person can do alone, the better his or her quality of life. To promote quality of life: Protect the right to privacy. Encourage personal choice. Protect the right to be free from abuse and mistreatment. Learn to deal with your anger and frustration. Encourage activities. Provide a safe setting. Show patience, understanding, and sensitivity.