Nurse Aide I Training Program - Module G: Basic Restorative Care
Module G: Basic Restorative Care
Definition List
Adaptive Devices (assistive devices): Special equipment that helps a disabled or ill resident perform activities of daily living (ADLs).
Amputation: Surgical removal of a body part.
Basic Restorative Care: Care provided after the resident’s highest possible functioning is restored through rehabilitation following illness or injury.
Bladder/Bowel Training: Measures taken to restore the function of voiding and defecating by a resident, with the ultimate goal of continence.
Contraindication: A specific situation or factor that makes a procedure or course of treatment inadvisable because it may be harmful to a person.
Defecation: The process of emptying the rectum of feces.
Empathy: Being able to identify with and understand how a resident feels with the willingness to alter one’s behavior in light of how others feel.
Enema: The introduction of fluid into the colon to eliminate stool or feces or stimulate bowel activity.
Functional Loss: Partial or complete loss of the function of a body part.
Incontinence: The inability to control urination or defecation.
Orthotic Device: A medical device designed to support, align, or enhance the function of a person's musculoskeletal system and may help with one’s appearance.
Prosthetic Device: Artificial replacement device for a body part that is missing or deformed and specifically fitted to one person; intended to improve a person’s function and appearance.
Range of Motion (ROM): The amount that a person can move a joint voluntarily.
Rehabilitation: Restoration of a resident’s highest possible functioning following illness or injury.
Supportive Device: Special equipment that helps a disabled or ill resident with movement.
Urination (or voiding): The process of emptying the bladder.
Objectives of Module G
Differentiate between rehabilitation and restorative care.
State the goals of restorative care.
Explain the role of the nurse aide in basic restorative care.
Describe the processes involved with bowel and bladder training.
Demonstrate selected range of motion exercises.
Rehabilitation and Restorative Care
Rehabilitation and restorative care work together to help residents regain lost abilities, maintain abilities, and prevent further loss of abilities.
Rehabilitation services:
Help residents maintain, regain, or improve skills lost or impaired due to illness, trauma, or disability.
These skills may include functions of daily life (cooking, dressing, bathing), staying balanced, walking, climbing stairs, talking, hearing, or swallowing.
May be necessary after a severe accident, brain or spinal injury, bone fracture, surgery, or diagnosis of a degenerative disorder.
Once a resident has reached their highest level of functioning through rehabilitation, they transition to basic restorative care.
Basic Restorative Care:
Restores the resident’s highest possible functioning through rehabilitation following illness or injury.
Assists with any adjustments and improvements that help residents live as independently as possible.
Goals of Restorative Care
Preserve and support accomplishments restored through rehabilitation.
Offer adjustments and improvements that help residents live as independently as possible.
The Importance of Basic Restorative Care
Emphasizes maintaining and improving existing abilities.
Prevents any further complications.
Aims at moving residents toward independence as much as possible and encourages residents to do as much as they can, as long as they can, as often as they can.
Provides a team effort to assist residents to develop a productive lifestyle.
Helps residents to accept or adapt to limitations that cannot be overcome.
Increases residents' self-esteem and helps them achieve and maintain the highest possible physical, mental, and psychosocial functioning.
Nurse Aide Role in Basic Restorative Care
Recognizing Signs of Functional Loss
Nurse aides are often the first healthcare providers to recognize signs that a resident is feeling a loss in independence, which should be reported to the supervisor.
Negative self-image.
Anger directed toward others.
Feelings of helplessness, sadness, hopelessness.
Feelings of being useless.
Increased dependence.
Depression.
Encourage the resident and support the family when a functional loss (partial or complete loss of a body part's function) and loss of independence leads to these feelings.
Be sensitive to the resident’s needs; some may be embarrassed, need more encouragement, and need to be more involved in planning their activities.
Recognizing and Addressing Feelings
Be positive and supportive.
Emphasize abilities.
Explain planned activities and how the nurse aide will help.
Treat with respect.
Allow for expression of feelings.
Develop empathy for the situation.
Praise accomplishments.
Assist the resident in doing as much as possible, but be realistic and never give false hope.
Giving Support During Resident Setbacks
Review skills needed by the nurse aide to assist with restorative activities.
Focus on small tasks and accomplishments.
Recognize that setbacks will occur.
Inform residents that setbacks occur and are to be expected.
Encourage residents to continue with planned care in the face of setbacks.
Explain that setbacks are an opportunity to improve the next attempt.
Encouraging Choices
Inspire the resident’s control over their life.
Support the resident’s choice of when their activities are scheduled.
Encourage the selection of appropriate clothing.
Show patience with a resident when preparing for activity.
Supporting Residents During Activities
Provide for rest periods.
Promote as much independence by residents as possible during an activity.
Encourage the use of any prescribed adaptive devices.
Consider involving the family in activities with the resident’s permission.
Types of Devices in Restorative Care
Prosthetic Devices
Definition: Artificial replacement devices for a body part that is missing or deformed and specifically fitted to an individual, intended to improve a person’s function and appearance.
Examples: Artificial eyes, hearing aids, artificial breasts, implanted lenses, cochlear implants, artificial hip joints, devices for use with amputation, artificial body parts such as a leg or hand.
Tips to Remember:
Devices are usually expensive; handle with care and prevent loss.
A nurse or therapist should demonstrate application before the nurse aide attempts.
Follow specific instructions for areas of prosthetic attachment.
Observe skin under and near the prosthetic device often for signs of skin breakdown (pressure and abrasion).
Keep any skin under the prosthetic device clean and dry.
Provide good skin care to all areas at risk for rubbing by any prosthetic device.
Respect the resident’s decision to wear or not wear a prosthetic device.
Be empathetic; remember the psychological toll a prosthetic device can take and commend the resident when they use it.
Orthotic Devices
Definition: Medical devices designed to support, align, or enhance the function of a person's musculoskeletal system; may help prevent or correct a deformity and protect joints and soft tissue injuries.
Examples: Fitted brace for weak body parts, splints, eyeglasses, contact lenses, crutches, walkers, canes, knee and spinal braces, finger and wrist splints, cervical collar, neck braces, helmet.
Tips to Remember:
Devices may be specific to the resident; only use with that resident and prevent loss.
If devices have wheels, lock them when moving the individual in or out of the device.
Always be alert for devices that might rub a bony prominence and report at once.
If trained, pad between a bony prominence and a device.
Supportive Devices
Definition: Special equipment that helps a disabled or ill resident with movement.
Examples: Canes, walkers, crutches, wheelchairs, and motorized chairs.
Assistive (Adaptive) Devices
Definition: Special equipment that helps a disabled or ill resident perform activities of daily living (ADLs).
Purpose: Promote independence.
Success Factors: Successful use depends on the resident’s attitude, acceptance, motivation, and support from others.
Assistive Devices for Positioning
Pillows: Regular (used for side-lying position), cylinder-shaped foam, abduction, wedge.
Bed Cradle: Keeps bed covers off legs and feet.
Footboards: Help prevent foot drop.
Heel Protectors: Some types help with foot alignment.
Assistive Devices for Eating
Angled utensils (for limited arm or wrist movement).
Sipper cup.
Large grip-handled utensils.
Plate with a lip around the edge (keeps food on a plate).
Snap on food guard (keeps food on a plate).
Drinking cup with flexible straw.
Curved handle spoon.
Assistive Dressing Devices
For Shirts, Jackets, Pants, Skirts, etc.: Button fastener, zipper pull.
For Socks and Stockings: Sock and stocking slider.
For Shoes: Long handled shoehorn.
Assistive Mouth Care Devices
Electric toothbrush, denture brush.
Assistive Nail Care Devices
Nail brush.
Assistive Bathing Devices
Long Handled Sponge.
Assistive Diabetic Foot Care Device
Long-handled mirror with brush (to wash feet and to examine heels, toes, and bottoms of the feet for reddened areas, abrasions, or sores).
Assistive Devices for Reaching
Reaching or grabber tools.
Documentation and Reporting – Assistive Device Use
When documenting and reporting on assistive device use, consider:
What activity was attempted?
What assistive devices were used?
How successful was the activity as it relates to the activity goal?
Any increase/decrease in ability noted?
Any changes in attitude or motivation, both positive and negative?
Any changes in health as evidenced by skin color, respirations, energy level, etc.?
Basic Restorative Care: Points to Remember
It may seem easier and quicker to do something for a resident rather than encouraging independence. However, it’s essential to be patient and encourage the resident to do as much as possible, regardless of duration or performance.
Independence helps with the resident’s self-esteem and speeds up recovery.
Range of Motion (ROM) for Muscles and Joints
Purpose: To prevent the development of muscle shortening, contractures, and shortening of the ligaments and tendons. ROM exercises also provide sensory stimulation.
Three Most Often Used Types in Restorative Care:
Active Range of Motion (AROM): Used by a resident who can perform the exercises without help. The nurse aide may need to remind and encourage the resident.
Active-Assistive Range-of-Motion (AAROM): Used when a resident needs help achieving full range of motion for one or more body parts due to weak or stiff muscles.
Passive Range-of-Motion (PROM): Used when a resident is unable to move one or more body parts. Nurse aides perform the full range of motion exercises without any help from the resident. Passive exercises will not preserve muscle mass but keep the joints flexible.
Performing AROM and PROM
Perform slowly and gently to avoid hurting the resident or harming joints and bones.
If a resident has pain during the exercises, stop at once.
Notify the nurse about the resident’s pain.
Contraindications to Range of Motion
A contraindication is a specific situation or factor that makes a procedure or course of treatment inadvisable because it may be harmful to a person.
ROM exercises may be contraindicated for residents with:
Heart and respiratory diseases and conditions (may cause heart to beat too fast, shortness of breath, chest pain, and fatigue). This information should be on the care plan; always check with the nurse.
Swollen or inflamed joints.
Muscle or bone injury near the joint. Always check with the nurse.
Bowel and Bladder Training
Definition: Measures taken to restore the function of urination and defecation by a resident, with the goal of continence.
Urination (or voiding): The process of emptying the bladder.
Defecation: The process of emptying the rectum of feces.
Continence: The ability to control urination or defecation.
Incontinence: The inability to control urination or defecation.
Importance of Bowel and Bladder Training
Incontinence creates barriers to the resident’s independence:
It is embarrassing for the resident.
The resident may limit their lifestyle due to incontinence.
Odors can cause family and friends to shun the individual.
Infections can develop.
Residents may find it difficult to discuss and ask for help.
Nurse Aide’s Role in Bowel and Bladder Training
Involved with the bowel and bladder training plan.
Support the explanation by the doctor or nurse to the resident about the training schedule.
Keep an accurate record of bladder/bowel pattern and output amounts.
Answer call lights promptly.
Do not rush the resident; be patient.
Be positive.
Don’t scold if there are accidents.
Assist to the bathroom, if requested.
Provide privacy, either in bed or in the bathroom.
Encourage the resident; be supportive and sensitive.
Offer and encourage fluids per the schedule.
Encourage fiber foods (fruits, vegetables, breads, and cereals).
Encourage regular exercise.
Teach good peri-care.
Keep bedding clean and odor-free.
Bladder Training – Adhering to a Schedule
The nurse aide encourages the resident to attempt voiding at scheduled times:
When the resident awakens.
1 hour before meals.
Every 2 hours between meals.
Before going to bed.
During the night, as needed.
How to Encourage Resident to Void
Assist residents to void by:
Running water in the sink.
Having the resident lean forward, putting pressure on the bladder.
Putting the resident’s hands in warm water.
Offering fluids to drink.
Pouring warm water over the perineum (perineal area).
Bowel Training
Enemas, laxatives, suppositories, and stool softeners may be ordered.
The doctor will order enemas, and the order may be found on the care plan.
Enemas usually contain approximately 500 ext{ ml} of the ordered fluid.
Commercially prepared enemas contain additives to soften stool.
The employer will train the nurse aide to administer an enema before the task is delegated.
Bowel and Bladder Training – Training Points to Remember
Bowel and bladder training can be accomplished.
Staff must be consistent and follow the plan.
Documentation and reporting are vital to the success of both bowel and bladder training.
Success can take 8 ext{ to } 10 ext{ weeks}.