Caring for Older Adults Holistically, 4th Edition
Chapter Eighteen
Rehabilitation and
Restorative Care
Caring for Older Adults Holistically, 4th Edition
Understanding Rehabilitation and
Restorative 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
Caring for Older Adults Holistically, 4th Edition
Understanding Rehabilitation and
Restorative 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
Caring for Older Adults Holistically, 4th Edition
Nursing Roles
 Bedside caregiver
 Provide direct care until older adult is able to
perform self-care
 Provide positive reinforcement, encouragement,
hope
Caring for Older Adults Holistically, 4th Edition
Nursing Roles
 Educator
 Provide information to older adults and their
families about disability, treatment, and
management
 Education plan includes health measures to obtain
and retain function
Caring for Older Adults Holistically, 4th Edition
Nursing Roles
 Counselor
 Assist older adults in solving and effectively coping
with their problems
 Ongoing process that requires supportive behaviors
Caring for Older Adults Holistically, 4th Edition
Nursing Roles
 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
Caring for Older Adults Holistically, 4th Edition
Nursing Roles
 Researcher
 Work with nurse researcher to gather data to
improve rehabilitation and restorative care
Caring for Older Adults Holistically, 4th Edition
Goals of Rehabilitation and Restorative
Concepts
 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
Caring for Older Adults Holistically, 4th Edition
Goals of Rehabilitation and Restorative
Concepts
 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
Caring for Older Adults Holistically, 4th Edition
Developing 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
Caring for Older Adults Holistically, 4th Edition
Implementing Goals
 Maintenance of joints
 Prevention of deformities
 Active exercise
 Improve function and performance
 Bladder continence
 Initiate bladder training programs when
appropriate
Caring for Older Adults Holistically, 4th Edition
Implementing 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 selfconcept
Caring for Older Adults Holistically, 4th Edition
Assessment 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
Caring for Older Adults Holistically, 4th Edition
Assessment of Goals
 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
Caring for Older Adults Holistically, 4th Edition
Assessment of Goals
 Goals specific to elderly population (cont.)
 Comfort in the dying process
 Provide comfort measures and palliative care
Caring for Older Adults Holistically, 4th Edition
Clinical 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
Caring for Older Adults Holistically, 4th Edition
Clinical Implications
 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
Caring for Older Adults Holistically, 4th Edition
Clinical Implications
 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