The document discusses restorative care, which focuses on maintaining or regaining physical function, in contrast to previous custodial care which focused only on comfort. It outlines the goals of restorative care and the roles of the interdisciplinary team members in developing a plan of care using the nursing process. Key programs in restorative care include range of motion, ambulation, transfers, activities of daily living, dining, and bowel and bladder care. Caregivers play an important role in implementing restorative plans as part of daily care routines.

1. RESTORATIVE CARE
In-Service Training Series

2. RESTORATIVE CARE
YOUR CHOICE SENIOR CARE
The Road Back
A skills update

3. Objectives
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 Describe the shift in focus from custodial to restorative
care
 List the 4 goals of restorative nursing care
 List 6 programs that are included in restorative nursing
 List 5 negative consequences of a lack of restorative care
 Discuss ways restorative care can be incorporated into
daily routine
 Discuss ways to help motivate the client to reach goals

4. Introduction
YOUR CHOICE SENIOR CARE
Restorative nursing care
promotes quality of life that
supports independence, dignity,
and self-esteem.
The goal of restorative care is
to maintain or regain
physical function.

5. Custodial Care Restorative Care
YOUR CHOICE SENIOR CARE
 Before 1975 the focus of
care for long term care
clients was custodial.
Custodial care focused
on keeping clients
comfortable until their
death. There was little
anticipation that they
would ever regain
independence or be
discharged to home.
 Restorative nursing care
ensures that every client
has the opportunity to
function at his highest
level by maintaining or
regaining independence.
The goal is to maintain
or regain physical
function.
Custodial vs. Restorative Care

6. Purpose of Restorative Nursing Care
YOUR CHOICE SENIOR CARE
 Ensuring that every client has the opportunity to
function at his highest level by maintaining or
regaining independence in activities of daily living
(ADL).
 Restoring independence in functioning ability for
short-term care clients following a cerebral vascular
accident (CVA), heart attack (MI), or after hip or
knee replacement surgery.
 Restorative nursing is necessary to maintain or
attain the highest quality of life possible for long
term care clients that have chronic health problems.

7. Goals of Restorative Nursing Care
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• Prevent complications that can develop from
inactivity
• Maintain or regain independence with mobility
• Maintain or increase the client’s level of
functioning in activities of daily living (ADL)
• Maintain or regain continence of bowel and
bladder
• Restore meaning, self-esteem, and dignity to
life

8. Complications as a Result of Inactivity
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There are several complications that can occur as a
result of inactivity. The next 3 slides explain these
complications.
If you don’t use it, you lose it!

9. Complications as a result of inactivity…
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 Loss of strength Strength is lost at a rate of 5% per
day with inactivity. Elders are slower to regain
strength once it is lost.
 Pneumonia is a major hazard to elders that are
inactive. This is due to diminished respiratory effort
and pooling of secretions.
 Blood clots can form in the lower extremities
because the blood vessels have lost elasticity and the
leg muscles aren’t squeezing the venous blood and
keeping it moving back toward the heart.

10. Complications as a result of inactivity…continued
YOUR CHOICE SENIOR CARE
 Pressure ulcers can easily form because tissue is
squeezed between bed and the client’s bones, closing
blood vessels that normally feed oxygen and
nutrients to tissue cells, causing them to starve and
die.
 Contractures or stretching of muscles can lead
to permanent crippling and loss of ability to
ambulate (move).
 Loss of calcium that leads to osteoporosis
increases when weight bearing exercise, such as
walking, does not occur.

11. Complications as a result of inactivity…continued
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 Kidney stones can form as a result of calcium loss
from the bones. The lost calcium accumulates in the
kidneys.
 Bladder infections can occur with inactivity
because of incomplete emptying of the bladder while
on bed rest.
 Constipation is a common result of inactivity and
weakened abdominal muscles.

12. IDP TEAM
Interdisciplinary
Planning
Team
The Interdisciplinary Planning
Team, or IDP Team, is
responsible for planning the care
that is needed. They are also
responsible for determining who
will carry out various aspects of
the Activities of Daily Living
(ADL) plan. There are 8
members of this team.
YOUR CHOICE SENIOR CARE

13. IDP Team Members: together they develop the
ADL Plan of Care
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1. Physical Therapist- recommends ROM (range of motion) and
ambulatory exercises.
2. Occupational Therapist- promotes independence with bathing,
feeding, and dressing.
3. Dietician-establishes nutrition and hydration goals
4. Social Worker- develops a discharge plan for each client
5. Physician- reviews recommendations of other IDP team members
and prescribes care activities accordingly.
6. Speech Therapist- assesses speech, hearing, and swallowing ability
and recommends food textures
7. Nurse- coordinates the development and implementation of the
ADL plan based on recommendations and physician’s orders
8. Caregiver-has the primary responsibility of implementing the ADL
care plan.

14. Restorative Care Plans follow the nursing
process
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The 4 aspects of the nursing process that are
used when developing a client’s ADL plan of care are:
ASSESSMENT
PLANNING
IMPLEMENTATION
and
EVALUATION.

15. ASSESSMENT:
The first step in
the nursing
process when
creating a
restorative care
plan is
assessment of the
client.
ASSESSMENT
1. Determines the ability of the
client to perform the restorative
activity.
2. Establishes a baseline from
which to measure future ability.
3. Determines how much help the
client will need.
4. Gives insight into why the client
cannot perform the task,
whether there is a physical or
mental deficit.
YOUR CHOICE SENIOR CARE

16. Planning
Planning is
the 2nd step in
the nursing
process when
developing a
care plan.
PLANNING
1. Focuses on client’s ability
maintain or improve functional
ability.
2. Develops short and long term
goals. These must be
measurable to determine
progress.
3. Involves the client in the
planning. This makes it more
likely that the client will
participate willingly in the
restorative activities.
YOUR CHOICE SENIOR CARE

17. Implementation
Implementation
is the 3rd aspect
of the nursing
process that is
used when
developing a
care plan.
IMPLEMENTATION
1. Short term goals are worked on
first.
2. A written plan ensures that it is
specific for that client, and that
there will be consistency in
approach among all caregivers.
YOUR CHOICE SENIOR CARE

18. Evaluation
Evaluation is
the 4th, and last
step in the
nursing
process when
developing a
care plan.
EVALUATION
1. Must be done on an on-going
basis to determine whether the
plan is appropriate for the
client’s abilities.
2. Identifies progress toward goals.
YOUR CHOICE SENIOR CARE

19. Programs
included in
restorative
care:
The programs
listed on the
right are
included in
restorative
nursing care.
We will discuss
each one in this
presentation.
 Range of Motion (ROM)
 Ambulation
 Transfers
 Activities of Daily Living
(ADL)
 Dining
 Bowel and bladder
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20. ROM
Range of
Motion
involves
movement
of joints and
soft tissue.
ROM, or range of motion,
exercises move each body part
through its whole potential
range of motion.
YOUR CHOICE SENIOR CARE

21. YOUR CHOICE SENIOR CARE
There are 4 ways of performing
range of motion (ROM)
activities.
1. Passive range of motion (PROM): The caregiver does the movement for the
client. This prevents muscle and joint contractures, but DOES NOT maintain
strength.
2. Active-assistive range of motion (AAROM): The restorative caregiver assists the
client with doing the full ROM. This helps the client gain strength, and to
eventually be able to do the ROM activities alone.
3. Active range of motion (AROM): The client does the same full range of motion
independently. This not only maintains full ROM but also retains muscle
strength.
4. Functional Activities for ROM: The client engages in these as he rolls over in bed,
sits up, dresses, etc.

22. YOUR CHOICE SENIOR CARE
As a caregiver, you need to know how to perform
range of motion (ROM) activities.
1. Make sure you understand how to do the ROM exercises.
2. Find out if there are specific instructions for clients with special
problems.
3. Never do passive ROM for a resident who can actively participate.
4. Be sure to give the client time to perform the ROM activity by
-moving an inflamed joint slowly through pain-free
-always explain what you plan to do and how the resident can participate
-remove any obstacles that could impede motion
-remember your own body mechanics; keep your back safe!

23. Ambulation
Ambulation,
like range of
motion
activities, is
one of the 4
parts of
restorative
nursing care.
AMBULATION
Factors to keep in mind:
1. Clients need to maintain/regain
independence with walking
2. Teach clients to walk with
assistive devices
3. Ask how far a client can walk
safely
4. Know whether you need another
staff member to assist with
ambulation
YOUR CHOICE SENIOR CARE

24. Transfers
Transfers
are a
program
that is
included in
restorative
nursing.
Transfers help maintain/retain
independence with self-transfer
between bed, chair, and toilet.
YOUR CHOICE SENIOR CARE

25. ADL- Activities
of Daily Living
ADL is a
part of
restorative
care.
ADL, or activities of daily living,
help maintain/retain independence
with bathing, dressing, and
grooming. ADL encourage clients
to do as much as possible for
themselves.
Although watching a client you care
about struggle, it is important that
they do as much as possible
independently.
YOUR CHOICE SENIOR CARE

26. Dining
Dining is a
program
included
in
restorative
care.
Dining
1. Helps maintain/regain independence
with self-feeding.
2. Provides necessary
supervision/cueing with eating.
3. Limit distractions to enable the client
to concentrate on the mechanics of
eating.
4. Monitor intake of food and fluid to
prevent weight loss and dehydration.
5. Promote safety to prevent choking or
aspiration.
YOUR CHOICE SENIOR CARE

27. Bowel and
Bladder
Bowel and
bladder
programs
are a part
of
restorative
care.
Bowel and bladder programs
1. Promote continence
2. Prevent skin breakdown
3. Prevent infection
4. Promote dignity and quality of
life.
YOUR CHOICE SENIOR CARE

28. The caregiver is an important
professional on the IDP team. As the
primary person who implements the plan
it is imperative that caregivers know how
to incorporate restorative care into their
daily routine.
YOUR CHOICE SENIOR CARE
Incorporating Restorative Nursing
into a Caregiver’s Daily Routine of
Care

29. Caregivers role in restorative care programs:
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 ROM- passive or active exercises can be included with A.M./P.M. care.
Encourage the client to do exercise routines while you are doing other
tasks in their room
 Ambulation- park their wheelchair and encourage them to walk to the
toilet and back, walk to their place at the dining table, and to walk
with/without assistive devices to activities as ordered
 Transfers-assist/supervise client with transfers in and out of bed to
chair, wheelchair, commode, shower chair
 ADL-supervise, cue, encourage clients to participate in self care with
bathing, grooming, dressing, mouth care
 Dining-cue, monitor, encourage eating in a safe, quiet environment
 Bowel and bladder-choose the type of program that seems
appropriate: prompted toileting (based on client’s schedule),n
scheduled toileting (habit training every 2 hours while awake), or check
and change program (results in client being clean, dry, and odor free)

30. Tips on
ways to
encourage
and
motivate
clients to
reach their
goals:
 Have a positive attitude
 Build a relationship of trust with the
client
 Minimize distractions so the client can
focus (T.V., phone, radio)
 Be patient
 Encourage client control by giving choices
 Provide positive reinforcement
 Make sure client has assistive devices in
place (hearing aids, clean glasses,
dentures…)
 Involve family or significant others. Ask
them about how the client coped with
challenges in the past. Ask what worked
best in helping the client reach goals.
YOUR CHOICE SENIOR CARE

31. In conclusion, restorative nursing care
must be a priority when giving care. With
patience, encouragement, and assistance
the road to restoration can lead to
independence, dignity, and hope. An
informed caregiver is an important part of
this care.
YOUR CHOICE SENIOR CARE
Conclusion

32. Summary
YOUR CHOICE SENIOR CARE
 Restorative care focuses on maintaining or regaining physical
function.
 Custodial care focused on safe comfortable care until death.
 The IDP team develops the ADL plan of care.
 4 aspects of the nursing process used in developing a restorative care plan are
assessment, planning, implementation, and evaluation.
 Dieticians establish nutrition and hydration goals.
 Speech therapists assess speech and swallowing ability and
recommends food texture.
 Social workers develop discharge plans
 Occupational therapy promotes independence with bathing dressing,
feeding
 Assistive devices are things like walkers, reachers, sippy cups.
 Physical therapy recommends ROM and ambulation exercises.
 Caregivers are primarily responsible for implementing the ADL plan
of care.