By Susan Kreimer, MS, contributor
Oct. 8, 2009 - As the number of elderly patients and others with deteriorating conditions continues to grow, nurses are discovering that they can do a lot to keep them on their toes. By following the principles of “restorative nursing,” they can encourage these patients to do more on their own, and help prevent progressive functional decline.
Restorative nursing is all about encouraging independence in any care setting, according to Barbara M. Resnick, Ph.D., CRNP, FAAN, an associate professor at the University of Maryland School of Nursing.
Resnick is actively engaged in several restorative care research projects in different types of health care settings. One of her studies involved 487 residents from eight nursing homes. The study showed that functioning abilities could be maintained among the residents, with no increased risk of falls or acute medical problems associated with restorative care activities.
In a current study evaluating approximately 200 residents at five assisted-living facilities, Resnick’s preliminary findings indicate that restorative nursing actually can help increase physical activity among these individuals.
Researchers believe that restorative care may also decrease emergency room transfers from nursing homes and assisted living facilities, by lowering infection rates often linked to immobility and deconditioning.
“Restorative care is most commonly thought of in the nursing home, where patients/residents tend to be frailer and need multiple care interactions,” Resnick said.
“However, we have implemented restorative care in the home, nursing home, assisted living and acute care setting.”
The traditional philosophy of nursing care has advocated for bathing and dressing individuals as opposed to helping them carry out as much of these tasks on their own as possible. “This type of care can exacerbate functional decline, particularly among older adults,” Resnick said.
In contrast, restorative care optimizes what elders can do with minimal or no assistance – walking to the dining room instead of being pushed in a wheelchair, participating in hand-over-hand bathing or ambulating 30 minutes daily.
“Restorative care benefits patients by preventing progressive functional decline and immobility,” Resnick said. “When this decline occurs, it can cause contractures, pain, pressure areas from decreased movement, and may increase the risk of infection and falls.”
For the most part, nurses know how to provide restorative care, but they tend to be focused on the task rather than the process, she said. They need to think about the steps involved and how the patient can string them together.
Nurses applying restorative principles can facilitate patients’ self-care in activities of daily living and enhance their overall quality of life, said Jeanne Dzurenko, MPH, BSN, RN, director of nursing at NYU Langone Medical Center’s Rusk Institute of Rehabilitation Medicine.
The aim of restorative nursing differs from rehabilitation nursing, which strives toward recovery or cure. Rehab treatments are likely to follow an acute event such as a stroke or spinal-cord injury, and they typically include learning to care for oneself with a new disability.
“Restorative nursing, on the other hand, seeks to maintain that optimal level of functioning that has been achieved through the interdisciplinary therapy programs on a longer-term basis,” Dzurenko said.
“Often, once acute rehabilitation is complete, patients lack the motivation and encouragement to continue to function as independently as possible,” she added. “Restorative nursing focuses on encouraging the patient to continue to do for themselves in the home and or long-term care facility.”
Many caregivers who see a loved one take a long time to accomplish a task feel a natural tendency to do it for them. This often contributes to deconditioning beyond the disease itself, said Ingrid Pretzer-Aboff, Ph.D., MA, RN, an assistant professor at the University of Delaware School of Nursing. She conducts research involving restorative care for caregivers and patients with Parkinson’s disease (PD) who live at home.
One study led by Pretzer-Aboff showed the benefits of not rushing a patient and instead allowing extra time to perform tasks. Other positive interventions included verbal and visual cues and assistive devices such as walkers with brakes and electric toothbrushes. Aerobics, as well as stretching and strengthening exercises, also helped patients with Parkinson’s disease remain self-reliant.
The study, published in the March/April issue of the journal Rehabilitation Nursing, noted that formal caregivers “would offer assistance if they saw the person struggling or becoming frustrated with a task or if the resident asked them for help. It was important to all formal caregivers to first establish what the person with PD was able to do before they offered assistance.”
Patients often appreciate the opportunity and freedom of trying to fend for themselves. “For instance, one woman with PD used to wake up at 5 a.m., so that her husband could put her shoes and socks on for her before he went to work,” Pretzer-Aboff said of a patient in a subsequent study. “After being introduced to sock helpers and elastic shoelaces, she sleeps in.”
Another patient with Parkinson’s disease discovered that he feels much better after exercising. He was surprised that he could still benefit from physical activity. “It is particularly rewarding to see the caregivers and patients embrace the philosophy of restorative care,” Pretzer-Aboff said.
“Several patients have come up with new strategies and even exercises that help them remain independent. One individual devised a rope-and-pole system that enabled him to get himself out of bed during the night, so he did not have to wake up his wife.”
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