Chapter 16
Providing Restorative Care to Help with Rehabilitation

Key Terms

The Art of Restoring

The master craftsman saw his task not as fixing, but as restoring. As a nurse assistant, your work is similar. You do not merely patch up people and keep changing their bandages. Instead, you help people find their inner strength, stand on their own again and find dignity in their lives, even though they are not like new. This kind of caregiving is called restorative care. When you provide restorative care, your goal is to help a person become as fully functional as possible and to help him or her be able to enjoy life.

How to Respond to the Person’s Needs

When providing restorative care (rehabilitation nursing), you use rehabilitation techniques and procedures. In addition to monitoring vital signs, you promote independence in daily living and emphasize communication. You also enable a person to enjoy life more fully. Enabling a person gives her the power to do something.

Enabling the resident, by ensuring that her walker is within reach, gives her the power to be more independent.

Enable a person when you:

• Emphasize abilities rather than disabilities. Recognize what she can do and encourage it.
• Begin the rehabilitation program early per orders. Less time in bed prevents pressure sores, UTIs, weakness/shortening, atrophy (disuse syndrome) and respiratory infections.
• Keep her active with exercise whenever possible—activity strengthens; inactivity weakens.
• Treat the whole person (emotional, social, spiritual, vocational, physical). Help develop a care plan tailored to specific needs.

Promoting a Healthy Lifestyle

Views on health have shifted from “luck” or solely medicines to recognizing how habits (smoking, inactivity, poor diet) drive disease. Many factors are controllable. Help the person reach best overall health by promoting independence, self‑care and good habits; teaching skills for independence; and measuring progress.

Promoting Independence, Self‑Care and Good Health Habits

Restorative care involves the entire team—PT/OT, speech therapy, dietitian, others. They rely on you to report progress and reinforce instructions. Encourage the person to take control.

Independence — Scenario

A resident with breathing difficulties moves slowly but prefers to select clothes and dress himself. Although you have several others to help, you hold up his robe, ask him to put his arm in, stand by to assist, notice fatigue, then help finish and allow a brief rest before shoes.

What you did to promote independence:

• Considered the whole person—mind, body, spirit—and respected his desire for self‑care.
• Explained what you would do for/with him.
• Encouraged and praised even small successes.
• Focused on abilities, not disabilities.
• Stayed patient.

Self‑Care Through Personal Care — Common Self‑Help Devices

• Toothbrush with built‑up handle (foam curler around handle adds size and grip).
• Long‑handled device with a hook to remove shoes.
• Zipper pull to grasp zippers for dressing.
• Long‑handled shoehorn to put on shoes.
• Washcloth mitt (self‑fastening fabric) for bathing.
• Sock aid for weak hands/limited finger motion.
• Long‑handled grabbing device to pick up items or reach light objects on shelves.

Encouraging self‑help devices increases independence, confidence and energy. Be patient—task time decreases as the person improves. Some tasks (e.g., elastic stockings per Skill 53) may still require assistance to promote circulation and prevent clots.

Teaching Independence Skills

Team members may start (teach/retrain); you often continue and reinforce—an essential part of your role. You spend the most time with the resident each day.

• Explain the task with short, concise statements; give clear instructions.
• Ask the person to repeat instructions; repeat as needed using the same wording.
• Give examples; demonstrate; explain why the activity matters.
• Invite questions; be patient—progress can be slow.

Prompting is a subtle reminder without doing the task. Example: Ask Mrs. Garcia if her walker is where she wants it to cue repositioning. If she hesitates, ask “What do you think you should do next?” Encourage independence.

The NA reinforces what the therapist or nurse taught Mrs. Garcia about using a walker.

Helping a Person Walk

Walking is good exercise. Devices—walker, cane, crutches—may be needed. PT/nurse teaches device use; you reinforce. Assist when the person is learning or unsteady. If dizzy, sweaty, in pain or short of breath, encourage rest. Follow Skill 54 for walking and for assisting a person who begins to fall.

Safeguard equipment: keep IV bag/bottle above the entry site; keep urinary catheter bag/tubing below bladder.

Walking with a Walker

• Ensure rubber tips and proper height (about hip level; fitted by PT/supervisor). Many walkers have adjustable legs.
• Types: Pick‑up (for those who don’t need to lean heavily), Four‑wheeled (for constant support), Semi‑wheeled (two front wheels, two back feet).

Walking with a Cane

• Support needed on one side; cane on stronger side; top even with hip; base ~6 inches lateral to foot.
• Walk on the weaker side to assist.

Walking with Crutches

• Adjusted by nurse/PT; do not lean on axilla to avoid injury.
• Fit: two‑finger space under armpit; comfortable handgrip with elbow extended.

Walking Without a Device

• Use a safety belt unless contraindicated (recent ostomy; severe heart/respiratory problems; recent chest/abdominal/back surgery; fear of belts).
• Stand on the weaker side unless directed otherwise; gradually increase distance. If no cane and a weak side exists, you become the “cane”—walk on the strong side.

Promoting Activity

“Use it or lose it.” Too little exercise leads to weakness, atrophy and immobility, and contributes to problems across body systems: constipation, pneumonia, blood clots, bone loss/osteoporosis. Even immobile persons need activity.

Exercise benefits physical and emotional health. Support activity with range‑of‑motion (ROM) and ambulation. ROM is how far a joint moves comfortably. Do ROM at least twice daily and walks several times daily for best results.

Helping a Person with Range of Motion

ROM varies across the day (e.g., arthritis worse in early morning). ROM can be active (person moves) or passive (you move joints). Passive ROM prevents shortening and contractures.

Follow Skill 55: start at the top and work down; exercise five sets of joints on one side, then the other. Make it pleasant—smile!

Measuring Progress

Rehabilitation can be slow. Observe and celebrate small gains; they motivate. Use all senses to gauge progress per care‑plan goals (distance walked, eating, joint flexibility; skin warm/cool/moist/dry as effort cues). Record observations for the team.

Mrs. Garcia tracks walking distance to see steady improvement despite off‑days. Noting small successes (“all but the sleeves today; last week only over the head”) encourages the next goal.

Always record observations about progress. These updates inform the whole care team.