Lecture # 402:
Restorative Care

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

A young man came to the master craftman's shop. He was hauling an old, water-marked chest of drawers behind him. He leaned it against the wall because one of the legs had been broken and it could not stand alone. The chest was made from a beautiful piece of wood, but a flood had ruined it. "Please, sir", he said, "can you fix this old chest? It was mine as a child. Now I have a son and I want him to have it." The master shook his head and asked the man to return in two weeks.

Later when the young father returned to the shop, he heard the sounds of the master craftsman working in the back room. While he waited for the craftsman, he looked around for his chest. He hoped the craftsman had been able to repair it. He did not see his chest anywhere. Perhaps the craftsman did not have time to work on it or perhaps it was too worn to be fixed.

Just then, the craftsman entered the room and asked, "Well, young man, what do you think of it?"

"Think of what?" asked the younger man.

"Of your chest of drawers, of course," the old man said as he pointed to a beautiful shining smooth piece that stood in the corner on its own feet.

The young man could not believe his eyes. "This is it?" he stammered. "I can't believe it!" He could see ever so slightly where the scratches had been. The rough edges had been smoothed and the old dirt rubbed out with oil to make the wood shine with luster. "I was afraid that you couldn't fix it", he finally said.

"I didn't fix it", said the old man, "I restored it!"

Meditate Word By Word On These Verses:
Mark 3:14-15.

When we work with people who have had an illness or accident, we do not merely patch them up and keep on changing their bandages. We need to help people find their own inner strength to stand again and be independent. Even though the bodies of these people have changed, they can yet have dignity. This kind of care is called restorative care, and the goal of this care is to help a person become as fully functional as possible and to help them enjoy life. When a person functions as well as possible in all areas of life, he has reached his best overall health. By encouraging him to do as much for himself as possible, his self esteem increases.

Question 1: Are there some examples of people in the Bible who were physically or mentally injured, but restored to live as normally as possible? Who are they and what happened to them?

The important word in restorative care is "enable." This word means giving a person the power to do something such as eat by himself or toilet himself. How do you give a person such power? By using the following techniques:

• Emphasize his abilities rather than disabilities. Recognize what he can do for himself and encourage him to do it.
• Begin rehabilitation early. Decrease the amount of time spent in bed to prevent the complications of pressure sores, urinary tract infections. tightening and shortening of the muscles (atrophy).
• Keep him active with exercise since this strengthens, but inactivity weakens him.
• Treat the whole person, not just the affected part of the body. Consider the emotional, spiritual, and vocational part of his lfe.

Promote Healthy Living
Views on being healthy have changed during this century. People once believed that being healthy was a matter of luck. After the discovery of antibiotics, and vaccines, people believed that taking these medicines was the way to control disease and illness.

Today, we know that many diseases are caused by an unhealthy lifestyle, such as smoking or eating foods with much fat in them. Many things that affect health can be controlled. As a caregiver, you can help a person to optimum health. You can encourage him to become as independent as possible, do his own self-care, and have good health habits. Teaching these skills helps him gain independence and you can measure his progress as he practices with you.

Question 2: What are some healthy lifestyle habits you have learned in the last few years?

How can you teach a person independence? Let's read the following scenario.
Mr. Sokolov has breathing difficulties and gets tired even when dressing. Although he moves slowly, he likes to choose his clothes and dress himself. Today, he chooses a warm sweater.

The caregiver has other persons to help and doesn't think he has time to stand and watch Mr Sokolov put on a sweater. However, since it is important that Mr. Sokolov dress himself, the caregiver holds up the sweater for him and asks Mr. Sokolov to put it over his head. The caregiver begins to make the bed. He notices that Mr. Sokolov is tired while pulling the sweater down over his chest. The caregiver praises Mr. Sokolov for completing the task of dressing thus far. The caregiver asks if he can straighten the sleeves of the sweater for Mr. Sokolov. Her lets Mr. Sokolov rest for a few minutes and then helps him put on his pants and belt.

What did the caregiver do to promote independence for Mr. Sokolov?

• He gave attention to Mr. Sokolov's whole being - He understood that Mr. Sokolov wanted to do things for himself. He encouraged Mr. Sokolov to do as much as he could physically do.
• He praised Mr. Sokolov for the smallest successes.
• He focused on Mr. Sokolov's abilities and not his disabilties.
• He was patient.

Sometimes it takes longer to do these tasks, but the person becomes more self-sufficient as he practices.

A person is never too young or too old to learn new health habits. What good health habits can you suggest to the people in your care?

• Eat plenty of vegetables, fruits, and grains.
• Exercise regularly, even if it must be done sitting on a chair.
• DO NOT SMOKE.
• Make time for relaxation daily.
• Talk about your feelings.
• Visit family and friends.
• Do tasks that give you a sense of accomplishment.

Question 3: What is the attitude in your country about living healthy - among the young, middle-aged, and older population?

Some people learn new ways of doing things so they can be as independent as possible. We may be asked to teach and continue or reinforce teaching to a handicapped person. Here are some suggestions for teaching a person a new skill:

• Explain the task that you want a person to do. Use short, concise statements.
• Give clear instructions.
• As the person to repeat your instructions. (This feedback lets you know if the person understands what he is being asked to do.)
• Give an example if necessary or demonstrate what you want done.
• Explain why the activity is important.
• Have patience, progress may be slow.

In addition, use a method called prompting. It is a way of reminding people what to do without actually telling him. For example, if Mrs. Takinov stands up alone but needs a walker for support to walk, you ask her where her walker is located. If it is to the right or left of her, she cannot begin to walk. You ask, "Is your walker where you need it?" By doing this, you remind her that she needs to place the walker correctly. Also, if a person hesitates to do something you know he can do, it is better to ask a prompting question than do it for him.

Question 4: What should you do if there is no progress in a person's rehabiltation?
(Select the best answer.)
Tell the person that you can't help him/her any longer.
It may be a "plateau." Step back, think about it, and talk it over with your coworkers.
Ask the person why he/she doesn't want to keep trying to make progress.

If a person is doing a task, but gives you a questioning look, he may be worried that he is doing something wrong. You can then ask the question, "What do you think you should do next?" The person may tell you the next step and go on with the task. If necessary, tell him what step should come next. Encourage him to proceed.

Rehabilitation can be a long and/or slow process. A key part of our job is to observe the smallest changes. Telling the person in your care about his progress encourages him to continue. Use your senses for observing a person for positive changes. You may have to watch to see how much he eats, walks, and how far he can bend a joint. Listen to how much effort the person is making, or touch him to find out if his skin is warm, cool, moist or dry. The skin can give you an idea of how much effort he exerted. If his skin is moist and warm, he used much effort. Make a note of these small steps to progress and verbally encourage your client.

Question 5: How are you going to measure a person's successes in rehabilitation?

Activity helps people regain independence. Have you ever heard the expression "if you don't use it, you lose it"? We often apply this to langauge learning, but it also applies to physical activity. When peole do not use their muscles, the muscles become flabby, weak, and tired. Their joints and muscles may atrophy, causing the joints to become permanently bent. Lack of exercise can cause problems in almost all body systems, and here is a list of some of the physical problems that can occur:

• decubitis ulcers
• constipation
• contractures and atrophy
• blood clots
• pneumonia
• osteoporosis
• decreased sense of well-being and independence

Therefore, as we have said previously, range of motion and walking help the person to remain active and prevent the physical problems listed above.

To help a person walk, put a belt on him, help him to stand if necessary, when he takes his first step, hold on to the back of the belt and walk to the right side of him. By holding the belt, you give him stability. If he falls, you can ease him to the floor, holding the belt.

Question 6: Why is walking important?
(One or more of the following answers may be correct.)
Walking helps people regain independence.
Walking helps keep the muscles strong and joints flexible.
Walking helps to avoid bed sores, blood clots and pneumonia.

If your client is using a walker, he needs support on both sides to walk. Again, when he begins to walk, use a belt to give support from the back and walk to his right side. (Please note: if a person has had a stroke, you may have to change the side on which you walk. With stroke patients, always support them on their weak side) As he becomes more proficient, you can stop the use of the belt. The walker should be the height of the person's hip bones. There are three kinds of walkers:

walking with a walker

1. The Pick-Up Walker - this model is for the person who is unsteady, but does not have to lean heavily. He can pick-up the walker as he walks.
2. The Four-Wheeled Walker - This is for a person who needs constant support when walking.
3. The Semi-Wheeled Walker - This is for the person who lacks strength and endurance. It has two front wheels and two back feet. The person can stop and lean on the walker. When he is ready to begin walking again, he can pick up the back feet and roll it forward on the wheels.

Question 7: Mr. Dalshun is angry because today his progress in walking with a walker was not good. He says, "I don't want to use this thing anymore!" What can you do to help him and his anger?

A person uses a cane when he needs support on one side, but is able to walk without much difficulty. Make sure the rubber tips are in good condition at the end of the cane. You may also want to fit the cane with a pointed end for winter walking. Put the cane near the person's stronger hand. The top of the cane should be even with his hip bone and the bottom, six inches away from his foot. Walk on his weaker side as he learns his gait. There are three types of canes. The single tip is used for someone who has fairly good stability while walking. The other two are used for persons who need more support. They have three or four small support legs.

If a person uses crutches for support of one weak leg or general weakness, measure two finger widths between the armpit and the top of the crutch. You must also be sure that he can comfortably grasp the hand grip with his elbow extended. He may cause nerve damage if he rests the crutch directly in his armpit. Depending on the amount of weight he can bear on his feet, he can walk in several different ways.

For the person with a prosthesis, we need to check the stump sock for signs of wear. This may give us a clue about the fit of the prosthesis. Check the stump for redness, swelling, sores or tears in the skin. If the person is new to using the prosthesis, you can gradually increase the time he wears it and watch his skin.

Question 8: Mr. Kuznetsov had a stroke 4 weeks ago and he now has right-sided paralysis. What suggestions do you have to increase his activity?