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December 2006

What does Restorative Nursing have to do with it?

Restorative nursing is based on a belief in the dignity and worth of each person as a unique individual moving away from stereotyping or labeling a person by injury, diagnosis or age. Restorative nursing is based upon the nursing model with less continued or no direct input from formalized therapy. Reaching an individual's highest possible level can mean maintaining a current level and instituting a program to assure an individual’s capabilities will not diminish. Although there are certain circumstances, such as a progressively deteriorating condition, that can make a decline unavoidable. Restorative Nursing is based on the Nursing Process. Restorative nursing seeks to maximize and prolong abilities with specific, measurable objectives and is a continuing process that can go on indefinitely.

Restorative nursing is not a new concept. The techniques and practices have been taught in nursing schools for years, and restorative nursing basics are included in CNA training programs mandated by the federal government.

Restorative Nursing has everything to do with succeeding in the quality of care provided, resident dignity and self worth, survey compliance and meeting payment criteria. Identifying individual resident restorative needs, planning and delivering Restorative Programs impacts the following areas:

  • Resident dignity and self worth Federal regulation compliance
  • Increased staff morale
  • Residents increase function; staff decrease direct care hours
  • Improved clinical outcomes
        –Decrease in the number of skin breakdowns and acquired pressure sores
        –Increase in the number of residents ambulating independently
          or with assistance
        –Increase in the number of residents performing some or all of their
         activities of daily living, including an individual’s ability to feed self
        –Decrease in the number of incontinent residents
        –Decrease in the number of residents with indwelling catheters
        –Increase in the number of individuals involved in sensory stimulation,
          exercise, grooming and social functioning events and classes
        –Decrease in numbers of individuals that develop contractures
        –Decrease in the number of physical restraints
        –Decrease in number of falls
        –Increase in individual mental status and awareness
  • Cost savings
  • Qualify for Medicare and Medicaid payments
  • Marketing opportunity
Facilities that have a comprehensive, fully integrated program involving all shifts are the facilities that achieve these outcomes. I can observe and feel an excitement, “things are happening”, an attitude, a "can do" force, a “bubbling over of enthusiasm” in facilities where all staff has become involved in the provision of restorative care. Staff exhibit pride and ownership about the program and what it is doing for the residents that live in their community, and both the staff and the residents are having fun with it. A one man show will not get you there. I have seen Restorative Nurse Coordinators and Restorative CNAs put forth a tremendously heroic effort, but they were still unable to reach these results. Until the program has administrative and DON support as well as an all-staff and all-discipline involvement the rewards of the environment described here and the outcomes as listed above will not be reached.

The challenge to success is getting the program organized and structured to provide Restorative care in a planned, systematic manner according to individualized needs. Briggs new manual, Restorative Nursing Simplified, provides tools, forms, policies, procedures and additional resources to help a facility organize and structure the program. The Quick Start Implementation Plan in the Introduction will guide you through the necessary steps. Use Restorative Nursing Simplified to position your Restorative Program for success.

Restorative Nursing has everything to do with it by positively impacting resident dignity, resident independence, staff morale, CMS regulation compliance, delivery of quality Restorative care and meeting Medicaid and PPS/RUGS III payment criteria.

B.J. Collard, RN, BSN, GNP, ANP, CPHQ, RAC-C
B.J. is founder of CTS, Inc., a Nurse Consultation and Education firm in Denver, Colorado specialized in post acute care.

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