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The Total Restorative Care Concept

May 1, 2004
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An Ohio retirement community involves trained nursing assistants in its revamped restorative care program by Sharon Sacre, RN, BS
BY SHARON SACRE, RN, BS

The total restorative care concept

Enriching nursing assistants' involvement in restorative care becomes a win-win situation Mercy Franciscan at Schroder, a retirement community located in Hamilton, Ohio, has implemented a unique approach to providing restorative care-an approach that has many advantages and no apparent disadvantages.

Schroder had a traditional restorative program with a program coordinator and designated aides for several years. We thought it worked very well. The program coordinator, through the assessment process and with input from therapy and the nursing staff, ascertained the resident's functional level, and designed and then implemented a restorative program. The restorative aide performed the interventions and documented the resident's participation and progress daily.

However, in June 2003 budgetary considerations made it necessary for us to re-evaluate staffing in the nursing department-specifically, we needed to reduce our FTEs. We had concerns about maintaining quality of care, and we knew change would be difficult for the staff. We believed that this could be accomplished without loss of quality by redesigning our restorative program using the concept of total restorative care.

We envisioned total restorative care this way: All state-tested nursing assistants (STNAs) would be trained in restorative care. Then each STNA would have a restorative assignment for his/her assigned residents on restorative care. Their assignments would essentially be the same each day and would change only if they requested a change or staffing emergencies dictated adjustments to the assignments. Initially, only the day shift STNAs would be trained. But, as the caseload increased, it became apparent that evening shift STNAs would also need training. The evening shift received training in more basic programs-for example, ambulation, range of motion, resident transfer, and dining assistance-in order to lighten the load for the day shift. This way the evening shift could complete the restorative care for a resident when the day shift did not have time to complete treatments because of their workload.

Communication would be key to this transition, and would require the day shift STNA to notify the evening shift STNA that treatment(s) had not been completed. Documentation of that restorative care would then be done by the STNA completing the care. The program coordinator would continue to design and implement programs but would now oversee all STNAs in the performance of restorative care. In essence, each STNA would provide total care to his/her residents seven days a week.

Once the program was implemented, we found compliance to be very high: 86% in the first two weeks. We also saw an immediate increase in the number of restorative programs that could be assigned. Under the traditional approach, we were limited in the programs we could offer by the number of staff that could perform the tasks and the hours they had to complete the programs. We were constantly adjusting programs to accommodate these. Programs had been offered inconsistently because of these limitations, but this new approach eliminated the inconsistency. Also, although we have more than 25 residents in restorative programs, we can quickly adjust upward to meet residents' needs.

Staff satisfaction also greatly increased. STNAs are not performing just basic daily care but now provide interventions that help their residents regain or improve functional status. The uniqueness of the program therefore gives the STNA an opportunity to function at a higher level. No longer did we have only a few STNAs who reaped the rewards associated with providing restorative care-they all did. This gave each of them a greater self-esteem and made them feel more valued.

A long-term STNA had this to say: "I have been a STNA for ten years. I really enjoy taking care of my residents. In the past year we added restorative care to our daily care. We are all able to help the residents not just with their daily care needs, but also to get back skills they have lost. Just to walk down the hall makes them proud. I like it better now that we have total care of our residents because we help them reach their goals."

We even saw greater satisfaction in our restorative aides. "I am an STNA again," said one. "At first I didn't think I would like the change, but now that I am doing aide work and restorative care, I enjoy it much better. I get to do hands-on work with the residents and have more time to get my restorative done. I really didn't realize how much I missed the one-on-one with the residents, and would not change back for the world."

A final advantage of this approach is that it provided for greater continuity of care because the resident had essentially the same STNA each day providing for all his or her care needs. The STNA, now trained in restorative care, became so familiar with the resident's functioning that he/she could readily identify problems and recommend placement in a restorative program or modification of an existing program to better meet the resident's needs. Families also liked the approach better because they knew with whom they could speak concerning their loved one's progress.

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