Basic Restorative Services
What you must understand
Restorative care means helping each resident keep or regain the highest level of function they can, and the nurse aide delivers most of it. The guiding principle is simple: never do for a resident what they can still do for themselves. If they can lift the cup, let them; if they can stand with a gait belt, do not lift them.
Know the terminology and technique. Range of motion can be active (the resident does the movement), passive (you move the joint), or active-assistive (both). Move joints slowly to the point of resistance, never past pain, and stop if the resident reports pain. Report contractures and stiffness. Dangling - sitting on the edge of the bed before standing - prevents dizziness.
Ambulation and devices: apply the gait belt snugly around the waist over clothing, walk on the resident's weak side, and stand slightly behind and to that side. A walker is picked up, placed ahead, and then the resident steps into it; the resident must not use a walker to climb steps. A cane is held in the hand opposite the weak leg. Cues such as "step, together" help. Measure and apply TED hose in the morning before the resident gets out of bed, and remove them for skin checks per policy. Splints and braces go on as ordered and are checked for skin irritation.
Bowel and bladder training, prompted toileting, hand-over-hand feeding, self-feeding with adaptive equipment, and speech practice all belong here. Praise effort, not just results.
Traps the exam sets
- Holding the cane on the weak side.
- Pulling a resident up by the arms instead of using a gait belt.
- Forcing a joint past the point of pain during ROM.
- Doing a task for the resident because it is faster.
Rule of thumb
Cane opposite the weak leg; gait belt on, walk on the weak side. Worked example: Mrs. P had a right-sided stroke. She holds the cane in her left hand and you belt her and walk on her right side.