Restorative Skills: Assist, Don't Replace
What this domain tests
Restorative care is the philosophy that residents should regain or maintain as much function as possible. You carry out the restorative plan written by the nurse and therapy team: range-of-motion exercise, positioning, splint and device use, ambulation, bladder and bowel training, and encouraging self-care.
Core concepts
- Use it or lose it. Muscles and joints that are never used become stiff and contracted. Daily movement preserves function.
- Types of ROM. Active means the resident moves the joint themselves. Passive means you move the joint for them through its full range. Active-assistive means the resident does part of the movement and you help with the rest.
- Positioning and splints. Change position on the schedule in the care plan, support limbs with pillows, and apply splints exactly as ordered - never tighter or looser.
- Ambulation. Apply the gait belt before standing, stand on the resident's weak side, take small steps at the resident's pace, and stop for dizziness, pain, or shortness of breath.
- Bladder and bowel training means following the scheduled toileting times and answering the call light promptly, not rushing the resident.
- Adaptive equipment such as plate guards, built-up utensils, and long-handled sponges lets the resident succeed without your hands.
Traps
The most common wrong answer is the efficient one: doing the task for the resident because it is faster. Restorative questions reward patience and the least assistance necessary. Other traps include forcing a joint past the point of pain, skipping the gait belt, or changing the exercise plan on your own.
Rule of thumb
"Assist, don't replace." If the resident can do any part of the task, let them, then report progress and problems to the nurse so the plan can be updated.