Last week we reviewed Restorative Nursing and its relationship with COVID in part 1 of this 2-part series. It’s been a tumultuous time in long-term care and restorative programs may have had to be put on the back burner temporarily. How do we rebuild and possibly even grow restorative back better, overcoming the barriers and challenges we faced in the past? In this blog, we examine some of those barriers and discuss what we can do to achieve sustained success in our Restorative Program.
Barriers to Restorative Programming
Restorative Nursing Program (RNP) refers to nursing interventions that promote the resident’s ability to adapt and adjust to living as independently and safely as possible. This concept actively focuses on achieving and maintaining optimal physical, mental, and psychosocial functioning. While a RNP can be so beneficial to our residents, it isn’t without its challenges. One of the most understandable barriers we face in long-term care and Restorative Programming is staffing shortages. In the best circumstances, we typically have one or more dedicated staff members serving as restorative aides who, along with the restorative nurse manager, are solely responsible for carrying out the Restorative Programs. This approach, however, can be extremely challenging when there are staffing shortages. Some of the ways to overcome this barrier include:
- Transfer of responsibilities
AANAC advised in a 2018 restorative article, “The restorative nurse manager and nursing leadership will need to review the restorative programs and work toward a transition from a dedicated restorative aide to nurse aides performing programs. To be successful, the programs must be integrated into the nurse aides’ work flow—for example, scheduling the passive range-of-motion (ROM) program to be performed in the morning prior to assisting the resident out of bed, or scheduling the walking program to coincide with the resident’s routine of attending morning coffee group. Using a shared-responsibility restorative model requires the entire interdisciplinary team to be involved.” Utilizing the staff we do have and integrating those programs across everyday ADL completion can assist us in our goals of a successful program. Ensuring the entire IDT understands the restorative process and goals will be imperative in rolling out a program that is a shared responsibility.
- Adjust the RNP to fit the IDT’s typical work day
Adjusting the RNP to fit the teams schedule will assist with meeting the goals of the program. For example, if a resident is on a transfer program, implementing this when they are transferring from dining or therapy, back to their rooms can help with time constraints. Thinking outside the box and being creative in considering how Restorative can be integrated organically into the daily routine can assist the team in overcoming this RNP barrier.
- Assess frequently for program appropriateness
The restorative nurse manager will need to identify residents on Restorative Programs who are no longer appropriate. Keeping residents on longer than needed is common and can make resident-specific program completion difficult. Ensuring we are graduating residents off of programs as appropriate will be necessary to add additional residents who may be appropriate restorative candidates. Reevaluation quarterly, unless the licensed nurse determines (based on the clinical status of the resident) that a more frequent evaluation is required is best practice.
Continuing the conversation
Join Proactive’s expert presenters for a weekly 6-part series, Restorative Nursing Excellence: Revitalizing Programs & Restoring Function After COVID-19, that offers a fresh perspective on restorative with insights into considerations related to COVID-19 recovery. This virtual series will cover restorative nursing staff orientation/competencies, program development essentials, care plans, promoting optimal care delivery and outcomes, compliant documentation, accurate reimbursement, and quality assurance best practices. Learn more
Resources
- Restorative Care Nursing for Older Adults: A Guide for All Care Settings (Springer Series on Geriatric Nursing). 2020.
- Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual. 2020. https://downloads.cms.gov/files/mds-3.0-rai-manual-v1.17.1_october_2019.pdf
- Kunkler, Jessica, Barriers to Implementing a Successful Restorative Program, Aug. 1, 2018, AANAC
- Barriers to Implementing a Successful Restorative Program | AANAC
Blog by Kristen Walden, MSN, RN, RAC-CT, Proactive Medical Review
Click here to learn more about Shelly and the rest of the Proactive team.