disorders. In each of these conditions, persons can be assisted to regain maximal functioning that may have been altered because of a disease process, injury, or congenital defect.
maintain their highest level of function and to assist residents in retaining the gains made during formal therapy” (Remsburg & Carson, 2006, p. 580). Restorative care differs from rehabilitation in that it does not include activities directed by therapists but emphasizes nursing interventions that promote adaptation, comfort, and safety within a long-term care setting. Restorative care focuses on maximizing an individual’s abilities, helping to rebuild self-esteem and to achieve appropriate goals (Nadash & Feldman, 2003; Resnick & Fleishall, 2002; Resnick & Remsburg, 2004). Restorative care often focuses on assisting individuals with ADLs as well as walking and mobility exercises, transferring, amputation/prosthesis care, and communication. Self-care skills, such as management of one’s diabetes, ostomy care, or medication set-up and administration, are also emphasized (Remsburg, 2004). Restorative care, although conceptually similar to rehabilitation, is most appropriate for those individuals who either have already reached their maximal functional level and need to maintain that function, or for those who are not appropriate candidates for intensive rehabilitation services.
the disabling process, i.e., rehabilitation, or the enabling process” (Brandt & Pope, 1997, p. 13). In the new Enabling-Disabling Process, “disability does not appear in this model since it is not inherent in the individual but, rather, a function of the interaction of the individual and the environment” (Brandt & Pope, 1997, p. 11). Disability is seen as a product of the interaction of an individual with the environment. The model posits that rehabilitation depends largely upon the individual and his or her unique characteristics, and that the disabling process may even be reversed with appropriate rehabilitation interventions (Lutz & Bowers, 2003). The basic concepts of the model include pathology, impairment, functional limitation, disability, and society limitation (Brandt & Pope, 1997). Table 24-1 provides a summary of the concepts of the Enabling-Disabling Process.
functional ability, depression, and quality of life. Their work resulted in the development of a tool to measure themes common to the post-stroke experience such as control, connection with others, and independence (Secrest & Zeller, 2003).
Table 24-1 Concepts of the Enabling-Disabling Process
identified six phases of post-stroke recovery that may help guide practice and interventions. She found that stroke survivors journey through a predictable pattern, with certain variables influencing the ease of adaptation after stroke. Other rehabilitation nurse scientists have explored the experience of caregivers of stroke survivors (Hartke & King, 2002; Pierce, Steiner, Govani, et al., 2004; Pierce, Steiner, Hicks, & Holzaepfel, 2006). Each of these examples suggest that although large, general models and classification systems are necessary and helpful, more manageable models, frameworks, and instruments are also needed to better reflect the unique experiences in rehabilitation and to guide practice.
Table 24-2 Concepts of the International Classification of Functioning, Disability, and Health
program for veterans. It is interesting to note that rehabilitation services at this time were not generally available to the public. With the discovery of sulfa drugs and antibiotics, those injured in World War II had a much greater chance of survival. So, the numerous veterans of World War II coming home with multiple trauma, amputations, traumatic brain injuries, and spinal cord injuries necessitated a more comprehensive rehabilitation program. During this time, Dr. Howard Rusk (1965) emerged as both a pioneer and champion for rehabilitation, believing that these therapeutic services should be available not just to veterans, but to the entire world population. He demonstrated to the military powers through his personal assistance with the rehabilitation of those whom other medical professionals deemed a lost cause, that rather than convalescence, rehabilitation could promote recovery (Kottke, Stillwell, & Lehmann, 1982). Rusk showed that disabled persons could still be productive members of society and enjoy a good quality of life. As technology continued to explode in the 1940s, the number of civilians with industry and motor vehicle injuries increased, leading to a need for rehabilitation to address continuing disability. In 1947, Dr. Rusk established the first hospital-based medical rehabilitation services for civilians (Edwards, 2007).
Table 24-3 Historical Events and Legislative Initiatives Affecting Rehabilitation
through spousal benefits (in case of death), medical and rehabilitation expense coverage, and lost wages (Kiselica, Sibson, & Green-McKenzie, 2004). Current workers’ compensation programs are more restrictive than they once were; they limit physician choice and eligibility, provide lower benefits, and use managed care for cost containment (D’Andrea & Meyer, 2004).
public accommodations related to transportation, education, and employment. Employment discrimination of qualified applicants because of disabilities is prohibited by this law (U.S. Equal Employment Opportunity Commission, 2008). Although the Rehabilitation Act of 1973 and its amendments covered accessibility to buildings of organizations that received federal financial assistance, the ADA also requires private organizations to comply with accessibility and employment laws. The concept of reasonable accommodation was introduced, requiring employers to make those accommodations within reason that may be necessary for a person with disability. Table 24-4 provides a summary of the ADA related to the four major areas it addresses: employment, public services, public accommodations services by practice entities, and telecommunications relay.
Table 24-4 Americans with Disabilities Act
care, and professional and informal caregiver issues.