restorative nursing

SitcomNurse, BSN, MSN, EdD, RN · Oct 27, 2009

keep in mind i have a 350 bed ltc facility, and we are all rna's.

how do you keep track of alarms and keep them from being broken? i have a list on the units, and when the shifts do walking rounds together at the beginning of their shift, they check the alarms for their assigned patients. a check on the list is ok. for alarms that are broken, we put on the 24* report sheet, batteries are always available, all nursing supv.'s have access to extra bed/chair pads and alarm boxes. (this is the ideal) if a replacement cannot be obtained, we will increase monitoring for the night/day for one to be obtained. if that still isnt possible(weekend) we exchange the monitor with someone who has it, but may not actually need it(boxes only)
what types of programs are you doing? 8 different modalities are employed at our facility. we do not do bladder re-training unless there is a discharge plan. how do you explain keigles to a 80 y.o man with dementia? you cant. we do a schedule after a 3 day voiding record at 2 hour intervals.
do you have group programs , one on one. how do you do it? group programs work best on the dementia unit. some cna's will do it if there is more than one on their assignment(remember i am talking about 36 cna's) and we do hospice care on the same unit as rehab care. most of the programs therefore are 1:1 as the cna's feel ownership of the progress for residents, its their resident.
do you do the care plans and mds? i do the initial ccp, and then the unit nurse takes over for all adjustments(plan changes not modality changes)
do you chart on all the residnets or just ones in restorative? the unit nurse or nurse manager will cnart on the resident if they are on maintenence, with the quarterly mds, because there is no standard other then "periodically". if the resident is on restorative with rehab low category for med a, i chart weekly, because the rl category dosent last forever.
yes we must keep this thread going and keep in touch. i whole heartedly agree!
my goal is to have the best programs and keep the staff positive and have some fun with both residents and staff. i am keeping staff positive with e-mails to the units weekly on progress(the are printed and posted by the unit nurse), graduation, people who went the extra mile, cna's and administrative staffers who come up with ideas and information, when they put articles in my mailbox or direct me to a website. i also post one information point in each e-mail..which gives a topic of conversation that weekend and the following week.
too many times the resident say how bored they are. i want to keep them at their highest functioning possible. for boredom, we incorporate the tr dept, and the excercize classes, as well as arts & crafts for fine motor skills.
thanks for any input you have

i hope some of this helps. i have questions about documentation.. like.. for toileting.. since for the mds, you need 2 modalities for 15 minutes or greater for 6 days or more in a 7 day look back.. what kind of minutes are there for toileting? it is coded under h for the mds, not p3, but the basic definition for rehab nursing includes 2 modalities for 15 minutes or greater.... blah blah... so.. how can i justify not having minutes to the auditing comittee. i cant find any language on it anywhere!!

also, the pt/ot rehab dept is on my case about not having distance in feet. are you putting the distance in feet on your

accountability sheets?

thanks!!

sitcom nurse. :nurse:

sometimes god turns on the sitcom nurse channel. its like comedy central for her. :jester:

Maedele · Nov 16, 2009

We just finished survey on friday 11/13/09 but they wont exit till monday that is when we find out the results, it shall be interesting. This was a very different survey called QIS, I believe it is the same everywhere? They walked around with their lap tops, no status reports at the end of ea day. Not many questions about restorative programs.

They did ask for bladder and bowel assessments but both residents they asked about are continent of both, one has a toileting schedule as part of fall prevention, she had falls r/t toileting needs. I did the initial incontinence monitoring for 7 days using the dot form to establish a voiding pattern, and the other resident did not a comprehensive assessment since she is able to use BR on her own or ask for help and is continent. They seemed to accept my answers after reading my quarterly restorative assessment notes.

We recently changed to charting by exception, we have 8 codes for the RNA to use if resident is not doing program on scheduled days. If resident does program RNA does not chart. I really likes this much better, reduces time spent charting,

Our Rehab dept is aware of our charting system and will let us know when it is important to document distance walked and minutes for programs to monitor progress otherwise we use the same charting for medicare residents.

We have group programs which does help, but we run into the problem of having the residents ready at the time needed for the group, they either need to be toileted, or have been laid down, I send schedules of groups to ea unit nurse manager,give a copy to the charge nurse and post it for the NAC's and yet it continues to be a challenge.

I'll write some more by the end of this week, thanks for keeping the thread going we really can learn a lot from each other, I believe that we all have strength that we can share and learn from.

de422 · Nov 16, 2009

Hi I know what you mean about the new survey. We had ours the last week of October came in on Monday and left friday about 5. They really didn't get into restorative at all. We got a cite for a PT order not done when someone was admitted the supervisor marked it on the POS but didn't send notice to therapy. We also received one for giving meds in the dining room they said a resident who feeds self independently was given meds on a spoon. I felt that they really couldn't find anything so they went digging. Was a very stressfull week put in at least 10 hour days. Still working on getting a great restorative program up and going. Am in the process of taking residents off restorative ambulation and place on walk to dine with floor staff to free up restorative staff for other programs. We still have some that are kept with restorative ambulation. Is your restorative note a narrative? What types of assessments do you do quartely and do you do them on all your residents. we do a fall assessment and a narrative note trying to find one that is more of a check list formate. Has anyone started working with the WI with your residents if so how is it going? Well thanks for keeping this thread going it is great to be able to talk to others in the same situation as I am in.

SitcomNurse, BSN, MSN, EdD, RN · Nov 16, 2009

WOO HOO!! Congratulations on getting through survey.

We just had a VA survey, and did relatively well, NR not yet fully on the radar, but the surveyors did say.... if it continues in this vein, other facilities will have alot to be jealous of. I thank you ladies for giving me someone to bounce ideas off of!!

I would like a look at your dot sheet for 7 days for continence. I used a different form, buy which the NA's were putting a check in dry or wet, at specific times written on the sheet.(2 hour spaces)

I would love to do charting by exception, but I wonder, are you on electronic patient record? or paper?

On paper, the aides will write R for refused or A for absent, oop for out on pass... but other than a charting system that is check marks by design, I am the first to require initials in the page.

I was thinking of creaating a checklist that would list distances, and they just need to check the corect box.(that would round up/down, which is a problem at times.)

Presently the look back period for an MDS is the situation where distances and minutes are important, but honestly, the NR program does not require distance in the program for LTC NR persons. The program is more life based. Will walk from room to toilet, from room to dining area, from dining area to common area... like that, although I know it is 120 from room to dining room, and 100 feet common area, the program is not requiring it, yet.

OK congrats again!!

Sitcom Nurse

de422 · Nov 16, 2009

I just read your last note over. The part with distance I put it on the CNAs sheet they sign daily it is walk to dine 10-20 feet or others is longer and either 2 or 3 times a week 5-10 minutes each and that gets my 15 minutes of ambulation a day.Since the MDS states it allows the time for set up and getting the task done.

cassgreenmartin · Nov 22, 2009

loved reading about the challenges in restorative nursing. starting tommorrow i will be responsible for the restorative department. any help getting started.. seems we all have the same concerns

SitcomNurse, BSN, MSN, EdD, RN · Nov 23, 2009

loved reading about the challenges in restorative nursing. starting tommorrow i will be responsible for the restorative department. any help getting started.. seems we all have the same concerns

Cass, Welcome to the NR thread!!! we all pertty much started out with the same thing.. What am I doing??!!

But, im sure you can go to the beginning of the thread for the places we refrenced, online and in books.

It is difficult trying to get interpretations, and "where is it written?" I am still trying to figure out one simple fact....

I cant even get clarification for it from my uppers...

For an inservice program, I have a standard sheet with information on it, and I hand write the specific informaiton of that resident.. like Problem:XX program 2* to (CVA, dmemntia etc....) Goal: Resident will ambulate from X to x (daily, for each meal, for program etc.) devices: rolling walker, quad cane, hemi walker etc..

And then listed under that are the standards for NR, walking on weaker side, questioning for pain, reminders, cues, physicial assist as needed for turns, checking for dizziness, pain, lethargy etc...

These items are also what the care plan is made of, and the CNA sheets have this info for signatures required.

The MDS book is your greatest resource, I think we can all agree with that.

Read it, re-read it, there is always new info in it, cuz at one point you are concentrating on one thing, and miss an important fact, and at another you think another way, and something else pops out at ya.

Other than that...

Check your F-tags...QOL: F-241, F 242 and QOC : F-309, F-310, F-311, F-312, F-316, F-317, F-318

Have fun with it. Immediately you may not see the return, but in the long run ( I have only been doing it 7 mos) it really pays off. If youre not having fun, neithr are the CNA/RNA's or the residents!

Sitcom Nurse :jester: :nurse:

Sometimes God turns on the Sitcom Nurse channel.. its like Comedy Central for her.

de422 · Dec 1, 2009

Hi sitcom its debbie from florida how are you doing. I have a quick question I know in restorative there is no such thing as a quick question. Our administration is asking for a manuel for the units. Now this isn't just a restorative manuel but it is so that all shifts at all times knows what to do. I guess you would call it a combination restorative/activities. We are about to reopen our new solariums/day rooms and they want something to be doing at all times. Any suggestions? We have come up with putting in the walk to dine or wheels for meals. Then toileting/grooming after meals but looking for a better name. We have named a few games ball toss trivia. They kinda want it so everyone knows what they are to do and at what time. unrealalistic maybe but need to put the best effort. Any ideas or suggestions from anyone would be appreciated thanks for listening.

SitcomNurse, BSN, MSN, EdD, RN · Dec 3, 2009

I guess you would call it a combination restorative/activities. We are about to reopen our new solariums/day rooms and they want something to be doing at all times. Any suggestions? We have come up with putting in the walk to dine or wheels for meals. Then toileting/grooming after meals but looking for a better name. We have named a few games ball toss trivia. They kinda want it so everyone knows what they are to do and at what time. unrealalistic maybe but need to put the best effort.

I like the walk to dine.... its simple, we use it here.

For other creative things, I would ask the recreation therapy dept to help with naming creatively

Sorry I coudnt be more help. But if I think of anything I will let ya know.

NC29mom, ASN, LPN, RN · May 18, 2010

are you girls still adding to this post?? i am also new to rcna and have really enjoyed reading your posts..........love to keep hearing about activities you do and such.

SitcomNurse, BSN, MSN, EdD, RN · May 25, 2010

are you girls still adding to this post?? i am also new to rcna and have really enjoyed reading your posts..........love to keep hearing about activities you do and such.

nc29, welcome to the post! i check back every once in a while, i am notified by e-mail too when someone posts. )

anyway.... i was wondering if anyone out there can do a little research for me.

in 2002 the oig(office inspector general) did a survey to cna's to determine if their traning was up to snuff.

it is not.

one of areas the graduates felt was not covered sufficiently was nursing rehab, of course. there were plenty of other areas, but mainly, palliative, death/dying, and dementias were on the top 5 with nr.

so, if you can get in touch with the education facilities that run cna programs, and find out how much time they dedicate to nursing rehab. i know in ny we are doing... 5.75 hours of didactic nursing rehab at stony brook. no clinical is required. this is out of a 100 our class. they do 30 hours of clinical minimum. this means they can do more, but that is up to the individual institution.

accross the nation, they have 16 hours as a minimum, and others have 60 hours as a minimum. i am truly amazed aqt the disparity.

where are you?

how many hours does your state have allotted for nursing rehab?

how many are clinical?

are you dept. of health or department of education enforced?

anyone out there that can help, would be helping me immensely.

maybe you know a cna educator who you can get the information from.

thanks!

sitcomnurse... sometimes god turns on the sitcomnurse channel. its like comedy central for her.

:nurse:

NC29mom, ASN, LPN, RN · May 25, 2010

as a matter of fact, we have cna students doing their clinicals at our facility. i am good friends with their instructor, i will ask her tomorrow and post her response tomorrow afternoon. we are in north carolina.