Immobility affects all our body systems, including our skin. According to the National Pressure Ulcer Advisory Panel, many contributing factors are associated with the formation of a pressure ulcer, with impaired mobility leading the list.
So what can clinicians do to prevent harm caused by immobility? One often-overlooked strategy is a restorative nursing program. (See About restorative nursing.)
Moving up the time line
Most patients who score poorly for mobility and/or activity impairments on the Braden Scale for Predicting Pressure Ulcer Risk are referred to physical therapy, but too often a restorative nursing program
isn’t started until patients are ready to be discharged from therapy. However, the more active we can keep patients, the less likely they will have prolonged periods of time in the same position, thus preventing pressure ulcer formation. If your patients are spending most of their time sitting in wheelchairs and/or in their beds, consider tapping into a restorative nursing program, which should run parallel to therapy.
Benefits of restorative nursing
Implementing a restorative nursing program can significantly benefit your patients. For example, restorative nurses can promote early mobility by assessing patients’ ability to turn and reposition themselves in bed, go from a lying to sitting position, and shift their weight in the wheelchair, including reverse push-ups.
Restorative nurses also can provide strength-training exercises as part of range-of-motion programs. These exercises can help patients develop the muscles they need for mobility and self-positioning. A strength-training program can be tailored to any position (supine, sitting, or standing) so it’s individualized for the patient’s needs. Many clinicians think patients who are of advanced age or deconditioned aren’t eligible for strength-training programs, but studies show that these patients still benefit. Essentially it is never too late.
Connecting patients with a restorative nursing program
To start a restorative nursing program, first discuss its benefits with the patient and ensure he or she is willing to participate. Next, work with therapists to identify the appropriate exercises that restorative nurses and nursing aides will perform with the patient. Physician clearance is recommended.
Remember that the program can be enhanced with interactive activities such as obstacle courses, video games, gardening, dance classes, tai chi, and bowling to keep your patients mobile.
Be proactive
The more active and mobile your patients are—and the earlier they begin activity—the less likely they will develop a pressure ulcer. You might want to have a policy in your care setting that automatically triggers a restorative nursing program for residents who score poorly for mobility and/or activity on the Braden Scale. The program may be just what the patient needs to protect him or her from harm.
Jeri Lundgren is the president of Senior Providers Resource in Cape Coral, Florida. She can be contacted at jeri@seniorprovidersresource.com.
Selected references
Edsberg LE, Langemo D, Baharestani MM, et al. Unavoidable pressure injury: state of the science and consensus outcomes. J Wound Ostomy Continence Nurs. 2014;41(4):313-34.
Minnesota Department of Health. What are restorative nursing programs? August 2014.
health.state.mn.us/divs/fpc/profinfo/cms/RUG-IV_FS12.pdf
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Ulcer Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. Emily Haesler (ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
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