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RESTORATIVE CARE NURSING
FOR OLDER ADULTS
Second Edition
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Barbara Resnick, PhD, CRNP, FAAN, is Professor, Department of Organizational Systems and Adult Health, University of Maryland School of Nursing. She also holds the Sonya Ziporkin Gershowitz Chair in gerontology and maintains a clinical/faculty position with clinical work at Roland Park Place, a Lifecare community. Her research is primarily concerned with care of the older adult, including health promotion and disease prevention, outcomes following rehabilitation, functional performance with special focus on motivation related to functional activities and exercise behavior, and testing outcomes of restorative care nursing programs and other innovative long-term care projects. She has published more than 200 articles in nursing and medical journals, and numerous chapters in nursing and medical textbooks related to care of the older adult. Dr. Resnick is coeditor and chapter contributor to multiple medical, nurs-ing, physical therapy, and interdisciplinary texts, and recently coedited the books Resilience in Aging and the 2011 Geriatric Nursing Review Syllabus.
Marie Boltz, PhD, RN, is an Assistant Professor at New York University where she has directed the undergraduate course in Nursing Care of Elders. Dr. Boltz is also Practice Di-rector of the NICHE (Nurses Improving Care for Healthsystem Elders) Program, which is the only national nursing program designed to improve care of the older adult patient. Her areas of research are the geriatric care environment including measures of quality, the geriatric nurse practice environment, and the prevention of functional decline in hospi-talized older adults. She has presented nationally and internationally, and authored and coauthored numerous journal publications, organizational tools, and book chapters in these areas. Dr. Boltz is a John A. Hartford Foundation Claire Fagin Fellow and the 2009–2010 ANCC Margretta Madden Styles Credentialing Scholar.
Elizabeth Galik, PhD, CRNP, is a nurse practitioner who specializes in the medical and neu-ropsychiatric care of older adults. She is an Assistant Professor at the University of Mary-land School of Nursing, where she teaches in the ANP/GNP program and maintains a clinical practice at Roland Park Place, a continuing care retirement community. Currently, she is a Robert Wood Johnson Foundation Nurse Faculty Scholar and conducts research to test the impact of interventions designed to optimize physical function, physical activity, mood, and behavior of long-term care residents with moderate to severe cognitive impairment. Dr. Galik serves on the Board of Directors of the Gerontological Advanced Practice Nurses Association and the Maryland Gerontological Association.
Ingrid Pretzer-Aboff, PhD, RN, is an Assistant Professor at the University of Delaware School of Nursing. Dr. Pretzer-Aboff has extensive experience working with neuro-compromised pa-tients; in particular, individuals living with Parkinson’s disease or stroke and their caregivers in the community, acute care, long-term care, and research settings. Her research includes the development and testing of a self-effi cacy-based function-focused care intervention designed specifi cally for Parkinson’s patients and their caregivers. She works closely with clinicians and scientists in Italy investigating older adults’ participation and adherence to community physi-cal activity programs. She is also working closely with engineers, biomechanical experts, and neurophysiologists to explore objective measurements of function in the neuro- compromised older adult. She has presented nationally and internationally and has authored and coauthored several chapters and journal articles in these areas. Dr. Pretzer-Aboff is the 2010 recipient of the fi rst Edmond J. Safra Philanthropic Foundation Distinguished Scholar in Nursing Award for outstanding achievement in improving the lives of people living with Parkinson’s disease.
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RESTORATIVE CARE NURSING
FOR OLDER ADULTS
A Guide for All Care Settings
Second Edition
Barbara Resnick, PhD, CRNP, FAAN
Marie Boltz, PhD, RN
Elizabeth Galik, PhD, CRNP
Ingrid Pretzer-Aboff, PhD, RN
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# 7900 Cust: Springer Au: Resnick Pg. No. iv Title: Restorative Care Nursing for Older Adults Server:
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Copyright © 2012 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any
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Library of Congress Cataloging-in-Publication Data
Restorative care nursing for older adults : a guide for all care settings / Barbara Resnick ... [et al.]. — 2nd ed.
p. ; cm.
Rev. ed. of: Restorative care nursing for older adults / Barbara Resnick. c2004.
Includes bibliographical references and index.
ISBN-13: 978-0-8261-3384-7
ISBN-10: 0-8261-3384-3
ISBN-13: 978-0-8261-3385-4 (e-book)
I. Resnick, Barbara. II. Resnick, Barbara. Restorative care nursing for older adults.
[DNLM: 1. Rehabilitation Nursing—methods. 2. Aged. 3. Caregivers—education. 4. Recovery of Function.
WY 150.5]
618.97’0231—dc23
2011036747
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This book is dedicated to all caregivers who have provided function-focused care during
care interactions with older adults; to all the older adults who have taught me about
resilience and ways to optimize function and physical activity despite multiple
challenges; to my family, friends, and colleagues for their support; and to my deceased
father for teaching me that saying “I can’t” is not an option.
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vii
CONTENTS
Foreword by Colin Milner xi Preface xiii Acknowledgments xv
1. Focusing on Function in All Care Interactions:
A New Philosophy of Nursing Care 1
Barbara Resnick
The Nursing Philosophy of Care 2
To Care for or Care With: Outcome-Based Evidence
for Decisions 3
Evidence of the Benefi t of Physical Activity 4
Function-Focused Care 4
Theoretical Model to Guide Integration of the Function-Focused
Care Approach 6
From Theory to Implementation of Function-Focused Care 10
2. Implementing Function-Focused Care in Any Setting 15
Barbara Resnick
Component I: Environmental and Policy Assessments 16
Component II: Education 21
Component III: Establishing Function-Focused Care Goals 25
Component IV: Motivating and Mentoring 25
Tricks of the Trade in Dissemination and Implementation 30
Conclusion 33
Appendix 2.1 35
Appendix 2.2 37
3. Function-Focused Care in the Nursing Home 41
Elizabeth Galik
Factors That Infl uence Functional Performance of Nursing
Home Residents 42
Evidence of the Benefi t of Function-Focused Care in Nursing
Home Settings 43
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Designated Versus Integrated Function-Focused Care Approaches 43
Challenges to Sustainability of New Interventions in
Nursing Home Settings 44
Implementing a Function-Focused Philosophy of Care in Nursing Home
Settings Using a Social Ecological Model 44
Culture Change and Function-Focused Care 50
Implementation of Function-Focused Care in Nursing Home Settings 51
Conclusion 51
Appendix 3.1 54
4. Function-Focused Care in Assisted Living Communities 67
Barbara Resnick
Facilitators and Challenges to Sustainability of New Interventions
in Long-Term Care Settings 68
Use of Dissemination of Innovation Theory in AL Communities 69
Use of Social Ecological Models 71
Environment 74
Policy 76
Prior Outcomes of Implementing Function-Focused Care
in AL Communities 76
Conclusion 81
Appendix 4.1 84
5. Function-Focused Care in the Acute Care Hospital 93
Marie Boltz
The Need for FFC 93
Challenges Hospitalized Older Adults Face 94
Functional Status: A Critical Vital Sign 95
FFC Components for Acute Care Settings 95
Special Considerations for Acute Care Settings 103
Conclusion 105
Appendix 5.1 110
Appendix 5.2 112
Appendix 5.3 115
6. Function-Focused Care in Home Settings 127
Ingrid Pretzer-Aboff
Impact of Intrapersonal Factors on Functional and Physical
Activity in Home Settings 127
Role of Interpersonal Factors on Functional and Physical
Activity in Home Settings 128
Motivating the Older Adult and the Caregiver to
Engage in FFC Activities 129
Impact of the Home Environment on Function and Physical Activity 132
Impact of Policy and Culture on Function and Physical Activity
in the Home 132
Components of FFC for Home Settings 133
viii Contents
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Expected Outcomes Following Implementation of an FFC Intervention
in the Home Setting 141
Physical Function Outcomes 143
Psychosocial Outcomes 143
Conclusion 143
Appendix 6.1 147
7. Function-Focused Care With Older Adults With Moderate
to Severe Cognitive Impairment 151
Elizabeth Galik
Factors That Infl uence Functional Performance of Older Adults With Moderate
to Severe Cognitive Impairment 152
Benefi ts of Function-Focused Care for Older Adults With Moderate
to Severe Cognitive Impairment 152
Barriers/Challenges to Function-Focused Care for Residents With Moderate
to Severe Cognitive Impairment 153
A Five-Step Approach to Implementing Function-Focused Care for Adults
With Cognitive Impairment 153
Conclusion 159
Appendix 7.1 163
8. Ethical Issues and Function-Focused Care 175
Barbara Resnick
Basic Principles of Biomedical Ethics 175
Nurses Code of Ethics 177
Ethical Challenges Associated With Function-Focused Care 178
Resident Safety 181
Ethical Issues Among Older Adults With Cognitive Impairment 182
Practical Ethics and Examples of Ethical Cases Related
to Function-Focused Care 182
Ethical Issues Around Restricting Function Through Use
of Protective Measures and Restraints 185
Conclusion 186
Index 187
ix Contents
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xi
FOREWORD
This book is truly a compilation of the many years of work delineating and demonstrat-
ing outcomes associated with restorative care, or function-focused care. My own work
as the CEO of the International Council on Active Aging further confi rms and reinforces
the critical need to change how we approach care to older adults. Function-focused care
is a practical and realistic way in which to solve the problems we face with regard to
insuffi cient time spent in physical activity, deconditioning, and functional decline that
commonly occur across all care settings. For example, I am well aware that the majority
of the time older adults are hospitalized is spent in bed (approximately 83%). Likewise, I
wholeheartedly agree with these authors’/practitioners’/doctors’ approach and philoso-
phy and appreciate the need for all members of the interdisciplinary team to work to-
gether to decrease needless immobility and prevent functional decline. Nurses certainly
provide the most direct care with patients and spend the most time in patient-provider
interactions and are thus central to this process.
For nurses, regardless of level or site of practice (e.g., LPN, RN, nursing assistant,
or advanced practice), this book provides a wonderful background about function-
focused care and why it is necessary to change the way in which nurses most com-
monly provide care to patients. While never mal-intended, too much care can rob
individuals of the opportunity to engage in a routine range of motion necessary for
maintaining underlying capability.
The book provides a practical hands-on perspective for implementing function-
focused care in all settings. The tables included in each chapter and the appendices
at the end of the book provide the tools that are relevant to these different groups
of individuals and sites of care. Specifi cally included are educational materials rel-
evant for each setting, documentation forms for those in long-term care or acute care,
and examples of goal forms that can be used. Educational materials and methods for
informal and formal caregivers are included because families of patients in acute care
need to understand and intervene in ways that are different from those in nursing
home settings or home settings.
Woven into the chapters is the research support related to the benefi ts and expected
outcomes associated with implementing function-focused care. Quite importantly, the
authors address safety issues associated with function-focused care and provide data
to support that this care approach is not only benefi cial but it is safe for all older adults.
Lastly, the book raises some important ethical considerations for implementation of a
function-focused care perspective.
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In summary, this is a unique resource that is relevant for all nurses and health
care providers working with older adults. In addition to addressing functional decline,
function-focused care provides a fresh and practical solution to many of the problems
that tend to arise with older adults, such as infections, falls, and pressure ulcers, all
known to be associated with immobility.
Colin Milner CEO
International Council on Active Aging
xii Foreword
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xiii
PREFACE
Restorative care nursing, more recently referred to as function-focused care, is a philoso-
phy of care that enables caregivers to actively help older adults achieve and maintain
their highest level of function. This is the only volume written to educate caregivers and
administrators about both the philosophy of restorative care and how to integrate this
philosophy in all types of care settings. This updated second edition contains new content
in each chapter along with two entirely new chapters on function-focused care for cogni-
tively impaired adults, ethical issues, and patient-centered care.
This book provides an education program about function-focused care for formal
and informal caregivers, suggestions for benefi cial activities, and practical strategies for
motivating older adults and caregivers to engage in function-focused care. Information
specifi c to settings as well as ways to provide function-focused care to those with moder-
ate to severe cognitive impairment are provided. Tables in each of the chapters and the
appendices feature the necessary tools for effective implementation of function-focused
care, and its philosophy, in any setting.
■ KEY FEATURES
■ Teaches practical application of function-focused care with educational programs rel-
evant for the various settings
■ Designed for use in long-term care, assisted living, home-based care, and acute care
settings
■ Provides a philosophy of care carried throughout all care interactions
■ Contains new content in each chapter and two new chapters
■ Includes helpful suggestions and strategies for motivating older adults and caregivers
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ACKNOWLEDGMENTS
This book could not have been revised and published without the support of Springer
Publishing Company for being willing and interested in this critically important care
approach, as well as the hard work and contributions of my co-authors Drs. Elizabeth Galik,
Marie Boltz, and Ingrid Pretzer-Aboff. Dr. Galik shares her research and expertise in imple-
mentation of function-focused care with older adults with moderate to severe dementia,
Dr. Boltz shares her work in acute care settings, and Dr. Pretzer-Aboff provides the sup-
port and tools to implement function-focused care in the home setting. Lastly, I want to
thank our amazing editorial assistant Ardis O’Meara who kept us all on track through the
process and completed our fi nal editing and book delivery. May the resources within this
book help you to change how you provide care to older adults and think fi rst about what
the individual can do and how to help him or her optimize underlying function, engage
in physical activity, and worry less about task completion.
xv
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1
ONE
FOCUSING ON FUNCTION
IN ALL CARE INTERACTIONS:
A NEW PHILOSOPHY OF NURSING CARE
Barbara Resnick
In understanding our current approaches to nursing care, it is helpful to refl ect on our
history and where nursing has been in terms of defi nitions of the profession and philoso-
phies of care. In ancient cultures, religious beliefs and myths were the basis for health
care and medical practice. Nurses delivered custodial care and depended on physicians
or priests for direction. We are all acutely aware of, and may have even experienced, the
days of nursing when the nurse stood by the bedside and took orders from the physician
for all patient care-related activities.
Under the influence of Christianity, nurses gained respect, and the practice of
nursing expanded. The Sisters of Charity, founded by St. Vincent de Paul, cared for
people in hospitals, asylums, and poorhouses. Then Louise de Marillac established
perhaps the first educational program to be associated with a nursing order. The
Sisters of Charity, following this approach, were introduced in America by Mother
Elizabeth Seton in 1809. In 1847, Florence Nightingale went to Kaiserswerth to work
with the deaconesses, and her career and the Civil War (1861–1865) stimulated the
growth of nursing in the United States. Clara Barton (who founded the American
Red Cross in 1882), Harriet Tubman, and others tended soldiers on the battlefields,
cleansing their wounds, meeting their basic needs, and comforting them in death.
Clearly, they provided care for these individuals throughout the acute and recovery
processes.
In the 1890s, after the Civil War, nursing fl ourished through the efforts of Mary
Agnes Snively and Isabel Hampton Robb, and the Nurses’ Associated Alumni of the
United States and Canada was founded. This is now known as the American Nurses
Association (ANA) and the Canadian Nurses Association. Early in the 20th century,
Mary Adelaide Nutting was instrumental in establishing nursing education within uni-
versities and became the fi rst professor of nursing at a university in 1907. From there
the profession and scope of practice have likewise expanded. It has not been made clear,
however, that we have altered our core philosophy and approach at the bedside in terms
of how care is provided to the patient and with what intention.
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2 Restorative Care Nursing for Older Adults
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■ THE NURSING PHILOSOPHY OF CARE
As far back as 1859, with the writings of Florence Nightingale, the philosophy of nurs-
ing care was defi ned as being in “charge of the personal health of somebody . . . and
what nursing has to do . . . is to put the patient in the best condition for nature to act
upon him.” This philosophy, although innovative when established, suggests a frame-
work in which nurses are in control and doing for rather than providing care with
the patient. Florence Nightingale’s philosophy of nursing has been revised over the
years by nurse theorists but has essentially remained the same. In the words of nursing
theorist Virginia Henderson, for example, nurses help people, sick or well, to do those
things needed for health or a peaceful death that people would do on their own if they
had the strength, will, or knowledge. This philosophy, yet again, refl ects the provision
of care by the nurse with no indication that the patient might be engaged in the care
activity.
Rosemarie Rizzo Parse, another nurse leader, provides another refl ection on nursing
and philosophy and the way in which nursing care is provided. She writes:
Every physician recognizes the importance of good nursing. In the treatment of dis-ease medicinal agents are necessary to combat the various symptoms as they arise, but it is equally important that the surroundings of the patient should be so arranged that he may be supported and tided over the critical period of his illness. It is not too much to say that in many illnesses good nursing is more than half the battle. When a man is seriously ill he is practically as helpless as a child, and can neither think nor act for himself. He is fortunate should there be some friend or relative who will take the initiative for him, but there are many people—often men in good social position—who have no one about them whom they would care to trust. The sick man sends for his doctor, and nurses are provided on whom rests the responsibility of see-ing that he is properly cared for, and that no advantage is taken of his helplessness. The trust is a sacred one, and for the honour of the nursing community is rarely or never abused. 1
Yet again, nurses are described as providing care to an individual with the assumption
that total care is needed and will best serve the individual throughout his or her recovery
process.
The ANA currently defi nes nursing as “the protection, promotion, and optimization
of health and abilities, prevention of illness and injury, alleviation of suffering through
the diagnosis and treatment of human response, and advocacy in the care of individuals,
families, communities, and populations.”2 Furthermore, the ANA differentiates between
nursing and medicine and suggests that nurses’ focus be on the whole person, not just the
unique presenting health problem. Specifi cally, nurses respond to the human response to
a health problem rather than the health problem in and of itself. The common thought is
that physicians cure and nurses care. In so doing, the ANA delineates that nurses build
on their understanding of disease and illness to promote the restoration and maintenance
of health in their clients. How health is defi ned and achieved and who does what in the
process of establishing health is not well articulated and varies by setting and by indi-
vidual nurse.
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Chapter One. Focusing on Function in All Care Interactions 3
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■ TO CARE FOR OR CARE WITH: OUTCOME-BASED EVIDENCE FOR DECISIONS
There is no question that the historically based philosophy of care and theories of nursing
are well substantiated in logical and well-intended approaches. They are not, however,
always evidence based. Intuitively, for example, we tend to believe that rest will facilitate
recovery. In fact, bed rest as a therapy can be traced back to Hippocrates and has been
used to manage many types of illnesses, acute and chronic, since that period of time. Cur-
rently, bed rest persists as a nursing intervention in some situations.
For example, patients undergoing some cardiac procedures such as percutaneous
coronary interventions are commonly given antiplatelet therapy before and after the pro-
cedure as well as heparin during the procedure. Thus, they are viewed as being at greater
risk of developing vascular complications, such as a hematoma, pseudoaneurysm, and
bleeding at the puncture site, than those patients undergoing coronary angiography with-
out anticoagulation. In order to prevent bleeding from a groin puncture site, patients who
were treated with anticoagulants are generally restricted to bed rest and advised to keep
the affected limb straight. 3 There is little evidence to support this approach and known
evidence of risks such as physical pain, depression, pressure sores, and deconditioning. 3
Further research demonstrated that reducing bed rest and engaging these patients in
functional and physical activity increased the comfort of the patient and did not increase
the risk of vascular complications at the wound site.
It is well known that there is a gap between research and practice. Nurses working
in clinical settings, for example, continue to fear that patients with a deep vein throm-
bosis (DVT) will be harmed by ambulating. 4 Nurses also implement bed rest with these
patients based on nursing diagnoses such as risk of falling. The Nursing Interventions
Classifi cation (NIC) defi nes bed-rest care as the promotion of comfort and safety and the
prevention of complications for a patient unable to get out of bed. 5 Nurses genuinely be-
lieve that bed rest will keep patients safe from harm and ensure optimal recovery.
Bed rest persists despite lack of evidence-based benefi t of this intervention and even
in the face of evidence to suggest harm. Multiple studies have been done, for example, to
demonstrate that there is no difference in occurrence of pulmonary embolism in patients
put on bed rest versus those allowed to ambulate freely post-DVT. 6 , 7 The persistence of
either medically prescribed or nursing-facilitated bed rest is evident empirically among
hospitalized older adults. In a recent study by Brown et al., 8 it was noted that older adults
were spending 83% of the time while hospitalized in bed and at least 40% to 60% of these
individuals demonstrated some decline in functional ability with declines occurring as
early as the second day of hospitalization. 9 , 10 Immobility and functional impairment in-
crease the risk that older adults will develop infections, pressure sores, and fall, or require
nonelective rehospitalization. 11 Nurses conceptualize their roles as “watching over” pa-
tients to protect them from falls and other adverse events 12 and encourage what are be-
lieved to be risk-free activities, such as staying in bed and using a urinal. 13 This protective,
custodial, task-oriented care facilitates functional decline, decreases physical activity, and
contributes to deconditioning and disability. 14 , 15
Although complete bed rest is less common in long-term care settings, there is
evidence of limited functional and physical activity and a persistent decline in func-
tion among residents in these settings. Specifi cally, it has been noted that the major-
ity of individuals in nursing homes and assisted living facilities are inactive and have
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limited opportunities to engage in physical activity. 16 Moreover, the activity that they
perform is mainly in a seated position. 16 , 17 The amount of activity engaged in by those
in assisted living settings was less than that reported by community-dwelling older
adults with degenerative joint disease (204,593 counts/day), 18 those at risk of disability
(113,695.6 counts/day), 19 those living in nursing homes (55,710–103,647 counts/day), 20
or healthy community-dwelling older adults (113,695.6–237,425 counts/day). 19 – 21 In
addition, direct care workers (DCWs) in these sites encourage participation in ambula-
tion and other types of physical activity in only approximately 3 out of 19 common care
interactions (e.g., bathing and dressing). 22 , 23
■ EVIDENCE OF THE BENEFIT OF PHYSICAL ACTIVITY
There is substantial evidence documenting the many health benefi ts associated with
physical activity for adults of all ages, 24 – 26 even for chronically ill or frail older adults for
whom it is often falsely believed that physical activity will exacerbate rather than amelio-
rate underlying health problems. Meta-analytic reviews have provided strong evidence
that participation in either nonspecifi c physical activity or specifi c aerobic or resistive
exercise is associated with a variety of health improvements, such as decreased risk of
coronary heart disease and stroke, 27 , 28 decreased progression of degenerative joint dis-
ease, 29 prevention of osteoporosis of the lumbar spine, 30 and increased gait speed if the
activity is of suffi cient intensity and dosage, 31 and is positively associated with successful
aging. 32 While there is some evidence for a dose–response relationship between physical
activity and health outcomes, 33 substantial benefi ts can be achieved at even relatively low
levels of exercise intensity, 34 and previously sedentary older adults are the most likely to
benefi t from physical activity. 33
In long-term care facilities, specifi cally nursing homes and assisted living communi-
ties, we have repeatedly shown that increasing participation in functional and physical
activity among residents results in improved gait and balance and improved mood and
fewer disruptive behaviors. 23 , 35 , 36 In addition, residents who are encouraged to optimize
their functional and physical activity are less likely to be transferred to the emergency
room for episodes of care associated with non-fall-related problems, such as infections. 37
Thus, there is suffi cient support for encouraging more time engaged in physical activity
and less time in bed and sitting for older adults across multiple settings.
■ FUNCTION-FOCUSED CARE
Function-focused care, previously commonly referred to as restorative care, is a phi-
losophy of care that focuses on evaluating the older adult’s underlying capability
with regard to functional and physical activity and helping him or her to optimize and
maintain abilities and continually increase time spent in physical activity. Transition-
ing restorative care to a function-focused care philosophy was done deliberately to
provide a more positive perspective as well as to move this work from a conceptual-
ization of a program (e.g., restorative care program) to a broader philosophy of care
that is needed regardless of setting. Examples of function-focused care interactions
are shown in Table 1.1 and include such things as using verbal cues during bathing so
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that the older individual performs the tasks rather than the direct care worker bathing
the individual, walking to the bathroom rather than using a portable urinal, or going
to an exercise class.
Function
Example of Function-Focused Care
Performed
Example of When
Function-Focused Care
Is Not Performed
Bed mobility Asks or encourages older adult to
move in bed and gives him or her
time to move
Gives step-by-step cues on how to
move in bed—for example, put your
right hand on the rail and pull your-
self over on your left side
Places older adult’s hands to facili-
tate independent movement, for
example, on guard rail
Asks or encourages older adult to
move in bed but does not allow
time for older adult to respond
Moves older adult without asking
older adult to help; pulls older
adult up fully on bed without ask-
ing older adult to help
Discourages or stops older adult
from performing activity
Older adult performed activity but
with no involvement or encour-
agement from direct care worker
(DCW)
Transfer from
one surface
to another
Asks or encourages older adult to
transfer and waits for older adult to
move
Gives step-by-step cues on how to
transfer, for example, “slide to the
edge of the chair”
Places hands to facilitate indepen-
dent movement, for example, places
hands on walker
Asks or encourages older adult
to transfer but does not wait for
older adult to initiate the transfer;
just starts to pull him or her up
Transfers/lifts older adult fully with
no encouragement by DCW to
have older adult perform any of
the transfer
Discourages or stops older adult
from performing activity
Older adult performed activity but
with no involvement or encour-
agement from DCW
Mobility
(ambulation/
wheelchair)
Asks or encourages older adult to
walk or independently propel wheel-
chair and gives him or her time to
perform activity
Gives step-by-step cues to get older
adult to walk, for example, “move
your left foot forward, now move your
right foot
Assists in, asks about, or encourages
use of assistive devices (e.g., Merry
Walker, rolling walker, standing table)
Utilizes wheelchair instead of en-
couraging ambulation and does
not encourage older adult to self-
propel (even short distance/even
with one hand)
Discourages or stops older adult
from performing activity
Older adult performed activity but
with no involvement or encour-
agement from DCW
TABLE 1.1 Examples of Function-Focused Care Activities
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■ THEORETICAL MODEL TO GUIDE INTEGRATION OF THE FUNCTION-FOCUSED CARE APPROACH
Evidence and knowledge of the benefi t of a care philosophy such as function-focused
care is not suffi cient to ensure that this will occur in real-world clinical settings. Using a
social ecological model (SEM; Figure 1.1 ) to guide the implementation of the function-
focused care philosophy provides an overarching framework for understanding the
interrelations among diverse personal and environmental factors in human health and
illness and addresses intrapersonal, interpersonal, environmental, and policy factors
that can be used to ensure successful implementation. There is increasing recognition
that this type of multilevel perspective is needed to address health behavior change
and facilitate changes in current care philosophies and care practices as has been done
with regard to use of physical restraints, 38 promoting health behaviors and achieving
the guidelines as noted in Healthy People 2010, 39 and understanding caregivers’ expec-
tations and care receivers’ competence. 40 , 41
Impact of Intrapersonal Factors on Function and Physical Activity
A number of intrapersonal factors can lead to functional limitation, disability, and low
physical activity in older adults. These factors include comorbidities, acute medical prob-
lems, and psychological factors (e.g., mood and motivation). There are also nonmodifi able
factors including demographic variables such as age, gender, and race. While it is useful
to acknowledge the presence of these factors, it is challenging to relate them directly to
FIGURE 1.1 FFC social ecological model.
Policy
Unit/Site/ Home Policies, norms and practices
EnvironmentEvaluation of P-E fit physicalEnvironment (e.g, bed height)
Fam
ily, friends, peers, interdisciplinary team
, NC
AInterpersonal for nurses and patie
nts
PatientsPhysicalBeliefsCapabilityPain, etc
NursesDemographicsKnowledgeBeliefsPhysical activity
Education and goal
setting.
Social cognitive theory:
Verbal encouragement;
Role modeling; Cueing;
Eliminating unpleasant
experiences.
Evaluate person-environment
fit and change environment
to eliminate barriers to activity.
Evaluate policies and alter as
needed to optimize a focus on
function and physical activity.
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function as individuals vary so much. Moreover, it is impossible to separate out the mul-
tiple comorbidities common in older individuals. Appreciating the potential impact of
these variables can help guide interventions; for example, knowing that someone has
Parkinson’s disease would impact the type of interventions used to optimize function.
Cognitive and Behavioral Intrapersonal Challenges
As many as 90% of older adults in long-term care facilities have some cognitive im-
pairment 41 and have associated symptoms such as aphasia, motor apraxia, perceptual
impairments, and apathy. This makes it particularly challenging to encourage older
adults in these settings to engage in functional activities and exercise. In addition to
functional and motivational challenges, problematic behavioral symptoms, such as
verbal and physical aggression, insomnia, depression, and resistance to care occur in
50% to 80% of individuals diagnosed with dementia at some time during the course of
their illness. Caregivers are frequently challenged by the agitated and uncooperative
behaviors of cognitively impaired residents and tend to focus on maintaining behav-
ioral stability rather than trying to engage them in functional and physical activities. 35
Unfortunately, this reinforces sedentary activity and a “just getting it done” approach
to personal care in which the caregiver completes the functional task rather than
supporting the resident in doing so. Individualized approaches, altering the environ-
ment, providing verbal encouragement, cueing, role modeling, and following a simple
routine are all techniques we will describe in subsequent chapters that successfully
engage these individuals in functional and physical activity.
Physical and Physiological Factors
There are numerous physical and physiological factors that can infl uence participation
in functional and physical activities among older adults. Quite simply, the individual’s
underlying physical capability, which we will evaluate using a brief assessment tool,
can limit what the individual is actually able to perform and must be used to guide the
development of goals. In addition, physiological contributors such as serum albumin,
endocrine immune dysregulation associated with sarcopenia, osteoporosis, D-dimer
and infl ammatory markers, testosterone levels, mitochondrial dysfunction, anemia,
vitamin D levels, and muscle mass changes, for example, are all associated with func-
tion in older adults. Some of these factors can be evaluated and treated at the individual
level, but others must just be recognized and function optimized in light of these changes.
Psychosocial Factors
The most commonly noted psychosocial factors infl uencing function are fear of falling
and depressive symptoms. Interestingly, depression can decrease the individual’s will-
ingness to engage in exercise, although participating in exercise decreases depression
and improves mood. 42 Resilience is another psychosocial factor that infl uences function
and participation in exercise or in any physical activity. Resilience is an individual’s
capacity to make a “psychosocial comeback in adversity,” 43 and is defi ned as the ability
to achieve, retain, or regain a level of physical or emotional health after illness or loss.
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Resilient individuals tend to manifest adaptive behavior, especially with regard to social
functioning, morale, and somatic health, and are less likely to succumb to illness. 44 , 45
For example, older women who have successfully recovered from orthopedic or other
stressful events describe themselves as resilient and determined and tend to have better
function, mood, and quality of life than those who are less resilient. 46
Interpersonal Factors: Motivation and the Theory of Self-Effi cacy
Motivation is a component of personality but is also infl uenced by variables extrinsic to
the individual. Bandura 47 conceptualized motivation within the broader spectrum of the
theory of self-effi cacy. The theory of self-effi cacy suggests that the stronger the individ-
ual’s self-effi cacy (SE) and outcome expectations (OE), the more likely it is that he or she
will initiate and persist with a given activity. SE expectations are the individuals’ beliefs in
their capabilities to perform a course of action to attain a desired outcome, and OE are the
beliefs that a certain consequence will be produced by personal action. Effi cacy expecta-
tions are dynamic and are both appraised and enhanced by four mechanisms: (a) enactive
mastery experience, or successful performance of the activity of interest; (b) verbal per-
suasion, or verbal encouragement given by a credible source that the individual is capable
of performing the activity of interest; (c) vicarious experience, or seeing like individuals
perform a specifi c activity; and (d) physiological and affective states such as pain, fatigue,
or anxiety associated with a given activity.
At the interpersonal level, the theory of SE can be used to guide interventions that
will strengthen SE and OE among older adults and their caregivers and thereby increase
the likelihood that caregivers will implement function-focused care and older adults will
engage in functional tasks and physical activity. Specifi cally, interventions such as the
use of verbal encouragement and goal setting, role modeling, mastery experiences, and
decreasing unpleasant sensations are all ways in which caregivers and older adults have
been motivated to successfully change behavior so that function and physical activity are
optimized. 17 , 23 , 48
Social Support
At the interpersonal level, social support networks including family, friends, peers, and
health care providers are important determinants of behavior. 49 , 50 Repeatedly, motivation
to perform physical activity and exercise has been found to be infl uenced by the social
milieu of the care setting. These social interactions can infl uence SE and OE and can
alter the progression of functional limitations to disability. Degenerative joint disease,
for example, may have less impact on dressing for individuals who are encouraged by
a family member to independently dress versus a family member who dresses or insists
that the caregiver dress the individual. The infl uence of any member of the older adults’
social network can be positive or negative depending on his or her philosophy and beliefs
related to function-focused care. For example, in assisted living settings, some families
advocate for maximal care to be provided to their loved one, regardless of the individual’s
ability to perform the activity alone. This propagates sedentary behavior, decreases SE
related to function, and can reduce participation in physical activity.
Unfortunately, the demonstration of dependent self-care behavior by long-term care
residents is usually followed by positive reinforcement and support from care providers,
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whereas the demonstration of independent self-care activities does not result in positive
reinforcement, and is generally unnoticed by care providers. 51 , 52 This is coupled with the
tendency of care providers, in an attempt to be more effi cient and caring, to complete
functional tasks for the residents. Establishing a culture and philosophy of care in which
older adults are consistently motivated to engage in functional tasks and physical activity
and achieve realistic goals given underlying disease is greatly needed.
The success of any intervention designed to improve care to older adults depends
heavily on the receptiveness of caregivers to learn new skills and their motivation to use
these skills regularly. SE related to employment activities has repeatedly been associated
with and can improve job satisfaction and job performance. 53 , 54 Specifi cally, SE-based in-
terventions such as verbal persuasion and education about care-related activities resulted
in improved job satisfaction and decreased turnover among direct care workers. 23 , 55 , 56
Environment
Environments that facilitate physical activity can reduce functional decline and enable
people to achieve their highest level of function and well-being. 57 – 59 Unfortunately, des-
ignated exercise space is generally limited in health care settings, and the hallways, com-
mon areas, and outdoor walkways are seldom used to promote physical activity. When
environments are evaluated, it is generally only for safety rather than optimizing func-
tional usefulness. Recommendations from case studies and direct observations of residen-
tial communities for older adults indicate that visibility of exercise-related areas, walkable
spaces, safety, and having interesting walking destinations can improve physical activity
among residents. 16 Simple and cost-effi cient modifi cations can be made to improve the
space, such as improving lighting, displaying signs that specifi cally promote active living,
and providing physical activity stations throughout the facility. Outdoor improvements
include ensuring that sidewalks and stairs are safe and accessible, providing greenery
and interesting destinations, and ensuring that there is adequate shade and seating so
that residents will feel comfortable outdoors. Interventions that educate and engage all
members of the community to utilize environmental resources to promote physical activ-
ity are underused and needed.
In addition to consideration of the objective physical environment, the degree of
person-environment fi t (P-E fi t) is critical to evaluate, especially as function declines. 60
The environment includes the physical, personal, small group, suprapersonal, and the
social environment. Adaptation, or P-E fi t, occurs when there is a match between the
person and the environment. There is evidence to suggest that individuals with lower
competence are particularly infl uenced by the P-E fi t as they have to spend a great
deal of energy overcoming and adapting to environments and consequently are un-
able to optimally engage in functional or physical activity. In these instances, physical
activity can be improved by lowering environmental demands through interventions
such as altering the height of a bed or a chair to facilitate transfers.
Policy
Policy initiatives have been successful in changing behaviors in areas such as wearing
seat belts and smoking cessation. There are, however, no national policies related to
physical activity. Nursing home settings are federally mandated by the Omnibus Budget
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Reconciliation Act (OBRA) of 1987 to provide care that ensures that residents attain and
maintain their highest level of function. There are no such national guidelines for assisted
living, acute care, or the home setting. General public health guidelines do, however, rec-
ommend 30 minutes daily of low- to moderate-intensity physical activity for all adults. 61
Dissemination of these guidelines can be used as a way in which to encourage caregivers
and older adults to engage in all types of physical activity.
In addition, the policies, procedures, and philosophy of care within organizations
are critical to establishing a function-focused philosophy of care. Policies related to use
of shared-space areas, provision of care, and availability of services in long-term care or
acute care facilities can infl uence participation in physical activity and function among
older adults within those settings. If outdoor space for walking is locked and made inac-
cessible, or if the underlying philosophy or culture within the facility is to provide care
rather than optimize function, perceptions and expectations among older adults, staff,
and families can be affected, which can lead to functional dependency. Understanding
the policies and informal structures in care facilities is a necessary fi rst step to identifying
barriers to implementing a function-focused care philosophy and interventions relevant
to function-focused care.
■ FROM THEORY TO IMPLEMENTATION OF FUNCTION-FOCUSED CARE
In summary, despite our long nursing history of providing care for individuals, there is
a great need, given what is known about physical activity and the impact of limited mo-
bility on future outcomes, to transition our philosophy of care in nursing to one focused
on optimizing function and physical activity. Use of a social ecological model is needed
to guide the implementation of this philosophy of care and ensure that outcomes are
achieved. At the intrapersonal level, the social ecological model serves as a reminder to
consider the many intrapersonal factors in residents and in caregivers that might infl u-
ence their perceptions about function-focused care and their ability to engage in these
activities. The interpersonal factors associated with implementation of function-focused
care are particularly critical to successful implementation. Self-effi cacy-based interven-
tions are very effective and include such things as ongoing education of caregivers and
older individuals, ongoing verbal encouragement, role modeling, cueing, and removal
of unpleasant sensations associated with function-focused care activities. These are de-
scribed in greater detail in subsequent chapters.
Environment interventions are useful to ensure that the resources are present so as
to optimize outcomes. If, for example, there is no place to walk safely, it may be diffi cult
to achieve a goal of walking for 20 minutes a day. Furthermore, the environment needs to
be arranged so as to ensure optimal completion of functional tasks. Bed and chair heights
are simple examples of how environmental interventions can facilitate transfers. Lastly,
at the policy level, it may be necessary to alter institutional policies and philosophy so
that there is a focus on optimizing function and increasing physical activity among older
adults within those settings. Acute care settings in which patients are unable to walk to
tests and procedures, for example, limit activity and can contribute to deconditioning.
Changes in such policies are needed to truly integrate a function-focused philosophy of
care and achieve optimal outcomes.
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There is suffi cient evidence to support the benefi ts of helping older adults remain
physically active through performance of functional activities and general physical
activity as per the guidelines set by the American College of Sports Medicine and the
American Heart Association. 61 Likewise, the implementation of a function-focused care
approach across multiple care settings has been shown to be safe and benefi cial for older
adults and may even prevent the need for acute medical interventions due to such things
as infections. The remaining chapters of this book will delineate how to implement a
function-focused care philosophy and provide older adults with this level of care across
all types of care settings and situations.
■ REFERENCES
1. Parse R. Essentials for practicing the art of nursing. Nurs Sci Q . 1989;2:111. 2. American Nurses Association. Nursing Scope and Standards of Practice . Washington, DC:
Nursesbooks.org; 2004. 3. Chang K. Prolonged bed rest duration after percutaneous coronary intervention. The
World of Critical Care Nursing, Summer, 2010. http://fi ndarticlescom/p/articles/mi_6812/is_2_7/ai_n53906142/?tag=content;col1.
4. Ciliska D, Robinson P, Armour T, et al. Diffusion and dissemination of evidence-based dietary strategies for the prevention of cancer. Nutr J . 2005;4:13.
5. Bulechek G, Butcher H, Dochteman JM. Nursing Interventions Classifi cation (NIC) . St Louis, MO: Mosby Elsevier; 2011.
6. Schellong S, Schwarz T, Kropp J, Prescher Y, Beuthien-Baumann B, Daniel W. Bed rest in deep vein thrombosis and the incidence of scintigraphic pulmonary embolism. Thromb Haemost . 1999;82:127–129.
7. Trujillo-Santos J, Perea-Milla E, Jiménez-Puente A, et al. Bed rest or ambulation in the initial treatment of patients with acute deep vein thrombosis or pulmonary embolism: fi ndings from the RIETE registry. Chest . 2005;127 1631–1636.
8. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc . 2009;57:1660–1667.
9. Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan JL. Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health . 2001;55:132–138.
10. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc . 2003;51:451–458.
11. Nolan J, Thomas S. Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project. BMC Health Serv Res . 2008;8:250.
12. Schmidt L. Patients’ perceptions of nursing care in the hospital setting. J Adv Nurs . 2003;44:393.
13. Lindquist R, Sendelbach SE. Maximizing safety of hospitalized elders. Crit Care Nurs Clin North Am . 2007;19:277–284.
14. Brown C, Williams B, Woodby L, et al. Barriers to mobility during hospitalization from the perspective of the patient, their nurses and physicians. J Hosp Med . 2007;2:305–331.
15. Buttery AK, Martin FC. Knowledge, attitudes and intentions about participa-tion in physical activity of older post acute hospital inpatients. Physioltherapy . 2009;95:192–198.
Resnick_33847_R3_ch01_11-07-11_001-014.indd 11Resnick_33847_R3_ch01_11-07-11_001-014.indd 11 07/11/11 1:15 PM07/11/11 1:15 PM
# 7900 Cust: Springer Au: Resnick Pg. No. 12 Title: Restorative Care Nursing for Older Adults Server:
KShort / Normal
DESIGN SERVICES OF
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12 Restorative Care Nursing for Older Adults
16. Mihalko S, Wickley K. Active living for assisted living: promoting partnerships within a systems framework. Am J Prev Med . 2003;25:193–203.
17. Resnick B, Galik E, Gruber-Baldini AL, Zimmerman S. Implementing a restorative care philosophy of care in assisted living: pilot testing of Res-Care-AL. J Am Acad of NPs . 2009;21:123–133.
18. Murphy S, Strasburg D, Lyden A, et al. Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Arthritis Rheum . 2008;59:1480–1487.
19. Pruitt LA, Glynn NW, King AC, et al. Use of accelerometry to measure physical activ-ity in older adults at risk for mobility disability. J Aging Phys Act . 2008;16:416–434.
20. Galik E, Resnick B, Gruber-Baldini A, et al. Pilot testing of the restorative care interven-tion for the cognitively impaired. J Am Med Dir Assoc . 2008;9:516–522.
21. Janney CA, Richardson CR, Holeman RG, et al. Gender, mental health service use and objectively measured physical activity: Data from the National Health and Nutri-tion Examination Survey (NHANES 2003–2004). Ment Health Phys Act . 2008;1:9–16.
22. Resnick B, Galik E, Zimmerman S, Gruber-Baldini A. Perceptions and performance of function and physical activity in AL communities. J Am Med Dir Assoc . 2010:11(6):406–414.
23. Resnick B, Gruber-Baldini A, Galik E, et al. Changing the philosophy of care in long-term care: testing of the restorative care intervention. Gerontologist . 2009;49:175–184
24. Netz Y, Wu MJ, Becker BJ, Tennenbaum G. Physical activity and psychological well being in advanced age: a meta-analysis of intervention studies. Psychol Aging . 2005;20:272–284.
25. Cress M, Buchner D, Prohaska T, et al. Best practices for physical activity programs and behavior counseling in older adult populations. J Aging Phys Act . 2005;13:61–74.
26. Prohaska T, Belansky E, Belza B, et al. Physical activity, public health, and aging: critical issues and research priorities. J Gerontol B Psychol Sci Soc Sci . 2006;61(5):S267–S273.
27. Cornelissen VA, Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens . 2005;23:251–259.
28. Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke . 2003;34:2475-81.
29. Roddy E, Zhang, W, Doherty, M, et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus. Rheumatology . 2005;44:67–73.
30. Palombaro KM. Effects of walking-only interventions on bone mineral density at various skeletal sites: a meta-analysis. J Geriatr Phys Therapy . 2005;28:102–107.
31. Lopopolo RB, Greco M, Sullivan D, Craik RL, Mangione KK. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis. Phys Ther . 2006;86:520–540.
32. Depp CA, Jeste DV. Defi nitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry . 2006;14:6–20.
33. Singh M. Exercise to prevent and treat functional disbility. Clin Geriatr Med . 2002;18:431–462.
34. Cornelissen V, Verheyden B, Aubert A, Fagard R. Effects of aerobic training intensity on resting, exercise and post-exercise blood pressure, heart rate and heart-rate variability. J Hum Hypertens . 2009;24:175–182.
35. Galik EM, Resnick B, Gruber-Baldini A, Nahm ES, Pearson K, Pretzer-Aboff I. Pilot testing of the restorative care intervention for the cognitively impaired. J Am Med Dir Assoc . 2008;9:516–522.
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36. Resnick B, Gruber-Baldini A, ZImmerman SI, et al. Nursing home resident outcomes from the Res-Care intervention. J Am Geriatr Soc . 2009;57:1156–1165.
37. Gruber-Baldini AL, Resnick B, Hebel JR, Galik E, Zimmerman S. Adverse events associ-ated with the Res-Care intervention. J Am Med Dir Assoc . In press.
38. Wagner LM, Capezuti E, Brush B, Boltz M, Renz S, Talerico KA. Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nurs-ing homes. Res Nurs Health . 2007;30:131–140.
39. Smedley B, Syme SL, ed. Promoting Health: Strategies from Social and Behavioral Research . Washington, DC: Institute of Medicine, National Academies Press; 2000.
40. Isal M, Montorio I, Marquez M, Losada A. Caregivers’ expectations and care receiv-ers’ competence: Lawton’s ecological model of adaptation and aging revisited. Arch Gerontol Geriatr . 2005;41:129–140.
41. Zimmerman S, Gruber-Baldini AL, Sloane PD, et al. Assisted living and nursing homes: apples and oranges? Gerontologist . 2003;43:107–117.
42. Singh N, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA. A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci . 2005;60:768–776.
43. Kadner K. Resilience: responding to adversity. J Psychosoc Nurs Ment Health Serv . 1989;27:20–25.
44. Kinsel B. Resilience as adaptation in older women. J Women Aging . 2005;17:23–39. 45. Hardy S, Concato J, Gill TM. Resilience of community-dwelling older persons. J Am
Geriatr Soc . 2004;52:257–262. 46. Wright LJ, Zautra AJ, Going S. Adaptation to early knee osteoarthritis: the role of risk,
resilience, and disease severity on pain and physical functioning. Ann Behav Med . 2008;36:70–80.
47. Bandura A. Self-effi cacy: The Exercise of Control . New York, NY: W.H. Freeman and Company; 1997.
48. Resnick B, Pretzer-Aboff I, Galik E, et al. Barriers and benefi ts to implementing a restor-ative care intervention in nursing homes. J Am Med Dir Assoc . 2008;9:102–108.
49. Resnick B, Orwig D, Magaziner J, Wynne C. The effect of social support on exercise behavior in older adults. Clin Nurs Res . 2002;11:52–70.
50. Casado B, Resnick B, Zimmerman B, et al. Social support for exercise by experts in older women post hip fracture. J Women and Aging . 2009;21:48–62.
51. Waters K. Getting dressed in the early morning: styles of staff/patient interaction on rehabilitation hospital wards for elderly people. J Adv Nurs . 1994;19:239–247.
52. Resnick B. Functional performance of older adults in a nursing home setting. Clin Nurs Res . 1998;7:230–246.
53. Judge T, Bono J. Relationship of core self evaluations traits—self-esteem, generalized self-effi cacy, locus of control, and emotional stability—with job satisfaction and job performance: a meta analysis. J Appl Psych . 2001;86:80–92.
54. Bono JE, Judge TA. Core self evaluations: a review of the trait and its role in job satisfac-tion and job performance. Euro J Pers . 2003;17:S5–S18.
55. Yeatts DE, Seward RR. Reducing turnover and improving health care in nursing homes: the potential effects of self-managed work teams. Gerontologist . 2000;40:358–363.
56. Parsons S, Simmons W, Penn K, Fulough M. Determinants of satisfaction and turn-over among nursing assistants. The results of a statewide survey. J Gerontol Nurs . 2003;29:51–58.
57. Rodiek S. Resident perceptions of physical environment features that infl uence outdoor usage at assisted living facilities. J Hous Elder . 2006:19(3–4);95–107.
Resnick_33847_R3_ch01_11-07-11_001-014.indd 13Resnick_33847_R3_ch01_11-07-11_001-014.indd 13 07/11/11 1:15 PM07/11/11 1:15 PM
58. Milano C. Outward bound: using design and environment to spur outdoor activity. Longterm Care Interface . 2006;6:30–37.
59. Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social-cognitive and perceived environment infl uences associated with physical activity in older Australians. Prev Med . 2000;31:15–22.
60. Iwarsson S. A long-term perspective on person-environment fi t and ADL dependence among older Swedish adults. Gerontologist . 2005;45:327–336.
61. American College of Sports Medicine and the American Heart Association. Guidelines for Physical Activity . http://wwwamericanheartorg.
14 Restorative Care Nursing for Older Adults
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