Rehabilitation And Restorative Nursing Program Manual - Select Rehab
Rehabilitation and RestorativeNursing Program Manual1 Page
Rehabilitation and RestorativeNursing Program ManualSec.1Philosophy and Organizational Structure, Policy and Procedure, Program Overviewp.3-9Sec.2Introduction to Rehabilitation/Restorative Nursingp.10-15Sec.3The Rehabilitation Teamp.16-20Sec.4Range of Motionp.21-50Sec.5Splint and Brace Carep.51-57Sec.6Bed Mobility and Transfersp.58-76Sec.7Activities of Daily Livingp.77-96Sec.8Eating and Swallowingp.97-121Sec.9Amputation and Prosthesisp.122-126Sec.10Communication Strategiesp.127-141Sec.11Ambulation Trainingp.142-158Sec.12Bladder and Bowel .14Program Quality Assurance Review, Improvement Plan,Annual Review/Position Description, Program Referral Form,Competency Assessments, Referencesp.211-2692 Page
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Rehabilitation and Restorative Nursing ProgramPhilosophy and Organizational StructureThe rehabilitation and restorative nursing program is developed to serve as a guide in establishing individualizedrestorative care to assist each resident in achieving the highest level of self-care and independence possible.Rehabilitative or restorative care refers to nursing interventions that promote the resident’s ability to adapt and adjustto living as independently and safely as possible. This concept actively focuses on achieving and maintaining optimalphysical, mental, and psychosocial functioning.Skill practice in such activities as walking and mobility, dressing and grooming, eating and swallowing, transferring,amputation care, and communication can improve or maintain function in physical abilities and Activities of Daily Livingand prevent further impairment.Resident/family involvement is encouraged in planning, implementing, and setting goals for the resident. Restorativecare needs are viewed as part of basic care rather than special care. The establishment of rehabilitation/restorativeprograms is begun after the interdisciplinary team assesses the resident and identifies the potential for improvingfunctional skills.Restorative nursing is indicated when the resident displays potential for functional decline following the end of therapyor has achievable goals for functional improvement through rehabilitative or restorative care. Rehabilitation orrestorative nursing is essential for carryover of therapeutic teaching. Restorative assessment may occur: When there is an assessment due to significant change in statusQuarterly with assessment processOn referral from Nursing or TherapyEach resident enrolled in a rehabilitation/restorative program has measurable objectives and interventions documentedin their care plan. The rehabilitation therapist assists nursing in developing and writing measurable objectives/goals andinterventions where appropriate.Implementation of rehab/restorative interventions/direct care is provided by Certified Nursing Assistants, under thesupervision of a licensed nurse.To qualify as a Restorative Nursing Assistant, an individual must be a Certified Nursing Assistant (CNA), have a highinterest in rehabilitation and demonstrate good qualities in communication, responsibility and sensitivity. In addition tocarrying out resident-specific treatment responsibilities, it is the responsibility of the RNA to, on a daily basis, documentthe specific tasks completed and to document weekly a summary of each resident’s progress, functional status/goalachievement, assistive devices used and the resident’s response to treatment.The RNA will be responsible to report immediately any unusual or unexpected responses of the resident to the chargenurse and/or referring therapist. The RNA should demonstrate care and concern for residents through exercisingrespect, dignity and a sense of worth in care giving; providing choices to the extent possible; involving the resident in thecare planning process; addressing the resident as an equal, avoiding a subservient manner; and providing opportunityfor the resident to have some control over his/her life.4 Page
A Philosophy of Care GivingThe RNA performs a very significant role in the care giving process. Because the RNA provides a great amount of care, itis essential that care be based on a philosophy that is holistic and humanistic. To provide care in a holistic way meansthe caregiver accepts the fact that each elderly person has unique characteristics, abilities and interests. Each elderlyperson is recognized as having a lifetime of experiences different from those of any other person. The combination ofthese experiences has influenced the person physically, psychologically, socially and environmentally. Everyone isdifferent and requires a variation in response that is unique to that person. When the caregiver provides care in keepingwith the uniqueness required for each person, holistic care is given.Rehabilitation/Restorative NursingRefers to nursing interventions that promote the resident’s ability to adapt and adjust to living as independently andsafely as possible. This concept actively focuses on optimal improvement of the resident’s physical, mental andpsychosocial functioning. Restorative Nursing does not include procedures or techniques carried out by or under thedirection of qualified therapists.Rehabilitation/Restorative careRefers to nursing interventions that assist or promote the resident’s ability to attain their maximum functional potential.These activities are carried out and supervised by members of the nursing staff. Other departmental staff may beassigned to work with specific residents.Models of Rehabilitation Restorative NursingThere are two basic models of Restorative Programs, designated staff model and integrated staff model, eachdelineating who provides restorative services. Designated Staff Modelo Designated staff members are specifically assigned to only deliver restorative serviceso Staff members received specialized training in Nursing Rehabilitation techniques (e.g., range of motion,swallowing, ADLs)o Job title is frequently used is Restorative Nursing Assistant (RNA) Integrated Staff Modelo Restorative programs are integrated into the resident’s daily careo All staff members caring for a resident are responsible for carrying out restorative serviceso All staff should receive specialized training in Nursing Rehabilitation techniques (e.g., range of motion,swallowing, ADLs)For both models, specific criteria should be in place for documentation and supervisiono Resident participation and progress must be documented dailyo Monthly progress reports should be completed by the Restorative Coordinator. Ideally, weeklydocumentation should be completed by the RNA and co-signed by the Restorative Coordinator.o A Licensed Nurse or Therapist may establish a resident’s restorative programo Each RNA should be supervised by a Licensed Nurseo Therapists should provide consultation for those restorative programs relating to therapy5 Page
Roles and ResponsibilitiesRestorative Nursing AssistantThe RNA provides the greatest amount of rehabilitative care to elderly residents. It has been estimated that nursingassistants provide at least 90% of the care to residents in nursing homes. Because of their advanced training, RNAs areable to assume a leadership role and set an example to other certified nursing assistants. Their contribution to the careof the elderly is meaningful and valuable because of advanced training beyond that other nursing assistants. Specializedtraining in rehabilitative care helps the RNA to individualize care, look for innovative ways to assist elderly residents toachieve optimal health and promote improved function and independence of each resident. The trained RNA will carryout each resident’s specific restorative program, document progress/changes/declines and report status to theCoordinator.NursingThe Licensed Nurse acting as the Restorative Coordinator should supervise delivery of restorative services, manage theprogram, assist with weekly documentation, and co-sign all progress reports written by RNAs. The Coordinator maychoose to establish facility communication systems (e.g., meetings, rounds, referral form) with RNAs and therapists toensure that any changes in function are addressed and highest functional level is attained and maintained.TherapyTherapists in the facility may assist to perform ongoing RNA training, identify appropriate candidates for the restorativeprogram, suggest appropriate treatment interventions/techniques, set resident-specific goals and interventions for therestorative program and assist in monitoring resident progress/decline in the program. When involving therapists in theprogram, it is important to consult state specific guidelines to ensure compliance.PolicyIt is the policy of this facility that all residents will be screened for restorative care: As terminated off active therapy When there is a significant change in status Quarterly with assessment process On referral from nursing or therapyRehabilitation/Restorative Nursing is: The prevention of secondary complications. The restoration of function or partial function. Helping residents learn to do for themselves. Developing untapped resources. Enhancing under-utilized abilities. Establishing life patterns within existing limitations. Minimizes degrading features (restraints and incontinence).Rehabilitation/Restorative Nursing programs are designed to create resident independence to improve self-image andself-esteem thereby improving the quality of life.Program Goals To restore function to maximum self-sufficiency. To replace hands-on assistance with a program of task segmentation and verbal cuing. To restore abilities to a level that allows the resident to function with fewer supports.6 Page
Programs Range of MotionThe extent to which, or the limits between which, a part of the body can be moved around a fixed point or joint. Rangeof motion exercise is a program of passive or active movements to maintain flexibility and useful motion in the joints ofthe body.o Active Range of Motion exercises performed by a resident with cuing or supervisiono by staff. Exercises are planned, scheduled and documented in the clinical record.o Passive Range of Motion exercises performed by a staff member or person that has been properlytrained.Splint or Brace Assistance Assistance can be of two types:o The staff provides verbal and physical guidance and direction that teaches the resident how to apply,manipulate, and care for a brace or splint.o The staff has a scheduled program for applying and removing a splint or brace, assess the resident’s skinand circulation under the device and reposition the limb in correct alignment. These sessions areplanned, scheduled and documented by the clinical record.Bed MobilityActivities used to improve or maintain the resident’s self-performance in moving to and from a lying position, turningside-to-side and positioning themselves in bed.TransferActivities used to improve or maintain the resident’s self-performance in moving between surfaces or planes either withor without assistive devices.Ambulation TrainingActivities used to improve or maintain the resident’s self-performance in walking, with or without assistive devices. Mayinclude gait training or building of strength and endurance.ADL Training, Dressing or GroomingActivities used to improve or maintain the resident’s self-performance in dressing, undressing, bathing, washing andperforming other personal hygiene tasks.Eating and SwallowingActivities used to improve or maintain the resident’s self-performance in feeding themselves food and fluids, oractivities used to improve or maintain the resident’s ability to ingest nutrition and hydration by mouth. Feedingtechniques, use or adaptive equipment, proper positioning and cuing are included.Amputation/Prosthesis CareActivities used to improve or maintain the resident’s self-performance in putting on and removing a prosthesis, caringfor the prosthesis and providing appropriate hygiene at the site where the prosthesis attaches to the body.CommunicationActivities used to improve or maintain the resident’s self-performance in using newly acquired functionalcommunication skills or assisting the resident in using residual communication skills and adaptive devices.Bladder/Bowel ContinenceActivities that look at elimination patterns and assist the resident with a decrease in incontinence, prevent complications(i.e. falls, skin breakdown) and ensure resident dignity.7 Page
Assessment ProcessResident assessments will include the following: Ability to perform activities of daily living. Current problems that need addressing. Potential for risk to develop a problem in the absence of intervention. Need for special equipment or cues to perform tasks. Areas of teaching that are needed (energy conservation, work simplification). Potential to improve or the need for rehabilitation services to prevent decline.Screening Instruments - MDSThe MDS provides the staff with information regarding the resident’s self-performance deficits and whether restorativeinterventions would be indicated. The goal of the MDS is to assist the clinician in identifying residents for whomrehabilitative/restorative goals can be reasonable established.DocumentationDaily Documentation – the staff member that has performed the task as assigned will do daily documentation of thespecific restorative nursing interventions. Daily documentation will be completed by using the facility-specific processwhich may include a flow sheet or electronic medical record documentation. The care plan will be modified when goalsare adjusted as necessary.Program OverviewThe strategies incorporated into rehabilitation/restorative nursing practice pervade all aspects of resident care andpromote independence, team communication and outcome assessment. Rehabilitation/restorative nursing assistantsincorporate these strategies under the supervision of nurses, 24 hours a day, 7 days a week. The program forrehabilitation/restorative nursing is a comprehensive program that includes competency assessment, educationalmodules, outcome assessment, ongoing tracking and system monitoring. The keys to success for this program areongoing monitoring, system assessment, and establishment of rehabilitation/restorative nursing as a core element ofnursing care within the skilled nursing facility.Following completion of the curriculum for rehabilitation/restorative nursing, a competency form will be placed in theCNAs personnel file.8 Page
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Objectives: To discuss rehabilitation philosophy To identify the effects of immobility and physical dependence To define rehabilitation To list goals for rehabilitation To describe the roles of the rehabilitation/restorative nurse and of the rehabilitation/restorative nursingassistantContent Outline: Introduction to rehabilitation/restorative nursingo Why Rehabilitation?o Hazards of immobilityo Immobility and Dependenceo Impact of increased dependenceo Definition of rehabilitationo Goals for rehabilitationo Role of the rehabilitation/restorative nurse and of the rehabilitation/restorative nursing assistantCourse Competency:Each participant will complete a pre-/post-test to validate retention of course content.10 P a g e
Introduction to Rehabilitation/Restorative NursingWhy Rehabilitation?Rehabilitation was not needed by ancient culturesIt is necessary today due to technological advancesAn individual is more likely to survive a life-threatening injury or illness today than ever beforeHazards of Immobility:Immobility affects every body systemMusculoskeletal System: Weakness and Atrophy Loss of Strengtho Occurs at a rate of 10% a weeko Recovery possible at only a rate of 6% a week Preventiono Early remobilizationMusculoskeletal System: Contractures Joint of muscle limitation causing decreased range of motiono Trauma and inflammationo Spasticity and paralysis Preventiono Flexibility exercises 10 to 15 minutes for 3 or more times a week Correctiono Stretching exercises 20 to 30 minutes twice dailyMusculoskeletal System: Osteopenia Osteopenia (bone loss) leads to fractures with minimal movement and exercise Preventiono Early mobilizationCardiovascular Systemo System wide problemso Redistribution of body fluidso Postural hypotensiono Thromboembolus Preventiono Early mobilization Correctiono Gradual reconditioningIntegumentary System (Skin) Pressure ulcerso Just 2 hours of pressure may result in tissue damage for an individual with impaired sensation Preventiono Identification of those at high risko Early mobilization11 P a g e
Respiratory System Pneumoniao Caused by decreased airway clearanceo Caused by pooling of secretions Preventiono Early mobilizationGenitourinary System Calculio Caused by absorption of calcium (as bone loss occurs) Urinary tract infectionso Inadequate bladder emptying, inadequate hydration associated with immobility Preventiono Early mobilizationGastrointestinal System Anorexiao Caused by decreased metabolism Constipation Preventiono Early mobilizationCentral Nervous System - Hallucinations and disorientation Preventiono Early mobilizationImmobility and Dependence Loss of Mobilityo Directly linked with a need for assistanceo Directly linked with a need to rely on others for daily careo Directly linked with a loss of independenceOne of the most common fears of older adults is the fear of loss of independence.Impact of Increased Dependence Fear of dependence causes anxietyo Loss of function and roleo Loss of purpose and self-wortho Loss of privacyo Loss of home and community12 P a g e
Definition of Rehabilitation:Dynamic process in which a disabled person is aided in achieving optimum physical, emotional, psychological,social, or vocational potential in order to maintain dignity and self-respect in a live that is as independent andself-fulfilling as possible.Goals for Rehabilitation Focus on abilities ratherthan disabilities Make the most ofremaining abilities Use the creative talents ofthe rehabilitation teammembers to design andimplement a program The resident, family andsupport are the center ofall rehabilitation effortsRehabilitation goals are ALWAYS determined through mutual goal settinginvolving the resident and the team members.Through the rehabilitation process the resident will: Achieve the highest Maximize quality of lifedegree of function and Meet the resident’sself-sufficiency possiblespecific needs Promote wellnessMinimize complications ole of the Rehabilitation/Restorative NurseQualifications Education or special training in rehabilitation nursingRole Characteristics Integration of rehabilitation program aspects 24 hours a day, 7 days a week Reinforcement of teaching and training completed by other disciplinesCharacteristics of the rehabilitation/restorative nurse Discharge Planner Teacher Caregiver Collaborator Confidant Coordinator Case Manager Liaison Advocate LeaderRole of the Rehabilitation/Restorative AssistantQualifications Education or special training in rehabilitation/restorative nursing Functions under the direction and supervision of a rehabilitation/restorative nurseRole Characteristics Member of the rehabilitation team Promotes carryover of therapeutic teaching by all disciplines Provides communication with team members on resident progress and limitations13 P a g e
Post-testIntroduction to Rehabilitation/Restorative Nursing1. Rehabilitation/restorative nursing is a key aspect of nursing care. The overall philosophy ofrehabilitation/restorative nursing is rest and recovery.True / False2. Immobility may be an issue with any chronic illness or injury. Immobility affects the skin and muscle strengthbut does not have a major impact on other body systems.True / False3. Rehabilitation goals are always determined through mutual goal setting involving the resident and the teammembers.True / False4. Rehabilitation/Restorative nursing care is best completed by focusing on rehabilitation program needs 24hours a day, seven days a week.True / False5. The rehabilitation team includes nurses, therapists, rehabilitation/restorative nursing assistants, the patientand family members.True / False14 P a g e
Answer keyIntroduction to Rehabilitation/Restorative Nursing1. Rehabilitation/restorative nursing is a key aspect of nursing care. The overall philosophy ofrehabilitation/restorative nursing is rest and recovery.True / False2. Immobility may be an issue with any chronic illness or injury. Immobility affects the skin and muscle strengthbut does not have a major impact on other body systems.True / False3. Rehabilitation goals are always determined through mutual goal setting involving the resident and the teammembers.True / False4. Rehabilitation/Restorative nursing care is best completed by focusing on rehabilitation program needs 24hours a day, seven days a week.True / False5. The rehabilitation team includes nurses, therapists, rehabilitation/restorative nursing assistants, the patientand family members.True / False15 P a g e
The Rehabilitation TeamObjectives:To describe rehabilitation philosophyTo describe the purpose of the team approachTo identify members of the rehabilitation teamTo identify patterns of communication within the rehabilitation teamContent Outline:Rehabilitation philosophyThe rehabilitation teamTeam membersTeam communicationVerbal communicationWritten communicationCourse Competency:Each participant will complete a pre-/post-test to validate retention of course content.16 P a g e
The Rehabilitation TeamRehabilitation PhilosophyFocus on abilitiesResident centered planUse of a team approachThe underlying philosophy of rehabilitation is:Focus on abilities rather than disabilities, and to make the most of the abilities that remain intact.The Rehabilitation TeamWhy a team? No single discipline has the knowledge and expertise necessary to provide all components of the rehabilitationprogram. All efforts at rehabilitation require integration of the program by the nurse and nursing assistant. It is the rehabilitation/restorative nurse and assistant who reinforce teaching and training completed by theother disciplines 24 hours a day, 7 days a week. One hour of physical therapy can be undone 23 hours a day – or it can be reinforced 23 hours a day. Solid rehabilitation nursing is essential for a successful rehabilitation outcome.Team Members Resident, family and support systemso Center of the teamo Must be included in decision making and planningo Active participation is essentialo Successful rehabilitation is possible only with commitment on the part of the resident, family and supportsystemo Rehabilitation/restorative nurse and assistanto Physiciano Physical therapisto Occupational therapisto Speech pathologisto Social workero Respiratory therapisto Therapeutic recreation specialisto Chaplain/Pastoro Dieticiano Psychologist17 P a g e
Team Communication Verbalo Care management meetingso Morning stand up meetingso Care planning meetingso Therapy treatment demonstrations Written Communicationo Daily documentationo Progress noteso Resident care planCharacteristics of Effective Teams Informal, comfortable, relaxed atmosphere Lots of discussion Solid understanding of group tasks and objectives Active listening Disagreement Consensus decision making Criticism frequent, frank and comfortable Freedom to express feelings, frustrations, ideas Action is equated with clear, accepted assignments Group takes time to evaluate its efficiency18 P a g e
Post-testThe Rehabilitation Team1. The three cornerstones of rehabilitation include: Focus on abilities, resident centered plan, andrehabilitation/restorative nursing delivered care.True / False2. A team is nice but not necessary for effective rehabilitation.True / False3. Rehabilitation teams achieve successful outcomes through effective communication, which includes theresident and family members.True / False4. Effective teams never disagree.True / False5. The rehabilitation team includes rehabilitation/restorative nurses, therapists, rehabilitation/restorativenursing assistants, the patient and family members.True / False19 P a g e
Answer keyThe Rehabilitation Team1. The three cornerstones of rehabilitation include: Focus on abilities, resident centered plan, andrehabilitation/restorative nursing delivered care.True / False2. A team is nice but not necessary for effective rehabilitation.True / False3. Rehabilitation teams achieve successful outcomes through effective communication, which includes theresident and family members.True / False4. Effective teams never disagree.True / False5. The rehabilitation team includes rehabilitation/restorative nurses, therapists, rehabilitation/restorativenursing assistants, the patient and family members.True / False20 P a g e
Objectives: To describe the need for range of motion To define active and passive range of motion To demonstrate active and passive range of motionContent Outline: Range of motion: Why is it needed? Guidelines for range of motion Return demonstrationsCourse Competency: Each participant will complete a pre/post-test to validate retention of course content.21 P a g e
Range of MotionWhy is it Needed?Rationale To counteract negative effects of immobility and disuseDefinitionRange of motion is the extent to which, or the limits between which a part of the body can be moved around a fixedpoint or joint.Range of motion exercise is a program of passive or active movements to maintain flexibility and useful motion in thejoints of the body.Normal Motions of the BodyAll motions of the body are described with the body starting in a neutral position. The neutral position is when head andbody face forward, feet are straight ahead, and arms are next to the body with the palms facing forward (Figure 1).Terminology used to describe motions occurring in the upper and lower extremities, neck and trunk are as follows:FlexionExtensionAbductionAdductionInternal rotationExternal rotationElevationCircumductionLateral flexionLateral ctionRetractionBending of the jointStraightening of the jointMoving the limb away from mid-lineMoving the limb toward mid-lineTurning the limb toward mid-lineTurning the limb away from mid-lineShoulder shrugsMoving limb in circular patternBending to the side by the head or trunkRotating to the side by the head or trunkTurning the palm of the hand upwardTurning the palm of the hand downwardTurning the foot inwardTurning the foot outwardSimilar to abduction or moving forward, usually associated with scapular motionSimilar to adduction or pulling back, usually associated with scapular motion22 P a g e
Basic ROM TerminologyExercise Classification: Passive: Joint motion within unrestricted range, produced by an external force (manual or mechanical) withoutvoluntary muscle activity by the resident Active: Any exercise where movement is accomplished by voluntary muscular contraction with or withoutexternal resistanceGlossary of Terms and Abbreviations: AROMActive range of motion AAROMActive assistive range of motion DIPDistal interphalangeal joint IPInterphalangeal joint MPMetacarpophalangeal joint PIPProximal interphalangeal joint PREProgressive resistive exercise PROMPassive range of motion ProneLying on abdomen (face down) SupineLying on back (back down) WFLWithin functional limits WNLWithin normal limitsROM Treatment Protocol Before performing ROM with a resident, the assistant must know:o Diagnosiso Medical precautions and contraindications (e.g., no excessive hip flexion or internal rotation) Always attempt to position the resident so the part of the body being ranged is waist height and as close to theassistant as possible. This will help to prevent poor body mechanics and potential injury.o Positioning the resident properly may involve the use of an adjustable bed or plinth, which can bemanually or electrically raised or loweredo If this is not possible, position the resident and yourself as best as possible, monitoring your bodymechanics throughout the activity ROM should be performed to the point of resistance or when a slight stretch is felto Monitor the resident’s face for a response, such as grimacing due to painDO NOT FORCE A MOVEMENT Each exercise should be performed for 10 repetitions and held for 30 seconds at end range. Follow the programset forth by the therapist as the resident’s functional activity tolerance may need to be built up to achieve 10repetitions. Support the extremity or body part throughout range of motion by placing one hand just above the joint and theother hand below the joint. Perform each movement slowly to prevent injury to the resident. This will allow the assistant to closely monitorthe resident for any signs of pain or discomfort. Refer to the program set forth by the therapist. If the resident appears to be unable to safely perform ortolerate the established program due to pain or discomfort, do not proceed with ROM. Notify the nursing staffand the therapist so they can assess the situation. When possible, incorporate the range of motion into a resident’s bathing or ADL session and teach the residentself-ROM whenever possible.23 P a g e
Sequence of Joint Motion Head and Neck Shouldero Flexion – extensiono Abduction – adductiono Internal rotation – external rotationo Horizontal abduction – adduction Elbowo Flexion – extensiono Supinaton – pronation Wrist Jointo Flexion – extensiono Ulnar deviation – radial deviation Finger Jointso Flexion – extensiono Abduction – adduction Thumb Jointso Flexion – extensiono Abduction – adductiono Opposition Hip Jointo Flexion – extensiono Abduction – adductiono Internal rotation – external rotation Knee Jointo Flexion – extens
The rehabilitation and restorative nursing program is developed to serve as a guide in establishing individualized restorative care to assist each resident in achieving the highest level of self-care and independence possible. Rehabilitative or restorative care refers to nursing interventions that promote the residents ability to adapt and adjust
“the essence of restorative justice is not the adoption of one form rather than another; it is the adoption of any form which reflects restorative values and which aims to achieve restorative processes, outcomes and objectives” 4. 1. New Zealand Restorative Justice Trust (2000) New Zealand Restorative Justice Practice Manual, pg. 13 . /p div class "b_factrow b_twofr" div class "b_vlist2col" ul li div strong File Size: /strong 428KB /div /li /ul ul li div strong Page Count: /strong 44 /div /li /ul /div /div /div
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funded programs advancing the theory of positive youth development. This article may be beneficial to researchers, program directors, and administrators evaluating restorative practice approaches or programs. Clifford, M. A. (2015). Teaching restorative practices with classroom circles. Santa Rosa, CA: Center for Restorative Process .
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ii Restorative Justice in U.S. Schools: An Updated Research Review Research on Restorative Justice’s Impact in Schools 21 Impact on student misbehavior and school discipline 24 Impact on attendance and absenteeism 29 Impact on school climate and safety 30 Impact on academic outcomes 31 Access to restorative justice 32 Limitations of the Literature Review 33
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Service Level Agreement For any other Business Broadband Service, We’ll aim to restore the Service within 24 hours of you reporting the Fault. Where we need a site visit to resolve a Fault, we only do site visits on Working Days during Working Hours (please see definitions at the end of the document). Service Credits are granted at our discretion date by which Exclusions (applicable to all .
