Implementing REST Routine

Implementation support is not currently available for the model as reviewed.

Model implementation summary last updated: 2012

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

The REST (reassurance, empathy, support, time-out) Routine was based on a theoretical model that conceptualizes infant colic using a developmental psychobiological perspective. Colic, also referred to as irritable infant syndrome, is viewed as a delay or disturbance in the infant’s sleep-wake cycling. Colicky or irritable infants have a disorganized or undeveloped sleep-wake cycle that leads to excessive crying and difficulty initiating sleep. This behavior instability may be exacerbated by parental inconsistency and environmental disruptions.

From this framework, irritable infants are viewed as sensitive and more easily over-stimulated by busy chaotic environments. As they become overwhelmed and fatigued, they cannot self-soothe or reduce their arousal level sufficiently to fall asleep. Parents may actually reinforce the irritable behavior pattern by using inconsistent strategies that are not compatible with the infant’s unclear signals and erratic cues. To address these issues, REST Routine provided support for the parents and modification of the infant’s environmental care routines.

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Implementation support

The REST Routine was developed by Maureen R. Keefe, RN, PhD, FAAN, at the College of Nursing, University of Utah, Salt Lake City.

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Intended population

REST Routine targeted families with healthy, full-term infants who had excessive and unexplained irritability or colic.

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Targeted outcomes

REST Routine aimed to reduce infant irritability and unexplained crying and to relieve parental stress. The four specific objectives were to (1) promote compatibility in the parent-infant dyad, (2) decrease intensity and duration of infant irritability, (3) promote state regulation and organization in the infant, and (4) provide information and support to the parents.

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Model services

REST Routine was a home-based intervention model with activities for infants and parents. For infants, nurses developed specific recommendations and care plans based on four guiding principles:

  • Regulation, the support required to assist infants in regulating their state behavior and to protect them from becoming overstimulated and exhausted during the first few months of life
  • Entrainment, whereby the infant’s basic sleep-wake cycles were synchronized with relevant aspects of the environment
  • Structure, or repetition, to create a predictable and recurrent pattern of events for infants who were not intrinsically well organized
  • Touch, which included various infant holds and positions

Similarly, four concepts guided nurses in working with parents:

  • Reassurance focused on the infant’s health and the parent’s competence
  • Empathy from nurses, who listened and acknowledged the challenge of parenting high-need and high-maintenance infants
  • Support from nurses, who served as an advocate and resource for parents in obtaining assistance and creating a support network
  • Time-out legitimized the primary caregivers’ critical need to take care of themselves. A specific period of time-out from parenting (at least one hour) was scheduled into each day

During the last home visit, nurses assessed the need and options for ongoing support and intervention. Home-visiting nurses also could conduct follow-up phone calls to check in with families.

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Model intensity and length

REST Routine consisted of weekly one-hour home visits for four weeks.

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REST Routine was implemented in Denver, Colorado, and Charleston, South Carolina.

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Adaptations and enhancements

No information is available.

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Implementation notes

The information contained on this page was last updated in January 2012.

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