Use creativity to design real-life experiences
Look at what you already have on campus
If you want to set up real-life experiences for your rehab patients, look at what's already available on your campus and use your creativity, advises Eileen Gibbs, RN, BSN, MA. A case manager, Gibbs chaired a committee at Genesys Regional Medical Center that designed the hospital's Therapeutic Rehabilitation Approach to Independent Living.
Most hospitals have a credit union, some sort of restaurant, and a gift shop. "It might not be all together, but it could be used," Gibbs says.
Here are the components of the program:
ATM/bank: This component makes use of the hospital's credit union. Patients may write a check or make an automated teller machine (ATM) withdrawal from a special account funded by the rehabilitation department. The patient then uses the money to purchase a meal at one of the food service shops or items at the gift shop, pharmacy, or medical equipment shop. Patients:
o practice money management;
o physically and cognitively manage the functions of the machine;
o propel a wheelchair or ambulate to the ATM;
o interact directly with the teller using effective communication skills.
Food shops: A coffee shop, sandwich shop, and restaurant are in the hospital atrium. Patients:
o practice making appropriate dietary choices;
o communicate appropriately and effectively;
o practice money management physically and cognitively;
o receive and transport food;
o ambulate or wheel themselves in the region;
o transfer on/off dining room chairs;
o demonstrate safe swallowing strategies.
Gift shop, medical shop, and pharmacy: These are businesses in the atrium. Patients:
o practice money management;
o practice decision-making skills, such as what items to purchase;
o interact with cashier and other customers;
o transport items to be purchased;
o move through the environment.
Information booth: As part of therapy, patients are asked to visit the hospital information booth, ask directions, and locate a place. Patients:
o interact appropriately and effectively with staff to inquire about the location of a doctor's office or other location;
o ambulate or propel themselves through the environment to reach a location;
o use maps of the facility to find a location, such as a doctor's officer or rehab unit.
Beauty shop: This is a special setup on the rehab unit, staffed by a beautician two days a week. Patients may have their hair professionally washed and dried, or a family member may reserve time to wash the patient's hair. Patients:
o follow the procedure to schedule appointments;
o manage the money to pay for the service;
o interact effectively with the beautician and other customers;
o style their own hair using a blow dryer, curling iron, etc.;
o apply their own makeup;
o cut or file their own nails.
Lounge: Located at one end of a long patient dining hall, the lounge area contains a television, books, and magazines. Patients are encouraged to visit the lounge for socialization when they are not undergoing treatment. On weekends, the staff show movies in the lounge and serve popcorn. Plans call for setting up a patient library with a card catalog or other cataloging system and adding a sewing center. Patients:
o search for books or audiovisual materials using card catalog or other system;
o reach for books;
o manipulate a VCR or tape player;
o practice sewing clothing in a supervised setting;
o clean the aquarium and feed the fish;
o water and tend to indoor plants.
Car activities: These will be conducted inside, using the donated car. Patients:
o transfer in and out of car from various surfaces;
o manipulate a curb step;
o use a parking meter;
o practice pumping gas.
Home entrance: This is a simulated home with front porch, steps, and wheelchair ramp, built on the hospital grounds. Patients:
o ambulate/propel a wheelchair up/down ramp;
o ambulate or bump up/down stairs;
o manipulate doors while on the porch;
o get mail out of the mailbox;
o sweep the porch;
o ambulate on different indoor surfaces.
Shopping: This component, still in the planning stages, will simulate the environment of a grocery store as closely as possible. Staff anticipate that patients will begin to practice shopping skills in this area, as a test run, then go shopping in the commercial establishments. Patients:
o use a shopping cart in a closed environment;
o practice reaching for various items and placing them in the cart;
o practice choosing specific items;
o practice money management at a cash register.
Gardening troughs: These are raised beds located on the hospital grounds. Patients:
o practice watering, planting, weeding, and tending plants;
o plan watering schedules and determine which plants will be used;
o use handheld tools to garden standing or sitting.
Arbor: This also is located on the hospital grounds. Patients:
o propel a wheelchair or ambulate uphill and downhill over a variety of surfaces including gravel, concrete, brick, rock, grass, and wood;
o transfer on and off seats;
o sweep the walkway;
o use standing garden tools to tend flowers, hoe, rake, and water.
Transitional living apartment: Before discharge, those patients identified by the team who would benefit spend at least 24 hours in the apartment to test their ability to function on their own and to prepare them for discharge. The apartment is equipped with call buttons and other equipment so staff are alerted if patients need help.
Chapel: Patients have the option of attending services in the chapel on Sundays. Church services also are provided on the unit.
Outdoor activities: Genesys Regional Medical Center is located on 480 acres surrounded by woods, ponds, and wildlife. The property includes trails open to the community at large.
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