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 some 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.

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.

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.

Outdoor activities: Genesys Regional Medical Center is located on 480 acres surrounded by woods, ponds, and wildlife. The property in-cludes trails open to the community at large.