“Ban the Hospital Gown – The Occupation of Being in Hospital” the discussion for an Occhat (4th June 2013) got me thinking and inspired me to imagine my ideal rehab ward. For the purpose of this imagining I will refer to patients rather than clients or service users. This will be a description of the “what” rather than the “how” of my ideal rehab ward and may be subject to change!
Working in the rehab ward will be something to work towards, all of the staff will have a special interest in working to rehabilitate and will want to be there. There will be a low turnover of staff and a high level of skill. There will be enough staff to listen and to answer questions from family and patients. Evidence based practice and continuing professional development will be well supported. There will be enough staff to support care and rehabilitation and to implement rehab advice over seven days. There will be a culture of innovation and a drive to improve services and outcomes from all levels of staff. The commitment, innovation and skill of the staff will be recognised and rewarded.
ADLs and Expectations
The patient will be expected to be an active participant in the rehab process and will be supported to reach that state as required. Patients will be encouraged to spend most of their time away from bed and bedsides.
As a general rule the patient will be expected to take an active part in self-care activities and to dress in his or her own clothes daily, when feeling well enough, we all need a duvet day now and then! There will always be enough staff to provide the appropriate level of supervision and/or assistance as required.
Patient choice and preference will be key to the rehab ward, particularly in cases where actively engaging in activities independently is not yet possible.
There will be patient access to laundry facilities where they can wash their own clothes or at least engage in the process with support.
Meals will, for the most part be taken in the kitchen/ dining area of the ward at a time of the patients choosing and will consist of freshly prepared food of the patients choosing, with guidance provided for healthy eating choices. Support and assistance will be available to follow therapeutic advice with regards to positioning, cutlery, consistency etc. The patient will prepare at least part of one meal or snack during the day, to the level of their ability with appropriate supervision or assistance. There will be resources to buy preferred food and ingredients when required. Trips to the local shops to purchase supplies for the ward for those who are able will be facilitated as part of the rehabilitation.
The ward will have a mixture of single rooms and small wards. This will allow for patient preference and/or need for solitude or company. There will always be an extra space or two to allow the patient to change as preference or needs change. There will be a patient kitchen where they can independently access facilities for simple food and drink preparation. Staff will have access to their own kitchen and food preparation area as well as staff rest area.
There will be a mix of bathroom facilities to reflect the most common types of bathrooms patients are likely to have in their homes as well as fully accessible facilities.
Several small but accessible living rooms will be part of the ward with a combination of soft chairs, high back chairs and space for wheelchairs. There will be a comfortable and homely feel with TV, DVD, books, games etc available for patients, family and friends to access. Free wifi and television will be available throughout the ward.
Leaving the ward will be a regular part of the rehab process, whether just to be brought to the hospital shop or local shop, to get fresh air sitting outside or to go out and about to practice essential skills at home and/ or in the community.
The ward will be run with “rehab glasses” on. There will be enough access to all necessary and relevant therapy services including Occupational Therapy, Physiotherapy, Speech and Language Therapy. Relevant therapies will advise as required and there will be enough skilled support staff to implement advice and strategies throughout the day and night. For example; to support correct transfer procedure on/off bed or mobilisation to/from the toilet. All therapy advice, strategies and recommendations will be given in a written format as well as verbally so they can be easily referred back to. It’s a lot of information to take in.
Outcomes and Next Steps
Success of the rehab ward will be measured by the patients achieving what they want, rather than on numbers seen and discharged. Small steps towards goals and independence will be celebrated. There will be strong links with community care and rehab services with some opportunity for ward staff to carry over work between hospital and home. Any equipment or supports required will be able to be put in place quickly and easily. Where early discharge is appropriate and desired this will be supported in collaboration with the ideal community rehab team!
Help me continue painting the picture – what would you change/add/ remove for your ideal rehab ward?