The Rehab Cycle

Evaluation
I’ll leave the rehabilitation center the day after tomorrow. The doctors wanted me to stay for one more week to make sure everything is OK. I have to say, I’m just tired of the hospital.
                        —Monica, one day before discharge against medical advice

Monica was released one week early against medical advice and at her insistence. Hence, after five-weeks evaluation took place. In this case, only Cycle Goal 1 (structure and healing of skin) was fully achieved. The post-operative incision and surgery were deemed to be successful. Cycle Goals 2 (mobility) and 3 (looking after one’s health) showed little improvement, not reaching any of the predicted targets. Mobility only slightly improved in Monica’s ability to transfer herself as well as with respect to muscle power.



One cause of her poor gains was her lack of concern for her skin that was at risk for ulceration when she was transferring herself without caring for her skin. Particularly problematic and worrisome for Monica’s health care team was her lack of progress with respect to looking after her health. She initially rejected her assigned psychologist, stating that she didn’t need counseling or psychological support. She then reluctantly accepted interacting with one resident psychologist.

Thus, it is of little surprise that the targets associated with looking after one’s health for the prevention of pressure ulcers (in other words for both health behavior and health maintenance) fell short of their targets. Monica’s impaired body image, acceptance of her disease and health behavior all remained unchanged, evaluated as “moderate problems or barriers.” Her emotional stability also remained unchanged with a score of one (“mild problem or barrier”).