By: Jean Johnson for Back1
Part One| Part Two
What’s going on at the Providence hospital that makes for such speedy turnarounds?For one thing, the suite of rooms where patients have therapy is directly in the nursing unit, and large glass panels allow direct visual contact between the nursing staff and therapists. “This direct line helps communication immensely. In most places rehab is located away from the nursing unit, often on an entirely different floor. So if anything happens like a patient needs to use the bathroom, therapy is often effectively over. Here you barely miss a beat,” said Dr. Molly Hoeflich before excusing herself to answer a page.
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The long suite of rooms connecting occupational and physical therapy units are dotted with patients and therapists using mats and parallel bars and stairs. When we discretely edged in close enough to eavesdrop on one team, we heard encouragement that would pass muster with anyone’s Aunt Martha. “Keep your elbow straight,” said a young therapist dressed in soft, dusty blue scrubs sitting across from an elder woman with permed white hair and hunched over in a wheelchair. “It’s tough,” the therapist added in a quiet voice. “Watch me one more time. Keep the elbow straight.” The senior did another couple arm lifts before the team moved on to the next sequence of exercises. “Now try this one,” the therapist said, again keeping her voice low and respectful of the senior’s need for as much dignity as the moment could afford. “Bring the arm all the up like this, and then straighten it all the way.”
Hoeflich returns and points us in the direction of the kitchen. “Our occupational therapists help patients with light meal prep and doing dishes. The kitchen isn’t ADA (American Disabilities Act)-approved, but it’s what most people go home to.”
The therapy room also has a state-of-the-art gadget called a Bioness that uses electrical stimulation to strengthen forearm muscles and help patients get sufficient grip to pick things up. Another therapist straps Hoeflich into the device for our photo op. “It’s on the uncomfortable side,” the physician said of the $7,000 technology, “but we feel it has a role in therapy. In addition to this one, we’re also testing one in our outpatient therapy.”
We leave the suite behind and tour the nursing unit where enough private rooms to accommodate 18 patients dot a T-shaped wing. In the process we view a bathtub with enough room to practice whatever moves a person’s got in their repertoire, capacious showers with an array of chairs and benches, and in-room bathrooms where curtains – not the old steel doors that were formerly there – provide privacy.
Indeed, that’s part of what makes Hoeflich’s rehab unit so successful. “Twelve to 15 years ago we got a grant for nursing improvement, and so we built a team of nurses and therapists that take an active role in suggesting and implementing changes. The bathtub is one innovation that came out of this. Nurses pointed out that they needed more room for patients to maneuver, so we got that arranged,” Hoeflich explained. “The bathroom doors are another. The staff thought that it would be less cumbersome getting patients into the toilet if the doors weren’t in the way, so we tried it with a few rooms.” After patients and staff alike gave the experiment two thumbs up, the rest of the heavy bathroom doors on the unit were history.
“The entire program of staff involvement has added much to our work here,” Hoeflich said. “And it’s put more responsibility on the staff too. They have to think through changes carefully in order to have meaningful input into the program.”
The tour’s almost complete. We’re headed down the halls toward the bright green sign on the door of the patient that we’ll profile in our accompanying story. “Risk to Fall,” reads the placard.
Before we enter, though, Hoeflich draws us into an adjacent empty room and alerts us to the last of the touches her team installed to keep the rehab unit up to snuff. Big sinks – not dinky as in days gone by – with tilted mirrors that accommodate wheelchairs, schedule boards so patients know what the day will bring and when they’ve had their last pain meds, wall mounts of gloves and gowns outside the door to reduce the spread of infection, and front and center near the nurse’s station, a rack of brochures explaining all manner of disabilities and offering helpful suggestions and tools to families.
All that and animal assisted therapy, too, on most Wednesday afternoons. “I have to say that our dog – she’s a Golden Retriever named Bickie – is a really special animal. She’s intuitive as far as people’s needs go and is calmer than half the people up here,” Hoeflich said laughing as she included especially herself. “And she offers patients a truly therapeutic opportunity. They can throw a ball to the dog, groom her, walk her – all of which works the upper extremities.”
There’s the emotional component of what the dog brings as well. In fact, there’s an emotional component throughout the whole rehab unit. A group of professionals under Hoeflich’s leadership geared toward providing the best care they can all the while remembering they are working with human beings.
In sum, then, our venture out and about was reassuring. We saw life and love and even some laughter. We heard about the dog with big luminous eyes and warm fur. We met a physician who while not backing away from tough decisions, is upbeat and supports her patients. All in all, it seemed like a glass half full to us.
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