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.

Her lack of acceptance of her condition was considered a mechanism for avoiding addressing her risks...

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.

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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 behaviour and health maintenance) fell short of their targets. Monica’s impaired body image, acceptance of her disease and health behaviour all remained unchanged, evaluated as “moderate problems or barriers.” Her emotional stability also remained unchanged with a score of one (“mild problem or barrier”).

Her lack of acceptance of her condition was considered a mechanism for avoiding addressing her risks, and addressing her body awareness proved particularly challenging. For instance, there were episodes where Monica forgot to avoid pressure stress on her skin and also showed little interest in self-checking her skin.

Where she did show some improvement were in the two targets looking after one’s health (from a complete problem to a moderate problem) and addicted to smoking. The latter target was reduced from 40 cigarettes per day (a complete problem) to 10 per day (a severe problem).

I’ve cut my smoking back to 8 or 10 cigarettes per day, and I’m happy keeping it there. I’ve been smoking for the last 40 years. … I’m not going to stop now.

Monica, five weeks into the Rehab Cycle

Figure 3: ICF Evaluation Display

Figure 3: ICF Evaluation Display; 1, 2, 3: Relation to Cycle goals; SP: Relation to Service-Program goal; G: Relation to Global goal; * ICF Qualifier rates the extent of problems (0 = no problem to 4 = complete problem) in the components of body functions (b), body structures (s), activity and participation (d) and the extent of positive (+)or negative impact of environmental (e) and personal factors (pf).