Just a little preface: The company I work with has a program called “Career Ladder.” The company encourages its employees to improve themselves and thereby the patients’ experience by obtaining continuing education, certifications, diplomas, actively participating in professional organizations, program improvements, etc. When you do these things, you advance yourself in the company and also earn a bonus. As part of my career ladder, I did a little project that I wanted to share here. I had gotten the idea from a class I took about 2 years ago (which mentioned this in 1 bullet point of a 3 hour lecture), but had never seen one of these in the flesh. So, my execution may be completely off.
Purpose: I’m in the inpatient rehab setting. We get a lot of cognitively impaired individuals, rather that be from brain injuries, strokes, or dementia. A lot of these folks’ cognitive deficits interfere with their ability to receive care and sometimes gets them in trouble, particularly with the nursing staff. Our nurses are great at being nurses…they are not good at entertaining cognitively impaired people that get bored and invent things for themselves to do. Often times the things they invent for themselves to do puts them in harms way, such as attempting to get up by themselves when they are a max to total assist transfer or trying to get out our front door. So I wanted to arm our nursing staff with some simple activities they could minimally monitor a patient with to keep everyone happy– the patient is not bored and the nurse is not trying to avert disaster (and even more paperwork) every 30 seconds.
Plan: Create the activites (with a budget of $50), place them together in a central location and educate the nursing staff on the purpose and the particular activities.
So I’ve created the Busy Box.
The individual activities include:
I’ll describe the activities and/or leave a link to instructions on how to make them. I got most of the ideas from that wonderful DIY land: Pinterest. Most of them were geared at pre-schoolers, but that could certainly work for our cognitively impaired adults too, I feel. Most of the supplies came from the dollar store, a few from Wal-Mart and Lowe’s.
Sandwich Kit: With this you can tell the patient to make their favorite sandwich. I also did some sandwich “orders,” so you can have them make sandwiches for other people too. Here’s how to make one. As you can see in the pic, my felts aren’t extremely realistic. Actually, I honestly didn’t try too hard in that department because, I can’t draw to save my life. So a little more imagination is necessary for my version. Haha.
Magazines, Newspapers, Ads, Coloring Books with Crayons: This one was simple. I just got a little bag and put a couple magazines that were lying around at the hospital (the nursing staff already used magazines for this purpose, so there were some around) and added a free local newspaper that comes to my door every Sunday, the Sunday ads that also come free to my door in a binder, and a couple coloring books with simple pictures and crayons. I asked the staff to help me out with this one: to bring magazines or newspapers they get and don’t need any more to add to keep it up to date. This activity is good for discussion about what the patient is looking at or reading. Also good for orienting a person confused about time and place (city). Coloring has gotten big here recently as a focusing and calming activity, so I threw that in there too. With the ads you can have the patient go shopping: give them a list of things you want, have them find them, note what store they are in and how much they cost. If you want to do some math, you could have them add up how much to take on your shopping trip.
Utensil Sort: This is a pencil bag with plastic utensils and 3 rectangular bins. You have the patient sort out the utensils into the forks, knives, and spoons into the 3 bins. I chose a bag (blue), utensils (red) and bins (white) with high contrast to help those with low vision on this one.
Baby Doll: I had been seeing dementia patients respond well to dolls. I had a patient about a year ago that brought her own with her and it went everywhere she did. She treated caring for that doll like her job… it gave her a purpose. We had to drop Baby off at “daycare”– case manager’s office– before she attended therapy. Haha! So the patient can rock the baby, grab a spoon from the pencil bag and the pompoms to feed the baby, burp the baby. If the patient is mobile, take Baby for a ride in a wheelchair or calm baby by walking with it.
Twisters: Just twist them together. Basically larger scale version of the nuts and bolts.
Simple Wooden Puzzles: I found 3 really cute wooden puzzles. The bases were a little rough, so I sanded them down a bit and added some clear spray paint. Put the pieces for each one in a plastic sandwich bag labeled with the design they were to make and then labeled the back of the bases the same too. All these went in a container.
Nuts and Bolts: This was a $5 box at Lowe’s. I just dumped them in the container. Have the patient sort them into the nuts on one side of the container and the bolts on the other, then have the patient twist them all together.
Pom Poms: Sort them out into their color piles.
Seek and Find: I attached a list of the items in the bottle to find. Click here to learn how to make it. Also makes a terrific rain maker/maraca!
Calming Bottle: This one’s for the agitated patients. I haven’t done it yet, but I intend to put a list of tips and tricks on calming an agitated patient on the inside lid of the box. I feel like most people don’t see the signs and so by the time they go to act, it’s to late the patient is out of control. So education will be another big one here. BUT to calm a patient that is showing the beginning signs of being agitated, you shake up the calming bottle and instruct them to just watch the glitter fall until it’s all drifted to the bottom. Click here to learn how to make this one.
I placed all these individual activities into a large-ish storage tub like this:
Then I took it all to a nursing staff meeting, introduced all the activities to the staff and (after speaking with the nursing director) told them where they could find the Busy Box. The past 2 days I’ve seen them actually using activities from the Busy Box with patients, so I think my mission here is accomplished.
I also took the Busy Box to a therapy staff meeting, so they know what’s in there too and can make recommendations on what would be appropriate for their cognitively impaired patients to use. I also encouraged them to assist with keeping the magazines, newspapers and ads up to date with fresh material, to add to it as their own career ladder or student projects. For example, I would love to have a “diaper bag” for the baby, a set of PVC pipes… What would you add?