Chapter 1

INRODUCTION

Background of the Study

Bedside nursing care is a very important activity that the nurse staff must provide patients

during the course of hospitalization. Since the staff nurses take care of the patients twenty-four

hours a day to continuously provide nursing care towards recovery, it is expected that the

patients will be assured of quality nursing care.

Therapeutic recreation plays an important role in the patient’shealing and enhancing

quality of life.  It is a tool that maybe use for patients with disabling conditions or sicknessto

improve or preserve physical, mental and emotional well-being and help lessen stress, depression

and anxiety .It is alsoconfirmed to be a vital component included to the nurses’ plan of care

inconnection to the course of treatment of a certain patient.It can manifest itself through many

forms like art, poetry, music, even humor and more.

Recreation has been used for therapeutic purposes since the time of the ancient Egyptians

and Greeks (Frye et al.,1972) It is not a cure but it has many significant benefits such as

increased in the self- esteem, improved social skills, a sense of meaning and accomplishment. It

also helps satisfy the needs of the “total” person, including their physical, social, emotional, and

spiritual well being.

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Recreation can be viewed as both a means and an end. It is used as a means in those

instances where recreation is part of a planned intervention to bring about improvement in

physical, social, emotional, and cognitive functions of a patient. As an end in itself relates to the

sense of emotional and physical well-being that is associated with engaging in essentially

motivated leisure pursuits. Research finding suggest that people with disabilities who are

experiencing diminished levels of independent activity may need support in accessing preferred

leisure and recreation opportunities. Therapeutic recreation has been found to be an effective

intervention with a wide range of populations in clinical and rehabilitation settings.

The primary purpose of a treatment service which are often referred to as recreation

therapy, is to restore, remediate, or rehabilitate, in order to improve functioning and

independence as well as to reduce or eliminate the effects of illness or disability. The primary

purpose of recreation services is to provide recreation resources and opportunities in order to

improve health and well being. Therapeutic recreation is provided by professionals who are

trained and certified, registered and/or licensed to provide therapeutic recreation" (ATRA, 1997)

Practiced in clinical, residential, and community settings, the profession of therapeutic

recreation uses treatment, education, and recreation services to help people with illnesses,

disabilities, and other conditions to develop and use their leisure in ways that enhance their

health, independence, and well-being.(NTRS 1994)

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The unique function of therapeutic recreation is to assist the client, sick or well, in the

performance of those leisure activities and experiences contributing to health or its recovery,

including general recreation participation.(O’Morrow et al.,1989)

Therapeutic recreation refers to the specialized application of recreation for the specific

purpose of intervening in and changing some physical, emotional, or social behavior to promote

the growth and development of the individual. Therapeutic recreation may be viewed as a

process of systematic use of recreation activities and experiences to achieve specific objectives.

(Carter et al.,1985)

Therapeutic recreation is the provision of purposeful intervention designed to help clients

grow and to assist them to prevent or relieve problems through recreation and leisure.(Austin

1982)

The prime role of therapeutic recreation is to assist patients in the development of their

personal capacity to cope with the disease process and its subsequent affective symptoms such as

psychological distress and depression (Willets et al., 1983).

Therapeutic recreation activities can help patients develop comfortable routines in

thehospital and increase opportunities for socialization and life affirming interaction (Willets et

al.,1983).

Therapeutic Recreation is a process that utilizes functional intervention, leisure education

and recreation participation to enable persons with physical, cognitive, emotional and/or social

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limitations to acquire and/or maintain the skills, knowledge and behaviors that will allow them to

enjoy their leisure optimally & function independently. (Therapeutic Recreation Ontario)

The researchers found it necessary to conduct research through survey to determine

whether the patients of Martinez Memorial Hospital - NBII,NBIII and the level III BSN students

of Martinez Memorial Colleges are both willing to cooperate in our propose idea which is

including therapeutic recreational activities as part of bedside nursing care to preserve the ideas

of Roper-Logan-Tierney model of nursing.

We have chosen our own beloved hospital to conduct our research for our main goal is to

at least offer something which can possibly enhance the confidence of the nurses in the said

institution and for all the student nurses having their Related Learning Experiences to also

increase their self- esteem and to be more skillful in terms of the therapeutic recreation as part of

nursing bedside care to their own assigned patients.

In addition, these research ought to know how the student nurses interact and treat their

patients, what might probably the use of rendering recreational activities to patient in alleviating

pain, stress and other subjective problems; how far would a student nurse do in relation to his

skills to promote holistic care and lastly, will it;in some way helpin patient's healing or it will

just worsen his condition.

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Statement of the Problem

Regardless of the healthcare settings, nurses are frequently at the heart of the patient care

and therefore, are able to influence significantly patient’s perceptions. The downside of this is

"finger pointing" at nurses when patients do not receive holistic care. It is important to remember

that it may be the smallest of incidents that have the greatest impact upon a patient's perception

of care (Willis 2003)

The Study aims to determine the willingness of the patients of Martinez Memorial

Hospital and the level III BSN students of Martinez Memorial Colleges to cooperate in rendering

therapeutic recreational activities and it’s effectiveness in alleviating pain, discomfort, stress and

anxiety. Specifically, it seeks to answer the following Questions:

1. What are the therapeutic recreational activities that can be used by the Nursing Student in

alleviating pain, discomfort,stress and anxiety to promote independence and to improve the

patient’s well being?

2. How much percentage of the patients of Martinez Memorial Hospital and the level III BSN

students of Martinez Memorial Collegesare willing to cooperate in the feasible implementation

of our propose idea which is providing therapeutic recreational activities as part of independent

nursing intervention.?

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3. What are the most favorable recreational activities to the patients of Martinez Memorial

Hospital and the level III BSN students of Martinez Memorial Collegesin terms of percentage?

3.1 Singing ________ %

3.2 Dancing _______ %

3.3 Sharing of thoughts (Bible & Inspirational) ______ %

3.4 Doing arts & craft together with the patient _______ %

4. What is the perceive effectiveness of therapeutic recreation of the patient in evaluating

student’s Clinical performance in terms of Independent Nursing Care?

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Objectives of the Study

The study aims to:

1. Identify therapeutic recreational activities that may be use by the student nurse in alleviating

pain, discomfort, stress and anxiety to promote independence and to improve the patient’s well

being.

2. Determine the percentage the patients of Martinez Memorial Hospital and the level III BSN

students of Martinez Memorial Colleges whom are willing to cooperate in

feasibleimplementation ourpropose ideawhich is providing therapeutic recreational activities as

part of independent nursing intervention.

3. Determine the most favorable therapeutic recreational activities to the patients of Martinez

Memorial Hospital and the level III BSN students of Martinez Memorial Collegesin terms of

percentage.

3.1 Singing ________ %

3.2 Dancing _______ %

3.3 Sharing of thoughts (Bible & Inspirational) ______ %

3.4 Doing arts & craft together with the patient _______ %

4. Identify the perceive effectiveness of therapeutic recreational activities of the patient in

evaluating student’s clinical performance in terms of Independent Nursing Care.

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Significance of the Study

The outcome of the study would be helpful in rendering an effective plan of care with the

aid of therapeutic recreational activities as part of bedside nursing intervention to the patients of

Martinez Memorial Hospital by means of identifying them through survey. The efficacy of the

teamwork of the patient and the health care provider in creating a therapeutic milieu in

facilitating patient’s independence and recovery

Furthermore, it will be beneficial to the following as well:

STUDENT NURSES- The findings of the study will serve as a guide in the practice

effectiveness of bedside care nursing thru therapeutic recreational activities to provide patient

comfort and quality care. It will also help them to uplift their own self- esteem to be the best that

they can be.

PATIENTS- They will be benefited primarily for the main focus of this study is to make sure

that they are all leading towards healing rather than getting worse. They are the ones whom will

testify weather this proposal brings improvement in their well being.

STAFF NURSES- The result of the study will be usefulin implementing in to what nursing

intervention will be given the most and the least importance above all. Therapeutic recreation is

sometimes taken for granted in providing bedside nursing management for the patients.

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THE NURSING SERVICE- The outcome of this study will aid in appraising the effectiveness of

therapeutic recreation as part of bedside nursing care and will be a guide in improving

professional practice of the staff nurses.

HOSPITAL ADMINISTRATION- Problems in implementing quality bedside nursing care will

be identified and solutions will be reinforced. Developing, modification and hopefully revision

of some policies to enrich hospital services.

CLINICAL INSTRUCTOR- The result of this study will guide them in becoming more prepared

in facilitating the effectiveness of applying therapeutic recreation as part of bedside nursing

care.. This will further help them to improve their related learning experiences activities in

relationship with their students.

OTHER RESEARCHERS- The result of this study will provide a frame of reference for further

investigation and nursing practice.

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Scope and Limitations of the Study

The research focuses on rendering therapeutic recreational activities as part of bedside

nursing care to patients of Martinez Memorial Hospital (NBII and NBIII )

The study will be limited to the information’s given by the patients and by the student

nurses of Martinez Memorial Colleges (Level III), finances and time constraints until March.

2011, availability of administrative support and the location of where the study would be

conducted ( at 198A. Mabini St., Maypajo, Caloocan City )

Uncontrolled variables are numerous because therapeutic recreational activities are

conducted at bedsidewhere physical conditions such as the temperature, humidity, lighting, and

ambient noise are out of the researcher’s control. Other uncontrolled variables include visitors

who may join a therapeutic recreational activity any time; disruptions such as fire drills, and

assorted distractions that may alter or have an unknown effect on desired outcomes.

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Theoretical Framework

This selection contains the theoretical basis of the study. It utilizes Roper- Logan-

Tierney model of nursing systems approach "Activities of Daily living" for it offer clear

information about useful framework from which nurses can base their assessments of patients

and decide and agree appropriate interventions from.

Roper- Logan- Tierney model of nursing denotes that differences in a person’s factors

influencing activities of living, the activities of living , the dependence continuum and

individuality in living is a reflection or the expression of the person’s individuality. This was first

worked up in 1980 which was based upon the work of Nancy Roper alone in 1976. It is the most

widely used nursing model in the United Kingdom and is mainly used by the nurses

in medical and surgical settings. The model groundedroughly upon the activities of daily living

(ADLs) that are evolved from the work of Virginia Henderson in 1966.Even though the model

promotes that the assessment be used throughout the patient's care; it has become the median in

United Kingdom nursing to use the model only as a checklist on admission rather than as

intended as an approach to the assessment and ongoing care of a person. It is often used as a way

of comparing how a patient's life has changed due to illness or admission to hospital rather than

as a way of planning for increased independence and quality of life.

The model appraises the individual's relative independence and potential for

independence in Activities of Daily Living as follows: maintaining a safe environment,

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communication, breathing, eating and drinking, elimination, washing and dressing,

thermoregulation, mobilization, working and playing, expressing sexuality, sleeping , death and

dying in the light of the five factors that influence its degree of performance such as biological,

psychological, sociocultural, environmental, politicoeconomic respectivelythat can affect a

person’s reaction to his health status and within the context of the person’s developmental age.

Continuum ranging from complete dependence to complete independence in order to determine

what kind of interventions will lead to increased independence as well as what ongoing support

is or will be required to compensate for dependency. Its application requires that it be used

throughout the engagement with the patient not only on admission as an approach to problems

and their resolution, and as a tool to determine how the patient can be supported to learn about,

cope with, adjust and improve their own health and challenges. The model has striking

contribution to the development of models of health that focus on the person’s capability to carry

out normal activities of living.

It becomes all the more necessary for the nurse to individualize patient care and to make

thorough nursing and health assessment as a vital step towards high quality nursing care.

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Conceptual Paradigm of the Study

INPUT

Type of therapeutic recreational

activities given by the nurse in

collaboration with the patient

OUTPUT

Reduce pain, stress,depression and anxiety

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FEEDBACK

Promote / improve patient’s well

being by being independent to

perform ADL’s

Conceptual Framework

The study abstracts that the researchers make the conceptual framework thru a simple

paradigm which shows the relationship of the type of therapeutic recreational activities in

collaboration with the patient ( input), reduce pain, stress, depression and anxiety (output) and

their feedback that it would promote and improve patient’s well being by being independent

again where he can perform ADL’s.

The researchers have faith that the patient and the student nurse will work together hand

in hand to achieve their aims therapeutically. They also consider the fact that this might not work

as foreseen but thru the results of the survey yet this may as well ring a bell to staff nurses; to

prioritized more on this matter by mainly focusing on the patient himself.

The target output of this research study does not limit the understanding of the patient to

participate and to withdraw in the suggested types of therapeutic recreational activities but the

end result of this study might probably be a basis to advance in delivering bedside nursing care

to all sorts of patients.

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Hypothesis

The hypothesis pursue in this study is express as follows:

There is no significant relationship among the perceptions of the patients of Martinez Memorial

Hospital and the level III BSN students of Martinez Memorial Collegeson the effectiveness of

therapeutic recreation as part of bedside nursing care.

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Definition of Terms

The following terms are defined conceptually and operationally.

Therapeutic Recreation

Recreational Activities

Bedside Nursing Care This refers to the activities provided by the nurses during

assessment, planning, nursing diagnosis, intervention and evaluation rendered on the bedside

while the patient is confined in the hospital

Patient This refer to an ill person who is the recipient of bedside nursing care

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Chapter II

REVIEW OF RELATED LITERATURE AND STUDY

When using a model of nursing, nurses are expected to provide individualized plans of

care aimed at identifying individual problems with the patient and agreeing interventions that

will, hopefully, achieve resolution. All aspects, considered within the chosen model, need to be

carefully thought about, including recreational needs. Roper et al. (1985)

Whenever a nursing model is used the nurse, by virtue of the model framework, is

accepting the responsibility of ensuring the individuals leisure/recreational needs are identified

and documented and where a problem has been identified, an appropriate plan of care with

realistic and achievable goals should be developed in conjunction with the individual. If the

nurse fails to provide this they could be considered to be in breach of his/hers professional

responsibilities, as stated in United Kingdom Central Council (1992) Code of Professional

Conduct section two which states: "Ensure that no action or omission on your part, or within

your sphere of responsibility, is detrimental to the interests, conditions or safety of patients and

clients." and section five which states: "Work in an open and co-operative manner with patients,

clients and their families, foster their independence and recognize and respect their involvement

in the planning and delivery of care." It is therefore every nurses responsibility to consider

activity along with all other aspects of the patients care.

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"Activities of Daily living" model, identify recreation as one of the activities of daily

living .Roper et al (1985), while Orem's (1991) model includes time spent with others and time

spent alone This then, places the responsibility on the registered nurse to consider this within the

nursing process to identify and develop plans to overcome any problems in this area with

patients.

The responsibility of the Social Therapeutic and Recreational Nurse/ Recreational

Therapist to educate others in the nursing profession on the use and benefits of therapeutic

recreation. This is supported by Crump, A. (1991) who suggests that the concept of nurses

becoming more actively involved in patient activities is receiving increased professional

attention. Vise, D. et al.(1994)

There has been much research done in the field of therapeutic recreation on an

international scale mainly America, Canada, Australia, and the United Kingdom (Buettner et al.,)

The concept of a social therapeutic and recreational nurse / recreational therapist was to

utilize/use recreation as a way of promoting and maintaining an individuals social, psychological

needs and increasing self-esteem (Vise et al,. 1994)

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"Recreational therapy is a concept of meeting the patients psychological and social needs

through meaningful daily activities” (Ryan 1993)

Nurses place therapeutic recreation low on the priorities of nursing intervention and see

the remit of providing therapeutic recreation as the role of other health care professionals such as

Occupation Therapists and Physiotherapists. It is true that the Physiotherapist and the

Occupational Therapist may both also have a part to play in helping individuals to develop a

positive self image and adjust to disabilities. (Crump1991)

"An objective for nursing care is to ensure that their level of function (Lucid Patients) is

at least maintained and does not deteriorate. Hence engaging them in conversation or structuring

activities with other patients that will stimulate psychosocial activities and skills must be seen as

an important and worthwhile nursing activity, enjoying the same status as the administration of

medicines. In fact it is not unreasonable to suggest that with more therapeutic and recreational

activities, nurses could extend their range of skills from the present model of custodial care for

elderly patients to one that has a restorative focus". (Armstrong-Esther et al.,1994)

The primary role of therapeutic recreation is to assist patients in the development of their

personal capacity to cope with the disease process and its subsequent affective symptoms such as

psychological distress and depression (Willets et al., 1983).

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A study of recreational interventions (Aronstein et al.,1996) explored the feasibility of

nursing assistants using recreational items as diversionary interventions for individuals with

dementia and agitation. This study showed that an environment enriched with appropriate

recreational items can provide stimulation and opportunities for interaction with others and thus

less self stimulating or inappropriate behavior. Although the sample size was small and no

control group existed, the study found that that recreational interventions are important adjuncts

in the handling of boredom and agitation.

"Recreation therapy, also called therapeutic recreation or TR, is the kind that aims at

improving the functioning and independence of the ill or disabled (Asenjo,2005). Recreation

therapists' incorporate into patients' conditions and treatment needs particular activities, meant to

help them cope with the stresses of their illness or disability. Examples of these activities are

wheelchair sports, exercises, and social activities. These activities enhance physical, cognitive

and emotional health and reduce the need for medications and medical services. TR services are

available in clinical facilities and in the community. (Asenjo2005)

"A person who has a physical disability may be defined in multiple ways. Henderson

(1999) suggests that a disability can be defined "as a physical or mental impairment that restricts

one or more aspects of a person's life" . This definition is supported by others who suggest that

people who are disabled generally are limited with respect to their ability to participate in certain

physical and recreation activities; this suggests a need to explore new ways for identifying how

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to help people who are disabled experience a full range of activities including physical and

therapeutic recreational activities .”(Henderson, 2002; Austin et al., 1996)

CHAPTER 3

METHODOLOGY

RESEARCH DESIGN

The study used the descriptive method of research. It is defined as a purposive process of

gathering, analyzing, classifying and tabulating data about prevailing conditions, practices, cause

and effect relationship and making adequate and accurate interpretation of the data with or

without the aid of statistical methods.(Calderon et al 1993)

Combined with correlational study which shows the relationship of two variables, that is,

how one varies with the other.

Basically, the study is an attempt to describe the effectiveness of therapeutic recreation as

part of bedside nursing care provided at Martinez Memorial Hospital and Martinez Memorial

Colleges. To be able to do this, data on the student nurses and patients assessment of

effectiveness are gathered. Statistical treatment will be applied to the data to come up with the

overall assessment of the condition of the nursing services delivered at the respondent institution.

RESEARCH LOCALE

The researcher will be conducting their study at Martinez Memorial Hospital and

Martinez Memorial Colleges and appraise the effectiveness of therapeutic recreation as part of

bedside nursing care.

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We will be conducting our research within the vicinity of Martinez Memorial Hospital.

This institution was established in 1955 by late Dr. Antonio C. Martinez, a general surgeon and

his wife Luz Agustin as a medium sized secondary hospital located close to the boundary of the

western part of Tondo district of Manila and the south western part of municipality of Caloocan

known as Maypajo district.

The hospital became a community oriented because the founder really wanted to serve

the Caloocan folks ; it was originally named as “Country Clinic”.

The couple aimed to help more so they decided to build a school of nursing but their faith

and strength were tested when Dr. A. Martinez died on November 24,1960. Madam Luz has this

strong personality and determination ; she decide to continue their vision towards having a

nursing school just beside the hospital. It opened in the year 1962.

From the beginning there were only twelve students who graduated and passed the board

examination but as time passes by, the institution continue to gain it’s progress. Different courses

were offered until it became Martinez Memorial Colleges.

We choose Martinez Memorial Hospital patients and Martinez Memorial Colleges

nursing students level III as our respondents for our study because we believe that these

institutions were founded by the Martinez’s who have a good heart and intention towards the

citizens of Caloocan.

We are inspired by their deeds, so we wanted to become more aware about their ways in

taking care of their clients by means of a survey . So that even in a small way, we can continue

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Dr. Martinez’s legacy in giving the best towards the patients and the nursing students in the said

establishments.

PARTICIPANTS OF THE STUDY

The primary sources of data are the patients and student nurses of Martinez Memorial

Hospital and Martinez Memorial Colleges respectively.

The respondents of this study consist of two groups, 30 patients and 78 student nurses

with a total of 108 from the said institutions. Their responses will provide the overall appraisal of

the effectiveness of therapeutic recreational activities as part of bedside nursing care in the two

establishments.

RESEARCH INSTRUMENTS

The researcher use structured type questionnaire as the research instrument were all

possible options/ answers are given. The questionnaire consist of two parts: Part I aims to gather

information on profile of the respondents patients ( gender, age, civil status, educational

attainment, number of times hospitalized, number of days hospitalized) and student nurses

( gender, age, civil status)

Part II contains questions that answer the problems indicated in the statement of the

problem, which will appraise the effectiveness of bedside nursing care as to what type of

therapeutic recreational activities will be rendered establishing rapport and providing

independent nursing care to the patients.

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The first draft of the instrument will be submitted to our adviser for critique, comments,

suggestions, revision, adviser’s approval and final validation.

Conduct a pilot test to identify any possible difficulties that may be encountered while

answering the questionnaire that will be considered in the finalization of the instrument. The

researcher submitted the instrument to the adviser for approval prior to administration.

POPULATION AND SAMPLING

The population of this study consists of all patients of Martinez Memorial Hospital

specifically the ward area during the school year 2010-2011,2nd semester (March 31,2011). The

researchers will be using Probability method which is systematic sampling to emphasize fairness

and equality towards our respondents.

DATA GATHERING PROCEDURE

After the validation and the incorporation of the suggestions and comments from the dry

run, the researchers will be administering the instruments.

A written permission to conduct the study is obtained from the hospital director

concerned through the chief nurse of the selected hospital to ensure support and cooperation of

the respondents in collecting the data.

The respondents will be given ample time to accomplish the questionnaire. The

distribution of the questionnaires will be on the month of June 2011.

The questionnaires will be distributed to patients and student nurses of the selected

institutions. After the respondents have answered the questionnaire copies, they will be

immediately gathered to ensure confidentiality of the responses.

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After gathering, the data will be tallied, tabulated, treated statistically, analyzed and

interpreted.

STATISTICAL TREATMENT OF THE DATA

A. Percentage Computation and Frequency Distribution

The frequency distribution and percentages use to compare the frequency of respondents to

determine the respondent’s demographic profiles.

%=f/N x 100

Where: % = percentage

f = frequency

N = total number of samples

100= constant

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Part I. Profile of the Respondents – Student Nurses

Please answer the question completely and honestly, your answer will be of the pertinent

data for our study. Rest assured that your answer would be treated confidentially.

Please put a check mark (√) on your answer.

For student nurses:

Gender: Civil Status:

_________Female _________Single

_________Male _________Married

Age: _________Separated

_________17-19

_________20-22 Religion:

_________23-25 _________Roman Catholic

_________26-29 _________Born Again

_________30-32 _________Iglesiani Cristo

_________33-35 _________others, specify

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Part II:

1. How long are you in the clinical exposure ( Related Learning Experience)?

_____1 year

_____2 years

_____3 years

_____others, pls. specify

2. What is the common independent nursing management you always render? Check all

_____physical assessment, health teachings

_____Vital signs

_____Medication (oral and IV)

_____Recreational activities ( singing, dancing, arts and crafts etc.)

_____others, specify

3. What is your best talent or skills?

_____singing

____dancing

____good therapeutic communicator

____arts & crafts

____others, specify

4. Do you read the Bible or any other spiritual, inspirational or motivational reading

materials?

_____yes

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_____no

If yes, can you site one?__________________________________________________

If no, Why?____________________________________________________________

5. What is your point of view on rendering recreational activities to the patients of

Martinez Memorial Hospital in terms of it’s efficacy towards alleviating pain, stress

and anxiety?________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

6. In your clinical exposure in Martinez Memorial Hospital, did you experienced to

render any recreational activities such as singing, dancing, and more to patients?

____yes

____no

If yes, pls. specify _______________________________________________________

How does if affect you?___________________________________________________

Do you think it will help the patient lessen the boredom ,pain, stress that he feels?

____yes

____no

If yes, please choose among the following:

____singing

____dancing

____sharing of thoughts(Bible text, inspirational readings etc)

____arts and craft

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____others

If no, what stops you from doing so?

____Low Self- Esteem

____No talent at all

____Scared or Shy to interact with the patient

____No care at all

____othes, pls. specify

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Part I. Profile of the Respondents – Patient

Please answer the question completely and honestly, your answer will be of the pertinent

data for our study. Rest assured that your answer would be treated confidentially.

Please put a check mark (√) on your answer.

For student nurses:

Gender: Civil Status:

_________Female _________Single

_________Male _________Married

Age: _______ _________Separated

Religion:

_________Roman Catholic Educational Attainment:

_________Born Again _________Elementary Graduate

_________Iglesiani Cristo _________High School Graduate

_________others, specify _________High School Undergraduate

_________College Graduate

_________College Undergraduate

No. of times hospitalized: ______

No. of Days hospitalized: ______

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