Patient Journey After an Injury up to and Beyond Discharge - Essay Example

Patient Journey After an Injury up to and Beyond Discharge Introduction Injury is a major public health burden. It is a potential cause of mortality and morbidity all over the world (Aitken, 2007). It is also a significant contributor for health care costs. According to statistics, in Australia, injury and poisoning account to about 8.2 percent of health expenditure (Aitken, 2007). Injury also leads to several consequences causing much discomfort not only to the injured individual, but also to the family members. Despite these attributes of injury, there is not much research on the experiences of the patient through the journey of injury. In this essay, the journey of injured patient from the time of injury through and beyond discharge will be discussed with relevance appropriate to research and literature. Site of injury Injury can occur anywhere, anytime and to anyone. As far as road traffic injuries are concerned, the patterns of injury differ for different types of road users like pedestrian, vehicle driver or passenger and motorcyclist. Also, helmets and seat belts affect the type of injury. Mayou and Bryant (2003) conducted a prospective cohort study on patients with road traffic accidents. Those with major head inuries were not included in the study. From the results, it was evident that pedestrians were more likely to suffer from a road traffic accident and they were much older than those using motor vehicles. They were more intoxicated than motorists, drivers, passengers and cyclists. Cyclists were lesss likely to suffer from najor injuries and were much younger than other road users. Motorists were more likely to suffer from limb injuries. Other groups had injuries injuries in the head, neck, chest and limbs. the outcomes of the injuries were measured, and varied from group to group. Soon after accident and injury, the injured people feel embarrassed and start blaming themselves. Some do not have memory as to how the event occurred and because of this the individuals feel unpleasant and confused. Initially, the individuals feel insecure and lose trust. But, the appearance of strangers to the site of injury, helping hands from several dimensions and immediate shift to hospital either through ambulance or someone elses vehicle causes restoration of security and trust. These feelings were further enhanced professional caregivers arrived and took command of the scenario. Strangers played a major role in building up trust and secured feeling by putting blankets, offering comfort, calling ambulance and calling near and dear ones (Franzen et al, 2006). Care in the hospital On arrival to the hospital, while some patients developed a sense of security and trust, other again feel insecure, worried and uncertain because of the procedures involved in admission, hospital rules and regulations and lack of attitude from caregivers. Improper communication from health professionals worsens insecurity feelings. Some individuals feel that they are neglected and disrespected not only by care-givers but also by insurance companies (Franzen et al, 2006). It is recommended that the initial orthopedic procedure pertaining to the injury must take place within 6 hours of arrival to the hospital and must encompass proper wound debridement and stabilization of fracture. Any soft tissue cover must be obtained before lapse of fifth day allowing space for more debridements, logistics and communication (Allison et al, 2004). In a study by Allison et al (2004) on patients with tibial fracture, it was found that 80 percent patients were transferred by ambulances while 20 percent were transferred aeromedically. The patients arrived either directly or from several other hospitals. From some hospitals, there was delay in transferring the patient. the average delay in transferring was 7.8 days, while the range of transferring was 1- 28 days. Of these 79 percent already had undergone a surgery in the hospital that referred them. The surgical procedures which the patients underwent were debridements, metal fixation and secondary amputation. The initial length of stay in the hospital was 24.9 days in the direct admission group, it was 35.3 days in the transferred group. Those admitted directly were operated within 24 hours and plastic surgery was performed at an average of 3.5 days. In both direct cases and referred cases, specialist registrars performed surgeries 50 percent of the time. While consultants were present 49 percent of the time in plastic surgery procedures, for orthopedic procedures, consultants were present 56 percent of the time. Nursing care, doctors role and patients concerns To face commotion at the time of injury can be a very frightening experience. Attitude of care givers, when appropriate ,can help reduce embarrassment and many other negative feelings associated with memory loss. These feelings can be reduced by explaining to the patient the details of the injury (Franzen et al, 2006). Injury and the subsequent orthopedic surgery have profound effects on the life of the injured. First of all, at the time of injury, the patient has to suffer from incapicitating pain, distress, immobility, shock, stress and unexpected hospitalization. Every injured person has this doubt raming in his mind "Will I get back to normal?" Getting back to normal is dependent on many factors like the type of injury, the extent of injury, the quality of health care received, coping strategies of the person (Griffiths and Jordan, 1998), emotional support, social support, complications of the injury, rehabilitation and several other factors. Of these, quality of care is very important and is dependent on health professionals. According to a study by Franzen, Bjornstig and Jansson (2006), quality of interaction between those who are injured in an accident and their care providers is very essential and helps the injured to come out of commotion, feelings of trust and security, inadequacy feelings of support and helps in the struggle to return to regular life. Management of compound leg injuries is time consuming and many surgeons may not be actually interested in this area. Several orthopedic organizations have drawn guidelines for management of compound tibial fractures and the aims of such guidelines are to improve the understanding of the diagnosis and management of complex problems associated with tibial fractures so that awareness for multidisciplinary approach to the management of the condition and early transfer to specialist center is sought (Allison et al, 2005). Jenkinson et al (2002), conducted a study to evaluate the experiences of injured patients with respect to healthcare services. In their study, the researchers found that patient satisfaction was dependent not only on age and health status, but also on emotional support, physical comfort and respect for patient preferences by the health care professionals. Most of the patients, according to the study were satisfied with care and satisfaction led to recommendation of others to the hospital. Coping strategies are important because stress can distort normal cognitive, perceptual and emotional processes and can contribute to abnormal behaviour and isolation (Griffiths and Jordan, 1998). In the study by Griffiths and Jordan (1998), the researchers found that many injured persons suffered stress because of pain and several other factors because of lack of congruency in the understanding of the distress the injured suffered, between patients and health professionals. While some patients complained that they were given insufficient analgesia despite the nurses and doctors were told that they had pain, many other complained that pain made their life miserable because of it causes sleep deprivation, stress and limited mobility. Some patients developed a sense of lack of control over events because injury occurred suddenly and they had to be hospitalized for that. This feeling worsened when they perceived that the health professionals were not concerned about their feeling and symptoms. This led to dissatisfaction in treatment. Dissatisfaction led to failure to adhere to treatment advises. Some patients complained that the hospital staff provided inadequate and inappropriate information which led to stress and emotional disturbance. Lack of proper information transfer led to underestimation of pain in the post-operative period and lack of awareness of alternative analgesic support, extent of tissue damage and side effects of medications. These in turn further contributed to non-concordance with the medications prescribed and non-compliance with treatment. Some injured individuals complained that health care professionals did not care to communicate as to when the patient would regain normality, how disability could be minimized, when the patient can expect return to work, what is the extent of financial expenditure and several other outcomes of injury. Health outcomes: Quality of life, physical and psychosocial Injury has several outcomes, both short-term and long-term, depending on the type of injury. One of the important outcome is deterioration in the health-related quality of life. There are several dimensions to health-related quality of life, the most important of which are "‘the dimensions of physical functioning, social functioning, role functioning, mental health and general health perceptions" (Aitken, 2007). Despite that fact that injury is one of the important preventable causes of morbidity and mortality, there is not much research on the outcomes of injury. In a study by Holbrook et al (cited in Aitken et al, 2007) from USA on general trauma patients, it was found that functions were reduced up to 18 months post-injury period. the same study identified that the function in women was worse than in men. In another study, Mackenzie et al (cited in Aitken et al, 2007) identified "poorer health across most dimensions measured by the SF-36 1 year post head injury and poor functional outcomes up to 7 years post-severe lower limb trauma." Andersson et al (1997) conducted a study on psychosocial complications following road traffic injuries. They were performed on 134 people, 90 percent of who had minor injuries and remaining has major injuries. These participants were subjected to a telephonic interview after 2 years after injury. From the results of the interview, it was evident that more than 50 percent of the respondents had some persistent complication because of their injury. Some of the complications that were reported were sleep disturbances, emotional problems and pain. Emotional problems were reported more commonly among women than in men. Increased anxiety in traffic situation was high among women than men, but impaired memory was more common in men. other emotional problems reported were fatigue, general anxiety, fluctuating moods, difficulty in concentration, weakness, irritability, nightmares, body aches and pains, startling by abrupt noise, tension, depression and restlessness. Injury has a significant impact on the psychological aspects of the injured, especially because of pain and impairment. According to Mayou and Bryant (2003), psychological problems are common in those inflicted with road traffic injury irrespective of the type of road user. The most commonly encountered psychological problem is phobia about travel. Another psychological problem frequently encountered was mood disturbance. Other psychological problems include general anxiety and depression (Mayou and Bryant, 2003). Psychological distress and problems were more common in women (Mayou and Bryant, 2003). As far as physical outcomes are concerned, age, type of injury, intervention provided and quality of care were major influencing factors. In the study by Mayou and Bryant (2003), majority of subjects had good physical outcomes at the end of 3 months, the remaining improved between 3- 12 months time. Of the different road users, motor cyclists and pedestrians reported continuing physical problems demanding medical care and help for disability. Passengers reported more persistent pain than other road users. The pain was attributed to musculo-skeletal region and neck. Continual physical problems after one year of injury are significant and depend on the type of injury. Most of the physical problems are related to musculoskeletal system. These problems were often a source of frustration and restriction to movement for the injured, especially for those who have physically demanding jobs or leisure activities (Mayou and Bryant, 2001). Added to these, injured patients to bear chronic pain, aesthetic problems and repeated interventions. In a study by Mustaq et al (2005), the researchers reported that, in their study, patients who underwent severe lower limb injury experienced poor sexual relationship, avoided undressing in front of partners, requested debunking, were inconfident in themselves, were distressed to see their legs in mirror, felt hurt and irritable at home, avoided going to beach, disliked using communal changing areas, avoided going for shopping, felt closed in a shell, felt rejected and chose not to attend social events. According to Aitken et al (2007), quality of life related to health significantly decreases 3 months after injury and every effort must be made to improve health outcomes by providing support and appropriate ongoing treatment. Mayou and Bryant (2003) reported that road traffic accidents lead to social disturbances like financial problems. In another erstwhile study by the same authors (Mayou and Bryant, 2001), 23 percent reported work difficulties and about 80 percent reported financial difficulties. In the study by Andersson et al (1997), 29 percent of the injured reported a gross reduction in the physical and social activities, especially sporting and organizational activities. 8 percent reported sexual disturbances, mainly because of pain. Some had sexual disturbances because of whiplash injury. Injury and fracture to lower limbs can lead to many complications. These include ankle osteoarthritis and subtalar stiffness, postphlebitic limb, foot and ankle deformities due to acute compartment syndrome, chronic osteomyelitis, local discomfort related to metal implants (Milner & Moran, 2003), symptomatic shortening and symptomatic angulation (Cattermole et al, 1996). Osteoarthritis is a crippling problem and there is no proper cure for it. While exercises and bracelets may be tried, they may not be of much use. Post discharge After discharge, the injured individuals develop doubts about returning back to normal and be able to healthy again. Return home is a struggle game with many having difficulties to take care of themselves and needing assistant for day-to-day chores (Franzen et al, 2006). In the study by Andersson et al (1997), 32 percent of patients received temporary personal assistance for various activities in daily living. While some were helped by friends and relatives, others were helped by municipal services. Five percent of respondents reported that they had to change the housing because of the disability that occurred due to their injury. Return to work In the study by Andersson et al (1997), 16 percent of injured were unable to return to work. While some continued on sick leave, others were at loss of pay. Some others changed the job. The return of muscle function is dependent on many factors like degree of direct damage and age. The time to return to work is significantly related to the severity of injury and there is no correlation with the skill of the injured person (Shaw et al, 1997). In a study by Stoffel et al (2007), they observed that combined tibial and fibular fractures following high-energy trauma healed late. Gaston et al (2000) reported that return of the power of the muscles of the leg may happen only after one year. Conclusion Injury can happen to anyone and anywhere and the first impact it has on the injured is confusion, embarrassment, insecure feeling and loss of trust. Arrival of helping strangers, health professionals and entry into ambulance makes the injured gain some trust and confidence but they worry whether they will be back to normalcy. Entry into hospital may be disgusting because of hospital policies, rules, admission procedures, interventions and attitude of health professionals. Differences in the perception of symptoms and discomfort of the injured patient between the patient and the health professional can lead to stress and distress. After discharge, depending on the extent of disability, the patient may need help from others for day-to-day living. Injury may have short term and long term complications related to quality of life, psycho-social attributes and physical aspects. Return to work may be delayed resulting in loss of finances. Thus injury is a source of morbidity and distress to the patient and more research is warranted in this field. References Allison, K., Wong, M., Bolland, B., Peart, F., and Porter, K. (2005). The management of compound leg injuries in the West Midlands (UK): Are we meeting current guidelines? British Journal of Plastic Surgery, 58, 640- 645. Aitken, L.M., Davey, T.M., Ambrose, J. (2007). Health Outcomes of adults 3 months after injury. Injury, 38, 19-26. Andersson, A.L., Bunketorp, O., and Allebeck, P. (1997). Injury, 28(8), 539- 543. Bream, E., and Black, N. (2009). What is the relationship between patients’ and clinicians’ reports of the outcomes of elective surgery? Journal of health Services Research and Policy, 14(3), 174- 182. Cattermole,H.R., Hardy, J.R., Gregg, P.J. (1996). The footballers fracture. Br J Sports Med., 30(2):171-5 Chang, W.R., Kapasi, Z., Daisley, S., Leach, W.J. (2007). Tibial shaft fractures in football players. 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