Critically Analyse the Impact of Psychological Coping Strategies on the Patients Life Outcome - Research Paper Example

EVALUATION OF NURSING EVALUATION OF THE NURSING ROLE IN ASSISTING PATIENTS COPING WITH PHYSICAL AND PSYCHOLOGICAL DIFFICULTIES FOLLOWING LOWER LIMB AMPUTATION Student's Name/ Author: University name/ Affiliated to: To critically analyse the impact of psychological coping strategies on the patient's life outcome Abstract The critical analysis of the impact of the outcomes in the patient's life talks about the psychological coping strategies. The psychosocial implications along with psychological factors were included in the study. The social and family causes for the implications and the ways to cope them were discussed. By thinking the thoughts as reflections of the deeds the cognitive methods are discussed and can be implemented. The thought of change of Body image, the refusal for the acceptance of the fact that disability occurred were analysed. The disturbance of self esteem and the impact of that fact on the life outcome is discussed and the ways that minimise the impact were discussed. The uncertainty in the outcomes of the various studies was taken into consideration to stress the need of further research to cope with the pain and handicap reducing methods by dealing with the patient psychologically were discussed. The psychological impact of the support given by the family members, friends and society were taken into consideration and the result of the reaction of the disabled person were also mentioned. Life Out Comes of lower limb Amputated Patients The life outcomes of lower limb amputated are physical, psychological and psychosocial conditions. This situation is somewhat out of the limits of the surgeon or a doctor. The nurses attending the patient during the course in the hospital and after discharge have more roles to play. The time taken to adjust with the disability depends on the nature of the patient. Though the time of adjustment depends on the sex also, it depends more on the circumstances. Men are more worried about losing their opportunities if they are the supporters of the family. (I think there should be reference to suppost) Same worry plays with the women also, if they have the responsibility of supporting the family. So the study about coping with the disability depends more on the support the disabled person gets from hospital, family, friends and relatives decides the course of acceptance and his will of acceptance finally plays a critical role in coping with the problem. 'Coping' is the word used by health professionals, which means about the patient's understanding and managing the situations that arise due to the disability. Body image and disturbance of self esteem were the main issues that affect the disabled person. The lot of literature till date that focussed on leg amputation can be divided into three categories: 1.Clinical observations of psychosocial responses, experiences, and expected phase for adaptation; 2.detailed in nature, empirical studies that show the affect of particular psychosocial responses and experiences among those with limb losses and 3. the investigations, which are related to each other and enable one to predict the relationship between a host of socio demographic, experiential, personality, environmental, and disability-related variables and certain psychosocial indices of adaptation to the traumatic loss1. The results of clinical observations link the loss of lower limb to castration, loss of spouse, and even equal to capital punishment in some sensitive persons. One thing in common is that the people who are amputated feel more depression, tension, and pressure when they think about the daily life activities and future course of action. The empirical research on amputated persons has gathered the results regarding predictive power of a person's socio demographic characteristics (present age, age at the time of amputation, marital status), disability related variables, psychological variables and the context of environment.2 But all the above three categories agree that the role of the strategies followed to cope up with the disability play major role in the course of adaptation and acceptance to social and personal activities. Along with strategies the support advanced by the family members and relatives will play a major role in the acceptance of the candidate and his adaptation to the activities. In fact the extent of success of the strategies adopted depends upon the support extended by the family members, friends and the actors of the society. The studies by Dunn D.S show that psychological pain and pressure experience by the person is a result of the helplessness. Dunn D.S (1996) researched the results of the effects of general coping strategies on two indices of psychological and social well being , depression and self esteem in persons who are amputated; he found positive meaning after amputation by adopting an positive out look and understanding how to get control over amputation. 1 In the studies mentioned in articles by Hanoch Livneh, Richard F. Antonak, John Gerhardt, and Dunn DS1996), it was found out that the coping attempts of the people who are amputated do not have much difference with the coping effects of the people who are not amputated. But the extent of discussion on the efforts of the amputated persons is due to the pressure and depression in those persons, which are capable of nullifying the results of coping attempts. These findings again raise number of questions regarding the different causes of amputation. They are amputation due to traumatic accident, diabetic vascular disease, amputation of upper limb and amputation of lower limb. These questions lead to newer researches and surveys involving the different questionnaires for different type of amputated persons. The adaptation of disability due to amputation psychologically by the person and the areas of rehabilitation dominated the studies in the last 50 years.2 But due to divergent views of different researches tell us that each research has different outcomes. Though any of them cannot be wrong, it speaks about varied contexts and factors which affect the coping and adaptation strategies followed by the disabled persons. In general the outcomes of the physical, psychological adaptation of disability can be termed as follows: 1expectations of life 2. measures of unsuccessful adaptation to successful adaptation 3. health index against professional functioning 3 The psychosocial adaptation involves a number of factors. They are Differences between coping in married and unmarried persons, the effect of age at the time of occurrence of disability, the limitations of the activities, ambiguity and the level of affect in post disability period, the support received and expected socially and from personal contacts. There will be two types of attributes for any disabled person. The unchangeable and changeable are the two of them. The unchangeable attributes are regarding social, demographic, societal conditions. The changeable are personal perceptions, self motivational character and cognitive attributes.2 (Is there reference)The psychological acceptance fundamentally depends upon anxiety and depression. The lasting time of these two things decide the adaptation period. The long lasting of these two is the main cause for unsuccessful adaptation of the disability. Successful adaptation depends upon the behavioural attitude and the psycho social outcomes of it. There will be a relationship between the behavioural attitude and the distress. The distress affects the behavioural attitude negatively. The distress depends on depression. The depression again related to behavioural attitude. The depression does not depend on the degree of disability. It depends on the attitude and the outcomes of it. A patient's attitude towards newly acquired disability may play a critical role in successful adaptation.3His calibre in dealing with the symptoms, disorders and the outcomes decide the course of adaptation. Due to this complexity in the context the psychological aspects of the patients coping with disability were considered as uncertain. According to Moos and Schaefer as mentioned by Stuart Larner in common psychological challenges for patients with newly acquired disability; there are seven series of challenges 1. knowing and gaining control over symptoms, 2. being accustomed to hospital procedures 3. maintaining good relations with hospital staff, 4. controlling the feelings of shock to gain hope, 5. acquiring the self image that was previous to the disability to cope with the situation, 6. to have good relations with family and friends to get support from them, 7. trying to make out certainty from the vague picture of the future. The extent of the success in coping with the disability depends on the quality of implementation of the above mentioned factors. This depends upon maintaining the balance in physical reactions as well as psychological reactions. Both are interrelated in a way that there will be no physical reaction without a psychological cause but there may be a psychological cause without physical reaction. The role of health care workers or nurses starts at the point that the patient was more receptive to outward impulses in the post disability period. The period after disability occurrence can be considered as a crisis in an individual's life. The actions taken and the reactions for the outcomes may decide the course of adaptation. Careful planning and selecting of actions for the coping with disability are need of the context. White in 2001 as mentioned in 'The impact of illness representations and disease activity on adjustment in women with rheumatoid arthritis: A longitudinal study' opined that cognitive behaviourism is the process of regarding one's thoughts as a reflection of one's behaviour. So, whether it is a person coping with disability or an ordinary person the thoughts depend upon the actions and the outcomes. Thinking positively and acting according is one general thing that any body suggest to the persons coping with disability and the health workers or nurses attending them. Psychologists and nurses may train patients in acquiring the new dietary habits and the new type of mobility. But it is difficult to answer the question that why this disability occurred to them This comes from acute depression and distress due to the incident. According to Scharloo (1998) 1, a belief that the illness is curable plays an important role in curing the illness. Similarly the confidence in coping with the disability decides the success of the coping strategies. Some compare themselves with the persons having more disabilities and acquire self confidence and some others feel depressed at the incident occurred to them and start thinking in an escapist way by not accepting the reality. The post surgical rehabilitation is considered for the patients who feel better than before after amputation. They are the patients who are suffering with ulcer and gangrene in lower limb or some like situations. After experiencing the acute pain and inability to use that limb the patient comes to a point of accepting amputation before it was done. In those patients the post surgical rehabilitation is offered to cope up with the pains and other disorders due to medication. But the outcomes study is more necessary for the patients who did not expect that type loss to them. More generally the loss of the limb may be due to an trauma filled accident. One most important and fundamental activity of the patient suffering with post disability coping is that how comfortable he/she is in transferring from bed to the wheel chair or to handle the crutches. The confidence in doing this activity varies from patient to patient. This confidence can be taken as a symbol of future course of coping with the disability as it was a daily need. The first of the first things is to make patient familiar with the hospital procedures. The negative reaction is minimized when one is familiar with the procedures. The minimized negative reaction plays a major role in acquiring confidence and a speedy acceptance of the disability which plays a major role in recovery from the psychological trauma.1 One thing that can be done as the first step to make the patients know about the hospital procedures is to encourage them to develop rapport with them. For this thing to be materialized the staff also should talk freely with the disabled persons and make them free to talk with them. This makes one to understand about the procedures and the benefits he can gain from them. This is capable of divert mind from depression and distress and paves the way for the future coping strategies. Health professionals should inculcate empathy towards the patients. This can be developed by experience if they have a minimum in them. Some persons keeping in view that it is permanent disability loose confidence and require more counseling and care. The persons having positive out look can develop better outlook and control denial, anger, depression, which help in acceptance of the disability. Depression that was to be overcome by the positive thinking depends on the physical effects and the thoughts of the persons fearing future problems. The physical effect may be the same in the case of persons faced identical cases but the thoughts and psychological effect may not be the same in all the cases and the patients. In this context cognitive behavior therapy can be used as it deals with thoughts as reflections of the reactions to the actions and outcomes. The health professionals or psychologists try to get the patient out of emotions and make him free to discuss his problems with them. This makes the further rehabilitation and coping strategies simple and easy. Evaluation of Nursing The Nursing Role Within The Multidisciplinary Team in Relation to the Rehabilitation Phase. Abstract Rehabilitation can be defined as restoring to normal life by giving treatment and therapy. The multi disciplinary team which provides rehabilitation is team capable of providing clinical, physical, psychological and emotional treatment to the amputated person. The nursing role within the multi disciplinary team involves the results of modern studies to reduce the agony, anguish and pain relating post surgical care. The rehabilitation in the previous days used to be limited to taking care of the wound and the patient's movements in the course of hospital. But now the 'physiatry' extends the care to the outpatient status of the patient by taking care about the physical medicine and by furnishing the information regarding the coping strategies and the preventive information. Different types of amputation like traumatic amputation, amputation due to diabetes, ulcers and cancers, below knee amputation, above knee amputation were discussed. The advantages and disadvantages of amputation in patients suffering with vascular diseases and the steps that can delay or prevent amputation are also given a place in discussion. The multidisciplinary team now extends the care from physical medicine to education via therapy and counselling. Rehabilitation starts before surgery if it is not the case of accident which causes a sudden surgery to amputate the limb. In this stage patient requires some exercises and will be prepared for recovery process after surgery if he is suffering from vascular disease or the like one. Generally surgeons try to amputate the part lower to the knee as it is easier to recover and walk with a support after surgery. If the limb was amputated from above the knee it is some what difficult to be mobile after the surgery. The post surgery preparation includes the shaping of stump, dressing and healing the wound. It is difficult in the cases of persons who suffer with diabetes. Mobility for the persons in the post operative stage is provided by hand sticks, crutches, wheel chairs and scooters. So from the starting of the flexibility exercises before the surgery which are meant for speedy recovery to the strategies for making the amputated person mobile a multidisciplinary modes and practices are involved. These require the supervision or monitoring of health professionals (nurses) being in contact with the patients continuously. These include assisting the patients in flexibility exercises, dressing the wound after surgery, shaping the stump, making him enable to walk with a support like a hand stick and up to use of wheel chair. In case of lower extremity cases the wheel chairs have an arrangement to move the chair with the hands. This type of scooter were also developed but preferred by few. (This is abstract and was written on the basis of the paper below.) The role of nurses lie in making patient adjusting with the support he gets. They must make him know how to use the hand stick and the posture that suits and make him mobile as soon as possible. The hand stick is used if the prosthesis is used to replace the amputated part. In between the gap (surgery and fixing of prosthesis) crutches were used to make a patient walk. This involves an unusual movement of the body, which the patient never experienced before and involves the usage of extra strength also. Nurses must assist the patients until he was familiarised with the crutches he is using. When prosthetic usage is concerned a specialist Multi disciplinary team can achieve best prosthetic outcomes.1 The physiotherapist plays a key role in coordinating the patient's rehabilitation.2 This makes a physiotherapist compulsory in a multi disciplinary team. Along with a nurse or nurses therapist, doctor, counsellor will be there in a multi disciplinary team. The attendance of Multi Disciplinary Team for the patients who were amputated for the vascular diseases demonstrated reduced stay in the hospital, less visits to the doctor as an out patient, showed more ease in usage of prostheses.1 The specialist physiotherapist will be made responsible for the physiotherapy the amputated patient undergoes. The team must give its consent to the approach of the rehabilitation process. It should concentrate on education of the patient about the processes that are undergoing and discussions should held with him to make him enable to explain the problems he is facing. All the treatment, therapy, execution of strategies must be recorded. The medication, therapy, education must be conducted in an integrated manner. The team members must be available to the patients whenever they need. For this purpose the personal telephone numbers of the team members must be present with the patients. . The combination of both of them can be known as Physiatry. Physiatry provides integrated and multidisciplinary care aimed at recovery of the amputated patient, by attending to his emotional, medical, physical, social needs. A physician who specialises in physical medicine and rehabilitation is known as physiatrist.2The rehabilitation programme through which the rehabilitation is addressed must be able to enable the patient to function at possible highest standard. This means the recovery of the person and the extent of walking and mobility he achieved will show the difference. The extent of success of physiatry depends on number of circumstances as the following: The nature and the extent of the problem, disability, the standard of resulting impairments (for eg., the difference between the amputation below the knee and above the knee), the general health of the patient, the support he receives from his family members, friends and the society he moves. Areas covered in rehabilitation programs may include the following: Patient need: Example: Self-care skills, including activities of daily living (ADLs) Feeding, grooming, bathing, dressing, toileting, and sexual function Physical care Nutritional needs, medication, and skin care Mobility skills Walking, transfers, and self-propelling a wheelchair Respiratory care Ventilator care, if needed; breathing treatments and exercises to promote lung function Communication skills Speech, writing, and alternative methods of communication Cognitive skills Memory, concentration, judgment, problem solving, and organizational skills Socialization skills Interacting with others at home and within the community Vocational training Work-related skills Pain management Medications and alternative methods of managing pain Psychological counseling Identifying problems and solutions with thinking, behavioral, and emotional issues Family support Assistance with adapting to lifestyle changes, financial concerns, and discharge planning Education Patient and family education and training about the condition, medical care, and adaptive techniques Table 1: Adapted from http://uuhsc.utah.edu/healthinfo/adult/rehab/overview.htm In order to extend help and treatment and therapy to the patients with disabilities due to amputation a complete understanding about rehabilitation is necessary. It is need of the hour when there is a disability that is loss of a body part. The loss extends to lack of normal function of the body. This may include paralysis or amputation of the limb due to diabetes, cancer or due to a traumatic accident. This makes the person suffering with that unable to walk and move like before. He will be lesser then normal due that acquired disability. This can be termed as handicap. Rehabilitation must reduce the limits of disability. When disability reduces person to below normal activities, rehabilitation must remove the barriers as much as possible to make one lesser handicapped. For these along with physiotherapy, education and change of attitude towards one's self is also needed, which is given by a doctor and a counsellor. When a disable person reduces his handicapped nature and if was enabled to perform his duties as much as possible the rehabilitation can be termed as success. Just confining the treatment to healing the wound and shaping the stump is not complete rehabilitation. Continuing education will usually be accomplished through individual organizations for health professionals, or not at all.1It is considered like that because the medical fields covering amputation do cover the rehabilitation aspects up to little extent only. But the most up to date rehabilitation activities enable an individual to return to normal life as early as possible. Continuing education include the activities reducing the surgery related trauma, the painful consequences of tumour and vascular diseases, taking decision about amputation, the issues regarding pain, post surgical care, the training that can be given in the way of walking after amputation, the ways and means of avoiding infection, issues regarding psychological, societal, family and friends, the usage and avoidance of various types of prosthetics. Timothy R. Dillingham (1999) opines that the rehabilitation of an Amputee is continuum of care. The rehabilitation attending to Amputee must give him information about how to assess his health condition and the issues regarding amputation. The important post surgical context is usage of prosthesis. For this thing the stump must be shaped well. If the health professionals are negligent, stump will be bulb shaped and pose difficulties in fixing the prosthesis and create problems regarding pain and discomfort to Amputee, though it was fixed. The shaping of stump also thus play an important role post surgical care. In the early post surgical period the rehabilitation of the person is confined to usage of crutches and wheel chair to cope up with daily activities. The reason for the arrangement of parallel bars to the limb in fitting prosthesis is it may shrink or contract in the process of healing. When the healing was complete the patient can walk with an hand stick or crutches. After that the prosthesis fitting is decided. However the rehabilitation amputee (may be due to traumatic accident or an vascular disease) is a multi disciplinary activity. Even care taken regarding the vascular diseases, and the foot ulcers can reduce the amputations in diabetes and cancer patients up to 44% 1The post surgical rehabilitation also depends on the expected life time after amputation. There will be difference in average life span of the people amputated in traumatic accidents and the people amputated due to diabetic vascular diseases. In the latter case the life span may range from two to five years.2 In some cases the amputation of second limb also may be inevitable within two years of amputation of one limb. This can be avoided by taking care about controlling diabetes, avoiding the ulcers in the foot, and following good paediatric care. The time taken for attaining ambulance in amputated depends upon the nature and extent of amputation. In case of traumatic amputation, if good care was taken to shape the stump and if given excellent counselling, the persons reverted to their social life sooner than the the persons who were not given enough care like that mentioned above. If the amputation is above knee then it may take some more time as the fitting of prosthesis is complex and the patient also takes time to be accustomed with the large extent disability (compared with below knee amputation). In case of amputation due to disease like diabetes and cancer the time taken by amputee to regain the required ambulance is more as the diabetes restricts and delays the fitting of prosthesis and this makes the patient to rely on wheel chair and crutches for more time. The time taken for ambulance depends also on the prosthetic device used and its quality. The advance in technology and biomechanics has little impact on the amputees due to dysvascular diseases. Considering the prosthetic issues the traumatic patients (who do not have other complications like diabetes and cancer) adapted quickly to the biomechanics of the prosthesis, which even have knee movements and lock the movement when the excess of weight is applied. The operation of the prosthesis is restricted in diabetics due to formation of wounds in the foot and on the stump. There will be a difference in the prosthesis for above knee amputees and below knee amputees. The above knee amputee needs knee stability and below knee amputee requires just prosthetic foot bio mechanics.1 Education process: The rehabilitation needs an education process for the patient to make use of the prosthesis and to avoid future complications.2 They include the usage of prosthesis fitted, the care taken to the residual limb to avoid further complications, the care taken for remaining limb to avoid amputation for it, goal setting to achieve the required ambulance using prosthesis or the wheel chair and using it to maintain the daily life chores, coping strategies. Patients or carers for them should taken information regarding the correct socket fit which can be strain tolerant and how to cope with pressure sensitive areas of the leg. The changing of footwear may change prosthetic alignment and the patient should be furnished with the information about the type of foot wear he/she should use. The way of management of phantom pain and the avoiding the sensation should be given training. Tips of information should be supplied to the patient regarding quick healing of wound, avoiding further wounds, the different factors that affect the healing of the wound. Specific directions must be given regarding the methods in preventing scars due to friction of prosthetic movement. References The references following were given in Harvard style which as following Name of author, year of publishing, title, publisher or web sponsor, edition information if available, type of media, date retrieved, and web site address. Please review the references, some are repeated. 1. Mattias Andersson, Francis Deighan, 2006, Coping strategies in conjunction with Amputation-a literature study, Division for health and sciences, ,electronic, www.diva-portal.org/diva/getDocumenturn_nbn_se_kau_diva-283-1__fulltext.pdf - 2. 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Penny Broomhead, Diana Dawes, Carolyn Hale, Amanda Lambert, Di Quinlivan Robert Shepherd, 2003, Evidence Based Clinical Guidelines for the Physiotherapy Management of Adults with Lower Limb Prostheses, British Association of Chartered Physiotherapists in Amputation Rehabilitation, .electronic, 31-08-06. http://www.csp.org.uk/uploads/documents/csp_guideline_bacpar.pdf#search=%223.%20Evaluate%20the%20nursing%20role%20within%20the%20multidisciplinary%20team%20during%20the%20rehabilitation%20process%20lower%20extremity%2C%20amputation%22 18. Faculty, 2006, Overview of Physical Medicine and Rehabilitation (PM&R), University health care, ,electronic, 31-08-06, http://uuhsc.utah.edu/healthinfo/adult/rehab/overview.htm 19. Richard Veith, MD., Chair John O'Laughlen, Administrator, 2003, Annual research report 2003, Department of Psychiatry and Behavioral Sciences University of Washington Medicine, ,electronic, 31-08-06, http://www.uwpsychiatry.org/Docs/PsychReport03.pdf#search=%22Thomas%2C%20D%201999%20observe%20patients%20behavior%20and%20act%20as%20a%20recipient%20for%20their%20anxieties%20and%20concerns%20relating%20to%20all%20psychological%20changes%20lower%20extremity%22 20. ACA team, 2006, Principles of care for Amputees, Amputee coalition of America, Aug 2006, electronic, 31-08-06, http://www.amputee-coalition.org/nllic_hcp.html 21. Timothy R. Dillingham, MD, 1999, Amputee rehabilitation can improve results, Bio Mechanics, Aug 1999, electronic, 31-08-06, http://www.biomech.com/db_area/archives/1999/9908oandp.45-53.bio.html Read More