The Nursing Role Within The Multidisciplinary Team in Relation to the Rehabilitation Phase - Research Paper Example

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.3 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.4The 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.5It 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% 6The 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.7 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.8 Education process: The rehabilitation needs an education process for the patient to make use of the prosthesis and to avoid future complications.9 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. Read More