How Do We Better Help or Understand an Amputee - Literature review Example

Topic: How do we better help or understand an amputee? Amputation is a surgical operation that involves theremoval of a person’s physical part. The operation is maybe a consequence of incidental injury or probably due to metabolically known cause, like diabetes, which need urgent surgical operation. This paper will help explicate how to understand an amputee. Amputation: Grief and Coping Strategies Amputation has serious psychological impact to patients. For most, it’s a devastating and distressing loss of a physical a part that is enormously painful to endure. More than throbbing pain to hurdle, there is also innate grief. Experts profess that grief is present in most major life-changing phenomenon, like amputation. It’s stressful; it depletes energy; and, causes numbness. Under the theory of grief, an amputee will pass the five stages: denial, anger, bargaining, depression, and toward acceptance. First, grief is expressed in denial at being suddenly struck to an overwhelming reality of amputation. The limitations present reflective questions about how life should be pursued? How to survive? How to maintain sense of purposefulness after the loss (Ross & Kessler, 2012, p. 1)? Psychologists further contend that grief is manifested in amputee’s anger, too. Psychologists posit that anger is a significant part of the healing process. As pain strongly affects human behaviors, anger and outbursts are likely expressed unlimitedly (Ross & Kessler, 2012, p. 1). However, psychologists positively argue that anger also bridges a person to those who are providing care to an amputee. Optimistically viewed, amputee’s anger is a dialectical expression of his desire to survive or to take life with zeal. Ross & Kessler (2012, p. 1) explained that an amputee will also pass a phase of bargaining such as when one implores to be spared from a traumatic experience. Thus, a patient would hope that medication will generate positive results and the healing process be hasten. This is a feeling when a person is lost in a struggle of cyclical pragmatic dilemma. The patient will even bargain for anesthetics support against pain. This is still part of the responses to feelings. The fourth phase of grief is depression. As grief deepens, a patient will succumb to withdrawal, isolation, wallow in sadness, and put across intense disliking to activities that is supposedly hoped to enliven his soul. An amputee lost concentration, interests, self-esteem, and suffers sleeplessness (Kennedy, 1997, p. 187). Burger and Marinc, (1997, pp. 35-38) pointed in their study involving 228 respondents in Slovenia that amputees can only survive depression if they are able to get ample rest, have ample food, indulge in recreational activities, undergo constant deep breathing, have decrease of alcoholic intake, and opt for best physical well-being. But as reality has dialectical impacts too, an amputee will still end in the fifth phase of grief’s cycle: acceptance. Acceptance here is the recognition that amputation is real and that life needs to go on. This entails adaptation to physical limitation albeit it may mean occasional irritation to the condition (Desmond & MacLachlan, 2006, pp. 208-216). Adjusting and accepting to changes take time for all patients but if care providers serve with utmost sensitivity for amputees such will help much in the healing process (Furst et al., 1983, p. 152). In a study involving 104 respondents using Trinity Amputation and Prosthesis Experience Scales (TAPES) and survey method, most of the amputees-respondents profess traumatic amputations (Gallagher et al., 2000, p. 86). About 56% of them spend most of their time thinking of their amputated limb while those with bilateral or a trans–femoral amputation thought more of their operation than those respondents with trans–tibial amputation (Gallagher et al., 2000, p. 89). There were 48% of the respondents who looked at their experience positively although this is associated with acceptable physical capabilities and good health ratings; less athletic activity restriction and better adjustment to limitation (Gallagher et al., 2000, p. 1). It’s affirmed that all of them deals about the loss with grief and depression expressed in denial, isolation, anger, and bargaining—an emotional experience explicated in Ross’ Grief Cycle. Furst et al. (1983, p. 152) interposed that family support is crucial for an amputee’s physical and emotional healing. Family members could encourage them to journal their feelings; help them realize that everyone is needing recovery; encouraging meditation and hypnotherapy to get off from anger; re-experiencing humor and laughters to combat depression; and, working toward acceptance of the condition (Gallagher, Desmond, Deirdre, 2007, p. 208-216). Efforts should be done to encourage amputee to take positive messages, commit for medical therapy, and to get themselves involved in alternative medication like massage, acupressure and the like (Gallagher et al., 2007). On the spiritual side, the situation of an amputee calls for redefinition to unburden self from inward judgment after an amputation (Gallagher et al., 2007, p. 167). Researchers have utilized standard evaluation tools in examining the relation of coping strategies and the adjustment to amputation. Coping mechanism proved to have assisted too in the adjustment of artificial limbs to about 44 persons with different sites and etiologies as they illustrated evident emotional avoidance or denials. They needed support mechanism to inspire within the optimistic perspective albeit the limitations (Gallagher et al., 2000, p. 196). Appreciating the positive consequence of amputation may reduce the impact of depression (Gallagher et al., 2000, p. 196). In case the healing process is slow among elderly, they should be made to understand that other factors that may have hindered their fast rehabilitation. This could possibly be dementia, severe kidney and heart disease. This is among the many risks associated with surgery. Desmond and MacLachlan (2006, pp. 208-216), who made a study of coping strategies for amputees involving 796 persons within the age bracket of 26-92 years, bared strong symptoms of intrusion, anxiety, depression and poor adjustment of amputees. They associated this to depression and anxious symptomatology, although they inspire social adaptation to design and promote particular coping strategies to improve psychosocial outcomes. Such helplessness and pessimism is aggravated at times with lack of control on chronic pain conditions. Thus, it’s perennial that family, medical and social supports be provided to amputees to lessen the trauma. Thompson & Haran (1985) pointed that in their study involving 109 caregivers for amputee-respondents about the psychosocial implications of amputation, they pointed that amputees felt the heavy burden and such led them to social isolation or stigmatization. This is affirmed by Thompson et al. (1985, pp. 319-323) who argued that most of the patient have diminishing capacity to express needs due to severe emotional depression. Thompson et al. (1985, pp. 319-323) sees the need to establish policies that are helpful for amputees and to develop community care to lessen the risk associated to caregivers providing help to depressed amputees. Desmond et al. (2006, p. 210) saw that such difficulties are further aggravated by catastrophizing results due to more pain interference in post-amputation. Full regard should therefore be accorded to both amputees and their caregivers who are constantly dealing about reducing the risk of phantom limb pain (van der Geer, van Tuijl, Harrie & Rutte, 2009, pp. 1523-1530). Medical experts suggest that although phantom limb pain is a general observation in post amputation, caregivers should assist them carefully throughout amputees’ rehabilitation or recovery (Furst & Humphrey, 1983, p. 152). Amputee and Physiological Impact A person movement is determined by its biochemical and limbic functions. Under biological psychology, a person’s physical, behavioral and mental activities correlate much. When this is radically altered due to some illnesses or fractures which necessitate amputation of bodily part, it will also have severe impact to one’s behavior because some physical reality can no longer be completed, thus, the anxieties (Kejlaa, 1992, pp. 25-31). Amputation of a leg, for instance, dissociates a person from his freewill to act because one is barred to act normally, including those act of passion innate in a person’s sexual lives (Kejlaa, 1992, pp. 25-31). The healing process entails the need for right blood supply to the tissues otherwise, surgical operation will be hindered. Blood supply is necessary for healing process specially those who needed to hasten the recuperation to enjoy prosthetics (Gallagher & Maclachlan, 2001, p. 88; Sullivan, Lew, Devine, Hakim, Reiber & Veenstra, 2002, pp. 1079-1089). Troup (1980) pointed that the use of CET possibility needs physiotheraphist to ease immediate mobility of the patient. In case of disadvantages, this can be corrected through the period of healing. Troup (1980, pp. 3-27) argued that the use of CET apparatus is self-managing and is relatively simple because it can support control of pressures, temperature, good sterility, and it’s easy for observational processes of stump and extremities. Troup (1980, p.27) however pointed that while knee can be exercised, in the case of minimal amputation, patient must still be assisted by physiotherapist to improve lymphatic return, control oedema, and support early joint mobilization. The most commonly adopted process is Burgess’ operation technique, otherwise known as posterior myoplastic flap (Gallagher & Maclachlan, 2001, p. 88). The technique uses the calf’s skin and muscle from to coat the shin bones. The other technique is Kingsley Robinson technique or the skew flap where calf’s muscles are skewed to correlate with the muscle (Gallagher et al., 2001, p. 89-92). The latter is bit easier in cases where there is relevant skin damage above the ankle. The incision is done and deepened in the subcutaneous fatty tissue to the muscles (Gallagher et al., 2001, p. 85). Bleeding is being controlled while muscles are divided to show the tibia and fibula, the leg’s bones as careful care is accorded to ligation of the major blood vessels of the calf. These processes are done to toward use of prosthesis (Gallagher et al., 2001, pp. 85-100). Conclusion: Caring for the Amputees Caregivers and social workers must be thorough in reviewing relevant information relating to an amputee to know the patient’s nature, including possible areas of consistency and differences (Furst & Humphrey, 1983, p. 152). They should have combined medical and psychological knowledge in counseling the amputee to bring him/her back out of grief to purposive and motivated perspective. Medical practitioners and caregivers must be enduring to understand amputees’ needs, the associated risks, and the implications of their behaviors to themselves and others (Topss UK Partnership, 2004, pp. 1-63). Advices should be accurate and must be in amputee-sensitive language (Topss UK Partnership, 2004, pp. 1-63). Social workers, working for amputees’ protection must nurture open communication with medical practitioners, patients, and staffs. Through communications, needs are articulated and response are generated. Some of the social workers, as caregivers, can assist too in planning for patient’s safe discharge from the hospital. They also connect the patient to the policy formulation for the interests of amputees. The British Association for Counseling (2012, p. 1) affirmed that those who’d sought the assistance of counselors for post-amputation rehabilitation should weigh practical considerations on factors surrounding rehabilitation process: time, place, cost and the counseling cycle. Desmond et al. (2006, pp. 208-216) opined that a stress-coping paradigm system should be adopted to manage post-amputation as a problem and emotion-focused process post-amputation (Desmond, 2006, p. 18.). Adjustments and acceptance of the condition may vary depending on support provided by the family and physician to lessen traumatizing and stigmatizing impacts (Gallagher & MacLachlan, 2000, p. 196). Nowadays, there are ongoing campaign by governments and institutions for people suffering physical disabilities. Denmark for instance regarded amputees’ rights and protection well by affording social welfare programs and laws (Kejlaa, 1992, pp. 25-31). Amputees therefore have good options still for them to continue working, to pursue leisure and to enjoy an alternative lifestyle that is not strenuous and difficult for them (Nyenhuis, Nicholas, Cash, Kaiser, 1995, pp. 95-110). In Britain for instance, there is an Equality Act Law which protects persons with physical disability and accord to them the right to enjoy opportunities for office-based works in telecommunication and call centers, provided, they possess good communication and leadership skills. The elderly however, will need to take rehabilitation coupled with complete rest. They should be stress free and should be supported with social programs supportive for elderly. References British Association for Counseling (2012). Choosing a Counselor, The UK Limb Loss Information Center (LLIC), The Douglas Bader Foundation, Tring, Hertfordshire. Burger, H. and Marinc, C (1997). The Lifestyle of Young Persons After Lower Limb Amputation Caused by Injury. 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Sage Publication, December 2000 vol. 24 no. 3 196-204 Gallagher, P. & MacLachlan, M. (2000). Positive Meaning In Amputation and Thoughts About Amputated Limb. Prosthet Orthot Int., Sage Publication, vol. 24: 196. Gallagher, P. & Desmond, Deirdre M. (2007). Measuring Quality Life in Prosthetic Practice: Benefits and Challenges, Prosthet Orthot Int. Sage Publication, vol. 31, p. 167. Halpern, J. & Hausman, J. A. (1985). Choice Under Uncertainty: A Model of Applications for the Social Security Disability Insurance Program," NBER Working Papers 1690, National Bureau of Economic Research, Inc. Kejlaa, G. H. (1992). The Social and Economic Outcome After Upper Limb Amputation. Prosthet Orthot Int., Sage Publication, vol 16, no. 25. pp. 25-31 Kennedy, M. J. (1997). Am I better off without it? A case study of patien having a trsn-tibial amputation after 52 years of chronic lower limb ulceration and pain. Prosthet Orthot Int., Sage Publication, vol, 21, pp. 187. Kubler-Ross, E. & Kessler, D. (2012). The Five Stages of Grief: Denial Anger, Bargaining, Depression, and Acceptance. http://grief.com/the-five-stages-of-grief/ Accessed; April 6, 2012. Nyenhuis, Rybarczyk DL. Nicholas JJ, Cash SM, Kaiser J. (1995). Body image, perceived social stigma and the prediction of psychosocial adjustment to leg amputation. Rehabil. Psychology, vo. 40: 95-110. Sullivan, S. D., Lew, D., Devine, E. V., Hakim, Z., Reiber, G. & Veenstra, D. L. (2002). Health State Preference Assessment in Diabetic Peripheral Neuropathy, PharmacoEconomics, Wolters Kluwer Health, Adis, vol. 20(15), pages 1079-1089. Thompson, D. M. & Haran, D. (1985). Living with an amputation: The helper, Social Science & Medicine, Elsevier, vol. 20(4), pages 319-323, January. Topss UK Partnership (2004). The National Occupational Standards for Social Work, Topss UK Partnership, Leeds, England. pp. 1-63. Morris, Saul (2008).The Psychological Aspects of Amputation. A Guide for Adapting to Limb Loss. Amputee Coalition America.Tennessee, US. van der Geer, E. & van Tuijl, Harrie F.J.M. & Rutte, C. G. (2009). Performance management in healthcare: Performance indicator development, task uncertainty, and types of performance indicators, Social Science & Medicine, Elsevier, vol. 69(10), pages 1523-1530, November. Troup. I.M. (1980). Controlled Environment Treatment (CET): The Use of a New Concept of Wound Environment in Amputation Surgery and Other Conditions of the Extremities. Prosthetics and Orthotics International, 4: 15, pp. 3-27. Read More