Rehabilitative Care of a Patient Following Polytrauma
Published: 29 November 2020
Published: 29 November 2020
Not only does trauma have severe consequences for the economy; it also has many ongoing effects for the individual.
The term ‘polytrauma’ (or ‘multi-trauma’) has no universal classification or definition. However, it is generally used to refer to patients whose injuries:
(Hsieh et al. 2018)
Polytrauma injuries commonly lead to physical, cognitive, psychological, psychosocial and functional impairments in addition to disability. Therefore, management of the patient with polytrauma involves highly focused specialist care and an interprofessional team approach with extensive rehabilitation (Mauk 2012).
Injuries vary depending on the accident or situation in which the individual sustained them, but may include the following:
Following acute management, these patients will often require rehabilitation in order to assist with their recovery and reduce disability.
Rehabilitation of the person who has experienced polytrauma extends beyond acute injury management. It focuses on reintegrating the person back into their community whilst also addressing any neuropsychological aspects of their care.
Rehabilitation may be difficult for the patient and is often the longest phase of their recovery (Khan et al. 2011). Therefore, it is important that the goals are set that are realistic, prioritised and established by both the patient and the interprofessional team (SA Health 2011).
Generally, rehabilitation will be carried out in an inpatient setting. Once discharged, patients may continue their rehabilitation with community health professionals.
Physiotherapy programs are essential to the treatment of a patient with polytrauma and are individualised to the patient, their injuries and their levels of motivation.
It must be taken into account that physiotherapy may cause emotional distress to the patient. This often occurs if the individual has limited awareness of their injury status and then attempts a physiotherapy exercise that they would have completed with ease prior to their injury. Now, however, they are experiencing difficulty or even failure. This can cause significant frustration and may be disheartening for the individual. These feelings may be exacerbated if prior to the traumatic event, the patient was physically strong, fit and healthy (Butcher & Balogh 2009).
Polytrauma may lead to a variety of psychological effects. Nurses need to be aware of these changes and assist in identifying strategies to support the individual. A psychologist will often be involved in the patient’s care and may help the patient to:
Following a traumatic event, the patient may also be at risk of post-traumatic stress disorder (PTSD). Therefore, nurses need to be aware of signs of this disorder and attempt to minimise any high-pressure situations for the patient with this diagnosis. Patient and family education of this disorder is also essential (Mauk 2012).
Patients may have limited insight into the extent of their injuries and may not understand that rehabilitation will be a long, ongoing process. This can impact on psychosocial aspects of their life, including their probability of returning to their prior work. Therefore, it is important that patients set realistic goals in this area.
The term ‘disability’ often has a negative stigma attached to it. If the patient views this term negatively, this can have adverse impacts on recovery (Butcher & Balogh 2009). Therefore, it is important to understand the patient’s perception of disability and what it means to them, and if needed, change this perception.
Interprofessional care of the patient who has experienced polytrauma is complex. Treatment depends on many factors, including the physical injuries, any consequent emotional or psychological trauma, changes in the individual’s level of functioning, and in severe cases, changes in the patient’s status within the community.
Nurses are involved not only in the treatment of the individual but also in the education and care of their family and friends. Nursing care of the individual will be dependent on their physical injuries, but will also involve their emotional, psychological and psychosocial needs (Mauk 2012).
Nurses caring for this population of patients may experience compassion fatigue. Compassion fatigue is a type of burnout where the nurse experiences emotional residue from caring for patients who have suffered traumatic events. This can present as feelings of low morale, anxiety, anger, blaming, complaining and an overall decrease in job performance (Mauk 2012). Support of the nurses in this environment is also essential.
Nurses are a pivotal component of the interprofessional team. They holistically support patients and their families, as well as actively participate in their recovery. They provide care that is individualised to the patient, helping them achieve their potential and return to their place in the community.