Professional Documents
Culture Documents
Goals
1.
2. 3. 4. 5.
Examine short & long term broad consequences of acquired disability Raise awareness of impact of acquired injury on specific aspects of psychosocial functioning of individual & family & friends Increase awareness of mental health issues associated with acquired disability Highlight role of Allied Health staff in identifying & addressing psychosocial functioning Provide specific strategies to address issues related to psychosocial functioning
1. broadening your understanding of adjustment reactions to Acquired Disability - how & why some cope & others dont
2. presenting options to help apply this understanding via psychosocial interventions that aid better adjustment - what individuals, family, friends, therapists & communities can do to help adapting & coping
Learning outcomes
1. You will be better able to appreciate the range of ways people react to AD, initially & long term
2. You will be better able to suggest what can be done to help people cope effectively with identified psychosocial problems
Form a triad
Share with your group some personal information about yourself, your dreams and some of your aspirations. You may refer to your career, family, relationships, education, hobbies,travel etc. Disabilities randomly allocated Given your acquired disability, describe your life now how have your dreams and aspirations been affected? Discuss in small and large group . . .
Prologue
Goal 1: Examining the broad issues of AD Acquired Disability defined Types of Acquired Disability How they may be acquired Areas of adjustment the bigger picture Rationale for focus on psychosocial rehabilitation
Acquired disability
An ongoing or permanent condition a person has received as a result of illness or accident . . . a condition may be stable, requiring only initial adjustment or it may progress to a debilitating level over time
Australian Federal Office of Equal Employment Opportunity
Types of disability
Intellectual or Learning Medical Physical Psychiatric Neurological Communication
Most who treat, work & live with those with AD share humanitarian concern to prevent or reduce this distress & social impacts But pts with psychosocial adjustment problems can distress health carers, often because pts misunderstood can be poorly serviced as result in turn resulting in high dissatisfaction with rehab
3.
4.
- Thomas Hardy
Adjusting
Goal 2: Awareness of impact of AD on specific aspects of psychosocial functioning of individual & family & friends
Initial & ongoing emotional reactions to AD
Initial reactions
Early responses to AD usually involve mixture of anxiety & depressed mood Worry & uncertainty about ability to cope with changes - usually high in early stages & short bursts. Diagnoses can produce shock & denial Denial & other avoidance strategies can be useful to help absorb the shock But, in excess, affects physical & psychological wellbeing e.g. not absorbing or applying info that aids recovery or prevents health problems
Initial reactions
Depressed mood: some say peaks shortly after diagnosis Others say when realise full extent of their disability & after many frustrating experiences. Can take more than a year to fully emerge Unlike anxiety which tends to appear in short-lived cycles, mood problems can be a long-term issue in AD lasting more than a year in many illnesses. Others though report cycles of despair & acceptance that can vary in length from less than 2 weeks to months
~A man who has thought about the human state should be pessimistic,
but the only spirit compatible with human dignity is optimism. - Coleridge
Adjusting
Goal 2: Awareness of impact of acquired injury on specific aspects of psychosocial functioning of individual & family & friends Personal & environmental resources that determine reactions: coping skills, personalities, beliefs & assumptions (schemas), social supports Comparisons of those who do & dont cope
Who copes?
Distancing try to detach from stress of situation (I didnt let it get to me. I refused to think about it too much) Positive focus try to see the positives in their situation/find meaning e.g. personal growth (I came out of the experience better than when I went in)
Who copes?
Seek out social support have skills, access & receive encouragement to do so. (The rehab people helped me find someone to talk to so I could find out more about my situation.) If done in ways that dont drive people away, connecting with family, friends, organisations can result in people living longer, adjusting more positively, improving health habits (e.g. sticking to medical routines) & use health services appropriately
Who copes?
Denial is used sparingly e.g. in early stages Problem-solving focus (Ill figure out ways, or find out what others do, to deal with the specific effects of the condition) on aspects of illness amenable to change but Use emotion-focused coping techniques (e.g. calming strategies) for aspects that cant be controlled So flexible use of coping strategies try to change the things I can & accept the things I cant
Who copes?
Open to self-management view of illness that complements efforts of doctors, therapists, & carers
Constructive schemas like Its not my fault that this happened to me. Factors outside my control lead to this illness but I do have a responsibility to help in my rehabilitation & care, as challenging as that will be. I can exert some control over the effects of this illness
Lots of escape fantasies or wishful/magical thinking e.g. I wish that the situation would go away. Avoidance efforts overeating, overdrinking, excessive smoking, overuse of medication Lots of self-blame, helplessness or anger/blaming others
Passive acceptance (vs. actively adjusting lifestyle to make best of situation), forgetting illness, fatalistic views of illness, withdrawal from others e.g. making doctors, pharmacy & therapists centre of their world Unable to access supportive networks in community as adjustment problems arise Unhelpful schemas e.g. about health No pain means no problem. No need to get blood pressure checked.)
Phases of grief
In many forms of AD characteristics of grief, its phases & elements, should be seen as chronic & recurring not in a time-limited, lock-step linear fashion Can set up perilous expectations for all if grief seen too simply as stages that permanently end, sooner or later. Failure to do so can oppress people into adjusting &accepting the unacceptable So consider these only as rough guide (See handout for expansion) Avoidance Confrontation Re-establishment
Adjusting
Goal 3: Awareness of mental health issues When coping doesnt happen mental health issues to be on the alert for with suggestions for management
Depression Anger & aggression Alcohol & other drug abuse throughout hospitalisation Pre-morbid psychiatric illness Past suicide attempts
Male Chronic pain Multiple medical problems Isolation Schizophrenia Expressions of hopelessness Family disintegration
Management
If an individual expresses suicidal ideation, ensure persons immediate safety Obtain an urgent psychiatric consultation if persons immediate safety at risk Determine appropriate setting of care Treat underlying problems such as depression, substance abuse, pain, etc
Management
Involve family & friends where possible Regular observation of the person is important Active listening by staff Encourage expression of feelings & encourage active coping Help with maintenance of health (e.g. hygiene, nutrition, bowel & bladder) programs while the person is in depressed state
Management of depression
Referral to GP/Psychologist/Psychiatrist for assessment Individually managed treatment plan Be aware of stigma & bias against people with mental health issues
Management of suicide
Ensure immediate safety Psychiatric consultation if necessary Involve others (eg. family/friends) where appropriate Use active listening skills Encourage feelings & encourage active coping
Management of PTSD
Referral to GP/Psychologist/Psychiatrist for assessment Treatment in this areas is specialised
~ Words are, of course, the most powerful drug used by mankind. - Rudyard Kipling
~ Loneliness is not a longing for company; it is a longing for kind. - Marilyn French
Psychological approaches
Ideally intervention programs involve interdisciplinary teams of professional doctors & nurses; speech, physical & occupational therapists; social workers; vocational counsellors & psychologists
Psychological contributions largely focus on moderating psychosocial impacts (e.g. thru enhancing participation & adherence, emotion focused strategies) with counselling techniques, behavioural & cognitive principles that have produced many useful interventions
Guided imagery e.g. for symptom control Attention re-focussing (stimuli outside body, on to activity)
Communication skills training/assertiveness training to improve communication with health care professionals, carers, workmates
Increasing appropriate movement walking, swimming, physio exercises via behavioural contracting & reinforcement contingencies
~A man who has thought about the human state should be pessimistic, but the only spirit compatible with human dignity is optimism. - Coleridge ~ To be heard is profoundly healing. - Moshe Lang
~ Words are, of course, the most powerful drug used by mankind. - Rudyard Kipling ~ Loneliness is not a longing for company; it is a longing for kind. - Marilyn French
Resources
Bibliography
Doing Up Buttons. Christine Durham. Penguin (Australia). 1997. Also available as an audiobook. This is Christine Durham's extraordinary courageous and uplifting story of the realities of coming to terms with the lasting effects of head injury and grief at the loss of the person she was. Christine's recovery encompasses both deep despair and hope as she discovers that recovery has more to do with effort, acceptance, invention, love, understanding and relearning than physical healing. Surviving Acquired Brain Injury (Australian edition). Brain Injury Association of Queensland. 2002. This book will assist people with acquired brain injury, family members, friends and professionals to understand and respond to the difficulties associated with acquired brain injury. The chapters on managing challenging behaviours will be of interest to many workshop participants
Resources
Living a Healthy Life with Chronic Conditions: Self-Management of Heart Disease, Arthritis, Diabetes, Asthma, Bronchitis, Emphysema & Others (Paperback) by Halsted Holman, David Sobel, Diana Laurent, Virginia Gonzalez, Marian Minor, Kate Lorig (Editor) Bull Publishing. 2000. The Arthritis Foundation of Australia has rights to a Leaders Manual developed by Stanford Patient Education Research Centre Health Psychology: Biopsychosocial Interactions An Australian Perspective. Marie L. Caltabiano, Edward L. Sarafino et al.. John Wiley & Sons Australia, Ltd.. 2002. Draws on Australian research and health promotion programs to give practical guidance on wholeperson approaches to issues such as the chronic illnesses.
This presentation in modified form is available from www.fmcdonald.com
Resources
State and National websites by disability e.g.
Brain Injury Association of Qld Inc www.biaq.com.au Arthritis Australia; Arthritis Queensland websites