Treatment Considerations in Disasters and Conflicts: Difference between revisions

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== Introduction ==
== Introduction ==
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== Education ==
== Education and Self-Management ==
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Patient education has been defined as, "any set of planned activities designed to improve a patient's health behaviours, health status, or both." <ref name="Louw & Puentedura">Louw, A, Puentedura, E. (2013). Therapeutic Neuroscience Education. Teaching patients about pain. A guide for clinicians. Minneapolis. Orthopedic Physical Therapy Products.</ref> These activities  aim to facilitate the patient's knowledge base in order to help them make sense of their condition and guide them towards effective, ongoing self-management by developing skills such as  problem solving, decision making, resource utilisation, action planning, self-tailoring, self-monitoring, which all requires a positive patient-rehabilitation professional partnership. 
 


== Self-Management ==
Self-management is a model of care in which patients are active participants in their own health care who are encouraged to use strategies and learn skills to manage their own health needs, and take responsibility for their own health care behaviours <ref>Oliveira VC, Ferreira PH, Maher CG, Pinto RZ, Refshauge KM, Ferreira ML. Effectiveness of self‐management of low back pain: Systematic review with meta‐analysis. Arthritis care & research. 2012 Nov;64(11):1739-48.</ref> <ref name="HARDING">Harding V, Watson PJ. Increasing activity and improving function in chronic pain management. Physiotherapy. 2000 Dec 1;86(12):619-30.</ref>. The World Health Organisation (WHO) define self- management as: <blockquote>“the ability of individuals, families and communities to promote health, prevent disease, and maintain health…..to cope with illness and disability with or without the support of a health-care provider.”<ref name=":0" /></blockquote>
Self-management is a model of care in which patients are active participants in their own health care who are encouraged to use strategies and learn skills to manage their own health needs, and take responsibility for their own health care behaviours <ref>Oliveira VC, Ferreira PH, Maher CG, Pinto RZ, Refshauge KM, Ferreira ML. Effectiveness of self‐management of low back pain: Systematic review with meta‐analysis. Arthritis care & research. 2012 Nov;64(11):1739-48.</ref> <ref name="HARDING">Harding V, Watson PJ. Increasing activity and improving function in chronic pain management. Physiotherapy. 2000 Dec 1;86(12):619-30.</ref>. The World Health Organisation (WHO) define self- management as: <blockquote>“the ability of individuals, families and communities to promote health, prevent disease, and maintain health…..to cope with illness and disability with or without the support of a health-care provider.”<ref name=":0" /></blockquote>


<br>Self-management, incorporating active involvement of the patient and their support networks in decisions about treatment and shared responsibility, has become a recognised aspect of all rehabilitation. In disaster and conflict settings self-management plays is a priority given reduced access to or time with rehabilitation professionals and often reduced follow up secondary to constrained health systems and infrastructure.  According to effective self-management is based on skills to actively participate in, and take responsibility for health conditions and relies on skills such as  problem solving, decision making, resource utilisation, action planning, self-tailoring, self-monitoring, and creating a patient-health professional partnership
<br>Self-management, incorporating active involvement of the patient and their support networks in decisions about treatment and shared responsibility, has become a recognised aspect of all rehabilitation and is a vital aspect of treatment in disaster and conflict settings given that patients often have reduced access to or time with rehabilitation professionals, with follow up often limited or delayed secondary to constrained health systems and damaged health and community infrastructure.  <ref>Mudge, S. et al, [https://members.physio-pedia.com/wp-content/uploads/2016/02/Who-is-in-control.pdf Who is in Control? Clinicians’ View on their Role in Self-management Approaches: A Qualitative Metasynthesis] , BMJ Open, 2015<div class="researchbox"></div></ref><ref>Jones, F. Chapter 19: Self-management , in Stokes, M. &amp;s Stack, E., [https://members.physio-pedia.com/wp-content/uploads/2016/02/Stokes-Chapter-19-Self-management.pdf Physical Management for Neurological Conditions], Churchill Livingstone, 2013.</ref><ref>Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Annals of behavioral medicine. 2003 Aug 1;26(1):1-7.</ref>
 
Education is
 
Educating patients and caregivers and providing them with clear guidance on any restrictions and signs of complications, advice and exercises, and explaining how to progress (and what to do if they don’t make progress) is key. Where patients are awaiting definitive management, pre-operative education can make post-operative care much easier.
 
for individuals with long term neurological conditions. Understanding what it is and why it is becoming such a key element of the rehabilitation process are important to ensuring your treatment has patient involvement and is patient focused.<ref>Mudge, S. et al, [https://members.physio-pedia.com/wp-content/uploads/2016/02/Who-is-in-control.pdf Who is in Control? Clinicians’ View on their Role in Self-management Approaches: A Qualitative Metasynthesis] , BMJ Open, 2015<div class="researchbox"></div></ref><ref>Jones, F. Chapter 19: Self-management , in Stokes, M. &amp;s Stack, E., [https://members.physio-pedia.com/wp-content/uploads/2016/02/Stokes-Chapter-19-Self-management.pdf Physical Management for Neurological Conditions], Churchill Livingstone, 2013.</ref><br> Lorig et al (2003)<ref>Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Annals of behavioral medicine. 2003 Aug 1;26(1):1-7.</ref>. explain that “wellness” from self-management requires attention in three key domains: the medical, behavioural, and emotional elements of a person’s life. They recognise that physiotherapists do not have extensive training in each domain, but they stress that physiotherapists’ expertise in exercise therapy, pain management, and healthy lifestyles promotion enables the profession to play a key role in supported self-management.<div class="researchbox">


According to Phillips (2012) <ref>Phillips J. The need for an integrated approach to supporting patients who should self manage. Self Care. 2012;3:33-41. </ref>, a person needs to learn a range of skills to manage the biological, mental, emotional, and social impacts of their condition, including the effects of physical inactivity on health. This is termed the “biopsychosocial approach.” The following diagram depicts the range of strategies available to support the use of self-management:
Educating patients and caregivers and providing them with clear guidance on any restrictions and signs of complications, advice and exercises, and explaining how to progress and what to do if they don’t make progress is hugely important within disaster and conflicts, this can be even more important when patients are awaiting definitive management, as pre-operative education can make post-operative care much easier.<div class="researchbox">
<div class="coursebox"></div>  
== Promoting Independence ==
== Promoting Independence ==
After a traumatic injury, people need rehabilitation assessment and interventions that take account of any pre-existing conditions and focus on helping them regain optimum function and independence as quickly as possible within the environment in which they will be discharged to. A person’s ability to participate in everyday activities in their home and community environments may be significantly disrupted both as a result of the disaster or conflict itself with damaged and destroyed infrastructure, poor access to essential services and crowded living conditions or as a result of the specific injury, which may require them to change their routines or daily activities  have to be relearned or managed differently, or may require assistance from others for personal tasks such as showering, dressing and grooming as well as domestic and community tasks. What is considered best practice may be different given the impact of the setting on the individual, and you need to always ensure you consider not only their specific injuries but the environment they have to live within.


== Psychological Support ==
== Psychological Support ==
Psychological first aid (PFA), describes a humane, supportive response to a fellow human being who is suffering and who may need support. PFA involves the following themes:  
Psychological first aid (PFA), describes a humane, supportive response to a fellow human being who is suffering and who may need support and involves the following themes:  
* providing practical care and support, which does not intrude;
* providing practical care and support, which does not intrude;
* assessing needs and concerns;
* assessing needs and concerns;
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== Peer Support ==
== Peer Support ==
Peer means the group of people who have faced the same kind of trauma. During the assessment, if the patient feels comfortable being with the peer group, the therapist can offer the option to the patient.<ref name=":0" /> Many patients may have little knowledge regarding their pain experience as some pain might be due to emotional suffering and central sensitization.<ref name=":1" />Peer support might provide emotional support and it can be provided face to face, in a group, or via the internet as per the patient's choice.<ref name=":2" />
Peer support occurs when people share their personal knowledge, experience, emotional, social or practical help with each other. Peer support comes from people who have faced the same kind of experience, trauma or injury. Peer support offers an environment where a person can feel that they are being listened to as a person and not as a patient and can offer a different and unique perspective to the medics and rehabilitation professionals as peers have that ''“lived experience”, t''hey can relate to the person in a way that only someone who has ''“been there and done that”'' can.
 
Peer support is commonly used in situations where a person has undergone a life-changing injury such as a spinal cord injury, traumatic brain injury or amputation and can take a number of forms including peer mentoring, reflective listening (reflecting content and/or feelings), or counselling  and can be provided face to face, individually or in a group based setting, or in some instances has also been provided through telehealth.<ref name=":2" /> Peer support can be utilised not only for the person who has had the injury, but can o=also include peer support for family members and care givers.


== Resources ==
== Resources ==
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== References  ==
== References  ==
<references /> 
<references /> 
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]]  
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]]  
[[Category:ReLAB Content Development Project]]
[[Category:ReLAB Content Development Project]]

Revision as of 21:40, 11 March 2022

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Introduction[edit | edit source]

Education and Self-Management[edit | edit source]

Patient education has been defined as, "any set of planned activities designed to improve a patient's health behaviours, health status, or both." [1] These activities aim to facilitate the patient's knowledge base in order to help them make sense of their condition and guide them towards effective, ongoing self-management by developing skills such as problem solving, decision making, resource utilisation, action planning, self-tailoring, self-monitoring, which all requires a positive patient-rehabilitation professional partnership.


Self-management is a model of care in which patients are active participants in their own health care who are encouraged to use strategies and learn skills to manage their own health needs, and take responsibility for their own health care behaviours [2] [3]. The World Health Organisation (WHO) define self- management as:

“the ability of individuals, families and communities to promote health, prevent disease, and maintain health…..to cope with illness and disability with or without the support of a health-care provider.”[4]


Self-management, incorporating active involvement of the patient and their support networks in decisions about treatment and shared responsibility, has become a recognised aspect of all rehabilitation and is a vital aspect of treatment in disaster and conflict settings given that patients often have reduced access to or time with rehabilitation professionals, with follow up often limited or delayed secondary to constrained health systems and damaged health and community infrastructure. [5][6][7]

Educating patients and caregivers and providing them with clear guidance on any restrictions and signs of complications, advice and exercises, and explaining how to progress and what to do if they don’t make progress is hugely important within disaster and conflicts, this can be even more important when patients are awaiting definitive management, as pre-operative education can make post-operative care much easier.

Promoting Independence[edit | edit source]

After a traumatic injury, people need rehabilitation assessment and interventions that take account of any pre-existing conditions and focus on helping them regain optimum function and independence as quickly as possible within the environment in which they will be discharged to. A person’s ability to participate in everyday activities in their home and community environments may be significantly disrupted both as a result of the disaster or conflict itself with damaged and destroyed infrastructure, poor access to essential services and crowded living conditions or as a result of the specific injury, which may require them to change their routines or daily activities have to be relearned or managed differently, or may require assistance from others for personal tasks such as showering, dressing and grooming as well as domestic and community tasks. What is considered best practice may be different given the impact of the setting on the individual, and you need to always ensure you consider not only their specific injuries but the environment they have to live within.

Psychological Support[edit | edit source]

Psychological first aid (PFA), describes a humane, supportive response to a fellow human being who is suffering and who may need support and involves the following themes:

  • providing practical care and support, which does not intrude;
  • assessing needs and concerns;
  • helping people to address basic needs (for example, food and water, information);
  • listening to people, but not pressuring them to talk;
  • comforting people and helping them to feel calm;
  • helping people connect to information, services and social supports;
  • protecting people from further harm

Psychosocial Support[edit | edit source]

Peer Support[edit | edit source]

Peer support occurs when people share their personal knowledge, experience, emotional, social or practical help with each other. Peer support comes from people who have faced the same kind of experience, trauma or injury. Peer support offers an environment where a person can feel that they are being listened to as a person and not as a patient and can offer a different and unique perspective to the medics and rehabilitation professionals as peers have that “lived experience”, they can relate to the person in a way that only someone who has “been there and done that” can.

Peer support is commonly used in situations where a person has undergone a life-changing injury such as a spinal cord injury, traumatic brain injury or amputation and can take a number of forms including peer mentoring, reflective listening (reflecting content and/or feelings), or counselling and can be provided face to face, individually or in a group based setting, or in some instances has also been provided through telehealth.[8] Peer support can be utilised not only for the person who has had the injury, but can o=also include peer support for family members and care givers.

Resources[edit | edit source]

References [edit | edit source]

  1. Louw, A, Puentedura, E. (2013). Therapeutic Neuroscience Education. Teaching patients about pain. A guide for clinicians. Minneapolis. Orthopedic Physical Therapy Products.
  2. Oliveira VC, Ferreira PH, Maher CG, Pinto RZ, Refshauge KM, Ferreira ML. Effectiveness of self‐management of low back pain: Systematic review with meta‐analysis. Arthritis care & research. 2012 Nov;64(11):1739-48.
  3. Harding V, Watson PJ. Increasing activity and improving function in chronic pain management. Physiotherapy. 2000 Dec 1;86(12):619-30.
  4. Cite error: Invalid <ref> tag; no text was provided for refs named :0
  5. Mudge, S. et al, Who is in Control? Clinicians’ View on their Role in Self-management Approaches: A Qualitative Metasynthesis , BMJ Open, 2015
  6. Jones, F. Chapter 19: Self-management , in Stokes, M. &s Stack, E., Physical Management for Neurological Conditions, Churchill Livingstone, 2013.
  7. Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Annals of behavioral medicine. 2003 Aug 1;26(1):1-7.
  8. Cite error: Invalid <ref> tag; no text was provided for refs named :2