Tips For Safety And Independence In Self-care Activities After Hip Replacement Surgery

The importance of consent in preserving cultural safety

1. As an occupational therapist, I would assist Mrs. Brown to use the adaptive devices while walking. I would also encourage Mrs. Brown in doing incidental exercises to improve her gait and mobility. Exercises under the guidance of a proper occupational therapist not only helps to improve the quality of living of the patient, but also helps to get rid of chronic pain and offers with psychological support (Drummond et al.2012).
2. The case study reveals that Mr. Brown is a 75 years old lady. Elderly patients are the vulnerable group, whose integrity and dignity is often at stake. Nursing homes and the hospitals often fail to treat the elderly people with dignity and respect.

One of the ways of paying respect and preserving the dignity of the patients is to take consent from the patient before touching them or carrying out any medical procedure (Chadwick 2012). As a health care professional it is our duty to educate the patient about the importance of the procedure. Again, the patient might feel uncomfortable letting the nurse to take care of her toileting activities. She might also feel uncomfortable in accepting the care from an opposite gender clinician (Chadwick 2012). Hence, during the entire therapy program, it is important to preserve the cultural safety of the patient.

1. Elderly people with several co morbidities often face from psychosocial trauma and often lose interest from the therapeutic regimen meant for them. Non –adherence to the treatment regimen might bring about adverse condition or might slower down the rate of improvement (Picorelli et al.2015).  Hence, Mrs. Brown should be motivated to take part in the occupational therapy program. At first Mr. Brown should be educated about the benefits of physical exercises and activities. Education should also empower the elders to improve their mental outlook and physical efficacies (Franco et al.2013). It seems from the case study, that she loves to attend the local church and spends time with them. She also loves to go on a walk with her pet snowy.
   She should be reminded of the fact that accepting occupational therapy would improve her gait and balance and her quality of living which will help her to participate in the church activities more actively.
2. There are several restrictions that have to be followed after a total hip replacement. Bathroom modifications are an import occupational intervention.

A stable chair is needed with a firm cushion, back and two arms. The bath or the shower chair should have rubber tips at the bottom to prevent slipping. Safety bars and handrails in the bath, a raised toilet seat and a stable shower bench or chair for bathing, a dressing stick, a sock aid and a shoe horn for putting on and taking off the shoe (Smith et al. 2016). The grab bars has to be secure vertically or horizontally, but not diagonally. Two grab bars has to be used- one for getting in and the other for getting out of the tub.  There should be non skid decals or bath mat on the floor of the tub to avoid slipping. A non skid bath mat has to be used for giving a firm support (Smith et al. 2016).
The floors of the bathroom should always be kept dry. The water heater temperature should be reduced for avoiding accidental burns. Raising the toilet seat would keep Mrs. Brown from flexing the knee excessively.

The major considerations would be that the hip should not be bended more than 90 degree during bathing or any activities, avoiding twisting of the legs, crossing of the legs and avoiding application of pressure to the wounds at an early stage.

1. As a an occupational therapist I would at first notify Mrs. Brown to stop moving in the recess and get hold of a side bar for support, then would instruct a health care worker to check the taps and clean the pooled floor.
2. A wheeled shower commode chair is exclusively for the patient who has restricted mobility and cannot use normal commode (Smith et al.2016). The chair can also be used for sitting while the showering. The cost of wheeled shower commode is high than the bench, hence as the occupational therapist, it is first important to find out whether the device would serve the purpose of Mrs. Brown. Then, it has to be brought under the notice of the facility manager to arrange for the same.
3. The ADL tasks that forms the part of the therapy program are toilet hygiene (that is getting to the toilet, cleaning herself and getting out of the toilet (Ibrahim et al.2016). This will mainly be done by giving the patient gait training.
4. SMART goals

Specific: Mrs. Brown will be able to engage in the self care and toileting activities on her own.

Measurable: Mrs. Brown will report less pain while getting in the tub.

Attainable: Mrs. Brown will be able to get in and get off the bath tub on her own.

Relevant: There will be an overall improvement in the gait .

Time bound: The balance ability of Mrs. Brown would improve within a period of three months.

1. SMART goals

Specific: Mrs. Brown will be able to use the assistive devices efficiently

Essential equipment for safe toileting and bathing

Measurable: Mrs. Brown would be able to use the walker while walking

Attainable: Mrs. Brown would be able to use rise efficiently from the toilet seat without any report of pain.  

Relevant: Mrs. Brown would be able to report any discomfort while using the assistive devices.

Time bound: The frequency and the amount of ADLs performed will increase within a period of three months.

1. Feedback is an important part of the clinical supervision, which aims to improve the experience and the health condition of the patients (Ivers, et al.2012). As an occupational therapist it is important to provide information about any improvement or deterioration of the health status of the patient. For example, the occupational therapist might provide recommendations regarding special diets to the nutritionist, who is also a part of the multidisciplinary team. Furthermore, the patient has some other comorbidities like COPD that can restrict some physical activities. In that case, such activities have to be cut off from the program. It is also required to inform the doctors about the different type of the activities and the exercises allotted for Mrs. Brown.

An occupational therapist should maintain a log report for documenting the duration of the therapy for the patients and then document the rate of progress or deterioration in the patient, which should then be sent to the doctor in charge of Mrs. Brown (Clark and Youngstrom 2013).  

1. Home visits before the discharge from the rehab is an important part of both the discharge process and the occupational therapy (Leland et al.2012). It gives a better understanding about the patient in the home environment. Conduction of an assessment within the home can improve the occupational performance of the patient. Prior to the completion of the home visit, one should be sure that there is effective lighting throughout the house. There is no unevenness in the floors, provision of side railings, and arrangement of the living area in the ground floor, bathroom and bed room arrangements for the support hip replacement, provision of alarm system within the easy reach to seek for help in emergency situations (Smith et al.2016).
2. Some assistive devices are required by Mrs. Brown to carry out some of the ADLs. The main assistive devices that is required includes a front- wheel walker, cane or crutches, a raised toilet seat that makes it easier to get on and of the toilet, a toilet safety frame, a tub chair for letting Mrs. Brown sit while taking a bath or a tub transfer bench that can be helpful in smooth transition out of the tub, a reacher to get things from the higher to the lower levels. It would also help the patient to put on clothes (Smith et al.2016).
3. Assistive devices are meant for the safety of the patient after a hip replacement surgery. An occupational therapist can show the use of the devices to help with the daily activities.

A cane or a walker will be used by Mrs. Brown as it will help to provide support to the body (Witt et al 2013). A cane used for support should be of appropriate length, otherwise it might lead to back and shoulder pain (Smith et al. 2016).

Mrs. Brown might be vulnerable to slips and falls as she had undergone a hip replacement surgery, hence a hip protector can be used that w9ould help the individual in enjoying independence. The hip pads would help to absorb any impacts if the patient suffered a fall (Smith et al. 2016).  The case study reveals that Mrs. Brown loves to do church activities and considers those attending the service as her extended family.

Grab bars are bars that is firmly attached to the wall in the bath tub or the shower, giving the patient to something to hold on while entering or leaving the bathroom. A grab bar can be placed vertically along the wall of the bathtub for hanging on, when they lean over for turning the water on and off (Smith et al. 2016); (Thienpoint et al. 2014). Mrs. Brown would need non slip mat in the bathroom for providing traction to the feet. A bath or a shower seat will be useful for Mr. Brown as it will help the patient to get down to sit at the bottom of the tub, if she gets weak or dizzy while standing in the shower. The assistive devices like the reacher and the sock aid would assist Mrs. Brown in carrying out some of the ADLs such as dressing (McNaught et al. 2013); (Thienpoint et al. 2016).

1. It is important to educate the families and the clients about the use of such devices. In this case, since Mrs. Brown will have to stay in care of her daughter. Her daughter will be educated about the use of the assistive devices by live demonstration of the devices. Initially group education can be given where similar patients as Mrs. Brown will be present, where a nurse practitioner will show the use of the assistive devices such as walker, hip protector or the wheeled shower chair. An information manual can be given to the patient to study about the use.
2. Adjustments can be made to the assistive devices as the height of the assistive devices has to be made as per the height, weight and the comfort of the patient. The height of the walker has to be adjusted as per the requirement of the patient and should be even to the hip joint (Rosso et al.2012).

Adjustment in the size of the equipment is necessary for Mrs. Brown to prevent unnecessary weight on the shoulder and the back.

1. It is important to notify any changes in the fittings made in the devices to the allied health care professionals, the height of the equipment and how is it helping in the support. It is also necessary for conveying this information to then  nurses such that they can handle the patient accordingly and can also educate the family about why such adjustments has been made. This feedback is provided in written form to the allied health professionals’ right after any such changed in the equipment has been made.
2. Of course, the client requires monitoring on the use of the items or equipment. It is clear from the case study that Mrs. Brown will have to go back to her house and stay alone after spending few weeks in her daughter’s home and hence will have to carry out some self-care activities on her own. Hence she needs to have a clear idea about the working of the assistive devices and it is necessary to monitor whether the devices are being used properly as improper usage of the devices might cause strain in the hip joints and can cause pain. It can also cause disfunctioning of the devices.

Each week a home visit can be provided by the occupational therapist nurses, for a follow up on the health status of the patient and the effective use of the devices.

1. Throughout the therapeutic period, a patient log book has been maintained containing record of the duration of the therapy each day, her medical history the number of the assistive devices used record of any improvement or deterioration made.

References

Chadwick, A., 2012. A dignified approach to improving the patient experience: Promoting privacy, dignity and respect through collaborative training. Nurse Education in Practice, 12(4), pp.187-191.

Clark, G.F. and Youngstrom, M.J., 2013. Guidelines for documentation of occupational therapy. The American Journal of Occupational Therapy, 67(6), p.S32.

Drummond, A., Coole, C., Brewin, C. and Sinclair, E., 2012. Hip precautions following primary total hip replacement: a national survey of current occupational therapy practice. British Journal of Occupational Therapy, 75(4), pp.164-170.

Franco, M.R., Tong, A., Howard, K., Sherrington, C., Ferreira, P.H., Pinto, R.Z. and Ferreira, M.L., 2015. Older people’s perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature. Br J Sports Med, 49(19), pp.1268-1276.

Ibrahim, M.S., Twaij, H., Giebaly, D.E., Nizam, I. and Haddad, F.S., 2013. Enhanced recovery in total hip replacement: a clinical review. The bone & joint journal, 95(12), pp.1587-1594.

Ivers, N., Jamtvedt, G., Flottorp, S., Young, J.M., Odgaard-Jensen, J., French, S.D., O’Brien, M.A., Johansen, M., Grimshaw, J. and Oxman, A.D., 2012. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev, 6(6).

Leland, N.E., Elliott, S.J., O’Malley, L. and Murphy, S.L., 2012. Occupational therapy in fall prevention: Current evidence and future directions. American journal of occupational therapy, 66(2), pp.149-160.

McNaught, H., Jones, T., Immins, T. and Wainwright, T.W., 2016. Patient-reported importance of assistive devices in hip and knee replacement Enhanced Recovery after Surgery (ERAS) pathways. British Journal of Occupational Therapy, 79(10), pp.614-619.

Picorelli, A.M.A., Pereira, L.S.M., Pereira, D.S., Felício, D. and Sherrington, C., 2014. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. Journal of physiotherapy, 60(3), pp.151-156.

Rosso, A.L., Taylor, J.A., Tabb, L.P. and Michael, Y.L., 2013. Mobility, disability, and social engagement in older adults. Journal of aging and health, 25(4), pp.617-637.

Schell, B.A., Gillen, G., Scaffa, M. and Cohn, E.S., 2013. Willard and Spackman’s occupational therapy. Lippincott Williams & Wilkins.pp.117-119

Thienpont, E., Berghe, A.V., Schwab, P.E., Forthomme, J.P. and Cornu, O., 2016. Joint awareness in osteoarthritis of the hip and knee evaluated with the ‘Forgotten Joint’Score before and after joint replacement. Knee Surgery, Sports Traumatology, Arthroscopy, 24(10), pp.3346-3351.

Thienpont, E., Opsomer, G., Koninckx, A. and Houssiau, F., 2014. Joint awareness in different types of knee arthroplasty evaluated with the Forgotten Joint score. The Journal of arthroplasty, 29(1), pp.48-51.