It has been already proven that depression can have extremely negative effect on the course of fracture treatment. Generally, anxiety and low mood both have a negative influence on recovery following pelvis fracture (Holmes and House, 2000).
Mrs. Couture, a 63-year-old woman, lives with her 67-year-old disabled husband in their own house. Her husband relies on her to take care of him and drive him to the hospital every week. Mrs. Couture slipped on the wet floor and fell while shopping in the supermarket and broke her pelvis. She was transported to the hospital with ambulance. Being very talkative and willing to communicate, she even made some jokes on the way to the hospital. The woman was operated on the same day. She had to stick to strict guidelines to ensure the full recovery. When the patient was assessed, she reported slight worries regarding how she would cope in the future. However, after some time these slight worries transformed into a severe depression.
We assessed Mrs. Couture one week later. Her mood was still low but it was decided that she needed no medications. However, it was obvious that she did require psychiatric help and guidance. At this point, Mrs. Couture expressed concern about being unable to take care of herself and her husband. The main interventions on this stage included building rapport with her, assessing depression and the need for medication. Our team discussed the problem and agreed on needs to be met.
The following week we visited Mrs. Couture and she was having a lot of concerns about how her husband would manage daily things as they did not have anyone else in the family to take care about him. Mr. Couture had an appointment in the hospital next week, and was concerned about transportation and support issues. Patient’s mood remained low, though she was encouraged by the staff support. Interventions on this stage included assessment of psychological condition, practical help, like booking transport to offer support, discussing weekly shopping with neighbors who offered their help, and of course counseling and positive reinforcement.
The following assessment has shown that Mrs. Couture was expressing discomfort in her pelvis. It became evident that this was because she was not well informed of the precautions needed following the fracture. She was sleeping in a position that aggravated pain along with other precautions that she was unaware of. This could lead to further complications of the injury. Mood of the patient remained low because her activities were restricted due to immobility. She expressed boredom, frustration, and felt hopeless about her future. She wanted to communicate with someone and could not stop talking during the time of assessment.
Interventions on this stage included physiotherapy and educational guidance about exercises and precautions, counseling regarding feelings of frustration. Mrs. Couture was encouraged to call the nurse every time she had any concerns or questions, which I must say she used very often, preferring not to ask questions about her condition, but talking about hydrangeas and Obama.
Posted by: Randi Elsass