Many people experience trauma every year as a result of motor vehicle accidents (MVAs), falling off structures such as roofs, or maybe even just falling off their pushbike. Trauma is one of the main causes of disability in adults of working age, with over 45 million people worldwide experiencing moderate to severe disability secondary to trauma every year (Khan et al. 2011). Not only does trauma have severe consequences for the economy, it also has many ongoing effects to the individual.
The term ‘multi-trauma‘ (or ‘polytrauma‘) has no universal classification or definition. In addition, it also has many different meanings and different descriptions, depending on a multitude of factors. Polytrauma involves injuries to several body regions and not only compromises the patient’s physical health but also potentially causes dysfunction to their uninjured organs. Because of their multiple injuries, individuals with polytrauma are at a risk of higher morbidity and mortality rates than if they had just sustained a single injury (Butcher & Balogh 2009).
Polytrauma injuries also commonly lead to physical, cognitive, psychological, psychosocial and functional impairments, as well as disabilities. Therefore, management of the patient with polytrauma involves highly focused specialist care and a multidisciplinary team approach with extensive rehabilitation (Mauk 2012).
Common Polytrauma Injuries
Injuries vary according to the accident or situation in which the individual sustained them, but can include the following:
- Brain injuries
- Internal injuries
- Orthopaedic injuries and fractures
- Psychological disturbances such as post traumatic stress disorder (PTSD)
- Cognitive impairments
- Sensory, vision and hearing impairments; and
Therefore, following acute management these patients will often require rehabilitation in order to assist with their recovery and reduce disability.
Rehabilitation is a ‘problem-solving educational process aimed at reducing disability and handicap (participation) experienced by someone as a result of disease or injury’ (Khan et al. 2011). Rehabilitation of the person who has suffered multi-trauma extends past the acute injury management, and goes into reintegrating the person back into their community whilst also looking at any neuropsychological aspects of their care as well.
Rehabilitation can be a difficult phase for the individual and is often the longest phase of their recovery (Khan et al. 2011). Therefore, it is important that goals are set that are realistic, prioritised and established by both the patient and the multidisciplinary team (SA Health 2011). Generally, rehabilitation will be carried out in an inpatient setting, with individuals continuing their rehabilitation with community health professionals when discharged home.
Physical and Functional Effects
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 also be taken into account that physiotherapy can also 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 which prior to their injury they would have completed with ease. Now, however, they are experiencing much difficulty or even failure. This can cause much frustration and be disheartening to the individual. These feelings can be exacerbated if prior to the traumatic event, the patient was physically strong, fit and healthy (Butcher & Butch 2009).
Psychological and Emotional Effects
Experiencing polytrauma can lead to different psychological effects in the individual. 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 can help the patient by:
- Understanding the physical and emotional changes following their injuries
- Coping with their adjustment to disability
- Helping with motivation for rehabilitation; and
- Helping them work with the rehabilitation team.
Following a traumatic event, an individual may also be at risk of posttraumatic 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 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 the patients set realistic goals in this area.
The term disability can often have a negative stigma attached to it. If the individual holds a negative association with the term, this can also have negative impacts on their recovery (Butcher & Butch 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.
Multidisciplinary care of the patient who has suffered 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, which due to circumstances surrounding the trauma, may be very intense. 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 also experience compassion fatigue. Compassion fatigue can be seen as 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 in the multidisciplinary team for a patient who has experienced polytrauma. They are holistically supporting their patients and their families, as well as actively participating in their recovery. They have many roles within the care of the patients and provide care that is individualised to the patient, helping them achieve their potential and return to their place in the community.
- Butcher, N & Butch, ZJ 2009, ‘The definition of polytrauma: The need for international consensus’, International Journal of Injury Control and Safety Promotion, vol. 40s4, pp. 12-22, viewed 29 November 2016, http://ac.els-cdn.com/S002013830900552X/1…b9f961678
- Khan, F, Amatya, B & Koffman, K 2011, ‘Systematic review of multidisciplinary rehabilitation in patients with multiple trauma’, British Journal of Surgery, vol. 99, no. S1, pp. 88-96, viewed 29 November 2016, http://onlinelibrary.wiley.com/doi/10.1002/bjs.7776/full
- Mauk, KL 2012, Rehabilitation Nursing: A contemporary approach to practice, Jones & Bartlett Learning, Sudbury.
- SA Health 2011, Models of Care for Orthopaedic Rehabilitation, viewed 29 November 2016, https://sahealth.sa.gov.au/wps/wcm/connect/70ee02804…d4