Trauma-Induced Total Knee Arthroplasty: Cognitive Behavioral Therapy

Topics: Cognitive Behavioral Therapy, Therapy Words: 2728 Pages: 14

Introduction

Total Knee Arthroplasty (TKA) is among the most affordable and generally successful procedures done in orthopaedics. Patient-reported results indicate a significant improvement in pain alleviation, functional restoration, and overall quality of life. The rationale for choosing Trauma-induced TKA as the clinical issue is its wide prevalence and a major cause of health burden to patients and the health care system. Trauma-induced injury to the knees occurs as a result of intra- or extra-articular injuries of the patella, proximal tibia, and distal femur. According to the research, the incidence of this injury ranges from 21% to 44% (Lie et al., 2019). Moreover, patients who have undergone TKA need close monitoring as well as prompt patient education that will help alleviate pain and restore the functionality of the knee.

Mr Neil, a 45-year-old roof tiler, underwent the TKA procedure after falling from the roof of a single-story building. He was transported to the hospital, where he underwent bilateral knee replacements as a result of the trauma from the fall. Mr Neil has a vertical incision covered by an occlusive dressing to both knees. Following a successful surgery and positive prognosis, he is discharged but with many routine self-care that he needs to cope with. Since he is not able to perform all normal daily life functions without assistance, it is crucial to demonstrate and draw to him an appropriate plan of care to assist him while at home.

Reference to Relevant Learning Theory

Cognitive Behavioral Therapy (CBT) is a successful psychological intervention method used by hundreds of therapists worldwide. The concept of CBT can be applied to Mr Neil in helping him to full recovery and functionality of his knees. Traditionally, psychologists have administered CBT therapies, and the use of physiotherapists to offer psychological therapy is a relatively new concept (Peters et al., 2021). On the other hand, physiotherapists have a long history of educating patients on pain and pain management. Recent research indicates that both physiotherapists and nurses are capable of providing high-quality pain coping skills training. According to CBT theory, thoughts, emotions, and behavior are interconnected, and one’s ideas and actions determine how one feels (Peters et al., 2021). The state of a person’s cognition has an effect on their emotions and moods, as well as their physiological responses and behavior. CBT involves the client developing and practising new techniques, with one goal being to reduce maladaptive pain responses (Peters et al., 2021). CBT’s objective is to recognize maladaptive ideas and then replace them with more genuine and constructive ones to alter emotions and behavior, hence the perception of pain.

The Rationale for the Selected Teaching-Learning Setting

The teaching-learning setting for Mr Neil is hospital-based and will incorporate his wife as well in the process. Since Mr Neil needs assistance with movement, involving his next of kin in health education is important. Hospital-based education is critical since the patient has a greater chance of obtaining further care. Additionally, it is cost-effective since it minimizes the expense of transporting the health care practitioner to the patient’s house (Werner et al., 2019). Another rationale for choosing patient education and learning in the hospital environment is that nurses, doctors, and pharmacists can all contribute to ensuring that the patient knows the type of medication they are getting and the necessity of taking it therapeutically at suitable intervals. Thus, it is critical to inform Mr Neil and his wife that they should stick to the drugs prescribed the following discharge.

Following Mr Neil’s surgery, it will take him a lot of time to recover fully, which will render him jobless or the coming months. Being a family man with two children and a wife, this proves to be a challenge for him as he needs to provide for them the basic needs. It is evident that this state of immobility due to surgery exposes Mr Neil to a stressful experience. Mr Neil can benefit from the use of the CBT concept in reducing psychological distress as well as alleviating the pain.

The core tenet of cognitive-behavioural therapy is that maladaptive cognitions perpetuate psychological distress and behavioural disorders. Thus, CBT employs a variety of strategies to foster the development of more adaptive thoughts and behaviours, such as psychoeducation, relaxation therapy, cognitive restructuring and guided imagery, problem-solving, and coping with stress (Peters, 2021). CBT focuses on lowering pain and suffering, particularly in the setting of pain, through changing bodily sensations, tragic and meditative thinking, maladaptive behaviours, and boosting self-efficacy (Peters, 2021). Thus, the intervention’s objective is to heighten Mr Neil’s knowledge of his thoughts and behaviours, as well as to teach and practice new ones in order for him to commence, maintain, or resume his regular physical and social tasks. Additional learning objectives include increasing patients’ confidence in establishing their evaluations and teaching them suitable ways to cope with pain.

Identification of Learning Readiness

Through self-assessment, Mr Neil can demonstrate appropriate readiness to learn new coping skills during the learning session. This entails maintaining a record of learning requirements that arise throughout a typical workday. Mr Neil can detect knowledge gaps by reviewing his diary. Notably, people who maintain a diary develop more defined learning goals than people who do not. Additionally, feedback evaluation may be used to indicate preparedness for learning. For example, Mr Neil may get comments from his wife, Lisa, about his strengths and weaknesses.

Furthermore, it is vital to evaluate the performance and provide comments on areas that may be improved throughout the learning session. Observing one’s practice and documenting consultations on film is a strong tool that may aid in understanding one’s learning requirements. It is especially useful for seeing how people interact with one another during consultations and how patient-centred they are. Mr Neil may also benefit from the use of questionnaires to aid in the comprehension of the teaching session. The formal patient participation questionnaire should as well be given to Mr Neil’s wife to demonstrate that she also understands the goals of CBT in achieving recovery.

Strategies for Minimising Learning Challenges

It is critical to incorporate family members in the administration of health care in order to reduce the likelihood of any difficulties arising during patient education. Family involvement in patient education increases the likelihood that patients will follow the advice (Dineen-Griffin et al., 2019). In many circumstances, nurses are the one that provides the majority of the training to family members. Families have an important role in the administration of healthcare resources. It is one of the most difficult but ultimately gratifying aspects of delivering nursing care to educate patients and their families. It is important to include Mr Neil’s wife in the training session; for example, she may be able to assist him in making sure he takes his antibiotic prescriptions at the appropriate times.

Additionally, stimulating the client’s interest is crucial to lowering the number of challenges they face throughout the learning procedure. Patients must comprehend why this is so vital to their health. As a nurse or other healthcare professional, one should create rapport with patients, respond to questions, and take into consideration individual patient problems. It is possible that some individuals want thorough information on every element of their health condition, while others may be satisfied with just the basics and would benefit from a basic checklist. In the end, technological advancements have made patient education resources more accessible (Dineen-Griffin et al., 2019). By just pressing a button, patients may have their educational materials tailored and printed out. Education technology has made learning processes easier to understand, reducing the number of obstacles to efficient learning. Going through the patient’s particular requirements with them can guarantee that they comprehend the instructions and can address questions that occur.

The Rationale for the Teaching Aids

A questionnaire is a frequently used health assessment device that assists in determining a patient’s progress toward achieving set objectives, or lack thereof. The utilization of questionnaires as a data-gathering tool in health research has risen in recent years, both nationally and internationally (Werner et al., 2019). It offers benefits over other data gathering techniques in that it is generally fast to complete, affordable, and often straightforward to analyze. Well-designed questionnaires may assess cognition, knowledge, attitudes, intention, emotion, and behaviour. They collect the person’s self-reported observations and are often used to assess patient views of a variety of areas of health treatment. Effective health education materials and assessment questionnaires may assist the medical team in designing a patient-centred care plan that is easy to execute and maintain. These technologies aid in the improvement of patient outcomes related to adherence to medical guidance.

Statement and Justification of Learning Outcomes

By the end of the teaching process with Mr Neil, he will have a clear understanding of adaptive cognitive behaviours such as relaxation techniques and cognitive restructuring that will assist him in managing chronic pain. Behavioural patterns vary over time as a person develops, societal constructions change, personal beliefs evolve, and others’ expectations alter. Patients with chronic pain have been shown to benefit from relaxation strategies such as deep breathing and music therapy.

By the end of Mr Neil’s learning session, he will be able to define his emotions and differentiate between unhealthy and good feelings. Mr Neil is subjected to stress as a result of his inability to return to work after surgery since he has a family to support. It is critical that he be able to distinguish between positive and negative emotions after the learning session. Mr Neil must pay close attention to his body for warning signs of stress, such as increasing discomfort, anxiety, or difficulties keeping a healthy sleep pattern.

Evaluation and Feedback

Behavioural theory is crucial for assessing the patient outcome after the scheduled teaching session. In order to offer the continuous repetition required for efficient reinforcement of response patterns, behaviourist teaching approaches often depend on the repetition of specific activities. Other techniques include question and response frameworks with progressively more demanding questions, guided practice, and periodic content reviews (Dineen-Griffin et al., 2019). Additionally, behaviourist approaches often emphasize the need for positive incentives such as compliments, excellent grades, and awards. Behaviourists determine the extent of learning by observable behaviour measures such as test performance. Behaviourist teaching strategies have been most effective in areas with a proper answer or content that is readily remembered. While behaviourist approaches have been shown to be effective in teaching organized content such as facts and equations and scientific ideas, their usefulness in teaching understanding, composition, and analytical ability is debatable.

It is critical to assess Neil’s responses throughout the training session by questioning him questions on previously taught outcomes. A favourable answer demonstrates Neil’s capacity to adapt to new coping mechanisms. A questionnaire may be used since it enables the collection of a vast quantity of data from a minimal sample size. Summative evaluations may be performed to determine a patient’s competency (Dineen-Griffin et al., 2019). Following training and effort, patients might be assessed to determine their level of mastery of a skill. These evaluations may serve as a roadmap for future endeavours. Furthermore, formative evaluation may be used to examine Neil’s competency. These contribute to competency-based education by ensuring that health personnel understands patients’ requirements, allowing for real-time lesson modification and feedback.

Evaluation is the process of passing judgment about an individual or something with little or no purpose in altering any of its characteristics or actions. It is meant to be summative. On the other hand, feedback provides formative information to help learners improve their competence regardless of their present performance, and it is participative (Dineen-Griffin et al., 2019). It is critical to construct a survey focused on patient learning that prompts the patient to reply to the lesson planning in their own words. The patient’s response can help assist in improving future patient education.

Conclusion

CBT may be administered to Mr Neil in order to assist him in achieving complete recovery and functioning of his knees. CBT entails the client creating and practising new skills, one of which is to decrease maladaptive pain reactions. Mr Neil’s teaching and learning environment is a hospital setting. Hospital-based teaching is crucial since it increases the patient’s chances of receiving more treatment. CBT incorporates a number of treatments, including psychoeducation and relaxation therapy, to promote the development of more adaptive beliefs and behaviours. Thus, the goal of CBT is to increase Mr Neil’s awareness of his thoughts and actions and educate and practice novel ones for him to begin, maintain, or resume his usual physical and social activities.

Through self-assessment, Mr Neil may show suitable preparedness to acquire new coping strategies throughout the learning session. This requires keeping track of learning needs that emerge during a regular workday. It is vital to engage family and friends in delivering health care to lessen the chance of any complications occurring during patient learning. Family engagement in patient education enhances the possibility that patients will implement the advice. For teaching aids, excellent health education resources and evaluation questionnaires may support the medical team in establishing a patient-centred plan of care that is simple to implement and maintain.

Lesson Plan

Learning outcomes

On completion of this teaching session, Neil will be able to:

Demonstrate various skills necessary in managing chronic pain.
Describe his emotions and distinguish healthy from unhealthy feelings.
Demonstrate understanding of various signs of asthma attacks and effective use of inhalers.

Timing (Minutes)	Content (Topic/subtopic)	Activity/teaching approach	Resources	Evaluation Methods
SET 2 minutes	Introduction	A proper introduction to the patient before commencing the learning session. Checking and confirming previous ideas or knowledge by asking questions. Introduction to the cognitive triangle – The association between feelings, thoughts, bodily reactions, and behavior.	Printed instructions for patients. Comfortable working environment.	Exchange of questions verbally with the patient.
BODY minutes	Demonstrate various skills and understanding of medications necessary in managing chronic pain.	Active and passive coping mechanisms. How to cope with chronic pain as well as distress in the context of family, relatives, and work. The results of fear avoidance and the association between activity and pain. Relaxation as well as mindfulness techniques. Homework: Understand and record the many coping mechanisms that you use when you are in pain or discomfort.	Printed instructions for patients. A pain scale tool.	Asking verbal questions. Observation of the patient’s performance of various relaxation techniques. Questionnaire to screen for depression as well as anxiety. A questionnaire utilized to measure the risk of overdose in opioid-treated clients
10 minutes	Describe his emotions and distinguish healthy from unhealthy feelings.	A brief summary of learned skills from previous learning sessions. The setting of various goals for the next 14 days. Importance of appropriate rest and activity. The cognitive triangle – The connection between thoughts, feelings, behavior, and bodily reactions. Learning how to transform negative automatic thoughts and catastrophic pain-related beliefs into more realistic thoughts via the use of cognitive restructuring methods can be extremely beneficial. Homework: Use pacing methods and pleasant activity scheduling to restart everyday activities and hobbies. Write down how it affects your mood and the level of pain. Identify and write down disturbed thoughts and how they affect feelings, bodily reactions and behavior. Ruminate on alternative realistic thoughts. Restructuring of unsuitable thoughts.	Videos on signs and symptoms of poor mental health. Quiet and a comfortable working environment. Mental health self-assessment tools.	Asking questions regarding the previous session. Providing questionnaires Assess the attitudes, motivations and dispositions of Neil.
10 minutes	Demonstrate understanding of various signs of asthma attacks and effective use of inhalers.	Importance of appropriate rest and activity. Teaching on the importance of avoidance of strenuous activities. An effective technique in the use of inhalers. Identification of signs and symptoms of an asthma attack. Avoidance of asthma triggers and how to do so. Importance of regular medical review and regular self-monitoring.	A video presentation that shows proper use of inhalers. Written action plan. Asthma education handouts.	Asking questions pertaining the topic covered on asthma. Observing patient performance on use of an inhaler.
CLOSURE	Review and Evaluation	Brush up on prior lessons and a reflection on the coping techniques and cognitive techniques the patient can and will use in the future Provision of booklets or handouts for the steps involved in dressing the surgical site. Ask for feedback from the patient and relative following the learning session. Ask for questions or any pending clarification.	Patient care booklet and handouts. A written plan of action.	Clarification and answers to questions. Observation of the errors and mistakes in an actual situation.

References

Dineen-Griffin, S., Garcia-Cardenas, V., Williams, K., & Benrimoj, S. I. (2019). Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PloS one, 14(8), e0220116. Web.

Lie, M. M., Risberg, M. A., Storheim, K., Engebretsen, L., & Øiestad, B. E. (2019). What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review. British Journal of Sports Medicine, 53(18), 1162-1167. Web.

Peters, W., Rice, S., Cohen, J., Murray, L., Schley, C., Alvarez-Jimenez, M., & Bendall, S. (2021). Trauma-focused cognitive–behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth. Psychological Trauma: Theory, Research, Practice, and Policy, 13(3), 313. Web.

Werner, R. M., Coe, N. B., Qi, M., & Konetzka, R. T. (2019). Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility. JAMA Internal Medicine, 179(5), 617-623. Web.