EFFECTS OF COUNSELLING ON DEPRESSED SPINAL CORD INJURED PATIENTS AT THE NATIONAL ORTHOPATHEDIC HOSPITAL AND LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS.

ABSTRACT

This study was undertaken to investigate and analyze the effect of counselling on the depressed spinal cord injured patients at the National Orthopaedic Hospital Igbobi, and Lagos University Teaching Hospital. It was a fact-finding research work, written explicitly in five chapters with each chapter containing interesting and vital information on the study.

The chapter one contained the background to the study, statement of the problem, purpose of the study, significance of the study, research hypotheses etc., all these were well written out to give the study a focus and solid background.

The methods and procedures used in the course of the study were contained in chapter three of the study. A descriptive survey design was adopted for the study based on its appropriateness and effectiveness in generating data for the study.

The study also relied on the use of questionnaires as an instrument of data collection; fifty copies of the questionnaire were administered on the sampled respondents in the two settings viz National Orthopaedic Hospital Igbobi, and University of Lagos Teaching Hospital respectively.

In the chapter four of the study, the data collected were adequately presented and analyzed using simple percentage and frequency distribution table. While the research hypotheses were tested using independent t-test statistical tool at 0.05% significant level.

TABLE OF CONTENTS

Title page                                                                                            i

Certification                                                                                        ii

Dedication                                                                                           iii

Acknowledgements                                                                              iv

Abstract                                                                                              v

Table of contents                                                                                 vi

CHAPTER ONE:    INTRODUCTION                                                   1

1.1         Background to the Study                                                             1

1.2         Statement of the Problem                                                           4

1.3         Purpose of the Study                                                                  5

1.4         Research Questions                                                                     6

1.5         Research Hypotheses                                                                  7

1.6         Significance of the Study                                                             8

1.7         Scope of the Study                                                                     9

1.8         Limitation                                                                                  9

1.9         Operational Definitions                                                               10

CHAPTER TWO:    LITERATURE REVIEW                                          11

2.0     Introduction                                                                              11

2.1         Pathophysiology and Causes of Spinal Cord Injury                         11

2.2         Incidence/Epidemiology and Clinical Manifestation of

Spinal Cord Injury                                                                      17

2.3         Mechanism of Spinal Cord Injury                                                  21

2.4         Management of Spinal Cord Injury                                               24

CHAPTER THREE: RESEARCH METHODOLOGY                                 27

3.0     Introduction                                                                              27

3.1     Research Design                                                                         27

3.2         Population                                                                                 27

3.3         Sample Size                                                                               28

3.4         Research Instrument                                                                   28

3.5         Procedure for Data Collection                                                      28

3.6         Procedure for Data Analysis                                                         29

CHAPTER FOUR:  Data Analysis and Presentation of Result          30

4.1         Introduction                                                                              30

4.2         Descriptive Analyses of Bio-Data                                                  30

4.3         Testing of Hypotheses                                                                36

4.4         Summary of Findings                                                                  41

CHAPTER FIVE:    SUMMARY, CONCLUSIONS, RECOMMENDATIONS AND SUGGESTION FOR FURTHER STUDIES          42

1.1         Introduction                                                                              42

1.2         Summary of the Study                                                                 42

1.3         Conclusions                                                                               44

5.1         Recommendations                                                                      45

5.2         Suggestions for Further Studies                                                    47 

References                                                                                 48

Questionnaire                                                                             49

CHAPTER ONE

INTRODUCTION

1.1       Background to the Study

National Orthopaedic Hospital, Igbobi, Lagos is a specialist hospital, established on the 6^th of December 1945 following the Second World War (1939 – 1945). It served as a military rehabilitation clinic for the wounded soldiers from the West Coast of Africa. Injuries suffered by the wounded soldiers include traumatic amputation, fractures, dislocations and spinal cord injuries.

The hospital was designated a Parastatal of the Federal Ministry of Health by the Decree 91 of 1979. The hospital was also designated as a World Health Collaboration Centre in 1981 for purposes of Education, Training and Research, clinical services delivery has also been extended to victims of burns and those for plastic and reconstructive surgery as far back as 1982.

The proliferation of spinal cord injured patients admitted into the hospital in the 70s necessitated the creation of special wards (male and female) for these unfortunate victims of vehicular accidents, falls and gunshot wounds. The extensive and prolonged care of these patients gave rise to the appellation – IGBOBI LANDLORD.

Spinal cord injury is one of the most devastating injuries resulting from motor vehicle accidents, stab injuries from assault, gunshot injuries and sports injuries with resultant paralysis and disability.

This spinal cord injured patients at the National Orthopaedic Hospital Igbobi, Lagos have been found depressed following injuries to their spinal cord. The researcher, a counsellor in training, sought to investigate into the effect of counselling on the depressed spinal cord injury patient at the National Orthopaedic Hospital because of the physical, physiological and psychological effect associated with these unfortunate patients.

The spinal cord injured patients have array of problems, they become paralyzed mostly unable to use the two upper limbs and the two lower limbs (especially in cervical spine injury) they cannot control their bladder and bowel anymore, urine has to be collected through the use of a catheter (Foley’s catheter) attached to a urine bag. Faeces, usually impacted, has to be evacuated manually aided by the use of suppositories. The patients often have the odour of urine and faeces around them. They feel sad when visitors come round visiting. Physically, the patients are bed ridden, they cannot turn from side to side, and they are dependent on the Nurses and their relatives to be able to move any part of their body. Even to drive away flies hovering around requires the services of well wishers. These demands from the patients often results into a burden for the care giver, they are therefore deserted by their relatives, they feel lonely and tend to have the tendency to commit suicide. Some even get abandoned by their spouses as their future appears bleak. Physiologically, the injury may affect the male to such extent that he may not be able to have an erection, needless to say be able to ejaculate. This is a harrowing problem which makes the males spinal cord injured patient depressed.

The spinal cord injured patient (cervical spine) will also require to be fed with cutleries, this may not be satisfactory to them but because they are helpless this also depressed them further.

There inability to move from side to side made them develop bed sores from pressure on the soft tissues of the body culminating in offensive odour and toxins into the blood stream. This may lead to death from speticaemia. They are also prone to Hypostatic Pneumonia.

The spinal cord injured patient may lose their job as they are unable to carry out activities of daily living or tasks associated with their job. Majority end upon wheel chair – bound for life and may require different vocation which may not interest them. This depressed them further. Some of them are “bread winners” to their families and now cannot fed for their immediate and extended family members.

1.2       Statement of the Problem

Over the years, it has been observed that the majority of the patients admitted into the spinal cord injury ward of the National Orthopaedic Hospital Igbobi, Lagos, suffer from accidental injuries which affect them physically, physiologically and psychologically. The causes of these accidental injuries include Road Traffic Accidents from cars, buses, lorries, trailers and the popular “Okada riders” (motorcycle accidents). Other causes are falls from house tops especially by carpenters and other workers in house construction. Sport injuries e.g. diving into shallow waters by swimmers, football and basket ball game have all been implicated. Violence e.g. direct blow are among the various causes of spinal cord injury.

The consequences (complications) of spinal cord injury are paraplegia and quadriplegia. Their families members are not spared from the psychosocial and economic effect of such injuries as most of these patients are “breadwinners” to their families. The economic costs of managing a spinal cord injured patient surpass that of their patients with injuries elsewhere in the body.

Most often also, the spinal cord injured patient lacks psychological, social and financial support which consequently lead to disillusionment and despair. This leaves the victim of this unfortunate circumstance to a life of unfulfilled hopes and aspirations. Such patients experience wide varieties of disturbing and conflicting emotions such as deep and pervasive depression, guilt, boredom irritability, helplessness and a feeling of losing control of self and social image.

Most often the patients are antisocial as they find it extremely shameful to attend parties or any social gathering on a wheel chair. These patients are often dependent on people for supply of food and drinks as they are no longer economically buoyant to make whatever financial assistance they can receive from their work place or family to even buy their drugs.

1.3       Purpose of the Study

This study was undertaken to fulfill the following objectives:

·                    To find out the causes of spinal cord injury among the patient admitted into the spinal injury ward of the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital, Lagos.

·                    To find out the psychological effect of spinal cord injury on the patient.

·                    To investigate the psychological/economic effect on the relations of the patients.

·                    To find out the clinical manifestations exhibited by patients at the spinal cord injury at the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital, Lagos.

·                    To highlight the effect of counselling at the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital, Lagos.

1.4       Research Questions

1.            What are the causes of spinal cord injury in the patients admitted into the spinal cord injury ward of the National Orthopaedic Hospital Igbobi, Lagos?

2.            What psychological effect does the injury have on the patient and his/her relations?

3.            What economic effect does the injury have on the patient, his/her relations?

4.            What are the causes of depression in the spinal cord injured patients at the National Orthopaedic Hospital Igbobi, Lagos?

5.            What are the clinical manifestations exhibited by patients with spinal cord injury at the National Orthopaedic Hospital Igbobi, Lagos?

6.            What will be the effect of counselling on the spinal cord injured patients at the National Orthopaedic Hospital Igbobi, Lagos?

1.5       Research Hypotheses

2.            There will be no significant difference in the prevalence of depression at the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital, Lagos.

3.            There will be no significant gender differences between the level of depression manifested by the spinal cord injured patient at the National Orthopaedic Hospital Igbobi.

4.            There will be no significant relationship between familiar commitment and prevalence of depression of spinal cord injured patients at National Orthopaedic Hospital Igbobi.

5.            There is no significant difference between the causes of depression in the spinal cord injured patient at the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital, Lagos.

6.            The psychological effect of spinal cord injury on patients at the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital does not differ.

1.6       Significance of the Study

Depression emanating from patients with spinal cord injury at the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital is viewed as a state of mind which can be ameliorated through counselling.

Counselling being a helping relationship which assists the patients develop their maximum potentials through self exploration and understanding of their strength and weaknesses.

Counselling therefore intend to assist the spinal cord injured patients accept their limitation or disability.

This study will be of immense benefit to the patients, family members, friends, hospital management and non governmental organisations. Individual and/or group counselling in the spinal cord injury wards of the National Orthopaedic Hospital Igbobi, Lagos and Lagos State University Teaching Hospital will in no small measure bring hope to these unfortunate patients.

It will also increase the level of acceptability by relations who will then give their unconditional love and financial support in alleviating the patient predicament.

The hospital management will have course to discharge the patient early and the label of “Igbobi Landlord” will be removed. The non government organisation (NGO) will readily come to the aid of the patient by providing accommodation, jobs, foods, and other materials needed by the patient. This will help in integrating them into the community/society (rehabilitation).

1.7       Scope of the Study

The study covered both the in patient and out patient suffering from spinal cord injury at the National Orthopaedic Hospital Igbobi, and Lagos University Teaching Hospital (LUTH), in Lagos State.

1.8       Limitation

Spinal cord injured patients are admitted in specialist hospitals in Orthopaedic Hospitals in Lagos, Kano and Enugu but due to the financial and time constraints, the study was carried out in the two identified hospitals in Lagos State.

1.9       Operational Definitions

1.            Spinal Cord Injury – Injury to the spinal cord producing paralysis and disability.

2.            Counselling – a helping relationship. Blocher (1966) sees counselling as helping an individual become aware of himself and the ways he is reacting to the behaviour of his environment.

3.            Depression – a biological disorder resulting from an imbalance of neurochemicals in the brain causing a variety of physical, physiological and psychological symptoms.

4.            Patient – people receiving health care in the hospital.

5.            Hospitalization – the act of admitting or confining a client (patient) to the hospital for necessary care and definitive treatment.

6.            Paraplegics – someone who is paralyzed from waist downwards.

7.            Quadriplegics – someone whose four limbs (upper and lower) are paralyzed.

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