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 6th 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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