l Who is an appropriate Counselor? l Definition: A person who counsels; an advisor l Various team members qualify
5 SLP Attributes to deal w/ the psychological well being of the Laryngectomee & family 1. Respect & Consideration for patient 2. Appreciation/Acceptance of the responsibilities to the patient 3. Commitment to understanding the individual needs 4. Need to encourage to ensure pt. compliance with treatment 5. Acceptance of self feelings & willingness to express these feelings
5 Counseling Skills Gilmore -97 1. Allow pt. to express, acknowledge & clarify feelings & concerns 2. Ascertain pts. knowledge, feelings & attitudes re: changes and problems…. 3. Promote pt. problem solving 4. Access, provide & evaluate needed info 5. Access & provide support for pt and spouse/family
5 Stages of Grief Both pt and spouse will experience 1. Denial and isolation 2. Anger 3. Bargaining 4. Depression 5. Acceptance
Pre-op Laryngectomy Consultation l Who should be present? l What do you do if they are not present?
Pre-op Laryngectomy Consultation l The SLP may be the first person who the patient is listening to when explaining the surgery; etc. l When pt. is first told by MD, they often just hear CANCER and do not listen or comprehend the information re: specifics because they are still dealing with the term CANCER
Pre-op Laryngectomy Consultation l How do you introduce the subject??? n Individually n Dr… has told me of your dx and has asked me to talk to you about it n I am sorry that you have been given some bad news….
Pre-op Laryngectomy Consultation l Tell the patient the goal of the session and encourage the patient and family members present to ask questions whenever they want throughout the session. l Frequently ask indirect questions throughout the session to assess understanding.
History l Educational Background l Employment Status l Family Status l Visual Acuity l Auditory Acuity l Writing Skills l Reading Skills
Consultation Topics l Anatomy/Physiology (Use Pictures/Models) n Preoperative n Postoperative l Operative site l Permanency of n Voice Loss-Not loss of Speech –/s-z/ production n Larynx Removal n Stoma n Stomal Respiration continued
Consultation Topics n Alteration of Taste and Smell n NPO Status n Swallowing Alterations n Surgical/Hospital Information –4-10 days n Intensive Care Visit n Family Information n Healing continued
Consultation Topics l Hospital stay communication n Immediate post-operative wake-up and initial reaction to speak
HOSPITAL NON VERBAL COMMUNICATION: "Laryngectomee Needs Chart" Actual size is 8 1/2" x 11". Makes communication a little easier. A small bell for your bedside will help get attention. A laptop, if you have one, will let you type messages in detail or a Magna Doodle from the toy store is great for write and erase. So is the little magic slate.
ADDITIONAL HOSPITAL NON VERBAL COMMUNICATION: l Magna Doodle from the toy store &/or Magic slate. n Preferable over a dry erase board as the eraser is built in. l Large pad of paper l A small bell for your bedside will help get attention. l A laptop l TELEPHONE USE WITH NO VOICE n Establish technique prior to surgery n Have nurse tell caller that pt. can communicate by touching a button on the phone, once for yes and twice for no, if the caller would ask questions.
Consultation Topics l Speech and Voice Rehabilitation n Immediate Post-Op Communication n Artificial Larynx n Esophageal Voice n Variations n Progression of the Rehabilitation Process
WHAT TO TAKE TO THE HOSPITAL l Clothes: Shirts that open in the front. l Take writing materials. l Take a good book, a small radio, a CD player, or a lap top, anything that will stimulate your brain and distract you.
PATIENTS VIEW OF WHAT TO EXPECT RIGHT AFTER SURGERY That you will have a feeding tube of some kind. That your neck (& ? face) will be very swollen. That you will have drains to help reduce the swelling in your neck. That you will have a humidifier with a tube and mask that should lie loosely by the stoma so you will be breathing in moist air. That they will suction out mucus and most hospitals irrigate with saline solution 4 x a day. That you will be up and walking faster than you think. That when you buzz for the nurse's station, they will answer without realizing you can't talk. Ring the bell you have brought and have by your bedside to remind them
Post-operative Laryngectomy Consultation l Review all information specifically in regards to the surgery that occurred. l Answer all questions l Oral Exam and Motor Speech Exam l Artificial Larynx Education and Evaluation Session