Improving the provision of emotional support for patients following major lower limb amputation.

Abstract

Major lower limb amputation (MLLA) is a lifesaving but life-altering surgical procedure. Psychological distress is common and typically heightened in the acute postoperative period. Despite the negative impact that poor psychological functioning can have on the health outcomes of this population, there is a lack of high-quality guidance outlining how to best support the psychological needs of individuals post-MLLA. The aim of this project was to develop practical and feasible interventions for improving the provision of emotional support for all patients on the vascular surgical ward post-MLLA. Adapted from the Holistic Needs Assessment Adversity-Restoration-Compatibility framework used within oncology services to provide holistic care to patients, the project included two key interventions. The primary intervention involved developing a model for an 'emotionally supportive conversation' (ESC), which was delivered by a member of the vascular surgical team under supervision of a Clinical Psychologist. During the 6-month implementation phase, 27 patients received an ESC, an average of 8 days post-MLLA. The secondary intervention involved training for vascular surgical ward staff, led by a Clinical Psychologist. This focused on raising awareness of common signs of distress, building skills and confidence in responding to distress and providing information on where to signpost patients for further support. Prior to the primary and secondary interventions, 43% of patients reported receiving sufficient information from hospital staff on how they would feel postoperatively and 57% stated they had received sufficient support from staff during their stay. Post-implementation, these figures increased to 86% and 71%, respectively. This project represents a novel, creative and cost-effective way for psychological services to add value to the quality of care provided to vascular surgical patients during the inpatient phase post-MLLA.