Counseling for the Laryngectomee

Counseling for the Laryngectomee

Who is an appropriate Counselor? Definition: A person who counsels;

an advisor

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 SkillsGilmore -97

1. Allow pt. to express, acknowledge & clarify feelings & concerns

2. Ascertain pt’s. knowledge, feelings & attitudes re: changes and problems….

3. Promote pt. problem solving4. Access, provide & evaluate needed info5. 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

Preoperative Laryngectomy Consultation

Pre-op Laryngectomy Consultation

Who should be present?

What do you do if they are not present?

Pre-op Laryngectomy Consultation

The SLP may be the first person who the patient is listening to when explaining the surgery; etc.

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

How do you introduce the subject???

Individually “Dr… has told me of your dx and has asked

me to talk to you about it” “I am sorry that you have been given some

bad news….

Pre-op Laryngectomy Consultation

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.

Frequently ask indirect questions throughout the session to assess understanding.

History

Educational Background Employment Status Family Status Visual Acuity Auditory Acuity Writing Skills Reading Skills

Consultation Topics

Anatomy/Physiology (Use Pictures/Models) Preoperative Postoperative

Operative site

Permanency of Voice Loss-Not loss

of Speech– /s-z/ production

Larynx Removal Stoma Stomal Respiration

continued

Consultation Topics

Alteration of Taste and Smell NPO Status Swallowing Alterations Surgical/Hospital Information

– 4-10 days Intensive Care Visit Family Information Healing

continued

Consultation Topics

Hospital stay communication

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.

Laryngectomee Needs Chart

ADDITIONAL HOSPITAL NON VERBAL COMMUNICATION:

Magna Doodle from the toy store &/or Magic slate. Preferable over a dry erase board as the “eraser” is

built in. Large pad of paper A small bell for your bedside will help get attention. A laptop TELEPHONE USE WITH NO VOICE

Establish technique prior to surgery 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

Speech and Voice Rehabilitation Immediate Post-Op Communication Artificial Larynx Esophageal Voice Variations Progression of the Rehabilitation Process

WHAT TO TAKE TO THE HOSPITAL

Clothes: Shirts that open in the front. Take writing materials. Take a good book, a small radio, a CD

player, or a lap top, anything that will stimulate your brain and distract you.

How much information ????????

1.Provide Additional Reading Material

Book Samples are

2.Possible Provision of Audio and/or Videotape Samples

Portray Confidence in your medical staff

PATIENT’S 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

Review all information specifically in regards to the surgery that occurred.

Answer all questions Oral Exam and Motor Speech Exam Artificial Larynx Education and

Evaluation Session

It’s Going To Be ALLRIGHT!!!!!!!!