74 Injury, 4, 74

Annotation Nursing and head injury

IT is not often the case that a surgical journal quotes a nursing journal but two articles in a recent issue of the Nursing Times (Griffin, 1972) deserve more than passing attention by doctors who have to look after victims of severe head injury. The matters discussed are of particular importance to nurses but may be unfamiliar to their medical colleagues, who should not remain entirely ignorant of them.

Nurses and social workers play a very impor- tant part in offering support and comfort to the patients' families. They should be able to feel that they can at any time call for medical support for their efforts to restore the patient both to the best possible condition and to his usual company and surroundings as soon as possible.

The relatives of lamebrain survivors of head injury have heavy personal burdens when the time comes for them to take some responsibility for the patients' care. A return to familiar faces and surroundings can have a strikingly beneficial effect. Trial outings and trial week-ends at home are well worth while for assessing the readiness of both the patient and his family for discharge.

The anxiety and attention of the early days can give way to disinterest, distaste, and avoidance when, as happens all too often, the person emerging from unconsciousness has little obvious resemblance to the person and personality that the family knew before. The foul habits, objec- tionable behaviour, and violent outbursts that can occur are unlikely to benefit from disciplinary measures. They owe a good deal to confusion and to lack of inhibition and there is often a large element of frustration, which has its origins in the fact that the patient cannot make known his thoughts and his needs. To the passer-by a patient may appear to be completely inert, even unconscious, whereas in fact he is acutely aware but unable to give expression to his awareness in a way that is understood. Unruly behaviour may be an exasperated attempt to attract attention and try to make someone understand.

Mrs. Griffin shows how much can be learned about a patient by studying carefully his reaction to nursing and related procedures and how important it is to know something about the personality of the patient before the accident. As she puts it, the slate is not wiped clean; the previous personality is still there but its expres- sion may be distorted and apparently completely altered.

As examples of the sensitivity and ability of her patient Jim, Mrs. Griffin describes his evident sorrow; his objection to less than the usual care in the cleaning of his mouth; his acceptance of some music and his objection to other. This was followed by his ability to select for himself the programme of his choice. Jim could spell his needs with the aid of a board upon which the alphabet and some everyday objects were painted. Such patients should be talked to as normally sentient persons and in the case of a man, the down-to-earth approach of a male nurse may rob toilet training of much of the embarrassment that it might cause a woman.

Meeting these standards requires uncommon devotion and patience and they cannot be met except in the privacy of a single room. When the time comes for the patient to be moved to a ward with other patients no such intensity of care and degree of devotion is possible, but the general effort to promote physical, emotional, and intellectual recovery must continue.

Occupational therapists and speech therapists may have much to offer and there is need for an understanding of educational psychology.

The measures described by Mrs. Griffin can be carried out on their own initiative by nurses and others but it is clearly preferable that they should work with the approval, and better still, the active--and probably admiring--support of their medical colleagues.

GRIFFIN, L. (1972), '"Jim"--Severe Head Injury', Nursing Times, 69, 231,235.