T h e  la tte r  p o in t is well s h o w n  by  th e  u n s a tis fa c to ry  
p o st-trau m atic  c o u rs e  o f  o n e  o f  th e  tw o  p a tie n ts  w h o  
refused p h y s io th e ra p y . It is e sse n tia l th a t  th e s e  p a tie n ts  
are e n c o u ra g e d  t o  p e rfo rm  th e ir  ex erc ises effectively, 
which o fte n  n e ce ssitate s a s o m e w h a t ag g ressiv e  a p p ro a c h .

T h e  su rv e y  sh o w e d  th a t t h e  tim e  in te rv a l be tw ee n  
adm ission a n d  th e  c o m m e n c e m e n t o f p h y s io th e ra p y  to  
be r a th e r  lo n g . I t w o u ld  be in te re s tin g  t o  c o m p a re  th e  
a b o v e re su lts w ith  th o se  a ch iev e d  in p a tie n ts  tre a te d  
im m ediately a fte r in se rtio n  o f  th e  d ra in . H e n c e  it is 
re aso n a b le  to  a ssu m e  th a t  a p h y s io th e ra p is t on  n ig h t 
duty, w h o  w o u ld  see th e  p a tie n ts  im m e d ia te ly  a fte r 
insertion o f  in te rc o s ta l d ra in a g e  w o u ld  p ro v e  v e ry  
beneficial. O n  th e  o th e r  h a n d , d u e  to  th e  f a c t th a t a 
co nsiderable n u m b e r o f  cases a re  a d m itte d  in  a d ru n k e n  
state, c o -o p e ra tio n  fro m  su c h  cases w o u ld  be m in im al.

F in a lly , th e  effective tre a tm e n t o f  c h est w o u n d s 
requires t h a t  th e  p h y s io th e ra p is t be a b le  to  assess X -R a y  
changes, a n d  b e  a b le  t o  u se  a s te th e sc o p e . T h e  la tte r  
permits in s ta n t re c o g n itio n  o f  effective e x p a n s io n  a n d

Qja ra n c e  o f  se o retio n s, a n d  a ls o  a llo w s th e  p h y sio -e rap ist to  d e te c t a re a s  o f c o n s o lid a tio n  a n d  ate lec ta sis, 
enabling h e r to  v a ry  h e r tre a tm e n t m o re  in te llig e n tly .

(VIARCH, 1973 Page 15

R E F E R E N C E S :
E D W A R D S ,  F . R .  F o u n d a tio n s  o f  T h o r a c ic  S u rg e ry  
(E d in b u r g h : L iv in g s to n e , 1966.)
H O O D , R .  M . (E d.). M a n a g e m e n t o f T h o r a c ic  I n ­
juries. (S p rin g fie ld : T h o m a s , 1969.)
J O H N S O N , 1. S u rg e ry  o f  th e  C liest, 3rd  e d itio n . 
(C h ica g o : Y e a r  B o o k  M e d ic a l P u b lish e rs, 1964.) 
S H E F T , L . M . In itia l M a n a g e m e n t o f T h o r a c ic  a n d  
T h o r a c o - A b d o m in a l T r a u m a , 2 n d  e d itio n  b y  H e w le tt. 
(S p rin g fie ld : T h o m a s , 1968.)
B L A D E S , B . Su rg ic a l D ise a se s o f  the C h e st, 2 n d  e d i­
tio n . (St. L o u is : M o s b y , 1966.)
A .  S T E I N ,  F .C .S ., a n d  G . S c h n ie r, D .M .R .D . ‘P e n e ­
tra tin g  S ta b  W o u n d s  o f  th e  C h e s t’ —  S o u t h  A fr ic a n  
M e d ic a l Jo u rn a l, 3 rd  J u ly , 1965, N o .  24, V o l. 39.

A C K N O W L E D G M E N T S :
/  w o u ld  lik e  to  th a n k  th e  S u p e r in te n d e n t o f  B ara- 

g w a n a th  H o s p ita l f o r  p e rm iss io n  to  p u b lis h  th is  article. 
M y  th a n k s  are a lso  d u e  to  P ro fe s so r R . L ip s c h itz  a n d  
to  M r. B . R a b in o w itz  f o r  th eir h e lp fu l a d v ic e , to  M r . 
M e lv y n  P en n  f o r  p r in tin g  th e  p h o to g ra p h s, a n d  to  m e m ­
bers o f th e  P h y s io th e ra p y  D e p a r tm e n t o f  B a ra g w a n a tli 
H o s p ita l f o r  th eir c o -o p e ra tio n .

P H Y S I O T H E R A P Y

BOEKBEOORDELING
PSYC H O LO G Y  F O R  N U R S E S  A N D  T H E  H O S P IT A L

T E A M  d e u r E v ry l E . F ish e r.
D ru k k e rs : J u ta  & C o m p a n y  L im ite d , K a a p s ta d , W yn- 

berg, J o h a n n e s b u rg , 1972.
H ie rd ie  b o e k  b e h o o r t d e u r  a lle  led e  v a n  die p a ra - 

mediese sp a n  w a a rd e e r te w o rd . D ie  s k ry fs te r b e h a n d e l 
’n wye v eld v a n  d ie  s ie lk u n d e  e n  die to e p a ss in g  d a a r- 
van in die h a n te rin g  v a n  d ie  p a sie n t.

D ie p e rs o o n lik h e id s o n tw ik k e lin g  w o rd  b e sp re e k  m et 
betrekking to t die v e rh o u d in g  tu sse n  d ie  o rg a n ie s e  stru k - 
tuur en em osie, d ie  in v lo e d  v a n  o o re rw in g  op d ie 
p e rsoonlikheid en d ie  ro l v a n  d ie  m o e d e r to t d ie  k in d . 
In la a sg e n o e m d e  b e k le m to o n  sy d ie  effek w a t ho s- 
pitalisasie o f  o p n a m e  in  ’n in rig tin g  o p  ’n k in d  h e t, en 
hoe die k in d  h ie rd ie  v e rw y d e rin g  v a n  sy o u e rs in te r- 
preteer. V e rd e r w o rd  die ro l w a t die m o e d e r k a n  speel 
in die b e h a n d e lin g  v a n  h a a r  k in d  b e n a d ru k .

In d ie b e sp re k in g  o o r  d ie  e m o s io n e le  fu n k sio n e rin g  
f ' j  ’n d ie p e r v la k  w o rd  k lem  gelS o p  d ie  sk u ld  e n  sk a a m - 
_<!voelens, d ie o n g e m a k lik h e id , v rees e n  a n g s  w a t by  
pasiente g e v in d  w o rd , die o o rs a k e  d a a r v a n  en die 
pasiente se re ak sie  d e u r  a g g ressie, p r ik k e lb a a rh e id  en 
aandags'oekery. M o tiv e rin g  m et b e tre k k in g  t o t sam e- 
werking in b e h a n d e lin g s  en o p e ra s ie s  w o rd  b e sp re e k . D ie 
vordering v a n  ’n p a sie n t h a n g  d ik w e ls n o u  sa a m  m et 
sy m o tiv e rin g  o m  te w il o o rle e f —  en sy d u i d a a r o p  
hoe h ie rd ie  wil g e stim u le e r k a n  w o rd . T e g n ie k e  h o e  
die p a sie n t g e h e lp  k a n  w o rd  om  a a n  te  p a s  e n  w a tte r 
hulp d ie  lede v a n  d ie  h o s p ita a ls p a n  h ie rto e  k a n  v e rle en , 
word o o k  b e sp re e k . H ie rm e e  sa a m  w o rd  d ie  le e rp ro se s 
behandel en is v e ra l v a n  w a a rd e  waair d ie p a sie n t by  
nuwe o m s ta n d ig h e d e  (bv. se re b ra le  tr a u m a , c h ro n ie se  
siektetoestand, v erlies v a n  ’n le d e m a a t) m o e t a a n p a s .

D ie k o rt h o o fs tu k  o o r  p yn en h o e  v e rsk ille n d e  in d i- 
widue d a a r o p  re a g e e r is o o k  w a a rd e v o l. L e d e  v a n  die 
hospitaal sp a n  w o rd  d a a r o p  gew ys h o e  om  py n  m ee r 
a a n v a a rb a a r te m a a k .

D a a r  v olg ’n b e s o n d e r in sig g ew en d e  en b re e d v o e rig e  
hoofstuk o o r d ie  e m o s io n e le  u itw e rk in g . w a t siek te en 
pyn op  d ie  k lein  k in d jie , a so o k  o p  d ie  a d o lle s e n t het. 
Die b e la n g rik h e id  v a n  die ro l w a t die o u e r s  h ie r k a n  
speel w o rd  te lk e n s b e n a d ru k . In  n o u e  v e rb a n d  h ie rm e e  
word die fisies g e stre m d e  k in d  o f c h ro n ie se  sie k  k in d

b e sp re e k  en h o e  h u lle  re a g e e r o p  b e h a n d e lin g . D a a r  is 
in h ie rd ie  h o o fs tu k , so w el a s  d ie  v o lg e n d e  o o r die 
v ro u e  p a sie n te  in  die m e n o p a u s e  e n  p a s ie n te  v a n  h o e  
o u d e rd o m  gew ys h o e  tra u m a tie s e  o n d e rv in d in g s in  ho s- 
p ita lis a s ie  o f se k e re  b e h a n d e lin g s (h e tsy  a s k in d , o f
a.g.v. o p v o e d in g s o p v a ttin g e ) k a n  lei to t e m o s io n e le  
tr a u m a  m e t se lfs irra s io n e le , selfs o n d a n k b a re  h o u d in g  
v an d ie  p a sie n t. D it  k a n  v e ral in  lg. tw ee (m e n o p a u se  
en h o e  o u d e rd o m ) v e ro o rs a a k  w e es d e u r e n d o k rin e  
v e ra n d e rin g e  o f  d e g e n e ra tie w e  p ro se sse , en d is g o e d  d a t 
d ie  p a ra m e d ie se  sp a n  d it in  a g  n e e m  b y  h a n te rin g  van 
die p a sie n te .

D a a r  v o lg  ’n k o r t o o rsig  o o r n e u ro s e  en psigose. W a t 
e g te r m e e r w a a rd e v o l is, v e ral v ir fisio te ra p e u te  en a n d e r 
p a ra m e d ie s e  lede b y  sp e sia le  sk o le  v ir fisies o f  se re b ra a l 
g e stre m d e s , is die b e sp re k in g  v a n  s u b n o rm a le  in te lli- 
ge n sie  en to e s ta n d e  w a t v o lg  o p  g e lo k a lis e e rd e  b re in - 
b eserings. D a a r  is o o k  ’n  h o o fs tu k  o o r die o n tw ik k e lin g  
v a n  die k in d  en n o rm e  w a t as le id ra a d  m ag  d ien.

’n W a a rd e v o lle  h o o f s tu k  is die o o r sie lk u n d e  in  v e rlo s- 
k u n d e . D ie  v o o rg e b o o rte lik e  ty d p e rk  m e t vrees, a ngs 
en o p g e w o n d e n h e id , d ie  b e la n g rik h e id  en sie lk u n d ig - 
fisio te ra p e u tie se  b y s ta n d  g e d u re n d e  k ra a m  w o rd  n o u - 
k e u rig  b e sp re e k . D a a r  w o rd  v e rd e r v erw ys n a  die 
v e rsk il tu sse n  p o s t-n a ta le  „ b lu e s ”  (n e e rsla g tig h e id ) en 
p n e p e re le  psigose.

Sy s k ry f in ‘n  w e te n s k a p lik e , d o g  m a k lik  b e g ry p b a re  
styl s o d a t b e g rip p e  e e n v o u d ig  e n  d u id e lik  u ite e n g e sit 
w o rd . Sy lig d a n  o o k  v e rd u id e lik in g s d ik w els m e t v o o r- 
b e e ld e  o f  in te re s sa n te  sta tistie k e  to e . Sy b e p le it v o o rt- 
d u re n d  d a t  tyd g e n ee m  w o rd  o m  p a s ie n te  te v e rd u id e lik  
w a a ro m  se k e re  b e h a n d e lin g e , o p e ra sie s o f h o sp ita lisa sie  
n o d ig  is, e n  e e rlik h e id  so v e r m o o n tlik  (v e ra l te n  o p sig te  
v a n  b e h a n d e lin g e  w a t p y n  sal v e ro o rs a a k ). S im p a tise e r 
lie w e r m e t p a s ie n te  d e u r jo u s e lf m e t d ie  p a s ie n t te 
identifiseer, o f tr o o s  (v e ra l ’n  k in d ) d ire k  d a a r n a  m a a r  
m o e t n e t n ie  o n w a a rh e d e  v e rte l nie. D ie  b e la n g rik s te  
f a k to r  b ly  e g te r d i e  ty d  w a t a a n  die p a s ie n t g e g u n  m o e t 
w o rd  s o d a t h y /sy  h u l v re se, b e k o m m e rn is se  (d a lk  by 
h u l h u is) en p ro b le m e  m e t jo u  k a n  b e sp re e k  e n  jy  v ir 
h u lle  v e rd u id e lik in g s k a n  gee w a t h u lle  m e e r  g e n e e  sal 
m a a k  o m  h u l b e h a n d e lin g  (o f b e h a n d e lin g  o p  h u l 
k in d e rs o f  geliefdes) te  a a n v a a r.

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