Proceso Electoral

An individual’s experience of limb loss appears to be greatly influenced by their ability to integrate the prosthetic device into their daily life in a personally meaningful way. The expectations that an individual has of the device impact on their experience and are also identified by the prosthetists as being influential on the rehabilitation process. Prosthetists perceive an expectation from the individuals that the prosthesis will provide a quick and easy fix to their limb loss but that they have a lack of appreciation of the complex interaction of

144 issues surrounding amputation and rehabilitation over and above the prescription of a prosthetic device. These are thought to be influenced by the portrayal in the media of high- functioning prosthesis use or from others who lack the professional knowledge to comment. The prosthetists therefore feel that they have a responsibility to “manage” these expectations and to tailor them to a reality which is more in keeping with their professional perceptions. Individuals admit a perception that the prosthesis would be able to “fix” them and allow them to return to their pre-amputation state. They express frustration when this is not the case and seem to have some difficulties appreciating the impact on life of using a prosthetic device. Again this does appear to be influenced by their perceptions of prosthesis use portrayed in the media and often they show little awareness of the differences between them and the high-functioning amputees that are highlighted. While the perceptions of the prosthetists that patients place too high an expectation on the device is in some cases founded, this highlights the need to address these issues at a clinical level and to acknowledge the influence they may be having on the individuals’ experience.

In terms of the integration of the device into daily living, both parties see the prosthesis as enabling and with the goal of returning to a pre-amputation level of activity where possible. However, the prosthetists indicate difficulties in terms of not always being able to meet the individuals’ expectations on these counts or being constrained within the system. They also express some difficulties in contending with patients who express dissatisfaction, often looking to the patient themselves for the source of the problem or to find the solution. Individuals do seem to be aware of the limitations that are placed on them in daily life with prosthesis use, which are mostly related to comfort and unexpected constraints. They seem to be able to find ways around these constraints for themselves although they also express a high level of anticipation of technological advances and solutions which is often unfounded.

Finally the priorities of each party relating to prosthesis use are discussed. For the most part, each party agreed on function as being of the greatest priority. However, in the

145 prosthetists’ experiences, it is revealed that often the patients’ view is not always fully considered or may be lost in trade off for the prosthetist-identified priority of function. While this may be constrained by systematic limitations, assumptions made by the prosthetists, based on other individual factors such as age and gender, should be considered for their role in clinical judgements. For the individuals, having a device which enables them, and which is useful and comfortable, was central to their experience. The concept of “useful” is personally specific and should be properly assessed in order to fully enable the individual in their particular circumstances.

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Chapter 7: Communication

Introduction

In the previous empirical chapters we have seen how prosthetists and individuals who have lost a limb share their understanding of the experience of amputation and rehabilitation to varying degrees. Issues of differing understanding within this experience often indicate the need for an evaluation of the conflicting perspectives between these two parties. Rehabilitation following amputation takes place with the relationship between prosthetist and individual at its centre. Aspects of this relationship are highlighted as being key components in shaping the experience of amputation and prosthesis use. Interactions between patient and practitioner are the main source of information sharing in this process and have the potential to influence preparation for and adjustment to limb loss. Divergent understandings of the level of such information sharing and understanding between the two groups has the potential to influence this adjustment and the overall rehabilitation experience. Patient involvement in care is also a key feature of these interactions. The understanding of the level of responsibility placed on the individuals within the context of a patient-led interaction varies between prosthetists and individuals. This varied understanding has the potential to impact on the experience of both groups and therefore requires further attention. Constraints and limitations under which the prosthetists must operate are discussed and the potential impact that these have on both the service provided and the experience of the individual are highlighted.

Exploration of the differing systematic expectations of each group begins with a discussion of the process itself and the understanding that each group has of it. Discrepancies in these experiences and a lack of shared understanding could lead to dissatisfaction and frustration for both parties. Similarly the expectations that each party has of the outcomes of rehabilitation, the way in which these are communicated and the potential

147 impact of incongruity is discussed. The perceptions of the NHS as being below par in comparison to private or military care seem to reflect the prior assumptions of individuals although this discrepancy is debated by the prosthetists.

Finally, the role of the prosthetist within the relationship and the rehabilitation process is discussed. The prosthetists view themselves as playing a complex, multifunctional role encompassing, not only technical expertise, but also social and moral support with ad hoc consideration of psychological issues. For the individual participants however, the prosthetists role comprised mainly of technical skills and provision of an appropriate device. Any additional support was found from a variety of other sources, both clinical and personal. Prosthetists highlighted the ambiguity of their role and the lack of psychological support services to which they could turn if needed. This posed a difficulty for prosthetists and should be considered as a potential area for further investigation.

Prosthetists’ Experience