Considering the psychological experience of amputation and rehabilitation for military veterans: a systematic review and metasynthesis of qualitative research.

PURPOSE: Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military. METHODS: A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss. RESULTS: Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond. CONCLUSIONS: Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes.

Implications for rehabilitationIdentify at an early stage of rehabilitation those veterans at risk for poorer adjustment, by examining their propensity or not to adopt goal pursuit and goal adaptation strategiesOffer psychological support prior to and after the transition to civilian lifeTarget psychological therapies, such as Cognitive Behavioural Therapy and Acceptance and Commitment Therapy, to veterans who are experiencing high levels of painEncourage peer support programmes and provide support and training to peer mentors.

Being a peer support mentor for individuals who have had a lower limb amputation: an interpretative phenomenological analysis.

Purpose: Although peer support has received research attention within different health related contexts, there is limited research considering individuals who have experienced an amputation. In particular, the peer mentoring role is under-explored. Therefore, this research aimed to explore the experiences of participants delivering peer support interventions to individuals with lower limb loss.Methods: Eight people who acted as peer mentors for people with limb loss took part in semi-structured interviews. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Results: Two overarching themes were identified from the data: "Developing a Helpful Self", in which the personal value and meaning of being a peer mentor is presented, and "Connecting with Vulnerability", which addresses the emotional challenges of peer mentoring and the impact of these on wellbeing.Conclusions: Findings suggest positive experiences of providing support, including increased hope, resilience and a sense of belonging and connection to others. However, peer mentors experienced challenges related to uncertainty and doubt about their mentoring abilities and with developing and maintaining resilience in the role. Recommendations include the development of training packages and increased clarity for volunteers of the peer mentor role.Implications for rehabilitationIt is important to define clearly the role of a peer mentor and the responsibilities this involves.Peer mentors should be provided with support and training to increase their confidence and ability to act appropriately when encountering distress.It is important to provide transparent guidelines and procedures to support peer mentors to minimize concerns over risk and safety.Feedback regarding how effective the support offered is and how it could be improved should be provided.

Insights into chronic obstructive pulmonary disease patient attitudes on ventilatory support.

PURPOSE OF REVIEW: A large proportion of chronic obstructive pulmonary disease (COPD) patients do not actually discuss ventilation and other end-of-life issues in the stable state. Such discussions often occur during the exacerbation itself. There is a paucity of data regarding attitudes of COPD patients toward end-of-life attitudes in general and specifically concerning the area of ventilatory support. RECENT FINDINGS: The majority of COPD patients feel end-of-life discussions are warranted in the stable state. Some studies have shown that increasing age and the presence of depression preclude patients from choosing life-sustaining treatment, whereas physicians were often inaccurate in judging patient preference for cardiopulmonary resuscitation and ventilation as they frequently underestimated patient quality of life. Patient information sheets and other tools may have a role as decision aids in end-of-life discussions. SUMMARY: Physicians should consider the discussion of end-of-life issues preferably when patients are stable. Decision aids may prove to be a valuable adjunct in framing treatments such as mechanical ventilation.