Informed consent is a fundamental right of the patient or guardian. The patient or guardian must understand his or her diagnosis, treatment and prognosis in order to participate in treatment decisions. The patient has the right to be informed of any human experimentation or other research/educational projects affecting the patient’s treatment and to have the right to refuse participation in experimental research. Patients should be informed of outcomes, risks, side effects and other treatment options by the hyperbaric physician.
Patients who understand their diagnosis and treatment plan are happier, more confident, and more compliant. Patient education involves the entire staff of the hyperbaric facility. There should be open communication between all members of the staff and the patient. The physician must be able to communicate in a way that the patient can understand.
Health care providers need to speak in simple, clear terms, repeating instructions as needed. Easy to read written patient education materials combined with oral instructions and repetition of key points will greatly enhance patient understanding and cooperation.
Patient and family education should be begun prior to initiating therapy and continually reinforced throughout the treatment process. Teaching the patient should be facilitated with videos, pamphlets and group teaching/support groups. All pertinent information should be reviewed on a consistent basis.
Effective patient education is necessary for patient satisfaction and safety. It has proven to reduce hospital stays and to improve clinical outcomes. This proves to be both cost effective as well as good medicine.
It is important to address the following in communicating with the patient:
- Introduce all caregivers to the patient
- Ask the patient what he or she knows about HBOT—ascertain any preconceptions or misconceptions and concerns
- Assess the patient’s readiness and capacity to learn and understand, remembering to be age appropriate
- Assess the physical and emotional needs and concerns of the patient
- Manage the anxiety levels of the patient so the patient can cope and cooperate with treatment.
- Determine if there is any discomfort or pain and relieve it enough so the patient can tolerate treatment
- Adapt and customize the teaching process to the individual patient and family
- Make sure the patient understands what is expected of him or her and answer any questions. Create a comfortable and reassuring atmosphere.
Risks associated with HBOT should be discussed prior to consent with the patient and any family members. These risk factors include fire, barotrauma, oxygen toxicity of the central nervous system, pulmonary, and ophthalmic. Other hazards relate to pure oxygen being highly flammable. Thus, the use of electronics, cell phones, pagers, etc. is prohibited in the chamber. Even the fumes from the print in books and magazines as well as the paint on toys can produce sparks leading to fire.
The patient should be oriented about what they can expect to hear, feel and experience during treatment. Patients should be reminded to empty the bladder before treatment. The possible ear discomfort of treatment should be compared to that of traveling in an airplane.
Staff should explain the many normal noises in the monoplace chamber (the background noise of the oxygen entering the chamber, closing of doors, returning the mike after talking to the patient) that will be amplified because of the enclosed space. In a multiplace chamber, patients will also hear the opening and closing of the pressure valves to maintain chamber pressure.
The patient should be informed about temperature changes during compression and decompression should be discussed. (Charles’ Law of physics states that when pressure is increased and the container remains constant—the volume, the temperature will increase.)
The importance of breathing normally during pressure changes and instruction in ear equalization techniques need to emphasized to assure the comfort of the patient and the success of the initial and subsequent treatments.
The patient should be able to demonstrate an effective technique for clearing the ears—swallowing, chewing, yawning and tilting the head back. There may be a need to take a decongestant and/or use a nasal spray. Patient history should include a history of ear surgery. The patient should be instructed to notify the attendant of any sinus or tooth pain during pressurization. Upper respiratory infections and sinusitis can make it difficult for the patient to clear the ears and sinuses.
Patients are advised to breathe normally and not hold their breath in order to prevent the risk of rupturing a lung. Eating at least two hours before treatment is a good idea to prevent low blood sugar and hypoglycemia. To receive maximum benefit from HBOT, patients are encouraged not to smoke during the course of therapy because smoking causes blood vessels to constrict, restricting the blood and oxygen supply to the tissues.