During the initial hyperbaric history and physical (H&P), the provider will prescreen each patient for contraindications as well as relative contraindications. Confinement anxiety or claustrophobia is fairly common. An estimated 10% of monoplace patients experience confinement anxiety. I, for one, am severely claustrophobic!
A patient once asked the provider and me to demonstrate the process of sliding into the chamber because the patient was very anxious about going into the chamber. I will never forget that moment when I suddenly got the gut feeling of dread, my palms started to sweat, and I tried to maintain my composure. Everything I had ever said to comfort a patient suddenly left me. I was now on the other side of the comfort zone!
I had to dig deep inside myself to find the strength I needed to do this, without displaying my fears to the potential patient. As I laid down on the gurney, my heart started racing and I kept telling myself, “I’m OK, I’m OK,” but then the tech closed the door. I wanted to scream, but I stayed focused on what I was trying to demonstrate for the patient. I made it through the agonizing 2-3 minutes laying there, but it was one of the hardest things that I had ever done. This gave me a clearer insight to what some hyperbaric patients experience.
Having gone through the process made me take a much closer look at what can be done upfront for a new hyperbaric patient who is claustrophobic. Although the provider can offer medication to the patient prior to their first hyperbaric treatment, I have found a somewhat successful method of resolution for the patient’s anxiety. Every new hyperbaric patient gets scheduled for a “dry run “before the first hyperbaric treatment. Providing a dry run for the patient accomplishes several things.
First, having patients sit on the gurney outside the chamber gives them time to emotionally prepare themselves without being under any time constraints. Second, this opportunity makes the patient feel in control and know the CHT will be with him or her the entire time. Gaining the patient’s trust is the goal. The third critical part of this dry run is for the CHT to slide the patient into the chamber. I always inform the patient what I’m going to do next, step by step. I have found the most important thing I say to the patient is, “I’m going to slide you into the chamber but will not close the door until both the intercom is turned on and you tell me you are ready!”
Once inside, I talk with the patient, informing him or her of the next step, such as placing the intercom phone back down or turning the TV volume on. This provides the patient with a similar experience as to what it will be like when hyperbaric therapy begins. I then tell the patient to lie there for a few minutes while I continue sitting next to him or her. This will allow the patient to have a clear and realistic understanding of what will be encountered on a daily basis.
Take home message: Take the time and schedule a dry run for your next potential patient. This may help eliminate his or her fears and the uncertainty he or she may have regarding a monoplace hyperbaric environment. It has been my experience that this will decrease the patient’s confinement anxiety.