Psychological Adjustments of Patients to Burn Injury

In Partial Fulfilment of the Requirements for Nursing Research

Submitted by: Manlangit, Sharmaine Gay Dela Torre, Aline Ramillano, Kristen Rae Paraji, Sabrina Balbuena, Dexter Ho, Donaline Albrecht, Stephanie Zharlynne Camlian, Alamen Salinas, Sarah Jane Lamberte, Bryan Yosores, Arvin Roi Formilleza, Arnie Luy

March 6, 2013 BSN III - D

TABLE OF CONTENTS
I. INTRODUCTION a. Background of the Study. 3 b. Statement of the Problem.3-4 c. Significance of the Study.....4 d. Scope andDelimitation..4-5 REVIEW OF RELATED LITERATURE.. .6-16 a. Conceptual Framework...17 b. Theoretical Framework ..18 c. Definition of Terms....19-20 METHODOLOGY..21-24

II.

III.

IV.

TABLE OF SPECIFICATION FOR DATA GATHERING.25-28

V.

FLOWCHART OF THE RESEARCH PROCEDURE29 BIBLIOGRPAHY ....30

VI.

INTRODUCTION
A. Background of the Study

Burn injuries are common traumatic experience which can set an enormous amount of stress and strain on an individuals psychological state. (Lawrence et al. 2006, Klein et al. 2007, Ulrich et al. 2009)

Commonly, burn injuries are followed by psychological difficulties. The patient may seem to be dealing with his or her injuries and the circumstances well; however, once the permanence of the situation hits them as reality and the lengthy therapy process is comprehended, the patient becomes submerged in psychological difficulties in the forms of resentment, depression and anxiety. The patient may also feel an unexplained feeling of loss, grief for his or her old life, identity and meaning.

However, due to the improvements in the emergency services and burn treatment in the past century more and more burn survivors are required to make psychosocial adjustments to cope with their new body image. (Lawrence et al. 2006, Klein et al. 2007, Ulrich et al. 2009)

Thus the researchers of this research shall develop the study Psychological Adjustments of Patients to Burn Injury.

B. Statement of the Problem This study aims to assess the psychological adjustments of 3rd-degree burn patients. Thus, it seeks to answer the following questions:
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1. What are the common psychological problems of 3 rd-degree burn patients? 2. What are the coping strategies and methods utilized by 3 rd-degree burn patients? 3. What are the effective coping strategies to be utilized in the care of burn patients?

C. Significance of the Problem This study will provide baseline information that presents the psychological difficulties experienced by 3rd-degree burn patients and certain coping strategies they utilized. Thereafter, it would help the researchers to come up with a plan of care as to what effective coping strategies are to be implemented.

This study also intends to highlight areas within this field which may be in need of assessment, improvement and/or complete development, and in turn improve standards and quality of patients psychological care.

D. Scope and Delimitation

This research study centers on the different psychological difficulties experienced by 3rd-degree burn patients.

Qualitative research will be used because a small selective sample provides an in-depth nature of the study and the analysis of the required data.

I. II.

A minimum of five and a maximum of ten respondents. Thirteen to thirty-year-old 3rd-degree burn patients admitted at the burn unit of Zamboanga City Medical Center.
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III.

Thirteen to thirty-year-old 3rd-degree burn victims with 3 to 6 months in the recovery phase prior to discharge at the burn unit of Zamboanga City Medical Center.

Review of Related Literature

Importance of Psychosocial Care Treatment of people with burn injuries includes recovery of optimal function for survivors to fully participate in society, psychologically and physically. Increased likelihood of physical survival has led to greater concern for potential psychological morbidity for the burn survivor. Surgical and medical technology has improved to such an extent that now, in most cases, burn care providers must assume that the patient will live. They must be aware, even in the first moments of treatment, of what will be important to the surviving patient. Burn survivors experience a series of traumatic assaults to the body and mind which present extraordinary challenges to psychological resilience. Contrary to what might be expected, empirical data regarding the long-term sequelae of burn injury indicate that many burn survivors do achieve a satisfying quality of life and that most are judged to be well-adjusted individuals. However, thirty percent of any given sample of adult burn survivors consistently demonstrate moderate to severe psychological and/or social difficulties. Similarly, most pediatric burn survivors, even those with the most extensive and disfiguring injuries, adjust well. Empirical studies, as well as clinical observations and patient self-reports, suggest that burn care of the whole person, including early and continued attention to psychosocial aspects of the patients life, can facilitate positive psychological adaptation to the challenges of traumatic injury, painful treatment, and permanent disfigurement. Estimates vary, but between one and 10 per cent of the UK population are believed to have a disfigurement such as a scar, blemish, or deformity which seriously hinders their capacity to lead a normal life (Office of Population Censuses and Surveys, 1988, p.65; Valente, 2004).

Disfigured individuals frequently report severe difficulties in social encounters (Jowett & Ryan, 1985; Lanigan&Cotterill, 1989, Porter et al., 1986, 1987, 1990; van der Donk et al., 1994). Studies using actors made up to look disfigured found that people offered less help and stood further away from people with a visible difference (Bull & Stevens, 1981; Piliavin et al., 1978; Rumsey et al., 1982). Some people whose faces have been disfigured can suffer a so-called social death. Unless they are given psychotherapeutic and social help in time, social death may instigate death by suicide (Konigova&Pondelicek, 1987). While many seek medical or surgical treatments for disfigurement, there are limitations as to what can be achieved, and for most people affected disfigurements are a lifelong condition (Clarke, 1998). Most of those with a visible difference continue to hope for facial surgery, creating a continued dissatisfaction with self (Richman, 1983). Surgery alone is not sufficient (McGrouther, 1997); it does not fix emotions (Hearst, 2007). PSYCHOLOGICAL IMPLICATIONS Burn victims are at increased risk of developing various psychological disorders. It is evident that preburn factors influence the post burn adjustments. Many studies recognise three major disturbances which occur after burn injuries including; depression, anxiety and posttraumatic stress disorder (PTSD) (Tebble et al. 2004, Lawrence et al. 2006, Williams et al. 2008 &Ullrich et al. 2009). Lawrence et al. (2006) states that depression is the most widespread disorder on follow-up, among burn survivors. Depression Depression is a major implication of burns, experienced by the majority of burn patients. Moi et al. (2008) in a qualitative study discuss the findings of their 20 open, in depth interviews with burn survivors. Their aim was to gain an understanding of their experiences. They selected a
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purposive sample from the national burn centre of Norway; there were 14 participants the majority of which were men. These survivors discussed the implications (mainly physical) which they have to cope with every day. They explained how their bodies now told their story for them, the scarring a permanent tale. Dealing with an unfamiliar body, many avoided the first mirror image after dressings were removed; some described how months later they still got a surprise when they saw their own reflection. A vulnerable body can be difficult to manage, which all burn survivors must learn to do. This affects the survivors life in many ways. Their new skin is fragile; requires a lot of protection. There is a risk of injury without sensing it, unable to sense warmth and cold. Not only do the physical aspects affect the patient, but also the psychological aspects, many survivors discussed how they experienced feelings of isolation, social withdrawal and feelings of stigmatisation. These results from the interviews portray factors which are predisposing factors of depression leaving burn survivors very susceptible. Anxiety As well as depression, anxiety is frequently witnessed in burn survivors. There are two forms of anxiety; state anxiety and trait anxiety. State anxiety is a continuously changing condition, trait anxiety remains more stable (Hulbert-Williams et al. 2008). State anxiety is often experienced with slow recovery and wound healing. Anxiety in burn patients may occur due to psychosocial matters, such as grieving over the loss of their previous appearance or troubled by reactions of others (Partridge & Robinson 1995). Hulbert-Williams et al. (2008) suggests that sufferers of major burns experience higher levels of distress when compared with those who have minor burns. In contrast Tebble et al. (2004) claims that injuries no mater what size may have a psychological impact on a patient according to literature (Shepard et al. 1990; Bisson& Shepard 1997; Padadopolous et al. 1999; Smith 2000).
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PSYCHIATRIC DIAGNOSES Acute stress disorder The DSM-IV includes the diagnosis of ASD, which may be made as early as 3 days following the traumatic event. Composed of dissociative, intrusive, avoidant, and arousal symptoms, the formulation of ASD emphasises dissociative symptoms. To be diagnosed with ASD, one must experience at least three of five possible dissociative symptoms but only one intrusive, avoidant, and arousal symptom. ASD was added to the DSM-IV, at least in part, on the basis of retrospective studies that documented the presence of dissociative symptoms including

derealisation, depersonalisation, emotional numbing, and a reduction of awareness in ones surroundings following various types of accidents. Speigel and colleagues have argued that a dissociative syndrome characterised by depersonalisation, derealisation, and psychic numbing is prominent immediately following a traumatic stressor. Post-traumatic stress disorder A diagnosis of PTSD requires the presence of at least one intrusive symptom and three avoidant and two arousal symptoms, each of which must persist for at least 1 month. Three of the dissociative symptoms included in the ASD diagnosis (depersonalisation, derealisation, and time distortion/daze) are new to the DSM-IV; the other two (numbing, amnesia) have been previously classified as avoidant symptoms within the PTSD diagnosis. Burn injury has occupied a unique role in the trauma literature. Beginning with the work of Cobb and Lindemann in 1943 documenting acute psychological responses to the Cocoanut Grove fire, studies of burn injury have offered perspectives which have helped validate the idea that trauma has mental health consequences. In a study, Cobb and Lindemann described dissociation, re-experiencing, avoidance, and acute

grief in those people hospitalised for burns following the Cocoanut Grove fire. More recent studies have documented that up to 45% of adults who were hospitalised for their burn injury have PTSD 1 year later and that severity of intrusive and avoidant PTSD symptoms within 1 week of injury predicts chronic PTSD. PAIN, DEPRESSION, AND PHYSICAL FUNCTIONING FOLLOWING BURN INJURY Depression following burn Much greater variability is found when outcomes beyond

survivability are considered. For example, depression is well recognised as a significant problem following burn injury. For most burn survivors, average scores on depression indices fall within the mild to moderate range. However, moderate to severe symptoms of depression have been found in 1845% of burn survivors, years after their physical injuries have healed. Pain following burn Pain is another serious problem for burn survivors, particularly during the early phases of burn care when open wounds are being subjected to debridement and movement therapies. In addition, pain remains a concern for years after burn injury wounds have closed. Choniere and colleagues found ongoing pain concerns in 35% of a sample of burn survivors, at least 1 year after injury. Similarly, Dauber et al. found that 52% of burn survivors who were on an average of 10 years after injury reported the presence of pain. Of those with pain, 45% reported that pain interfered with their daily lives. Malenfant and colleagues found pain in over 36% of their sample and demonstrated that pain prevalence did not vary greatly between 1 and 4 years after injury. Although noting that the average severity of pain was mild (3.4 on a 0 10 visual analogue
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scale) among burn survivors, Malenfant and colleagues point out that pain severity varied widely both within and between patients. For example, 19% of their sample reported average pain as severe. Association of pain, depression and functioning Pain and depression represent suffering for burn patients, thus deserving attention in research and clinical settings. In addition, both pain and depression have been associated with other negative outcomes among burn patients. For example, two studies have demonstrated that elevated pain during hospitalisation for burn injuries is associated with poorer adjustment and reduced physical functioning up to 2 years after discharge from the hospital. Depression has been associated with reduced physical function and change in physical health over time among burn patients. Although past studies have clearly shown that pain and depression have prospective associations with physical functioning, much less is known about how these conditions might interact as predictors of functioning among survivors of burn injuries. Cognitive behavioural theories of pain, depression, and functioning have emphasised that certain cognitive processes associated with pain and depression may make the co-occurrence of these conditions especially deleterious to functioning. For example, persons with pain and depression show enhanced memory for negative self-referent pain and illness information as compared with persons with pain who are not depressed. Vlaeyen and Morley have noted that co-occurring pain and depression may activate cognitive processes that guide a person towards completing or terminating a task. For example, a person may terminate a functional activity as soon as he or she no longer enjoys the task, perhaps due to pain perceptions. Understanding associations between pain, depression, and physical functioning is critical because burn survivors have considerable difficulties in returning to personal, social, and community roles after their injuries have healed.
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PSYCHOSOCIAL MECHANISMS Many disfigured people find that coping with the daily trials of living with their difference is so difficult that aloofness or total withdrawal is their only options. Others use a range of strategies to help them function. Depending on the individual and on the situation, these may be overt or covert, aggressive or passive, hostile or receptive. For example, when stared at, many individuals feign unawareness or look away, whereas others stare back or make defiant remarks, Take a good look (Macgregor, 1990). Others adopt more positive methods, such as compensating for their difference with charm (Macgregor, 1974), or helping themselves by helping others. Social Support Social support has been defined as information leading people to believe that they are cared for and loved, esteemed, and a member of a network (Cobb, 1976). Social functioning is often the ultimate goal for both biomedical and psychosocial interventions for disfigurement (Ong, Clarke, White, Johnson, Withey& Butler, 2007), and the use of avoidance and concealment illustrates the overriding concerns of social exclusion among the disfigured (Goffman, 1963). Ong, Clarke, White, Johnson, Withey& Butler (2007) suggest that successful adjustment in disfigurement lies in the ability to interact with other people at various levels, from meeting people for the first time to enjoying an intimate relationship. The quality of perceived social support has been found to be particularly important to adjustment in a number of studies (Baker, 1992; Blakeney, Portman, & Rutan, 1990; Browne et al., 1985). High-quality social support is a powerful resource aiding adaptation. Reported benefits of social support include encouragement to enter anxiety-producing settings, reassurance of acceptance regardless of appearance, and the
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development of adaptive cognitions. Carver and Scheier (1981) found that social support can serve to facilitate the development of problem-focused and emotion-focused coping strategies. Helpful comments from friends and relatives were internalized by participants and used as part of their self-talk (Thompson, Kent & Smith, 2002). Poor quality support hinders adjustment e.g. by adding to existing demands and exacerbating or prolonging negative emotions (Furness, Garrud, Faulder& Swift, 2006 [19]). The Fear-Avoidance Model Newell (2002) explains the variation in ability to cope with visible difference in terms of a fear-avoidance model rooted in cognitive behavioural therapy. Based on Lethem et al.s (1983) fear -avoidance model of exaggerated pain perception, the model predicts that fear of, and anxiety in, social situations results in avoidance coping because it limits exposure and habituation to others behaviour (Newell, 1999). Avoidance is associated with problematic long-term adjustment, poorer quality of life and negative affect (Cochrane & Slade, 1999; Wahl, Hanestad & Wiklund, 1999). Cahners (1992) argues that avoidance thwarts the development of coping strategies and does not allow for disconfirmation of unrealistic beliefs. Conversely, people predisposed to confront such situations headon will feel their anxiety decrease as they perform the activity more, and will cope better (the rationale behind exposure therapy in phobias etc) (Newell, 2002). According to Newell, arguably the most important thing about the fear-avoidance model is that it emphasizes the normality of psychological distress following disfigurement (Newell, 2002).

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Theories of Small Group Communication Functional Theory The functional approach to small group communication is concerned with the results or outcomes of group behaviours and structures. This perspective sees communication as the tool group members use to solve problems and make decisions. Communication helps group members by promoting rational judgments and critical thinking, as well as preventing group members from faulty decisionmaking and flawed problem solving. Thus, communication is instrumental because it provides the means by which group members can achieve their goals. From a functional perspective, researchers are concerned with identifying the specific aspects of group communication and structure that produce the group's desired outcomes. Symbolic Convergence Theory Symbolic Convergence Theory studies the sensemaking function of communication. "Symbolic" refers to verbal and nonverbal messages and "convergence" refers to shared understanding and meaning. In small groups, members develop private code words and signals that only those inside the group understand. When groups achieve symbolic

convergence, they have a sense of community based on common experiences and understandings.

Central to this theory is the idea that group members share fantasies that serve as critical communication episodes, forming the basis for members' sensemaking. Sharing fantasies helps group members create a social reality that indicates who is part of the group and who is not. Sharing fantasy themes increases group cohesiveness as members develop a common interpretation of their experiences. Fantasy themes are stories or

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narratives that help group members interpret group interactions and their surrounding environment. Fantasy themes develop when group members actively engage in dramatizing, elaborating on, and modifying a story. In this way, the story becomes publicly shared within the group as well as privately shared by each group member. Fantasy themes are related to small group culture in that the stories reveal the group's identity and underlying values. Structuration Theory Structuration Theory distinguishes between systems, such as small groups, and structures, the practices, rules, norms, and other resources the system uses to function and sustain itself. When applied to small groups, Structuration Theory views small groups as systems that both produce structures and are produced by structures. This means that group members follow particular rules in their interactions that produce some sort of outcome. That outcome eventually influences the group's future interactions.

Naturalistic Paradigm Like Systems Theory, the Naturalistic Paradigm is a general approach that is applicable to many communication contexts and academic disciplines. When applied to small groups, the Naturalistic Paradigm focuses our attention on "real life" groups.

The Naturalistic Paradigm addresses a major fault in small group research-its reliance on zero-history groups in which strangers interact in a laboratory setting to solve an artificial problem. Researchers using the Naturalistic Paradigm study groups situated in their natural settings.

Unlike Functional Theory and Structuration Theory, which assume there is

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a measurable, objective reality, the Naturalistic Paradigm assumes that communicators construct social reality as they interact. Research within the Naturalistic Paradigm is qualitative (e.g., observation, in-depth interviews) and assumes that researchers' values and biases are part of the research process. Researchers look at the relationship between researcher and study participants as an interdependent one. That is, communicators are not simply objects to be studied, but are partners in the research process. For example, researchers within the Naturalistic Paradigm often ask study participants for their responses to the researchers' report. Those responses then become part of the report or are used to modify the report.

The Naturalistic Paradigm focuses the researcher's attention on human communication as it naturally occurs. In small group communication research, this means that researchers study real groups in their natural settings. The greatest strength of the Naturalistic Paradigm is its focus on naturally occurring small groups. We learn about the idiosyncrasies and similarities of communication practices and norms as group members coordinate their interactions in everyday life. Second, the Naturalistic Paradigm has greatly broadened our conceptualization of small groups and moved the study of small groups outside the corporate context and traditional task groups. Third, the Naturalistic Paradigm study of small groups working in their natural contexts has produced advances in communication theory and practice.

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CONCEPTUAL FRAMEWORK
COMMON PSYCHOLOGICAL PROBLEMS EXPERIENCED BY BURN PATIENTS Stress due to: Body image disturbance Further complications Changes in activities of daily living Fear of total dependence Sleep disturbance Depression and anxiety brought about by current situation Financial difficulties

COPING STRATEGIES/METHODS UTILIZED BY BURN PATIENTS Communication Elicit openness to verbalize and share feelings related to his or her condition or situation Support System Willingness of family or significant others to aid in clients recovery Stress Management Ability to accept and adjust to current condition or situation

Development of effective coping strategies to the different psychological problems exhibited by the burn patients

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THEORETICAL FRAMEWORK

INPUT

PROCESS

OUTPUT

Gather support systems and other theories for the integration of the plan of care for burn patients Strategies and methods management

Design an effective plan of care for burn patients based on the gathered theories Process steps in the delivery of the plan of care for burn patients

Integration of the effective coping strategies for the psychological care to burn patients Implementation of the different strategies and methods management

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Definition of Terms
A. Assessment - an identification by a nurse of the needs, preferences, and abilities of a patient. Assessment includes an interview with and observation of a patient by the nurse. B. 3rd-degree burn - also called full thickness burn. A third degree burn destroys both the epidermis and the dermis, often also involving the subcutaneous tissue They cause white or blackened, charred skin that may be numb. C. Burn patients those patients suffering from third degree burns, admitted in the hospital. D. Psychological dimension - the aspect that focuses on the patients way of thinking and coping in relation to his or her social and physical environment. E. Psychological problems refers to the difficulties that the patient encounters in terms of his/her function of awareness, feeling or motivation. F. Coping strategies any effort directed by the patient toward stress management; the factors that enable the patient to regain emotional equilibrium after the stressful experience. G. Debridement - the process of removing nonliving tissue from burns and other wounds. H. Support system refers to the people who provide assistance to the patient, such as physical support and emotional support. I. Stress any emotional, physical, social, or economic factor that the patient experiences which requires a response or change.

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J. Financial problems pertains to the difficulties relating to money matters experienced by the patient or his/her significant others. K. Communication the exchange of thoughts, messages, or information, as by speech, signals, or behavior of the patient. L. Stress Management the techniques that the patients use to cope with or lessen the physical and emotional effects of their current condition or situation. M. Body image - Body image is the patients subjective concept of his/her physical appearance. N. Body image disturbance - the way one perceives ones body image. Defining characteristics include verbal or nonverbal responses to a real or perceived change in structure or function, a missing body part, negative feelings about the body, trauma to a nonfunctioning part, a change in general social involvement or lifestyle, and a fear of rejection by others. L. Total dependence the total reliance of the patient to other people for support to perform basic and daily activities. M. Sleep disturbance refers to the patients difficulty to sleep because of psychological factors such as if the patient is experiencing anxiety. N. Depression - a major implication of burns, experienced by the majority of burn patients. It is a mood disturbance characterized by feelings of sadness, despair, and

discouragement resulting from and normally proportionate to some personal loss or tragedy. O. Anxiety refers to the patients feeling of apprehension, uneasiness, agitation, uncertainty, and fear resulting from the anticipation of some threat or problem.
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METHODOLOGY
This chapters aim is to present the methods and procedures that will be used by the researchers in the gathering, describing, and inferring of the data and information. The subject of the research and the statistical data collected will both be included to be used as a method of apprehending the goals and objectives of study to be conducted.

A. Research Design

Qualitative research design is a systematic, subjective approach to describe life experiences and give them meaning (Burns and Grove, 2009). It allows exploring of behaviors, perspectives, feelings and experiences in depth, quality and complexity of a situation through a holistic framework (Holloway and Wheeler, 2002)

This study will be a qualitative study that will strive to seek the problems that 3rd-degree burn patients experiences psychologically by collecting data from thirteen to thirty-year-old 3rd-degree burn victims admitted at the burn units of Zamboanga City Medical Center.

B. Sampling Method

The sampling method to be used is the non-probability sampling, the purposive method in particular. Non-probability purposive sampling will be used due to the fact that the researchers will gather the respondents of the study from the burn units of the Zamboanga City Medical Center.

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Inclusion: A minimum of five and a maximum of ten (in order to gain detailed accounts of the responses and allowing for large amounts of information to be analyzed, a small population was chosen). Respondents are under the category of 3rd degree burn patients. Respondents who are admitted at the burn unit of Zamboanga City Medical Center. Respondents with 3 to 6 months in the recovery phase prior to discharge at the burn unit of Zamboanga City Medical Center. Participants should be aged between thirteen to thirty years old (so as to obtain a more detailed and clear response). Respondents with visible burnt areas such as the face, arms, and legs. Respondents who have or who have not undergone debridement.

Exclusion: Respondents below thirteen years old and above thirty years old. Respondents who are not willing to participate. Respondents who are not capable of being interviewed due to the severity or extent of the affected body part. Respondents with more than 6 months of recovery phase prior to discharge at the burn unit of Zamboanga City Medical Center.

C. Data Collection

Researchers of the study will start the collection of pertinent data from June of 2013 until September of 2013. The researchers will secure permission to conduct the study in Zamboanga City Medical Center from the Chief Nurse and consents from the patients or their significant others before conducting the study in consideration with legal matters and issues.

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The researchers will perform open-ended interviews, which will allow the respondents to freely express their point-of-views and experiences in full detail, to five to ten of the thirteen to thirty-year-old aged 3rd-degree burn patients admitted at the burn unit of Zamboanga City Medical Center and those who patients who are within 3 to 6 months in the recovery phase prior to discharge at the burn unit of Zamboanga City Medical Center.

A semi-structured interview will also be used by the researchers hence, a topic guide and a set of certain and related questions will be prepared.

A face-to-face interview will be used in the study in order to permit the researchers to observe and interpret any non-verbal communication performed by the respondents and in order for both the researchers and respondents to make necessary clarifications.

The interviews will be involving ten to fifteen open-ended questions solely constructed for this study. The interview is estimated to last for at least fifteen to twenty minutes.

The interview will be recorded through an audio recorder with the permission from the respondents so as to gather an accurate and precise account of the interview. The recorded outcome will be replayed for the purpose of analysis and interpretation and the anonymity and

confidentiality of the respondents will be a priority of the researchers during the whole course of the study.

The respondents will be guaranteed that they have the right to withdraw or terminate the interview anytime that they feel necessary.

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The interviews will be lasting for at least three to five days which will allow the researcher to study the answers of the respondents and make necessary adjustments.

D. Validity and Reliability of Tool The validity of this studys contents will be ensured through tool validating to be performed by an expert in the field of tool development and by comparing the contents of the study to review of related literatures.

The participation of the teachers in the study will guarantee the reliability of the tools.

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Table of Specification

TABLE OF SPECIFICATION FOR DATA GATHERING

Research Question

Data Needed

Blueprint of Tool

1. What are the Difficulties: common psychological problems of Stress due to: Disturbed body image Further complications Changes in the activities of daily living Fear of total Dependence Sleep disturbance Depression and anxiety brought about by current situation Academic, occupational, financial and social difficulties 3. What are the factors that trigger the difficulties that you experience? 2. Are you having difficulties in adjusting with the situation? 1. What difficulties do you most experience after the burn incident?

burn patients?

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Financial Problems due to: Expenses for operations Inability to settle hospital fees Inability to find sufficient finances

4. What will you do in case of financial shortage?

Support System: The availability of family members and/or significant others Willingness of the family members and/or significant others to aid in clients recovery.

5. When you cannot handle the situation, does your family, partner, or significant others, pay attention to your needs? How?

Coping and acceptance of the present physical condition or situation

6. Do you find it hard to cope with the daily difficulties that you experience? If so, how do you cope?
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2. What are the Coping Strategies: coping strategies methods utilized by 3rddegree patients? burn and Communication Elicit openness to verbalize or to share feelings and emotions related to his/her present condition or situation. 2. When you have problems, how do you and your partner or other family members talk about it? 1. Do you find this method effective in handling the difficulties?

Support System

3. When you cannot handle the situation, to whom do you seek help?

4. Do your parents, partner, or significant others help you with your problems? How?

5. Is there any organization that you are involved that help you alleviate your problems?

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Stress Management: Ability to accept and adjust to current condition or situation

6. If you feel stressed, how do you adjust to the situation?

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Flowchart of the Research Procedures

Pre-Research Phase Research Phase

Identification of research problem

Formulation of Research Tool (for data gathering)

Selection of clients, signing of informed consent, and validation with health service providers

Interview of Burn patients selected for the study

Analysis and Interpretation of Data

Development of a design for effective coping strategies for burn patients

Educating burn patients on the effective coping strategies to different psychological problems

Evaluation

29 Summarization and Conclusion

Bibliography
Newell, R.Living With Psychological Implications of Burn Injuries. NursingMidwifery Literature Review (2000). Web. 13 February 2013. Madianos MG, Papaghelis M, Ioannovich J, Dafni R. Psychiatric disorders in burn patients: A follow-up study. Psychother Psychosom. 2001;70:307. Medknow Publications. Web. 13 February 2013. Poole, M., Seibold, D., & McPhee, R. (1985). Group decision-making as a structurational process. Quarterly Journal of Speech, 71, 74-102. InterNeg Group Website. Web. 15 feruary 2013. Blakeney, Patricia E. Psychosocial Care of Persons with Burn Injuries WorldBrun Documents (2009). Web. 17 Februay 2013.

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