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Konsekvenser av en akut traumatisk handskada: en prospektiv studie av patientens situation under det första året efter olyckan
Örebro University, Department of Nursing and Caring Sciences.ORCID iD: 0000-0002-8658-3360
2003 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the research project was to investigate the consequences of an acute traumatic hand injury during the first year after the accident. The project involved 112 patients with acute traumatic hand injuries requiring inpatient hand-surgical treatment. The majority of the patients were men. Most of them were injured at home or at their usual place of work. The hand injuries differed in degree of severity. Nearly one third of the patients had amputations.

The project comprised two qualitative and two quantitative studies. Data for the qualitative studies were obtained by interviews with a theoretical sample of 20 patients between 8 and 20 days after the accident. Data for the quantitative studies were obtained from a consecutive sample of patients by means of questionnaires answered 1-2 weeks, three months and one year after the accident. All 112 patients participated in the first and 91 patients in all three assessments. The questionnaires included were the Impact of Event Scale (IES) for measuring trauma-related distress, the Hospital Anxiety and Depression scale (HAD) for measuring mood disorders and study-specific questions for measuring problems experienced. Information about injuries and accidents was obtained from the patients’ medical records.

The results of the studies showed that psychological problems were frequent the first weeks after the injury and related to consequences of both the injury and the traumatic experience. Nearly half of the patients had symptoms of traumatic stress and one third had signs of a mood disorder. Negative reactions at the sight of the hand were associated with both trauma-related distress and mood disorders, suggesting that observations of the patients’ reactions when the dressing is changed might help to identify those in need of psychological support in the early stage. One third still had increased levels of traumatic stress symptoms and one out of ten had signs of a mood disorder in the one-year follow-up.

The first weeks after the accident more than half of the patients reported substantially limited physical function and had a need for help with activities of vital importance in everyday life. Troublesome pain was felt by one third of the patients. Most patients experienced significant improvement during the first three months. One year after the accident the majority of the patients had slight or moderate physical limitations. Only one out of five experienced no limitations at all. One out of seven reported troublesome pain. Patients with amputations had more pain than others both the first weeks and one year after the accident.

About 16 % were on the sick-list one year after the accident. Half of the patients back at work experienced a worse work-situation as a result of the injury. One third of all patients experienced a worse life-situation. A worse life-situation was experienced not only by patients at the sick-list but also by patients back at work. Patients with amputations and blue-collar workers more often experienced a worse life-situation than others.

In sum, this project showed how important it is that the care of patients with acute traumatic hand injuries, in addition to surgical treatment and other action for restoring function in the hand, also should include preventive action and follow-up of trauma-related distress and pain.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2003. , p. 68
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 1
Keywords [en]
Vårdvetenskap, Hand injuries, traumatic stress, anxiety, depression, pain, outcome, nursing, omvårdnadsforskning med medicinsk inriktning
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-48ISBN: 91-7668-368-0 (print)OAI: oai:DiVA.org:oru-48DiVA, id: diva2:136862
Public defence
2003-11-28, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2003-11-04 Created: 2003-11-04 Last updated: 2017-10-18Bibliographically approved
List of papers
1. Trauma-related distress and mood disorders in the early stage of an acute traumatic hand injury
Open this publication in new window or tab >>Trauma-related distress and mood disorders in the early stage of an acute traumatic hand injury
2003 (English)In: Journal of Hand Surgery - British and European Volume, ISSN 0266-7681, E-ISSN 1532-2211, Vol. 28B, no 4, p. 332-338Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to estimate the incidence of trauma-related distress and mood disorders in the early stages after acute traumatic hand injuries and identify characteristics associated with these reactions. Data were obtained from 112 patients by means of mailed questionnaires and medical records. Nearly half of the patients had increased levels of intrusive and avoidance symptoms, indicating trauma-related distress. One-third showed signs of a mood disorder. Mood disorders were associated with the need for help with activities of daily living, pain and avoidance symptoms. The study showed that emotional problems in the early stages after injury are related to the consequences of both the injury and the traumatic experience. Negative reactions to the sight of the hand were associated with both trauma-related distress and mood disorders, suggesting that observation of the reactions to the sight of the hand could help to identify patients in need of psychological support.

Keywords
Activities of Daily Living/psychology, Acute Disease, Adult, Aged, Amputation; Traumatic/psychology/surgery, Anxiety/*diagnosis/psychology, Avoidance Learning, Defense Mechanisms, Depression/*diagnosis/psychology, Female, Hand Injuries/*psychology/surgery, Humans, Logistic Models, Male, Middle Aged, Pain/psychology, Psychiatric Status Rating Scales, Questionnaires, Stress Disorders; Post-Traumatic/*diagnosis/psychology
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-4412 (URN)10.1016/S0266-7681(03)00138-4 (DOI)000184372900009 ()12849944 (PubMedID)2-s2.0-0042816236 (Scopus ID)
Projects
Consequences of an acute traumatic hand injury
Available from: 2008-02-27 Created: 2008-02-27 Last updated: 2017-12-14Bibliographically approved
2. A qualitative study of stress factors in the early stage of acute traumatic hand injury
Open this publication in new window or tab >>A qualitative study of stress factors in the early stage of acute traumatic hand injury
2000 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 32, no 6, p. 1333-1340Article in journal (Refereed) Published
Abstract [en]

The aim of the study reported in this paper was to identify stress factors in the early stage of acute traumatic hand injury. Stress factors were defined as circumstances which the hand-injured patients experienced as problems in the actual situation. A total of 20 patients, treated as inpatients at the Department of Hand Surgery in Orebro Medical Centre Hospital, Sweden, were interviewed 8-20 days after the day of the accident. The analyses of the interviews followed the first step in the analytical process described in a modified model of grounded theory. The trauma experience was one of the stress factors in the early stage. Single acute traumatic stress symptoms, mostly involuntary recollection and re-experience of the trauma, were found in a fourth of the hand-injured patients. All patients reported impaired functioning caused by their hand, irrespective of injury. Practical problems with daily activities and being dependent on help from others for solving practical problems were stress factors caused by functional impairment. Before the accident most of the hand-injured had been very active, also working a lot with their hands in their leisure-time. Involuntary inactivity was a big problem for some of them. Other stress factors in the early stage were uncertainty about function in the future and pain. The appearance of the hand was a minor problem before the first follow-up visit. Probably because the hand was hidden in a bandage. However, some hand-injured felt discomfort in seeing the hand when the dressing was changed at the first follow-up visit.

Place, publisher, year, edition, pages
Oxford: Blackwell Science, 2000
Keywords
Activities of Daily Living, Adult, Aged, Female, Freedom, Hand Injuries/complications/*psychology, Humans, Male, Middle Aged, Pain/etiology/psychology, Stress; Psychological/*etiology, Sweden
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-4411 (URN)10.1046/j.1365-2648.2000.01630.x (DOI)000166164500022 ()11136400 (PubMedID)2-s2.0-0034574114& (Scopus ID)
Projects
Consequences of an acute traumatic hand injury
Available from: 2008-02-27 Created: 2008-02-27 Last updated: 2019-10-08Bibliographically approved
3. A qualitative study of coping in the early stage of acute traumatic hand injury
Open this publication in new window or tab >>A qualitative study of coping in the early stage of acute traumatic hand injury
2002 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 5, p. 594-602Article in journal (Refereed) Published
Abstract [en]

Twenty patients with acute traumatic hand injury were interviewed 8-20 days after the day of the accident. The aim of the study was to identify coping strategies, defined as thoughts or actions used by the hand-injured patients to manage stress factors and resulting emotions in the early stage. Stress factors were reported in an earlier study. The analyses of the interviews followed the first steps in the analytical process described in a modified model of grounded theory. Eleven different coping strategies were identified in the interviews. By "comparing with something worse", "positive thinking", "relying on personal capacity", "distancing" and "distracting attention" the patients tried to play down the seriousness of the problem or situation. Other coping strategies used by the hand-injured were "accepting the situation", "seeking social support", "maintaining control", "solving practical problems by oneself", "pain-relieving actions" and "active processing of the trauma experience." The findings of the study show how important it is to identify the patient's own way of coping with a stressful illness situation in order to give adequate psychosocial support.

Keywords
Activities of Daily Living, Acute Disease, Adaptation; Psychological, Adult, Aged, Attitude to Health, Female, Follow-Up Studies, Hand Injuries/complications/*psychology, Humans, Internal-External Control, Male, Middle Aged, Nursing Methodology Research, Problem Solving, Questionnaires, Social Support, Stress; Psychological/*etiology/*prevention & control/psychology, Sweden
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-4410 (URN)10.1046/j.1365-2702.2002.00657.x (DOI)000177748800006 ()12201886 (PubMedID)2-s2.0-0036718019 (Scopus ID)
Projects
Consequences of an acute traumatic hand injury
Available from: 2008-02-27 Created: 2008-02-27 Last updated: 2017-12-14Bibliographically approved
4. Problems experienced during the first year of an acute traumatic hand injury: a prospective sudy
Open this publication in new window or tab >>Problems experienced during the first year of an acute traumatic hand injury: a prospective sudy
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 8, p. 986-995Article in journal (Refereed) Published
Abstract [en]

Background. Evidence-based nursing of patients with acute traumatic hand injuries treated at the hand-surgical clinic calls for knowledge about long-term implications. Aims and objectives. The aim of the study was to investigate consequences of an acute traumatic hand injury during the first year after the accident. Specifically, the objectives were to investigate changes in the experience of physical and psychological problems over time, frequencies of remaining problems and the impact of the injury on work situation and life situation 1 year after the accident.

Design. The study was prospective and followed the patients from the first weeks to 1 year after the accident. Method. Ninety-one patients were assessed three times during the year. Each time the patients answered study-specific questions, the Impact of Event Scale and the Hospital Anxiety and Depression Scale.

Results. Problems experienced decreased during the first 3 months but tended to remain unchanged during the rest of the year. In the 1-year follow-up, the majority of the patients experienced slight or moderate functional limitations in the hand, onethird had symptoms of trauma-related distress and one out of seven had troublesome pain. Half of the patients who had returned to work reported a worse work situation and 16% were still on the sick list. One-third of all patients considered their whole life situation to be worse as a result of the injury. Patients with amputations more often experienced a worse life situation. Blue-collar workers reported functional limitations and a worse life situation more often than white-collar workers.

Conclusions. Patients with acute traumatic hand injuries requiring surgical treatment may experience problems, such as functional limitations, trauma-related distress and troublesome pain, with long-term implications for their work situation and life situation. Relevance to clinical practice. Caring for hand-injured patients should include, not only surgical treatment and other actions for restoring the function of the hand, but also preventive action and follow-up of trauma-related distress and pain.

Keywords
disability, evidence-based nursing, hand injury, outcome, pain, psychological stress
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-3088 (URN)10.1111/j.1365-2702.2004.01019.x (DOI)000224922100010 ()15533105 (PubMedID)2-s2.0-9244229494 (Scopus ID)
Projects
Consequences of an acute traumatic hand injury
Available from: 2003-11-04 Created: 2003-11-04 Last updated: 2017-12-14Bibliographically approved

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