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A qualitative study of stress factors in the early stage of acute traumatic hand injury
Department of Orthopedic Surgery and Department of Hand Surgery, Örebro Medical Centre Hospital, Örebro, Sweden. (Omvårdnad)ORCID iD: 0000-0002-8658-3360
Department of Nursing, University of Gothenburg, Gothenburg, Sweden.
Department of Hand Surgery, Örebro Medical Centre Hospital, Örebro, Sweden.
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. Vol. 32, no 6, p. 1333-1340
Keywords [en]
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: urn:nbn:se:oru:diva-4411DOI: 10.1046/j.1365-2648.2000.01630.xISI: 000166164500022PubMedID: 11136400Scopus ID: 2-s2.0-0034574114&OAI: oai:DiVA.org:oru-4411DiVA, id: diva2:138710
Projects
Consequences of an acute traumatic hand injuryAvailable from: 2008-02-27 Created: 2008-02-27 Last updated: 2019-10-08Bibliographically approved
In thesis
1. Konsekvenser av en akut traumatisk handskada: en prospektiv studie av patientens situation under det första året efter olyckan
Open this publication in new window or tab >>Konsekvenser av en akut traumatisk handskada: en prospektiv studie av patientens situation under det första året efter olyckan
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
Vårdvetenskap, Hand injuries, traumatic stress, anxiety, depression, pain, outcome, nursing, omvårdnadsforskning med medicinsk inriktning
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-48 (URN)91-7668-368-0 (ISBN)
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

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