The patient–body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment

Journal of Multidisciplinary Healthcare, Aug 2015

The patient–body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment Loyola M McLean,1–3 Vanessa Rogers,3–4 Rachel Kornhaber,5–7 Marie-Therese Proctor,8 Julia Kwiet,3–4 Jeffrey Streimer,3–4 John Vandervord6 1Brain and Mind Centre and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney and Western Sydney Local Health District, Parramatta, NSW, Australia; 3Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia; 4Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 5School of Health Sciences, Faculty of Health, University of Tasmania, Alexandria, NSW, Australia; 6Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; 7School of Nursing, University of Adelaide, SA, Australia; 8Graduate School of Counselling, Excelsia College, Sydney, NSW, Australia Background: Throughout development and into adulthood, a person's face is the central focus for interpersonal communication, providing an important insight into one's identity, age, sociocultural background, and emotional state. The face facilitates important social, including nonverbal, communication. Therefore, sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Burn survivors may encounter unique psychosocial problems and experience higher rates of psychosocial maladjustment, although there may be a number of potentially mediating factors. Objectives: The purpose of this phenomenological study was to examine the early recovery experience of patients with a facial burn. In particular, this study focused on how the injury impacted on the participants’ relationship with their own body and the challenges of early psychosocial adjustment within the first 4 months of sustaining the injury. Methods: In 2011, six adult participants encompassing two females and four males ranging from 29 to 55 years of age with superficial to deep dermal facial burns (with background burns of 0.8%–55% total body surface area) were recruited from a severe burn injury unit in Australia for participation in a Burns Modified Adult Attachment Interview. Narrative data were analyzed thematically and informed by Colaizzi's method of data analysis. Results: Three overarching themes emerged: relationship to self/other, coping, and meaning-making. Themes identified related to how the experience affected the participants’ sense of relationship with their own bodies and with others, as well as other challenges of early psychosocial adjustment. All participants indicated that they had experienced some early changes in their relationship with their body following their burn injury. Conclusion: These findings highlight the struggle burn survivors experienced with postburn adjustment, but expressed altruism and optimism around their recovery. Past trauma was observed to be a significant finding in this sample. Understanding the “lived experience” supports the way clinical and family systems can foster positive adjustment and coping. Consequently, multidisciplinary burn teams and health care professionals need to understand the principles of trauma-informed care and translate these into practice in the treatment of this group of patients. Keywords: facial burn, body image, psychosocial adjustment, complex trauma, posttraumatic growth, phenomenology

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The patient–body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment

Journal of Multidisciplinary Healthcare The patient-body relationship and the “lived experience” of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment Loyola M McLean 2 Vanessa Rogers 0 Rachel Kornhaber 5 Marie-Therese Proctor 7 Julia Kwiet 0 John Vander vord 4 0 c onsultation-Liaison Psychiatry, Royal North s hore Hospital , sydney, N sW , Australia 1 Westmead Psychotherapy Program, Discipline of Psychiatry, sydney Medical school, University of sydney and Western sydney Local Health District , Parramatta, NsW , Australia 2 Brain and Mind c entre and Discipline of Psychiatry, sydney Medical school, University of sydney , sydney, N sW , Australia 3 s chool of Nursing, University of Adelaide , sA , Australia 4 severe Burns Injury Unit, Royal North shore Hospital , st Leonards, sydney, N sW , Australia 5 s chool of Health sciences, Faculty of Health, University of Tasmania , Alexandria, NsW , Australia 6 Discipline of Psychiatry, s ydney Medical school, University of sydney , sydney, N sW , Australia 7 Graduate s chool of c ounselling, excelsia college , sydney, N sW , Australia 8 1 0 2 - l u J - 2 1 n o 9 1 1 . 9 5 . 2 3 . 3 1 2 y b / m o c . s s e r p e v .do l.y fded roF PowerdbyTCPDF(ww.tcpdf.org) Background: Throughout development and into adulthood, a person's face is the central focus for interpersonal communication, providing an important insight into one's identity, age, sociocultural background, and emotional state. The face facilitates important social, including nonverbal, communication. Therefore, sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Burn survivors may encounter unique psychosocial problems and experience higher rates of psychosocial maladjustment, although there may be a number of potentially mediating factors. Objectives: The purpose of this phenomenological study was to examine the early recovery experience of patients with a facial burn. In particular, this study focused on how the injury impacted on the participants' relationship with their own body and the challenges of early psychosocial adjustment within the first 4 months of sustaining the injury. Methods: In 2011, six adult participants encompassing two females and four males ranging from 29 to 55 years of age with superficial to deep dermal facial burns (with background burns of 0.8%-55% total body surface area) were recruited from a severe burn injury unit in Australia for participation in a Burns Modified Adult Attachment Interview. Narrative data were analyzed thematically and informed by Colaizzi's method of data analysis. Results: Three overarching themes emerged: relationship to self/other, coping, and meaningmaking. Themes identified related to how the experience affected the participants' sense of relationship with their own bodies and with others, as well as other challenges of early psychosocial adjustment. All participants indicated that they had experienced some early changes in their relationship with their body following their burn injury. Conclusion: These findings highlight the struggle burn survivors experienced with postburn adjustment, but expressed altruism and optimism around their recovery. Past trauma was observed to be a significant finding in this sample. Understanding the “lived experience” supports the way clinical and family systems can foster positive adjustment and coping. Consequently, multidisciplinary burn teams and health care professionals need to understand the principles of traumainformed care and translate these into practice in the treatment of this group of patients. facial burn; body image; psychosocial adjustment; complex trauma; posttraumatic - open access to scientific and medical research Introduction Early psychoanalytic literature examines the important function of the skin as both a physical and psychological container for the infant during its early development.1 The skin and face are documented as an avenue for communication and bonding between an infant and the mother.2 Throughout development and into adulthood, a person’s face is the central focus for interpersonal communication, providing an important insight into one’s identity, age, sociocultural background, and emotional state. The face facilitates an array of important nonverbal communications.2,3 Many Western societies place an emphasis on the significance of one’s facial appearance and associated level of attractiveness,3 with the stigmatization of those with facial disfigurement famously described by McGrouther as “The Last Bastion of Discrimination”.4 Sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Partridge and Robinson’s5 research on psychosocial aspects of burn injury reported that a significant proportion of patients who sustained a severe burn were left to contend with noticeable scars throughout their lives. Furthermore, patients with a facial burn found becoming awa (...truncated)


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Loyola M McLean, Vanessa Rogers, Rachel Kornhaber, Marie-Therese Proctor, Julia Kwiet, Jeffrey Streimer, John Vandervord. The patient–body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment, Journal of Multidisciplinary Healthcare, 2015, pp. 377-387, DOI: 10.2147/JMDH.S89375