Coming to terms with it all: Adult burn survivors’ ‘lived experience’ of acknowledgement and acceptance during rehabilitation
Introduction
Despite the enormity of progress seen in the field of burn care, burns remain a tragic event with profound effects both physically and psychologically on individuals and their families, experiencing long periods of hospitalisation and rehabilitation. The loss of both function and independence can be physically limiting, benefiting from aggressive rehabilitation to improve functionality and quality of life. Coming to terms with the devastation of a severe burn and the resultant sequelae is challenging for patients experiencing emotional difficulties concerning coping, adapting and accepting an altered body image [1].
Acceptance and adjustment after a severe burn is a tedious process with survivors confronted with many physical and psychological challenges. Therefore it is not surprising that those who sustain a severe burn experience difficulties with coping, adapting and accepting an altered body image. In terms of adjustment to the effects of a severe burn, it has been predict that a secure state of mind might optimise overall coping in the context of the trauma, by means of encouraging a more direct coping strategy that does not foster avoidance and promotes social support, acceptance and the ultimate resolution of the trauma or loss experienced [2]. However, it has been reported that avoidance and wishful thinking are strategies that can be used to cope with the trauma associated with burns [3], [4]. Tedstone et al. [5] found that coping strategies of burned patients based on high levels of emotion and poor acceptance was correlated with Post Traumatic Stress Disorder (PTSD). Willebrand et al. [6] identified that burn survivors who used avoidance displayed a low health status and were reported to exhibit neurotic and aggressive behaviours while those who adapted demonstrated optimism and problem solving with favourable outcomes. Additionally, Kildal et al. [7] suggested that the use of avoidance and minimal emotional support are related to poor outcomes. Conversely, positive coping strategies have been related to personality traits such as extraversion, optimism and self-discipline [4], [6], [8].
The notion of acceptance has been reported to be a helpful state of mind in adjustment to burns and the use of humour to be an effective coping strategy [9]. Decreased levels of anxiety and the incidence of PTSD are associated with high levels of acceptance at two weeks after burn [5], although accepting the unchangeable is often a difficult notion for burn survivors to address [10]. Depression and anxiety can negatively influence a patients’ ability to cope with burn trauma however coping strategies have been identified as influential in the rehabilitation journey for burn survivors [11]. Yet, within the burn literature, there remains a dearth of literature that explores the ‘lived experience’ of burn survivors [10], [12], [13], [14], [15], [16]. Although these studies have provided valuable insight and knowledge on how patients have experienced their lives after a severe burn, they do not address the issues within an Australian context. To our knowledge, few studies have specifically explored the ‘lived experience’ of burn survivors’ journey and the notion of acknowledgement and acceptance. Examining the concepts of acknowledgement and acceptance from the burn survivors’ perspective will, potentially, facilitate a better understanding of how to best provide for this cohort of patients. Consequently, this descriptive phenomenological study poses the questions “How do burn survivors’ acknowledge and accept their injury?” and endeavours to reveal this concept from burn survivors’ ‘lived experience’.
Section snippets
Design
The study utilised a descriptive phenomenology methodology using Colaizzi's [17] method of data analysis. The aim of phenomenological research is to explore and capture the meaning of the phenomenon through analyses of participants’ descriptions. This enabled a rich understanding of the burn survivors’ ‘lived experience’ of acknowledging and accepting their injury.
Ethical considerations
Ethics approval was obtained from five different ethics committees within four Australian states [18]. Written consent was obtained
Results
The emergent theme Acknowledgement described the traumatic nature of a severe burn as a challenging experience for the participants in this study. Participants felt the need to accept their injury, and a variety of acceptance behaviours was evident in the following four cluster themes. The emergent theme acknowledgement identified four cluster themes that emerged from the data analysis: (1) reasoning (2) humour (3) the challenge of acceptance (4) self-awareness (Fig. 2). Specific excerpts are
Discussion
This phenomenological study aimed to explore how burn survivors acknowledge and accept their severe burn. The descriptive phenomenological framework facilitated an in-depth understanding of burn survivors ‘lived experience’. The emergent theme of acknowledgement identified four cluster themes: Reasoning, Humour, The challenge of acceptance and Self-awareness that illuminated the means by which survivors came to terms with their burns and the difficulties experienced during their rehabilitation.
Limitations
Whilst the findings of this study contribute to the growing body of knowledge related to burn rehabilitation, the applicability and transferability of the results may be limited. Using a qualitative methodology may be perceived as being less objective and generalizable. However to ensure trustworthiness, the researcher made explicit all biases and preconceptions, the process of bracketing, verification of participants’ feedback, a protracted encounter with the transcriptions, the use of
Conclusion
This descriptive phenomenological study explored burn survivors’ ‘lived experience’ of acknowledging and accepting their injury during the rehabilitative phase within the Australian context perceived from the viewpoints of those who have endured a severe burn and survived. The described findings highlight the challenges experienced and the value of coping strategies encompassing reasoning, humour and self-awareness to facilitate acceptance. Consequently, the findings in this study provide a
Conflicts of interest
The authors declare that they have no conflicts of interest; such as employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, grants or other funding.
Acknowledgements
We thank all the participants who participated in this study. We also thank Sue Taggart, Rae Johnson, John Vandervord, Anne Darton, Siobhan Connelly, Diane Elfleet, Julia Kweit, Sheila Kavanagh, Stewart Harper, Hanna Menenzies, Natalie Picton and Heather Cleland for their assistance with recruitment.
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