ARTICLE INFO

Article Type

Qualitative Study

Authors

Dadkhah   B. (1 )
Valizade   S. (*)
Mohammadi   E. (2 )
Hassankhani   H. (3 )
Mozaffari   N. (4 )
Mohammadi   M.A. (4 )






(*) Pediatric Department, Nursing & Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
(1 ) Nursing Department, , , , , Nursing & Midwifery Faculty, Ardabil University of Medical Sciences, Ardabil, Iran
(2 ) Nursing Department, Medicine Faculty, Tarbiat Modares University, Tehran, Iran
(3 ) Medical-Surgical Nursing Department, , , , , Nursing & Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
(4 ) Nursing Department, Nursing & Midwifery Faculty , Ardabil University of Medical Sciences, Ardabil, Iran

Correspondence

Article History

Received:  March  5, 2014
Accepted:  May 17, 2014
ePublished:  April 2, 2014

BRIEF TEXT


… [1-4] Accidents, industrial injuries and war are the most important causes result in amputation in developing countries [5, 6]. In Iran, there are 12981 persons with lower limb amputation [7]. Amputation has a deniable effect on mental states and social interactions, so social isolation is more observed among these persons [8, 9]. Suicide, weak social interaction, economic problems, and unemployment, are some of the examples [8-15].

According to some studies, veterans with different kinds of injuries live with a lower quality than normal people [16, 17]. … [18-21] “Lifestyle” refers to ordinary life activities, accepted by peoples in their own life [22, 23]. Studies conceptualized adoption of a new lifestyle as “compatibility with disease” [24].‏

The aim of this study was to explain the effective factors to modulate and modify the lifestyle among patients with trauma during adaptation process with lower limb amputation.

This is a qualitative study, done with content analysis method.

Patients with trauma and lower limb amputation were studied, in Ardebil Province, Iran.

20 persons were selected, using purposive sampling method.

Interviews with the subjects were performed, up to data saturation. The main method to collect data was unstructured depth interview, using open questions. Al interviews were done by the main researcher. At first, the interview began with this question, “Please explain about your amputation”. Further and following-up questions were concentrated on effective factors to modulate and modify the lifestyle based on obtained information. Using the members’ viewpoints, ambiguous points were identified and considered, whereby these points were resolved and the status of each code was fully determined in each class. Correctness of data and extracted codes were confirmed, and data credit was assured, with a review applied by the participants. The results were evaluated by three other faculty members, besides the researcher; and agreement coefficient r=0.91 was obtained from three experts. After observing the results some persons with amputation, who were not participated in the study, confirmed fitness of the results. Interview with different participants, providing direct quotations and examples, and data enrichment explanation made data transfer and fitness possible. Data reliability (or stability) was provided using writing prescriptions immediately, colleagues’ viewpoints, and reviewing all data. All the interviews were recorded, and analyzed word for word by MAXq10 software, quickly. Analyzing was done according to content analysis based on Landman and Garnhaym’s five-stage [19]. Data analysis and data collecting were done simultaneously, using qualitative content analysis method according to continuous comparison of data.

The mean age of the subjects was41.7±7.9, and 17 participants were male. The mean time of amputation occurrence was 20.4±10.5. Accident and war were the causes of amputations of 7 participants (43.8%) and of 9 participants (56.2%), respectively. 8 persons (40%) had lower than diploma degree, 9 persons (45%) had associate degree or BS degree, and 3 persons (15%) had a master's or doctoral degree. There were 9 government employees (45%), 6 free-employed persons (30%), and 5 unemployed or housewife persons (25%). Interview was lasted between 30 to 120 minutes, with72 minutes average. The main and central concept of lifestyle was composed of primary and underlying classes and events, such as “awareness achievement ”, “feeling independent”, “pain control”, “prosthesis replacement”, “daily affairs management”, “ exercise”, “travelling", “ education”. Awareness achievement: Awareness achievement regarding care and complications of amputation had a crucial role in tolerance of the conditions of persons with amputations. Feeling independent: Participants had the tendency towards independence. Pain control: Need to pain control is one of the important problems which imputed person is facing with since many imputed persons complain about pains due to the amputation, rather than the amputation itself. The subjects stated that despite of these intolerable pains they try to endure them using drugs and increasing the mood, sense of fighting, and compulsive habits tricks. Assistance of religious approach: It continued as an important strategy, which had been taken into account previously. Prosthesis replacement: The participants were using appropriate alternatives such as prosthesis for their amputation. They believed that it leads to positive self-imaging and increasing their self-confidence helping them to overcome their motion limitations. Daily affairs management: By an exact planning use the minimum of time and transportation, and can rest at home without prosthesis, and prevents exacerbation of wounds and stimulation of defected area. Exercise: Exercise was introduced as another important factor to cope with amputation. Travelling: The participants stated that travelling had an important effect on increasing their own mental refresher and self-confidence. Education: Education is one of the factors results in an increase in self-confidence and to satisfy people to fill the spiritual gaps, as well as improving mood and interaction with the environment and society. In addition, it leads to increase of the hope to acquire a constant job position with an enough earning, facing financial problems caused by amputation.

… [25-36] According to the results of the present study, alongside some studies [37], some activities such as sport, and self-care activities, help patients to manage and control the disease. According to some studies, there was a positive correlation between general health of amputated patients, with taking part in sports, and such patients are aware of positive influence of sport on mental and physical health [38, 39]. In addition, according to the present study, amputated patients took part in some activities, in order to modulate daily stresses and pressures.

It is suggested that more studies to be conducted concerning lifestyle modifying in accordance with the upper limb amputees, as well as in accordance with amputations due to diabetes. In addition, it is suggested that more studies to be conducted concerning management process of lower limb amputation, religious strategies coping with lower limb amputation and its effects on the patient’s compatibility both in qualitative and quantitative ways. In order to consider cognitive, psychological and social aspects in accordance with lower limb amputation, conducting more studies is suggested. In addition, it is suggested that more studies to be conducted to design a model of empowerment for patients with lower limb amputation, and concerning the effective communication of the medical teams in accordance to lower limb amputation.

Limited access to information related to the persons belonged to Foundation of Martyrs and Veterans and Welfare Office, was one of the limitations of the present study.

Totally, the use of effective coping strategies, alongside social support, is the most important factor in adaptation and compromise with amputation.

The researchers fell grateful to all the participants, the officer of the welfare unit, Therapy Deputy of Foundation of Martyrs and Veterans, and Ms. Ghavmi (expert of Ardebil Foundation of Martyrs and Veterans).

Non-declared

Ethical permission has been confirmed in a session held at September 2012 by Council of Graduate Schools and Regional Ethics Committee of the University (letter number 5/4/6156, Ethics Committee Number 91106, thesis umber 321).

The study has been conducted under the financial aids of Tabriz University of Medical Sciences, Deputy of Research.


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