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Psychological Adjustments of Patients to

Burn Injury

In Partial Fulfilment of the Requirements for Nursing Research

Submitted by:

Manlangit, Sharmaine Gay

Dela Torre, Aline

Ramillano, Kristen Rae

Paraji, Sabrina

Balbuena, Dexter

Ho, Donaline

Albrecht, Stephanie Zharlynne

Camlian, Alamen

Salinas, Sarah Jane

Lamberte, Bryan

Yosores, Arvin Roi

Formilleza, Arnie Luy

March 6, 2013

BSN III - D

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TABLE OF CONTENTS

I. INTRODUCTION

a. Background of the Study. 3

b. Statement of the Problem.3-4

c. Significance of the Study.....4

d. Scope andDelimitation..4-5

II. REVIEW OF RELATED LITERATURE...6-16

a. Conceptual Framework...17

b. Theoretical Framework ..18

c. Definition of Terms....19-20

III. METHODOLOGY..21-24

IV. TABLE OF SPECIFICATION FOR DATA

GATHERING.25-28

V. FLOWCHART OF THE RESEARCH

PROCEDURE29

VI. BIBLIOGRPAHY ....30

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INTRODUCTION

A. Background of the Study

Burn injuries are common traumatic experience which can set an

enormous amount of stress and strain on an individuals psychological

state. (Lawrence et al. 2006, Klein et al. 2007, Ulrich et al. 2009)

Commonly, burn injuries are followed by psychological difficulties. The

patient may seem to be dealing with his or her injuries and thecircumstances well; however, once the permanence of the situation hits

them as reality and the lengthy therapy process is comprehended, the

patient becomes submerged in psychological difficulties in the forms of

resentment, depression and anxiety. The patient may also feel an

unexplained feeling of loss, grief for his or her old life, identity and

meaning.

However, due to the improvements in the emergency services and

burn treatment in the past century more and more burn survivors are

required to make psychosocial adjustments to cope with their new body

image. (Lawrence et al. 2006, Klein et al. 2007, Ulrich et al. 2009)

Thus the researchers of this research shall develop the study

Psychological Adjustments of Patients to Burn Injury.

B. Statement of the Problem

This study aims to assess the psychological adjustments of 3rd

-degree

burn patients. Thus, it seeks to answer the following questions:

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1. What are the common psychological problems of 3 rd-degree burn

patients?

2. What are the coping strategies and methods utilized by 3 rd-degree burn

patients?

3. What are the effective coping strategies to be utilized in the care of burn

patients?

C. Significance of the Problem

This study will provide baseline information that presents the

psychological difficulties experienced by 3rd

-degree burn patients and

certain coping strategies they utilized.

Thereafter, it would help the researchers to come up with a plan of

care as to what effective coping strategies are to be implemented.

This study also intends to highlight areas within this field which may be

in need of assessment, improvement and/or complete development, and

in turn improve standards and quality of patients psychological care.

D. Scope and Delimitation

This research study centers on the different psychological difficulties

experienced by 3rd-degree burn patients.

Qualitative research will be used because a small selective sample

provides an in-depth nature of the study and the analysis of the required

data.

I. A minimum of five and a maximum of ten respondents.

II. Thirteen to thirty-year-old 3rd-degree burn patients admitted at the burn

unit of Zamboanga City Medical Center.

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III. Thirteen to thirty-year-old 3rd

-degree burn victims with 3 to 6 months in the

recovery phase prior to discharge at the burn unit of Zamboanga City

Medical Center.

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Review of Related Literature

Importance of Psychosocial Care

Treatment of people with burn injuries includes recovery of optimalfunction for survivors to fully participate in society, psychologically and

physically. Increased likelihood of physical survival has led to greater

concern for potential psychological morbidity for the burn survivor.

Surgical and medical technology has improved to such an extent that now,

in most cases, burn care providers must assume that the patient will live.

They must be aware, even in the first moments of treatment, of what will

be important to the surviving patient. Burn survivors experience a series of

traumatic assaults to the body and mind which present extraordinary

challenges to psychological resilience. Contrary to what might be

expected, empirical data regarding the long-term sequelae of burn injury

indicate that many burn survivors do achieve a satisfying quality of life and

that most are judged to be well-adjusted individuals. However, thirty

percent of any given sample of adult burn survivors consistently

demonstrate moderate to severe psychological and/or social difficulties.

Similarly, most pediatric burn survivors, even those with the most

extensive and disfiguring injuries, adjust well. Empirical studies, as well as

clinical observations and patient self-reports, suggest that burn care of the

whole person, including early and continued attention to psychosocial

aspects of the patients life, can facilitate positive psychological adaptation

to the challenges of traumatic injury, painful treatment, and permanent

disfigurement.

Estimates vary, but between one and 10 per cent of the UK

population are believed to have a disfigurement such as a scar, blemish,

or deformity which seriously hinders their capacity to lead a normal life

(Office of Population Censuses and Surveys, 1988, p.65; Valente, 2004).

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Disfigured individuals frequently report severe difficulties in social

encounters (Jowett & Ryan, 1985; Lanigan&Cotterill, 1989, Porter et al.,

1986, 1987, 1990; van der Donk et al., 1994). Studies using actors made

up to look disfigured found that people offered less help and stood further

away from people with a visible difference (Bull & Stevens, 1981; Piliavin

et al., 1978; Rumsey et al., 1982). Some people whose faces have been

disfigured can suffer a so-called social death. Unless they are given

psychotherapeutic and social help in time, social death may instigate

death by suicide (Konigova&Pondelicek, 1987).

While many seek medical or surgical treatments for disfigurement,

there are limitations as to what can be achieved, and for most people

affected disfigurements are a lifelong condition (Clarke, 1998). Most of

those with a visible difference continue to hope for facial surgery, creating

a continued dissatisfaction with self (Richman, 1983). Surgery alone is not

sufficient (McGrouther, 1997); it does not fix emotions (Hearst, 2007).

PSYCHOLOGICAL IMPLICATIONS

Burn victims are at increased risk of developing various

psychological disorders. It is evident that preburn factors influence the

post burn adjustments. Many studies recognise three major disturbances

which occur after burn injuries including; depression, anxiety and post-

traumatic stress disorder (PTSD) (Tebble et al. 2004, Lawrence et al.

2006, Williams et al. 2008 &Ullrich et al. 2009). Lawrence et al. (2006)

states that depression is the most widespread disorder on follow-up,

among burn survivors.

Depression

Depression is a major implication of burns, experienced by the

majority of burn patients. Moi et al. (2008) in a qualitative study discuss

the findings of their 20 open, in depth interviews with burn survivors. Their

aim was to gain an understanding of their experiences. They selected a

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purposive sample from the national burn centre of Norway; there were 14

participants the majority of which were men. These survivors discussed

the implications (mainly physical) which they have to cope with every day.

They explained how their bodies now told their story for them, the scarring

a permanent tale. Dealing with an unfamiliar body, many avoided the first

mirror image after dressings were removed; some described how months

later they still got a surprise when they saw their own reflection. A

vulnerable body can be difficult to manage, which all burn survivors must

learn to do. This affects the survivors life in many ways. Their new skin is

fragile; requires a lot of protection. There is a risk of injury without sensing

it, unable to sense warmth and cold. Not only do the physical aspects

affect the patient, but also the psychological aspects, many survivors

discussed how they experienced feelings of isolation, social withdrawal

and feelings of stigmatisation. These results from the interviews portray

factors which are predisposing factors of depression leaving burn

survivors very susceptible.

Anxiety

As well as depression, anxiety is frequently witnessed in burn

survivors. There are two forms of anxiety; state anxiety and trait anxiety.

State anxiety is a continuously changing condition, trait anxiety remains

more stable (Hulbert-Williams et al. 2008). State anxiety is often

experienced with slow recovery and wound healing. Anxiety in burn

patients may occur due to psychosocial matters, such as grieving over the

loss of their previous appearance or troubled by reactions of others

(Partridge & Robinson 1995). Hulbert-Williams et al. (2008) suggests that

sufferers of major burns experience higher levels of distress when

compared with those who have minor burns. In contrast Tebble et al.

(2004) claims that injuries no mater what size may have a psychological

impact on a patient according to literature (Shepard et al. 1990; Bisson&

Shepard 1997; Padadopolous et al. 1999; Smith 2000).

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PSYCHIATRIC DIAGNOSES

Acute stress disorder

The DSM-IV includes the diagnosis of ASD, which may be made asearly as 3 days following the traumatic event. Composed of dissociative,

intrusive, avoidant, and arousal symptoms, the formulation of ASD

emphasises dissociative symptoms. To be diagnosed with ASD, one must

experience at least three of five possible dissociative symptoms but only

one intrusive, avoidant, and arousal symptom. ASD was added to the

DSM-IV, at least in part, on the basis of retrospective studies that

documented the presence of dissociative symptoms including

derealisation, depersonalisation, emotional numbing, and a reduction of

awareness in ones surroundings following various types of accidents.

Speigel and colleagues have argued that a dissociative syndrome

characterised by depersonalisation, derealisation, and psychic numbing is

prominent immediately following a traumatic stressor.

Post-traumatic stress disorder

A diagnosis of PTSD requires the presence of at least one intrusive

symptom and three avoidant and two arousal symptoms, each of which

must persist for at least 1 month. Three of the dissociative symptoms

included in the ASD diagnosis (depersonalisation, derealisation, and time

distortion/daze) are new to the DSM-IV; the other two (numbing, amnesia)

have been previously classified as avoidant symptoms within the PTSD

diagnosis. Burn injury has occupied a unique role in the trauma literature.

Beginning with the work of Cobb and Lindemann in 1943 documenting

acute psychological responses to the Cocoanut Grove fire, studies of burn

injury have offered perspectives which have helped validate the idea that

trauma has mental health consequences. In a study, Cobb and

Lindemann described dissociation, re-experiencing, avoidance, and acute

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grief in those people hospitalised for burns following the Cocoanut Grove

fire. More recent studies have documented that up to 45% of adults who

were hospitalised for their burn injury have PTSD 1 year later and that

severity of intrusive and avoidant PTSD symptoms within 1 week of injury

predicts chronic PTSD.

PAIN, DEPRESSION, AND PHYSICAL FUNCTIONING FOLLOWING

BURN INJURY

Depression following burn

Much greater variability is found when outcomes beyond

survivability are considered. For example, depression is well recognised

as a significant problem following burn injury. For most burn survivors,

average scores on depression indices fall within the mild to moderate

range. However, moderate to severe symptoms of depression have been

found in 1845% of burn survivors, years after their physical injuries have

healed.

Pain following burn

Pain is another serious problem for burn survivors, particularly

during the early phases of burn care when open wounds are being

subjected to debridement and movement therapies. In addition, pain

remains a concern for years after burn injury wounds have closed.

Choniere and colleagues found ongoing pain concerns in 35% of a sample

of burn survivors, at least 1 year after injury. Similarly, Dauberet al. found

that 52% of burn survivors who were on an average of 10 years after

injury reported the presence of pain. Of those with pain, 45% reported that

pain interfered with their daily lives. Malenfant and colleagues found pain

in over 36% of their sample and demonstrated that pain prevalence did

not vary greatly between 1 and 4 years after injury. Although noting that

the average severity of pain was mild (3.4 on a 010 visual analogue

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scale) among burn survivors, Malenfant and colleagues point out that pain

severity varied widely both within and between patients. For example,

19% of their sample reported average pain as severe.

Association of pain, depression and functioning

Pain and depression represent suffering for burn patients, thus

deserving attention in research and clinical settings. In addition, both pain

and depression have been associated with other negative outcomes

among burn patients. For example, two studies have demonstrated that

elevated pain during hospitalisation for burn injuries is associated with

poorer adjustment and reduced physical functioning up to 2 years after

discharge from the hospital. Depression has been associated with

reduced physical function and change in physical health over time among

burn patients. Although past studies have clearly shown that pain and

depression have prospective associations with physical functioning, much

less is known about how these conditions might interact as predictors of

functioning among survivors of burn injuries. Cognitivebehavioural

theories of pain, depression, and functioning have emphasised that certain

cognitive processes associated with pain and depression may make the

co-occurrence of these conditions especially deleterious to functioning.

For example, persons with pain and depression show enhanced memory

for negative self-referent pain and illness information as compared with

persons with pain who are not depressed. Vlaeyen and Morley have noted

that co-occurring pain and depression may activate cognitive processes

that guide a person towards completing or terminating a task. For

example, a person may terminate a functional activity as soon as he or

she no longer enjoys the task, perhaps due to pain perceptions.

Understanding associations between pain, depression, and physical

functioning is critical because burn survivors have considerable difficulties

in returning to personal, social, and community roles after their injuries

have healed.

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PSYCHOSOCIAL MECHANISMS

Many disfigured people find that coping with the daily trials of living

with their difference is so difficult that aloofness or total withdrawal is their

only options. Others use a range of strategies to help them function.

Depending on the individual and on the situation, these may be overt or

covert, aggressive or passive, hostile or receptive. For example, when

stared at, many individuals feign unawareness or look away, whereas

others stare back or make defiant remarks, Take a good look

(Macgregor, 1990). Others adopt more positive methods, such as

compensating for their difference with charm (Macgregor, 1974), or

helping themselves by helping others.

Social Support

Social support has been defined as information leading people to

believe that they are cared for and loved, esteemed, and a member of a

network (Cobb, 1976).

Social functioning is often the ultimate goal for both biomedical and

psychosocial interventions for disfigurement (Ong, Clarke, White,

Johnson, Withey& Butler, 2007), and the use of avoidance and

concealment illustrates the overriding concerns of social exclusion among

the disfigured (Goffman, 1963). Ong, Clarke, White, Johnson, Withey&

Butler (2007) suggest that successful adjustment in disfigurement lies in

the ability to interact with other people at various levels, from meeting

people for the first time to enjoying an intimate relationship.

The quality of perceived social support has been found to beparticularly important to adjustment in a number of studies (Baker, 1992;

Blakeney, Portman, & Rutan, 1990; Browne et al., 1985). High-quality

social support is a powerful resource aiding adaptation. Reported benefits

of social support include encouragement to enter anxiety-producing

settings, reassurance of acceptance regardless of appearance, and the

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development of adaptive cognitions. Carver and Scheier (1981) found that

social support can serve to facilitate the development of problem-focused

and emotion-focused coping strategies. Helpful comments from friends

and relatives were internalized by participants and used as part of their

self-talk (Thompson, Kent & Smith, 2002). Poor quality support hinders

adjustment e.g. by adding to existing demands and exacerbating or

prolonging negative emotions (Furness, Garrud, Faulder& Swift, 2006

[19]).

The Fear-Avoidance Model

Newell (2002) explains the variation in ability to cope with visible

difference in terms of a fear-avoidance model rooted in cognitive

behavioural therapy. Based on Lethem et al.s (1983) fear-avoidance

model of exaggerated pain perception, the model predicts that fear of, and

anxiety in, social situations results in avoidance coping because it limits

exposure and habituation to others behaviour (Newell, 1999). Avoidance

is associated with problematic long-term adjustment, poorer quality of life

and negative affect (Cochrane & Slade, 1999; Wahl, Hanestad & Wiklund,

1999). Cahners (1992) argues that avoidance thwarts the development of

coping strategies and does not allow for disconfirmation of unrealistic

beliefs. Conversely, people predisposed to confront such situations head-

on will feel their anxiety decrease as they perform the activity more, and

will cope better (the rationale behind exposure therapy in phobias etc)

(Newell, 2002). According to Newell, arguably the most important thing

about the fear-avoidance model is that it emphasizes the normality of

psychological distress following disfigurement (Newell, 2002).

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Theories of Small Group Communication

Functional Theory

The functional approach to small group communication isconcerned with the results or outcomes of group behaviours and

structures. This perspective sees communication as the tool group

members use to solve problems and make decisions. Communication

helps group members by promoting rational judgments and critical

thinking, as well as preventing group members from faulty decision-

making and flawed problem solving. Thus, communication is instrumental

because it provides the means by which group members can achieve their

goals. From a functional perspective, researchers are concerned with

identifying the specific aspects of group communication and structure that

produce the group's desired outcomes.

Symbolic Convergence Theory

Symbolic Convergence Theory studies the sensemaking function of

communication. "Symbolic" refers to verbal and nonverbal messages and

"convergence" refers to shared understanding and meaning. In small

groups, members develop private code words and signals that only those

inside the group understand. When groups achieve symbolic

convergence, they have a sense of community based on common

experiences and understandings.

Central to this theory is the idea that group members share fantasies that

serve as critical communication episodes, forming the basis for members'

sensemaking. Sharing fantasies helps group members create a social

reality that indicates who is part of the group and who is not. Sharing

fantasy themes increases group cohesiveness as members develop a

common interpretation of their experiences. Fantasy themes are stories or

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narratives that help group members interpret group interactions and their

surrounding environment. Fantasy themes develop when group members

actively engage in dramatizing, elaborating on, and modifying a story. In

this way, the story becomes publicly shared within the group as well as

privately shared by each group member. Fantasy themes are related to

small group culture in that the stories reveal the group's identity and

underlying values.

Structuration Theory

Structuration Theory distinguishes between systems, such as small

groups, and structures, the practices, rules, norms, and other resources

the system uses to function and sustain itself. When applied to small

groups, Structuration Theory views small groups as systems that both

produce structures and are produced by structures. This means that group

members follow particular rules in their interactions that produce some

sort of outcome. That outcome eventually influences the group's future

interactions.

Naturalistic Paradigm

Like Systems Theory, the Naturalistic Paradigm is a general

approach that is applicable to many communication contexts and

academic disciplines. When applied to small groups, the Naturalistic

Paradigm focuses our attention on "real life" groups.

The Naturalistic Paradigm addresses a major fault in small group

research-its reliance on zero-history groups in which strangers interact in

a laboratory setting to solve an artificial problem. Researchers using the

Naturalistic Paradigm study groups situated in their natural settings.

Unlike Functional Theory and Structuration Theory, which assume there is

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a measurable, objective reality, the Naturalistic Paradigm assumes that

communicators construct social reality as they interact. Research within

the Naturalistic Paradigm is qualitative (e.g., observation, in-depth

interviews) and assumes that researchers' values and biases are part of

the research process. Researchers look at the relationship between

researcher and study participants as an interdependent one. That is,

communicators are not simply objects to be studied, but are partners in

the research process. For example, researchers within the Naturalistic

Paradigm often ask study participants for their responses to the

researchers' report. Those responses then become part of the report or

are used to modify the report.

The Naturalistic Paradigm focuses the researcher's attention on human

communication as it naturally occurs. In small group communication

research, this means that researchers study real groups in their natural

settings.

The greatest strength of the Naturalistic Paradigm is its focus on

naturally occurring small groups. We learn about the idiosyncrasies and

similarities of communication practices and norms as group members

coordinate their interactions in everyday life. Second, the Naturalistic

Paradigm has greatly broadened our conceptualization of small groups

and moved the study of small groups outside the corporate context and

traditional task groups. Third, the Naturalistic Paradigm study of small

groups working in their natural contexts has produced advances in

communication theory and practice.

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CONCEPTUAL FRAMEWORK

COPING STRATEGIES/METHODS UTILIZED BY BURN PATIENTS

Communication

Elicit openness to verbalize and share feelings related to his or her condition

or situation Support System

Willingness of family or significant others to aid in clients recovery

Stress Management

Ability to accept and adjust to current condition or situation

Development of effective coping strategies to the different psychological problems

exhibited by the burn patients

COMMON PSYCHOLOGICAL PROBLEMS EXPERIENCED BY BURN PATIENTS

Stress due to: Body image disturbance

Further complications

Changes in activities of daily living

Fear of total dependence

Sleep disturbance

Depression and anxiety brought about by current situation

Financial difficulties

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THEORETICAL FRAMEWORK

INPUT PROCESS OUTPUT

Gather

support

systems and

other theories

for the

integration of

the plan of

care for burnpatients

Strategies and

methods

management

Design an

effective plan of

care for burn

patients based

on the gathered

theories

Process steps in

the delivery ofthe plan of care

for burn patients

Integration of

the effective

coping

strategies for

the

psychological

care to burn

patients Implementation

of the different

strategies and

methods

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Definition of Terms

A. Assessment - an identification by a nurse of the needs,

preferences, and abilities of a patient. Assessment includes

an interview with and observation of a patient by the nurse.

B. 3rd-degree burn - also calledfull thickness burn. A third

degree burn destroys both the epidermis and the dermis,

often also involving the subcutaneous tissue They cause

white or blackened, charred skin that may be numb.

C. Burn patients those patients suffering from third

degree burns, admitted in the hospital.D. Psychological dimension - the aspect that focuses on

the patients way of thinking and coping in relation to his or

her social and physical environment.

E. Psychological problems refers to the difficulties that

the patient encounters in terms of his/her function of

awareness, feeling or motivation.

F. Coping strategies any effort directed by the patient

toward stress management; the factors that enable the

patient to regain emotional equilibrium after the stressful

experience.

G. Debridement - the process of removing nonliving tissue

from burns and other wounds.

H. Support system refers to the people who provide

assistance to the patient, such as physical support and

emotional support.

I. Stress any emotional, physical, social, or economic

factor that the patient experiences which requires a

response or change.

http://medical-dictionary.thefreedictionary.com/epidermishttp://medical-dictionary.thefreedictionary.com/dermishttp://medical-dictionary.thefreedictionary.com/dermishttp://medical-dictionary.thefreedictionary.com/epidermis

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J. Financial problems pertains to the difficulties relating

to money matters experienced by the patient or his/her

significant others.

K. Communication the exchange of thoughts, messages,

or information, as by speech, signals, or behavior of the

patient.

L. Stress Management the techniques that the patients

use to cope with or lessen the physical and emotional

effects of their current condition or situation.

M. Body image - Body image is the patients subjective

concept of his/her physical appearance.

N. Body image disturbance - the way one perceives ones

body image. Defining characteristics include verbal or

nonverbal responses to a real or perceived change in

structure or function, a missing body part, negative feelings

about the body, trauma to a nonfunctioning part, a change in

general social involvement or lifestyle, and a fear of rejection

by others.

L. Total dependence the total reliance of the patient to

other people for support to perform basic and daily activities.

M. Sleep disturbance refers to the patients difficulty to

sleep because of psychological factors such as if the patient

is experiencing anxiety.

N. Depression - a major implication of burns, experienced

by the majority of burn patients. It is a mood disturbance

characterized by feelings of sadness, despair, and

discouragement resulting from and normally proportionate to

some personal loss or tragedy.

O. Anxietyrefers to the patients feeling of apprehension,

uneasiness, agitation, uncertainty, and fear resulting from

the anticipation of some threat or problem.

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METHODOLOGY

This chapters aim is to present the methods and procedures that

will be used by the researchers in the gathering, describing, and inferringof the data and information. The subject of the research and the statistical

data collected will both be included to be used as a method of

apprehending the goals and objectives of study to be conducted.

A. Research Design

Qualitative research design is a systematic, subjective approach to

describe life experiences and give them meaning (Burns and Grove,

2009). It allows exploring of behaviors, perspectives, feelings and

experiences in depth, quality and complexity of a situation through a

holistic framework (Holloway and Wheeler, 2002)

This study will be a qualitative study that will strive to seek the

problems that 3rd

-degree burn patients experiences psychologically by

collecting data from thirteen to thirty-year-old 3rd-degree burn victims

admitted at the burn units of Zamboanga City Medical Center.

B. Sampling Method

The sampling method to be used is the non-probability sampling, the

purposive method in particular. Non-probability purposive sampling will be

used due to the fact that the researchers will gather the respondents of the

study from the burn units of the Zamboanga City Medical Center.

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Inclusion:

A minimum of five and a maximum of ten (in order to gain detailed

accounts of the responses and allowing for large amounts of

information to be analyzed, a small population was chosen).

Respondents are under the category of 3rd

degree burn patients.

Respondents who are admitted at the burn unit of Zamboanga City

Medical Center.

Respondents with 3 to 6 months in the recovery phase prior to

discharge at the burn unit of Zamboanga City Medical Center.

Participants should be aged between thirteen to thirty years old (so

as to obtain a more detailed and clear response).

Respondents with visible burnt areas such as the face, arms, and

legs.

Respondents who have or who have not undergone debridement.

Exclusion:

Respondents below thirteen years old and above thirty years old.

Respondents who are not willing to participate.

Respondents who are not capable of being interviewed due to the

severity or extent of the affected body part.

Respondents with more than 6 months of recovery phase prior to

discharge at the burn unit of Zamboanga City Medical Center.

C. Data Collection

Researchers of the study will start the collection of pertinent datafrom June of 2013 until September of 2013. The researchers will secure

permission to conduct the study in Zamboanga City Medical Center from

the Chief Nurse and consents from the patients or their significant others

before conducting the study in consideration with legal matters and issues.

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The researchers will perform open-ended interviews, which will

allow the respondents to freely express their point-of-views and

experiences in full detail, to five to ten of the thirteen to thirty-year-old

aged 3rd-degree burn patients admitted at the burn unit of Zamboanga City

Medical Center and those who patients who are within 3 to 6 months in

the recovery phase prior to discharge at the burn unit of Zamboanga City

Medical Center.

A semi-structured interview will also be used by the researchers

hence, a topic guide and a set of certain and related questions will be

prepared.

A face-to-face interview will be used in the study in order to permit

the researchers to observe and interpret any non-verbal communication

performed by the respondents and in order for both the researchers and

respondents to make necessary clarifications.

The interviews will be involving ten to fifteen open-ended questions

solely constructed for this study. The interview is estimated to last for at

least fifteen to twenty minutes.

The interview will be recorded through an audio recorder with the

permission from the respondents so as to gather an accurate and precise

account of the interview. The recorded outcome will be replayed for the

purpose of analysis and interpretation and the anonymity and

confidentiality of the respondents will be a priority of the researchers

during the whole course of the study.

The respondents will be guaranteed that they have the right to

withdraw or terminate the interview anytime that they feel necessary.

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The interviews will be lasting for at least three to five days which

will allow the researcher to study the answers of the respondents and

make necessary adjustments.

D. Validity and Reliability of Tool

The validity of this studys contents will be ensured through tool

validating to be performed by an expert in the field of tool development

and by comparing the contents of the study to review of related literatures.

The participation of the teachers in the study will guarantee the reliability

of the tools.

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Table of Specification

TABLE OF SPECIFICATION FOR DATA GATHERING

Research

Question

Data Needed Blueprint of Tool

1. What are the

common

psychologicalproblems of

burn patients?

Difficulties:

Stress due to: Disturbed body

image

Further

complications

Changes in the

activities of daily

living

Fear of total

Dependence

Sleep

disturbance

Depression and

anxiety brought

about by current

situation

Academic,

occupational,

financial and

social difficulties

1. What difficulties doyou most

experience after

the burn incident?

2. Are you having

difficulties in

adjusting with the

situation?

3. What are the

factors that trigger

the difficulties that

you experience?

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Financial Problems

due to:

Expenses for

operations

Inability to settle

hospital fees

Inability to find

sufficient

finances

Support System:

The availability

of family

members and/or

significant

others

Willingness of

the familymembers and/or

significant

others to aid in

clients

recovery.

Coping and

acceptance of the

present physical

condition or situation

4. What will you do in

case of financial

shortage?

5. When you cannot

handle the

situation, does

your family,

partner, or

significant others,

pay attention to

your needs? How?

6. Do you find it hard

to cope with the

daily difficulties

that you

experience? If so,

how do you cope?

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2. What are the

coping

strategies and

methods

utilized by 3rd

-

degree burn

patients?

Coping Strategies:

Communication

Elicit openness

to verbalize or

to share feelings

and emotions

related to

his/her present

condition or

situation.

Support System

1. Do you find this

method effective in

handling the

difficulties?

2. When you have

problems, how do

you and your

partner or other

family members

talk about it?

3. When you cannot

handle the

situation, to whom

do you seek help?

4. Do your parents,partner, or

significant others

help you with your

problems? How?

5. Is there any

organization that

you are involved

that help you

alleviate your

problems?

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Stress Management:

Ability to accept

and adjust to

current

condition or

situation

6. If you feel

stressed, how do

you adjust to the

situation?

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Flowchart of the Research Procedures

Interview of Burn patients

selected for the study

Pre-Research Phase

Formulation of Research

Tool (for data gathering)

Selection of clients, signing

of informed consent, and

validation with health service

providers

Research Phase

Analysis and Interpretation

of Data

Development of a design for

effective coping strategies

Identification of research

problem

Summarization and

Conclusion

Educating burn patients on

the effective coping

strategies to different

psychological problems

Evaluation

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Poole, M., Seibold, D., & McPhee, R. (1985). Group decision-making as a

structurational process. Quarterly Journal of Speech, 71, 74-102. InterNeg GroupWebsite. Web. 15 feruary 2013.

Blakeney, Patricia E. Psychosocial Care of Persons with Burn Injuries

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