Browsing School, Graduate by Subject "Wounds and Injuries--psychology"
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Appraisal, coping, social support, and posttraumatic stress of trauma patients one week following accidental injuryThe purposes of the study are to test relationships among injury appraisals, coping, social support and outcomes of coping efficacy, mood states, and post-traumatic stress; and to test the interaction effects of coping and social support on the relationship of stress and outcomes in the traumatically injured individual one week following accidental injury. The conceptual model for the study is primary derived from the stress and coping theory which includes major components of stress appraisals, coping, social support, and outcomes. A sample of 152 hospitalized trauma patients a week following accidental injury were recruited from two trauma centers. The measures included the injury appraisal of perceived stressor, perceived stressfulness, perceived controllability, and perceived injury severity; the modified Ways of Coping Scale (WCS); the brief Social Support Questionnaire (SSQ); the brief Profile of Mood State (POMS); the Impact of Event Scale (IES); and selected demographic and injury related variables.;Data were analyzed by multivariate statistics. The results indicated that perceived controllability (beta=.17, p<.01), satisfaction with social support (beta=.27, p<.01), wishful thinking (beta=-.33, p<.01), and problem-focused coping (beta=.23, p<.01), were the significant predictors for coping efficacy; perceived stressfulness (beta=.33, p<.01), problem-focused coping (beta=-.19, p<.01), and wishful thinking (beta=.47, p<.01),explained a significant amount of variance in mood states; and avoidance coping (beta=.42, p<.01), and wishful thinking (beta=.23, p<.01), were the significant predictors for post-traumatic stress. The moderating effects of emotion-focused coping at high and medium levels were identified as the underlying mechanism that affects coping efficacy by enhancing negative effect of stress on outcome. No buffering effects of social support were identified in the study. These findings can be used to identify traumatically injured patients who are at risk for mood disturbance and post-traumatic stress in the trauma center. Nursing interventions to address these factors can be developed and tested. Longitudinal studies are needed for understanding the mechanism of relationships among appraisals, coping, social support and outcomes of coping efficacy, mood states, and post-traumatic stress.
Pain, coping, and depression following burn injuryPain, coping, and depression were examined in a convenience sample of 32 burn injured men and women. Subjects were interviewed 3 times at approximately weekly intervals. The first and third interviews focused on coping, the second interview focused on how burn pain is described and rated by burn injured subjects and their care providers. Three criterion variables, pain intensity, pain distress, and depression were used to measure coping outcome. Five variables, severity of injury, surgical intensity, baseline depression, duration of pain, and level of analgesic drug were predicted to influence coping. Although the burn wound was identified as the source of worst pain, when subjects were asked to rate wound, donor, and skin graft pain using the short form McGill Pain Questionnaire (MPQ-SF), no significant differences were found. Average pain intensity, average pain distress, and level of depression decreased significantly over time. Pain with routine activity and pain worst continued to be rated moderate to severe by most patients at the third interview. No changes were noted in coping strategy use when coping was measured using the Coping Strategies Questionnaire. Subjects' perceptions of their ability to control pain increased significantly over the three measurement sessions. Subjects' perceptions of their ability to decrease their pain increased but did not achieve significance. Significant correlations between predictor and criterion variables were found for severity of injury, duration of pain, level of analgesic drug, baseline depression, and perceptions of ability to control and decrease pain. Significant correlations were also found between the criterion variables and beliefs related to personal control and the tendency to catastrophize. A significant positive correlation was found between care provider estimates of pain distress today and the average self-reported pain distress score. Care provider estimates of pain intensity today did not correlate with the average self-reported pain intensity score. When t-test comparisons were made between care provider and patient ratings no significant differences were found.
A qualitative analysis of the implementation of a complex intervention: evaluating implementation of the Trauma Survivors NetworkBackground: Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically. Purpose: The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified. Methods: In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level. Results: The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.