Maxwell Joanne, Friedland Judith, Kirsh Bonnie, Beaton Dorcas
Holland Bloorview Kids Rehabilitation Hospital, 50 Kilgour Road, Toronto, ON, M4G 1R8, Canada.
Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
J Occup Rehabil. 2022 Mar;32(1):87-95. doi: 10.1007/s10926-021-09976-5. Epub 2021 May 19.
Purpose Upper extremity traumatic amputation due to work injury is a devastating injury with poor outcomes. As it does not appear to follow existing theories of psychosocial adjustment to injuries and illness, we sought to understand this problem by asking those who have sustained the injury, how they try to adjust. Methods Qualitative methods were used to interview 11 participants within 3 years of their accident. Questions included "Tell me about the impact of the amputation on your life". Data were systematically gathered and analyzed using a grounded theory (constructivist) approach which led to a preliminary model of adjustment. Results The Value of the Hand, and the Value of Working and Doing, emerged as central phenomena and created a Value Filter through which our participants' new experiences were interpreted. Two interacting themes, Instability of the Core Identity, and Efforts to Stabilize the Self, describe the effects of the process which either interfered with or promoted the formation of new values that, in turn, could lead to adjustment. Conclusions The preliminary model helps explain psychosocial adjustment for individuals with a traumatic upper extremity amputation due to work injury. The model may also be useful with other acquired injuries where the lost body part was deemed highly valuable for the individual's sense of self.
目的 因工伤导致的上肢外伤性截肢是一种具有严重后果的毁灭性损伤。由于它似乎不符合现有的关于对损伤和疾病进行心理社会调适的理论，我们试图通过询问那些受过这种损伤的人他们是如何尝试调适的，来理解这个问题。方法 采用定性方法对事故发生3年内的11名参与者进行访谈。问题包括“告诉我截肢对你生活的影响”。使用扎根理论（建构主义）方法系统地收集和分析数据，从而得出一个初步的调适模型。结果 “手的价值”以及“工作和行动的价值”成为核心现象，并创建了一个价值过滤器，通过该过滤器来解读我们参与者的新经历。两个相互作用的主题，即“核心身份的不稳定性”和“稳定自我的努力”，描述了该过程的影响，这一过程要么干扰要么促进新价值观的形成，而新价值观反过来又可能导致调适。结论 该初步模型有助于解释因工伤导致上肢外伤性截肢的个体的心理社会调适情况。该模型对于其他后天性损伤可能也有用，在这些损伤中，失去的身体部位对个体的自我认知具有很高的价值。
