title: The experience of living with a traumatic hand injury in a rural and remote location: an interpretive phenomenological study.
abstract: BACKGROUND
  The aim of this research study was to gain an understanding of how rural and remote residents in North Queensland, Australia, engaged in work, activities of daily living tasks and social activities following a traumatic hand injury. Findings from a previous retrospective survey with these participants revealed that patients experienced difficulties such as pain for many years after their injury; however, because of the survey methodology, the voices of participants were not heard. This study contributes to a larger project that seeks to propose a model of service delivery to rural and remote residents who have sustained a traumatic injury.
  
  
  METHODS
  Utilising an interpretive phenomenological research design, data were gathered through in-depth, semistructured interviews. Fifteen participants were recruited into this study and questions were designed to explore the experience of having a traumatic hand injury in rural and remote areas of North Queensland.
  
  
  RESULTS
  The thematic analysis indicated five major themes: injury and impairment, pain, occupation and activity, and resilience. Participants reported that having a hand injury often caused further injury due to the impairment. The pain experienced could be 'all consuming' yet participants reported 'pushing through' this pain to complete daily tasks. Participants reported that they would 'go mad' if they did not work and highlighted the importance of activity in their recovery. Participants felt grateful at having their hand and thought towards the future. Being self-reliant was important but they were willing to accept support from others when needed.
  
  
  CONCLUSIONS
  Incorporating activity and occupation in rehabilitation programs as opposed to focusing on strict protocols is an important consideration in the recovery process of rural and remote residents. In particular, engaging in activity and occupation was an important part of managing the pain associated with the hand trauma. This research also found that participants demonstrated resilient qualities while recovering from a traumatic hand injury. Health professionals who work with people from a rural and remote location with a traumatic hand injury should consider a treatment model that encourages active patient participation, identifying collaborative treatment goals that align with the values of people living in rural and remote locations. Education regarding the high risk of further injury due to the nature of, and exposure to, the type of work and activity in rural and remote locations is also recommended.
authors.affiliation: 1 James Cook Drive Townsville 4811. gail.kingston@my.jcu.edu.au.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Kingston
authors.affiliation: 1 James Cook Drive Townsville 4811. jenni.judd@jcu.edu.au.
authors.forename: Dr Jenni
authors.initials: DJ
authors.lastname: Judd
authors.affiliation: 90 Sippy Downs Drive, Sippy Downs, 4556. marion.gray@usc.edu.au.
authors.forename: Marion A
authors.initials: MA
authors.lastname: Gray
mesh_terms: D000203:Activities of Daily Living; D005260:Female; D006230:Hand Injuries / Q000150:complications / Q000523:psychology*; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011793:Queensland; D055500:Resilience, Psychological; D012189:Retrospective Studies; D012424:Rural Population; D014937:Work / Q000523:psychology*