The patient-body relationship and the "lived experience" of a facial burn injury: a phenomenological inquiry of early psychosocial adjustment.
BACKGROUND
Throughout development and into adulthood, a person's face is the central focus for interpersonal communication, providing an important insight into one's identity, age, sociocultural background, and emotional state. The face facilitates important social, including nonverbal, communication. Therefore, sustaining a severe burn, and in particular a facial burn, is a devastating and traumatizing injury. Burn survivors may encounter unique psychosocial problems and experience higher rates of psychosocial maladjustment, although there may be a number of potentially mediating factors.


OBJECTIVE
The purpose of this phenomenological study was to examine the early recovery experience of patients with a facial burn. In particular, this study focused on how the injury impacted on the participants' relationship with their own body and the challenges of early psychosocial adjustment within the first 4 months of sustaining the injury.


METHODS
In 2011, six adult participants encompassing two females and four males ranging from 29 to 55 years of age with superficial to deep dermal facial burns (with background burns of 0.8%-55% total body surface area) were recruited from a severe burn injury unit in Australia for participation in a Burns Modified Adult Attachment Interview. Narrative data were analyzed thematically and informed by Colaizzi's method of data analysis.


RESULTS
Three overarching themes emerged: relationship to self/other, coping, and meaning-making. Themes identified related to how the experience affected the participants' sense of relationship with their own bodies and with others, as well as other challenges of early psychosocial adjustment. All participants indicated that they had experienced some early changes in their relationship with their body following their burn injury.


CONCLUSIONS
These findings highlight the struggle burn survivors experienced with postburn adjustment, but expressed altruism and optimism around their recovery. Past trauma was observed to be a significant finding in this sample. Understanding the "lived experience" supports the way clinical and family systems can foster positive adjustment and coping. Consequently, multidisciplinary burn teams and health care professionals need to understand the principles of trauma-informed care and translate these into practice in the treatment of this group of patients.
Brain and Mind Centre and Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney and Western Sydney Local Health District, Parramatta, NSW, Australia ; Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia.
Loyola M
LM
McLean
Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia ; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Vanessa
V
Rogers
School of Health Sciences, Faculty of Health, University of Tasmania, Alexandria, NSW, Australia ; Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia ; School of Nursing, University of Adelaide, SA, Australia.
Rachel
R
Kornhaber
Graduate School of Counselling, Excelsia College, Sydney, NSW, Australia.
Marie-Therese
MT
Proctor
Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia ; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Julia
J
Kwiet
Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia ; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Jeffrey
J
Streimer
Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia.
John
J
Vandervord
body image; complex trauma; facial burn; phenomenology; posttraumatic growth; psychosocial adjustment