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Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury
Archives of Psychiatric Nursing xxx (2014) xxx–xxx
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Archives of Psychiatric Nursing journal homepage: www.elsevier.com/locate/apnu
Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury Duangporn Piyakong ⁎ Christine E. Lynn College of Nursing, Florida Atlantic University
a b s t r a c t The purpose of this study were to explore challenges and approaches for resolving challenges that Thai family members face when engaging with their loved one with severe traumatic brain injury in the critical care setting. This pilot study used an exploratory design. Nine family members were interviewed at a hospital in Thailand. Story-inquiry method guided data collection and analysis. Three challenges themes were identified: facing the uncertainty of their loved one's illness, dealing with personal sufferings, and changing everyday life patterns. Attending to their loved one and attending to self were two themes that family members used to manage challenges. © 2014 Elsevier Inc. All rights reserved.
Traumatic brain injury (TBI) is a major health problem in Thailand, often caused by motorcycle accidents (Kitisomprayoonkul, 2010; Petchprapai, 2007; Prateepwanit, 2008). The consequences of TBI can affect mobility, memory, perception, social engagement, economic security, and consciousness. Uncertainty is an implicit dimension of TBI, and this uncertainty directly affects family members, making them feel stressed and vulnerable (Hawley & Joseph, 2008; Verhaeghe, Defloor, & Grypdonck, 2005). Little is known about challenges faced and approaches used to manage challenges for Thai family members of patients with TBI. Story theory was used to guide the conceptual focus on health challenges and approaches to resolve challenges (Smith & Liehr, 2014) for Thai family members when a loved one has suffered a TBI. METHOD An exploratory descriptive design was used in this theory-guided pilot study. Thai family members of TBI patients were interviewed at the neurological critical care setting (ICU) of a hospital in Thailand. The interviewer asked about challenges and approaches used by Thai family members to manage challenges. The 1 hour interview was tape recorded, transcribed, and translated to English. The translation enabled collaboration with an experienced qualitative researcher who supported and verified analysis modalities. Content analysis was used to identify challenges and management approaches. Transcripts were read and re-read to identify segments describing challenges. Author Note: Duangporn Piyakong is a nursing instructor at Faculty of Nursing, Naresuan University, Phitsanulok Province, Thailand. Duangporn Piyakong is now a PhD student at Christine E. Lynn College of Nursing, Florida Atlantic University. Post code: 33431. ⁎ Corresponding Author: Christine E. Lynn College of Nursing, Florida Atlantic University, FL. 33431. E-mail address: [email protected].
Like segments were grouped and named as themes. A comparable technique was undertaken for the management approaches. PARTICIPANTS Nine Thai family members participated in this pilot study. The majority was female (78.8%). Relationship with the patient included: wives (44.4%), mothers (22.2%), fathers (22.2%); and one niece (11.2%) participated. Their ages ranged from 20 to 62, with a mean age of 40 years. All were Buddhist. FINDINGS Challenges Three challenge themes were identified: 1) facing the uncertainty of a loved one's illness, 2) dealing with personal suffering, and 3) changing everyday life patterns. 1. Six participants indicated they feared that the loved one would die: “I’m very worried that my husband will die because his symptoms are very severe and unstable.” Three feared worsening symptoms: “I feel terrible because her consciousness does not recover, but it’s worse.” 2. Most participants (n = 8) described that they had emotional sufferings. “I cannot restraint my mind,” and “I always cry whenever thinking about my loved one.” Only one participant reflected about economic suffering: “My family will confront the economic problem if he has to be admitted in the hospital for a long time.” 3. The third challenge theme was composed of three sub-themes: working problems, loss of personal time, and sleep–wake problems. Six participants had to stop working, and two participants
http://dx.doi.org/10.1016/j.apnu.2014.03.001 0883-9417/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Piyakong, D., Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2014.03.001
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D. Piyakong / Archives of Psychiatric Nursing xxx (2014) xxx–xxx
needed to change their work shifts. Representative quotes included: “I need to stop working on the farm in order to visit and take care of my son in every visiting time” and “I have to change my working shift from the morning shift to be the evening shift because I need to visit my husband everyday at the visiting time.” For the loss of personal time sub-theme, all participants described that they abandoned family routines or other responsibilities so that they spent time each day visiting the patient: “My life is extremely changed. I am concerned about his illness so much that I don’t have time to talk to other people, and don’t want to do any activities,” and “I’ve spent my all day with taking care of my son in the hospital and asked for my husband to do the housework instead of me.” In addition, most participants (n = 7) encountered sleep–wake problems, including getting up early and changing sleeping places (in a visiting room, a rental house, and a relative's house). “I have to wake up very early, about 4 a.m. and take a bus to the hospital…,” “I’ve stayed overnight at the visiting room when my husband has been in the hospital” and “Since my son has been admitted in this hospital, I need to rent a room which is located next to the hospital in order to come to the hospital very early.” Managing Challenges Two themes were identified: 1) attending to the loved one and 2) attending to self. 1. Attending to the loved one included stimulating consciousness and providing care. Stimulating consciousness was described in several ways, such as using family members' voice, using the Buddha teaching sound, kissing, touching and blessing. Representative quotes include: “I use my loud voice and shake his arms whenever I visit him,” “I open the Buddha teaching tape recorder for him… hope to stimulate his consciousness,” and “What I’ve done to help him have a better consciousness are kissing his cheek, and touching his face, chest, and arms.” Providing care included participating in activities of daily living and attending to fever. Representative
quotes were: “I clean his body, and exercise his limbs…I believe that these actions will help him feel comfortable and will stimulate his consciousness” and “I check her temperature and do a tepid sponge if she has got a high fever.” 2. The attending to self theme included spiritual self-support, such as praying to Buddha, and making a wish: “make a merit by offering foods to Buddhist monks every morning.” This theme also included finding support from others: “Ask for the physician and nurses to put in more effort,” and “My brothers and sisters have supported me many ways, such as giving me Buddha teaching books, taking care of my children, and consoling me whenever I cry.” DISCUSSION The research findings from this pilot study revealed that Thai family members face the health challenge of uncertainty when a loved one suffers unconsciousness from TBI. Moreover, their approaches to manage challenges include the use of familiar resources to connect with the loved one and improve consciousness. These results will be useful to create supportive interventions for Thai family members in similar circumstances. Story theory provided meaningful guidance for story-gathering and data analysis. References Hawley, C. A., & Joseph, S. (2008). Predictors of positive growth after traumatic brain injury: A longitudinal study. Brain Injury, 22, 427–435. Kitisomprayoonkul, W. (2010). Traumatic brain injury rehabilitation. In D. Chaiwanichsiri, & W. Kitisomprayoonkul (Eds.), Rehabilitation medicine textbook (pp. 187–197) (2nd ed.). Bangkok: Chulalongkorn University Company (Thai version). Petchprapai, N. (2007). Adaptation to Mild traumatic brain injury Among Thai adults. (Dissertation for the degree of doctor of philosophy). Case Western Reverse University. Prateepwanit, P. (2008). Introduction of rehabilitation medicine. In K. Pajaree (Ed.), Rehabilitation Medicine (pp. 1–8). Bangkok: N.P. Press (Thai version). Smith, M. J., & Liehr, P. (2014). Story theory. In M. J. Smith, & P. Liehr (Eds.), Middle range theory for nursing. New York: Springer. Verhaeghe, S., Defloor, T., & Grypdonck, M. (2005). Stress and coping among families of patients with traumatic brain injury: A review of the literature. Journal of Clinical Nursing, 14(8), 1004–1012.
Please cite this article as: Piyakong, D., Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2014.03.001
Contents lists available at ScienceDirect
Archives of Psychiatric Nursing journal homepage: www.elsevier.com/locate/apnu
Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury Duangporn Piyakong ⁎ Christine E. Lynn College of Nursing, Florida Atlantic University
a b s t r a c t The purpose of this study were to explore challenges and approaches for resolving challenges that Thai family members face when engaging with their loved one with severe traumatic brain injury in the critical care setting. This pilot study used an exploratory design. Nine family members were interviewed at a hospital in Thailand. Story-inquiry method guided data collection and analysis. Three challenges themes were identified: facing the uncertainty of their loved one's illness, dealing with personal sufferings, and changing everyday life patterns. Attending to their loved one and attending to self were two themes that family members used to manage challenges. © 2014 Elsevier Inc. All rights reserved.
Traumatic brain injury (TBI) is a major health problem in Thailand, often caused by motorcycle accidents (Kitisomprayoonkul, 2010; Petchprapai, 2007; Prateepwanit, 2008). The consequences of TBI can affect mobility, memory, perception, social engagement, economic security, and consciousness. Uncertainty is an implicit dimension of TBI, and this uncertainty directly affects family members, making them feel stressed and vulnerable (Hawley & Joseph, 2008; Verhaeghe, Defloor, & Grypdonck, 2005). Little is known about challenges faced and approaches used to manage challenges for Thai family members of patients with TBI. Story theory was used to guide the conceptual focus on health challenges and approaches to resolve challenges (Smith & Liehr, 2014) for Thai family members when a loved one has suffered a TBI. METHOD An exploratory descriptive design was used in this theory-guided pilot study. Thai family members of TBI patients were interviewed at the neurological critical care setting (ICU) of a hospital in Thailand. The interviewer asked about challenges and approaches used by Thai family members to manage challenges. The 1 hour interview was tape recorded, transcribed, and translated to English. The translation enabled collaboration with an experienced qualitative researcher who supported and verified analysis modalities. Content analysis was used to identify challenges and management approaches. Transcripts were read and re-read to identify segments describing challenges. Author Note: Duangporn Piyakong is a nursing instructor at Faculty of Nursing, Naresuan University, Phitsanulok Province, Thailand. Duangporn Piyakong is now a PhD student at Christine E. Lynn College of Nursing, Florida Atlantic University. Post code: 33431. ⁎ Corresponding Author: Christine E. Lynn College of Nursing, Florida Atlantic University, FL. 33431. E-mail address: [email protected].
Like segments were grouped and named as themes. A comparable technique was undertaken for the management approaches. PARTICIPANTS Nine Thai family members participated in this pilot study. The majority was female (78.8%). Relationship with the patient included: wives (44.4%), mothers (22.2%), fathers (22.2%); and one niece (11.2%) participated. Their ages ranged from 20 to 62, with a mean age of 40 years. All were Buddhist. FINDINGS Challenges Three challenge themes were identified: 1) facing the uncertainty of a loved one's illness, 2) dealing with personal suffering, and 3) changing everyday life patterns. 1. Six participants indicated they feared that the loved one would die: “I’m very worried that my husband will die because his symptoms are very severe and unstable.” Three feared worsening symptoms: “I feel terrible because her consciousness does not recover, but it’s worse.” 2. Most participants (n = 8) described that they had emotional sufferings. “I cannot restraint my mind,” and “I always cry whenever thinking about my loved one.” Only one participant reflected about economic suffering: “My family will confront the economic problem if he has to be admitted in the hospital for a long time.” 3. The third challenge theme was composed of three sub-themes: working problems, loss of personal time, and sleep–wake problems. Six participants had to stop working, and two participants
http://dx.doi.org/10.1016/j.apnu.2014.03.001 0883-9417/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: Piyakong, D., Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2014.03.001
2
D. Piyakong / Archives of Psychiatric Nursing xxx (2014) xxx–xxx
needed to change their work shifts. Representative quotes included: “I need to stop working on the farm in order to visit and take care of my son in every visiting time” and “I have to change my working shift from the morning shift to be the evening shift because I need to visit my husband everyday at the visiting time.” For the loss of personal time sub-theme, all participants described that they abandoned family routines or other responsibilities so that they spent time each day visiting the patient: “My life is extremely changed. I am concerned about his illness so much that I don’t have time to talk to other people, and don’t want to do any activities,” and “I’ve spent my all day with taking care of my son in the hospital and asked for my husband to do the housework instead of me.” In addition, most participants (n = 7) encountered sleep–wake problems, including getting up early and changing sleeping places (in a visiting room, a rental house, and a relative's house). “I have to wake up very early, about 4 a.m. and take a bus to the hospital…,” “I’ve stayed overnight at the visiting room when my husband has been in the hospital” and “Since my son has been admitted in this hospital, I need to rent a room which is located next to the hospital in order to come to the hospital very early.” Managing Challenges Two themes were identified: 1) attending to the loved one and 2) attending to self. 1. Attending to the loved one included stimulating consciousness and providing care. Stimulating consciousness was described in several ways, such as using family members' voice, using the Buddha teaching sound, kissing, touching and blessing. Representative quotes include: “I use my loud voice and shake his arms whenever I visit him,” “I open the Buddha teaching tape recorder for him… hope to stimulate his consciousness,” and “What I’ve done to help him have a better consciousness are kissing his cheek, and touching his face, chest, and arms.” Providing care included participating in activities of daily living and attending to fever. Representative
quotes were: “I clean his body, and exercise his limbs…I believe that these actions will help him feel comfortable and will stimulate his consciousness” and “I check her temperature and do a tepid sponge if she has got a high fever.” 2. The attending to self theme included spiritual self-support, such as praying to Buddha, and making a wish: “make a merit by offering foods to Buddhist monks every morning.” This theme also included finding support from others: “Ask for the physician and nurses to put in more effort,” and “My brothers and sisters have supported me many ways, such as giving me Buddha teaching books, taking care of my children, and consoling me whenever I cry.” DISCUSSION The research findings from this pilot study revealed that Thai family members face the health challenge of uncertainty when a loved one suffers unconsciousness from TBI. Moreover, their approaches to manage challenges include the use of familiar resources to connect with the loved one and improve consciousness. These results will be useful to create supportive interventions for Thai family members in similar circumstances. Story theory provided meaningful guidance for story-gathering and data analysis. References Hawley, C. A., & Joseph, S. (2008). Predictors of positive growth after traumatic brain injury: A longitudinal study. Brain Injury, 22, 427–435. Kitisomprayoonkul, W. (2010). Traumatic brain injury rehabilitation. In D. Chaiwanichsiri, & W. Kitisomprayoonkul (Eds.), Rehabilitation medicine textbook (pp. 187–197) (2nd ed.). Bangkok: Chulalongkorn University Company (Thai version). Petchprapai, N. (2007). Adaptation to Mild traumatic brain injury Among Thai adults. (Dissertation for the degree of doctor of philosophy). Case Western Reverse University. Prateepwanit, P. (2008). Introduction of rehabilitation medicine. In K. Pajaree (Ed.), Rehabilitation Medicine (pp. 1–8). Bangkok: N.P. Press (Thai version). Smith, M. J., & Liehr, P. (2014). Story theory. In M. J. Smith, & P. Liehr (Eds.), Middle range theory for nursing. New York: Springer. Verhaeghe, S., Defloor, T., & Grypdonck, M. (2005). Stress and coping among families of patients with traumatic brain injury: A review of the literature. Journal of Clinical Nursing, 14(8), 1004–1012.
Please cite this article as: Piyakong, D., Challenges Faced By Thai Families When a Loved One Has a Traumatic Brain Injury, Archives of Psychiatric Nursing (2014), http://dx.doi.org/10.1016/j.apnu.2014.03.001