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CHAPTER 2
This chapter presents foreign and local literature and studies to provide
background to perceived stress level and coping mechanism of amputees.
Foreign Literature
According to Your Care after Leg Amputation Below Knee (2018) (p.50), no
one is possibly in a better position to understand about living life with an amputation
or supporting a person with limb loss than someone who has been there. That is
why the Ohio State University has partnered with the Amputee Coalition to provide
peer support to amputees and their families through the Certified Peer Visiting
(CPV) Program. Peer visitors are trained volunteers who have adjusted well to limb
loss and lead full, active lives. They have lived with limb loss for at least one year
and believe that peer support is a vital part of the recovery process. Peer visitors
may also be family members of amputees. Peer visitors are available to meet with
them in person or over the phone to listen and provide support. They may share
their own experiences and offer helpful insight and tips for their recovery. They do
not provide medical advice, but simply help answer questions that may help
amputees about living life with limb loss. Every effort is made to match them to a
peer visitor who closely relates to the individual situation.
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Foreign Studies
Moreover, one of the factors affecting the adaptation with the lower limb
amputation is social support. Khademi (2011) showed that people with high social
support had lower levels of depression and anxiety. Additionally, in the study
conducted by Engstorm, family support can have a positive impact on adaptation
with amputation. While Ziad's study revealed that unmarried (single) patients and
patients who had no social support have high levels of anxiety and depression.
Likewise, Tyc stressedxz that social support also had a direct impact on general
adaptation with amputation among adolescents and young people. Also, according
to Furst, in his qualitative study, participants stated that one of the effective factors
on the promotion of successful rehabilitation is family support.
Kamel revealed that respondents were also worried about their position in
the society in which they lived “How will people take me?” concerns about
inferiority, lack of pride and rejection, resentment and neglect by the family came
up frequently, fear of losing their spouse, and spouse response was crucial in
deciding about the operation. Concerns about sex and getting married, losing
respect of their children were expressed. One respondent revealed that his family
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People may be anxious and feel less confident about having to re-establish
themselves in the community and this can even result in immobility (Kamel, 2010).
People feel “low” in society and even inferior to others “I feel how low in society,
inferior to others: have to accept any job, life plans have changed” “here (in
Rwanda) nobody values a disabled person (Amosun et l, 2010). Their study was
not explicit in determining whether when a person feels low, that means a low self-
esteem, low confidence or low morale. Mobility impaired people report the least
distress in relationships in their lives but more distress in their ability to participate
in community activities and the ability to work (Misajon et al, 2010).
Marques et al. (2014) report that patients complained of neglect and lack of
information on the part of physicians in regard to the amputation surgery. Health
professionals face ethical dilemmas such as inequalities in living condition, access
to health services and the lack of preparation/qualification of the human resources
in health. Furthermore, amputee patients demand specific rehabilitation care in
that sense, the medical professionals need to be prepared to work competently.
Study conducted by Batista and Luz (2012) reports that patients started to depend
on their physicians’ consent to make certain decisions. In another paper Gabarra
and Crepaldi (2009) suggest the behaviors physicians could adopt to facilitate the
rehabilitation process, such as individualized attention, active listening, giving
opportunities for patients to ask questions, use of accessible language,
encouraging the active participation of the patient in the decision-making regarding
the surgery process, and embracing patients distress. Moreover, bad news is
those that drastically and negatively alter the patients’ perspective on his future
and in this type of communication the doctor obviously has a major involvement.
Dealing with emotional aspects is also concerned with the doctor- patient
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The study Duran and Alonso- Balmonte (2016) that are being amputated is
a distressing experience that can lead a challenge to social dysfunction and
significant psychological (Desmond & MacLachlan, 2006). Supports of a person
addressed and derive the stressful events of the patient who is amputated as
based on the study. The study of Carver and Connor-Smith (2010) describes that
optimistic individual tends to be persistent and more confident in striving their goals
in the front of different life challenges may slow or difficult in progress but explains
differences of pessimistic individuals which are tended to be avoidant in coping-up
such as behavioral disengagement, while those optimistic individuals provide a
certain coping strategy to overcome their problems. As stated, this will help to
provide coping mechanisms that will help to understand their daily situations (as
cited in Taylor, 2007).
As a result, the coping mechanism varies stressors and situations faced by
different individuals. Emotional strategies focus on denial or avoidance are
generally most considered as to be Maladaptive, by allowing much time for the full
impact on the event to be absorbed may prove to be adaptive in the early stages
by reducing distress of coping with others (as cited Kortte & Wegener, 2004).
The result of the study Baqutayan (2015), coping mechanism and stress
are together on what method is the best it depends on individual needs and type
of stress. A meditation based stress reduction-counseling program can guide and
help the person to identify which coping method suite their needs.
Based on Chalya et al., (2012) study, the major limb amputation that is a
major public health problem but preventable consociate with economic, social and
psychological effects on patient and family. This was a descriptive cross-sectional
study, conducted at Bugando Medical Centre with a total of 162 patients. Lower
limb amputation was the most common procedure than upper limb amputation.
The common hint for major limb amputation was diabetic foot complications,
trauma and vascular disease. Difficulty of diabetic foot ulcers and trauma effects
from road traffic crashes were the most common lead for major limb amputation in
our environment. Provision of health education, early presentation and appropriate
management of major limb amputation are preventable by these.
Local Literature
Synthesis
People with a lower limb amputation state a feeling of insignificance and not
being valued in their society. High frequency of depression among people with
lower limb amputation is also associated with decreased social interaction, lowered
self-esteem due to distortion of body image, with increased dependency and lack
of social support. The impact of amputation on the balance of interpersonal
relationships and loss of status within the family may surface. People may be
anxious and feel less confident about having to re-establish themselves in the
community and this can even result in immobility (Amosun et al. 2011, Kamel 2010,
Misajon et al. 2010, Engstorm & Van de Ven 2011).
Similarly, in the present study, individuals who had no social support report
most distress unlike people who have high social support results to cope easily.
However, there are those who cope with amputation on their own and only
require guidance and support. In some instances, regression, helplessness, anger
and denial are evident (Kamel, 2010).