Amputees' Perceptions of What Nurses Should Know about Mirror Interventions

Sunday, 8 November 2015: 4:00 PM

Wyona M. Freysteinson, PhD, MN, BSN, RN
Nelda C. Stark College of Nursing, Texas Woman's University, Houston, TX, USA
Lisa W. Thomas, MS, BSN, RN, CRRN, APRN, CNS
TIRR Memorial Hermann, Houston, TX, USA
Amy L. Sebastian-Deutsch, DNP, MSN, BSN, APRN, CNS, AOCNS
System Cancer Services, Memorial Hermann Health System, Houston, TX, USA

Purpose: Approximately two million people in the United States are living with the loss of a limb. Researchers have demonstrated that a visible disfigurement such as an amputation may have a profound psychological impact on individuals, including his/her perception of one’s own body image. An aspect of body image that appeared to be neglected in the literature for amputees was the mirror-viewing experience. Evidence that addressed viewing one’s self in a mirror after the amputation of a limb(s) appeared to be non-existent. The aim of this multi-disciplinary, qualitative research study was two-fold: to generate a description of the trajectory of the mirror experience over time following a limb amputation, and to gain an understanding of appropriate clinical and/or educational mirror interventions for individuals who have had limb amputations. In this presentation, the perceptions of the participants as to what nurses should know and do concerning the mirror experience are examined.

Methods: Audio-taped focus groups were held with nine women and eight men, ages 19 to 68 (M=42.82, SD=14.34), who had lost an upper or lower limb anywhere from 1 to 48 years prior to the study. One of the questions asked in the focus groups was: What should every health care provider know about the mirror experience?  This question generated a considerable amount of data that pertained to a variety of health care professionals including nurses.

Results: Key life stories the amputees shared are used to highlight the need for nurses to take an active role in the mirror experience following amputation. The lack of mirrors in hospital rooms was acknowledged by almost all study participants. Only one participant had ever discussed mirrors with a health care provider. As such, amputees in these focus groups learned from each other how mirrors may be used: to care for their residual limbs, in gait and prosthesis training, and in coming to know one’s new body. Viewing self in a mirror after an amputation may be a traumatic event as evidenced by words such as shock, horrible, disgust, devastated, and ashamed.  A story is shared of the visceral reaction of one participant who accidentally encountered her reflection in a full length mirror for the first time after her amputation in a physical therapy room surrounded by numerous other patients. Step by step instructions as to how these participants believed large mirrors should be introduced after an amputation and who should be present, for support, are provided. Information as to when a patient should be referred to a psychologist regarding the mirror experience is explored. In addition, education on the importance of using a small mirror in self-assessment of the residual limb is examined.

Conclusion: The information provided in this presentation may be used in preparing interventions for future mirror studies aimed at the ways in which nurses may be more involved in the care of an individual who has suffered an amputation of a limb. It has also provided information that will allow for the development of caring, compassionate, clinical nursing mirror interventions and professional education aimed at enhancing acceptance of body image and avoidance of skin breakdown and infection.