Effect of yoga nidra on the self-esteem and body image of burn patients

https://doi.org/10.1016/j.ctcp.2019.02.002Get rights and content

Highlights

  • It was observed that 30 min of yoga practice for 3 days a week for four weeks increased the self-esteem.

  • It was observed that the 30 min yoga practice for 3 days a week during for four weeks improved the body perception.

  • It was observed that the body perception of the group which does not practice yoga declined.

Abstract

Background

This study was conducted to determine effect of yoga nidra on the self-esteem and body image of burn patients.

Materials and methods

This study was performed in a quasi-experimental model with pretest and post-test control groups. The domain of the study was formed with the patients at adult burn unit of a university. One hundred ten patients participated in the study. The data were collected using the Self-Description Form, the Rosenberg Self-Esteem Scale, and the Body Image Scale.

Results

After yoga practice, there was a statistically significant increase and improvement in the self-esteem and body image of the experimental group (p < 0.05). A statistically significant decline in the score average of pretest and post-test of body image of the patients in the control group was observed (p < 0.05).

Conclusion

It has been observed that yoga practice increases self-esteem and improves the body image of burn patients significantly.

Introduction

The type of injuries that cause psychological and physical problems in an individual and that occur due to the exposure of the skin layers to thermal, electrical, chemical agents, or radiation is called burn [1,2]. It is estimated that approximately 180,000 deaths occur every year due to this type of injury worldwide [3]. As a result of precautions, deaths due to this type of injury are less common in high-income and developed countries. Each year in the United States, nearly 40,000 individuals receive treatment as burn patients in hospitals, 30.000 of whom are treated in burn units and 3275 of whom lose their lives as a result of burns [4]. In 2016, in Turkey, 260 individuals lost their lives due to burns [5]. In the process of burn treatment and care, the self-esteem and body image of the patients are generally negatively affected due to the burns [6]. The self is defined as the individual's own feelings, attitudes, physical and mental characteristics, and self-evaluation and awareness [7]. The elements of the concept of the self are often perceived as definitions coming to the individual from his or her surroundings, and the individual evaluates the self with respect to these definitions [8]. The emotional aspect of the self is formed through these evaluations [9]. Self-esteem that constitutes the emotional part of the self implies that the individual accepts himself/herself as is and cherishes himself/herself [10]. Burns or sickness can affect the physical or psychological response of the individual to the sickness, and individual's self-esteem either makes the individual orient with the illness or affects this response negatively due to a conflict with the self [1,11]. There is a strong relationship between self-esteem and an individual's body image [12]. Conditions such as burn injuries, which cause changes in the individual's physiological functions and self-esteem, also affect the individual's body image [9,13].

Body image is the entirety of the positive and negative perceptions, reactions, and evaluations of an individual regarding his or her body in the individual's mind [14]. Body image, which is a multidirectional concept, possesses features that include psychological and social aspects and the physical development of the individual at the beginning of the life process [15]. Body image is shaped by the social position of the individual, previous experience, and values [15,16]. The significance/importance of the changes in the person's appearance or a reduction in physical functions differ with respect to the perception of the individual [1,17]. The evaluations of others also affect an individual's body image [18].

Burn injury alters the body image of the individual [1]. The injury that occurs on the skin of the patient causes the patient to think that the body integrity is broken [1,19]. The patient whose appearance is distorted and who has physical impairment due to burns may experience a change in body image and a personality crisis [1,18]. For example, patients think that their bodies have changed irreversibly after burn injuries, and they worry about the future and experience physical limitations [18]. Burn patients tend to approach their bodies negatively [18]. The tendencies toward stigmatization from others, such as prejudice, lack of eye contact, ignorance or compassion affect body image even more negatively [18]. Patients who encounter this negativity are more likely to get angry and afraid [18].

Yoga, which is one way of coping with these fears, is a body-mind method that has a history of 6000 years or more. Yoga means to unite, connect, or integrate with the universe, and it is widely practiced in the world [20,21]. During yoga, all the systems in the body physically work in harmony, allowing the individual to get rid of contradictory situations, reaching an integrity of body, mind, and soul [[21], [22], [23]]. The term yoga nidra, which is a type of yoga resulting in the integration of body, mind, and soul, means falling asleep through integrity [24]. In yoga nidra practice, to provide complete relaxation, the individual takes the Savasana position (lying on the back with lower and upper extremities separated from each other at approximately 45°) [25]. In yoga nidra practice, the nyasa technique, which is characterized by the consciousness wandering through the different parts of the body, is applied [24]. By wandering the consciousness through the physical body, the individual senses that the body is an energy vibration field [24,25]. When yoga nidra is practiced, the individual contacts the second energy layer by focusing on breathing, examines this layer, and monitors self-breathing without interfering with the process of inhalation-exhalation [24]. The energy of life, called prana, is taken by means of breathing and is distributed to all parts of the body [25].

The most effective method of training the mind in yoga nidra practice is the sankalpa technique. Sankalpa means “intention” or “proposal” in Sanskrit [24,26]. Negative tendencies and habits can be corrected by positive sankalpa so the whole self of the individual changes to a positive direction [24]. In this stage, the nature of the ego begins to be examined, and the physical self and the spiritual self are realized [24].

In the case of illness, which is defined as the deterioration of the balance between the body, mind, and soul, the nurse's comprehension of the individual's anxiety and developing appropriate coping strategies will improve the patient's prognosis [27]. Yoga is one of the most reasonable strategies to use with burn patients. For instance, Tenenhaus et al. have stated in their studies that yoga can help with the independence of burn patients [28]. Miller et al. have reported that yoga improves the cardiovascular function of burn patients and enhances quality of life in both functional and emotional areas [29]. Conn et al. have performed yoga with pediatric burn patients and have found that yoga diminished the somatic and cognitive anxieties of the patients [20].

The results of the literature review showed that there are a limited number of studies on yoga in burn patients [20,28,29], and none have been done in Turkey. Yoga, which enables the individual to turn to the inner world, is considered to be an effective strategy for increasing self-esteem and improving body image when practiced as an independent nursing act with burn patients. It is also expected that the study will contribute to the literature on nursing practices.

The purpose of our study is to determine the effect of yoga on the self-esteem and body image of burn patients. This study is seeking answers to three hypotheses.

H0

There is no effect of yoga on self-esteem and body image of burn patients.

H1

Yoga increases the self-esteem of burn patients.

H2

Yoga improves the body image of burn patients.

Section snippets

Study desingn and settings

This study is a quasi-experimetal pretest post-test with a control group clinical trial that was performed on 110 burn patients hospitalized in the Adult Burn Unit (ABU) of İnonu University Turgut Ozal Medical Center (Turkey). ABU has a 13-bed capacity. There are special rooms that are divided into chambers to prevent patients from being affected by each other. ABU has one faculty member and five assistant physicians working day and night shifts. A total of 15 nurses work the morning and night

Results

The distribution of descriptive characteristics for the individual patients included in the study are shown in Table 1. There was no statistically significant difference between the groups in terms of age, gender, marital status, education level, occupation, income status, and burn percentage in the experimental and control groups of the study (p > 0.05). The results show that both groups have a homogeneous distribution with respect to their descriptive characteristics.

The comparison of the

Discussion

The need for the use of yoga in the nursing practice of burn patients has become increasingly important in recent years. Tenenhaus et al. stated that yoga could help burn patients regain their independence [28]. Miller et al. noted that yoga improves the cardiovascular function of burn patients and improves their functional and emotional quality of life [29]. Conn et al. performed yoga with pediatric burn patients and found that it reduced somatic and cognitive anxiety [20].

In the literature,

Conclusion and implications in practice

As a result of this study, it was determined that yoga is an effective method to increase the self-esteem and the body image in burn patients.The strengths and weaknesses of our study contain suggestions that will guide future study. It may be suggested that the nurses in burn units teach yoga practice to patients to use as a method of coping. In addition, it is advisable to investigate the effect of yoga on the stress anxiety situations of patients returning to their inner world from their own

Statement

This study was produced from Ahmet Özdemir's doctoral thesis under the supervision of Assistant Professor (Ph.D) Serdar Sarıtaş.

Conflicts of interest

Authors declare that they have no conflict of interests.

Acknowledgements

I would like to thank to the patients who agreed to participate in the study.

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