Introduction

This chapter serves to outline the outcomes of the in-depth interviews with key
informants. Following analysis of the in-depth interview, five main themes emerged after
the categorization of the various concepts expressed by the key informants. These were: a
psychological aspect, Changes in lifestyle, Adaptation and adjustment, Rehabilitation and
nursing and professionals care.

Demographic data :

The number of interview was seven

5 male and 2 female

The mean of age for the group is 59 years old

All of them have below knee amputation

Theme Sub themes

3.1 Psychological aspect Emotional disturbances after amputation
Positive psychological impact
Negative psychological impact
Body image
feeling of Pain
3.2 Changes in lifestyle Be dependent
Social identity
The life become hard
3.3 Adaptation and adjustment Ability to adapt
Adjustment to new situation
3.4 social support social support
3.4 Rehabilitation Rehabilitation
needed facilities
3.5 nursing and professionals care nursing and professionals care

4.1 Psychological aspect

Psychologically the participants dealt with a lot of hardships following a lower limb
amputation. The new life experience, having to face the world without a limb brought
different psychological reactions. Participants went into a state of shock and disbelief.
The reality of not knowing what to expect following an amputation was a concern. Not
knowing what the difference will be now that they had to live with an amputation and
how the amputation was going to impact on their lives was a concern. In these situations,
they did not know what adjustments they needed to make and what adaptation they had to
make in order to factor the amputation smoothly into their lives. They did not know what
difficulties they had to face and there were perceived uncertainties about life in the
future.

4..1.1 Emotional disturbances after amputation

“Initially it was a big shock. I was feeling crushed, I really cried so much.”1

“This is unbelievable that one tell you that you will continue your life without your leg,
but the worst thing become really.”2

“I didn’t realize I would have an amputation’ I didn’t realize the restrictions … It is sad
that it happened because of the diabetes, I blame my self for not adapt with regulation of
diabetes.”3

“In the beginning I think in my life how will be like, I feel depressed, nervous, I hoped
that I am died before this moment.” 4

“I didn’t realize that my leg wasn’t there, this was the biggest shock in my life.”5

“Initially I found it very hard to understand to terms amputation, this term mean that the
cure is become amputee person, I feel my life will end.”6

“In the first I can’t understand the thought that I will be without leg, its like magic.”7

4.1.2 Positive psychological impact

Some of the participants were able to draw positive inspirations from the amputation.
They tried to live a positive life, keeping a positive attitude. They were able to see that
there is still a life after the amputation. There is still a lot to live for. Some even modified
their lifestyles.

Every human mind is different, not everyone thinks alike. Some people get
disheartened . ..There were some who gave up and passed away within a fortnight, for
me my life continue as in the past. 2

In the first I ask myself, why me? What I did in my life? but I do things like I did before,
the difference is that it is time consuming, it now takes long to do an activity but not
much has changed5 ‫ الحمد هلل على كل حال‬.. ‫قدر هللا وما شاء فعل‬

I want to make sure that it looks good, especially if I’m wearing a dress. 7

4.1.3 Negative psychological impact

I feel that the time for the strong man ended.1

“I have been cheated out of a lot of things. I feel that I miss out of a lot of Things, it’s the
worst thought, there is a lot of things that go through my mind, everything is
disorganized.”3

For me it was hard, one leg gone, I will never get it again, I will be disable person. It
made me feel inferior, because I could no longer be my family’s breadwinner 4

“When I was still in the hospital, I usually think, what will the people say? How they will
look to me? 6

4.1.4 Body image

Almost of Participants connecting lower limb amputation with disability but all of them
are conscious about their image . A lower limb amputation changes ones’ physical
appearance so much that they feel that the general public will perceive them differently.

The first thought in my brain that I will be disable person. 1

I feel that me less of a person now that I have this disability.6

You need to show for all that you are still strong, unfortunately this is hard with
amputation leg.7

4.1.5 feeling of Pain

All limitations were generally of mobility with stability and balance challenges rather
than pain inhibiting their function. In this study, some participants experienced a great
deal of pain and discomfort following lower limb amputations. This may include rest pain
in the stump or even pain from ischemic changes of the contralateral leg. This is also the
case in participants with peripheral vascular disease where the other leg is starting to
show signs of vascular disease while the participant is recovering from the leg that was
amputated. The pain is unbearable and so uncomfortable that it can have an impact on
sleep and result in sleep disturbances. According to Resnick at al, (2004), participants are
likely to experience pain following a lower limb amputation.

The pain wakes me up in the middle of the night. I sit up, I was scream like a baby.1

“Actually, since my leg amputation. Initially, I don’t sleep well, and now I have lots of
pain and numbness at night.”3

I experienced many type of discomfort, pain, numbness.4

No pains, I don’t feel anything else. 5

Pain was after surgery while I am in the hospital, after that no pain or any discomfort
sensations.7

4.2 Changes in lifestyle

People with a lower limb amputation faced challenges and limitations including social
interaction during their time of reintegration to the society of origin. At times they were
unable to join fellow family members in social outings and events. In other instances
they loved doing certain activities together before they had an amputation and after the
amputation they were unable to continue with shared activities.

4.2.1 Be dependent
One of the changes in life style after amputation as participant said that they have to
depend on other in their daily activates, this are some examples.

It’s very difficult! You have to depend on many people. I hate it when I can’t do
something myself 1

I could no longer be my family’s breadwinner 2

I depend on my son in all thing.4

I can’t do all of my activates in home without assistance.5

All want to help me but I don’t like this, this give you feeling of disable.

This is the life, after I care for them (her sons and daughters), they care for me now.6

4.2.2 Social identity

All Participants were seen to have strong relationships with their sons, daughters and
relatives following a lower limb amputation, this result in strong support from family and
friends.

Certain things like walking, shopping and standing. .. The worst thing of them all is not
being able to visit neighbor, friends. 2

I think just in terms of moving around, having to get up for pray in early morning I have
to find out crutches first. And make sure that the light on I need to walk in the dark
without knocking into anything. 5

I’m a women. I like to socialize but since I have amputation I’m out of it. 3

4.2.3 The life become hard

Really after amputation, I can’t do normal things that I was doing it and I have to use a
wheelchair all the time. 1

Sitting in a wheelchair, go to the toilet, it’s not be easy thing this now a long story,
ooooooooooh.4
In any place the first thing that you think to be sure you will not fall because its will be
an embarrassment more than any thing else.6

4.3 Adaptation and adjustment

Participants may have accepted the new condition gradually. Participants may be withdrawn,
feeling that coping in their new chapter of life will be overwhelming.

4.3.1 Ability to adapt

There is always a solution to most things 1

This situation annoying me because I don’t want it to win … I don’t want my left leg or
lack of leg to rule me.2

2 .‫ بس انا ما رح خلي فقداني لقدمي اليسرى او اني اعيش بدون قدم يقيدني‬.. ‫هاد الوضع بالنسبة لي مزعج‬

Now I am in realty, I start think how to facilitate my life and how to depend on my self, I
would wear clothes that easy to put on e.g. trouser with elastic rather than the belt.5

Losing a leg is not a problem. I help myself with whatever. Life will goes on. I feel good,
leg amputation had no effect on my life. It hadn’t made difference for me.7

“I am coping well, I move around, I do bath myself and do some cooking, ,‫الحمد هلل‬
4 ‫ربنا يديم علينا الصحة والعافية‬

4.3.2 Adjustment to new situation

some participants had accepted the amputation and stating that there are have varying
ways of adjusting, coping and adapting to a lower limb amputation.

Other ways of coping, staying positive and avoiding destructive situations involved
managing and handling stress well. Some participants made every effort to depend on
themselves.

Some of the Participants also felt that they did not have a choice but to accept the current
status and not accepting it will result in more struggle.
If I could get back to my previous function everything would be normal. 1

Now my inseparable friend is my pair of crutches.2

Until now I still in denial about my leg amputation or this just thing difficult thing to
believe in my mind, now or later I must to accept, realizing that there are some of the
difficulties that I should deal with it in my future.6

“It [the experience of an amputation] brought me closer to God. It made me realize God
was by my side all along. 3

In the first I had must to learn to live with this and that’s all, the God give us the power
to adapt. 4

4.4 social support

My family have been giving me a lot of support, helped me to trust myself again and to
cope with this situation. 1

In this age what we need rather than go to pray, there is multi cars, ‫هللا يرضى عليهم اوالدي‬
1 ‫مش منقصين علي شي‬

My sons, daughters, friends give me support from the beginning until now, without them I
don’t know how to do. 2

My friends and neighbors still coming to me, my sons and Grandsons always near me.3

My daughter despite her responsibilities in her home, she would make sure that she
makes food at home and send them to me, to make sure that I have enough to eat. 3

All family members are supportive, I don’t feel alone in any time.4

My family are supportive and very helpful. They also hire someone to help me. 5

My daughter and wife help with all needs and they get me feeling shy and cooking
Washing my clothes and making bed.6
4.4 Rehabilitation

4.4.1 Rehabilitation

Rehabilitation is important because it is helping me to return to do my daily life. 1

What means of rehabilitation, I never have it.3

I don’t go to special center.4

Rehabilitation has helped me, but it’s very hard for me, and I don’t know if I’ll be able to
walk alone!. . . I can’t accept this situation because it’s revolting being like this . . .
without driving, walking, working . . . it’s very sad depending on others . . . I was a very
dynamic man before this happened. 5

No one tell me about this. 6

After my leg amputation what will help, I am still alive.7

7 .‫ هينا عايشين والحمد هلل‬.. ‫شو رح ينفع شي‬...‫بعد ما راحت رجلي‬

4.4.2 needed facilities

We don’t need thing rather than Satisfaction of God. 1

If they offer to me Electric wheelchair, to able go around. 2

The government not offer prosthesis, I hope to have one.3

I need financial support.4

4.5 nursing and professionals care

“While in hospital I don’t found any emotional support from health professionals at all.
They don’t give me any information on the procedure, or how this will affect your life
and how to adapt or cope . 1

“I cannot complain about anything. When I was in hospital, I had good support because I
had doctors, nurses. .. They were all supportive. They were always there to help change
my dressings [following the amputation] and provided for my needs. 2
Nurses and doctors do what they can do, thanks for them. 3

3 .‫ والباقي على هللا وهاد الي مكتوب علينا‬... ‫االطباء والممرضين عملو الي عليهم يخلف عليهم ما قصرو معي‬

Some of them are supportive, and some are careless.4

Thanks to all. 5

They don’t understand how its hard to person to loss part of his body, how he complain,
some of them are easily become nervous.6