Have We Lost Sight of the Mirrors?: The Therapeutic Utility of Mirrors in Patient Rooms

The mirror viewing experience of women undergoing a mastectomy: An integrative review

AIMS

To appraise the current literature on the mirror viewing experience of women undergoing a mastectomy.

DESIGN

Whittemore and Knafl's approach to integrative reviews, Braun and Clarke's thematic analysis, and PRISMA guidelines were utilized for this review.

DATA SOURCES

A systematic search of primary peer-reviewed articles from April 2012 to 2022 was conducted using PubMed, CINAHL, Academic Search Complete and Google Scholar databases.

REVIEW METHODS

Eighteen studies met the inclusion criteria (15 qualitative and 3 quantitative) and were appraised using the Johns Hopkins evidence-based practice appraisal instrument.

RESULTS

Five themes describing the mirror viewing experience were revealed: Mirror viewing motives, mirror viewing preparedness, mirror viewing experience, mirror comfort/avoidance and women's mirror viewing recommendations.

CONCLUSION

The review findings were found to align with Freysteinson's Neurocognitive Mirror Viewing Model highlighting the occurrence of short-term memory disruptions and an autonomic nervous system response that can lead women to experience a flight/fright or faint response, mirror trauma and mirror avoidance when looking at themselves in the mirror after a mastectomy.

IMPACT

Women reported feeling unprepared to look at themselves in the mirror, with some experiencing shock and emotional distress, which led to mirror avoidance behaviours as a way to cope with their new body image. Nursing interventions aimed at improving women's mirror viewing experiences may help mitigate this autonomic nervous system response and minimize mirror trauma and mirror avoidance. Preparing women to view themselves in the mirror for the first time may help reduce psychological distress and body image disturbances in women undergoing a mastectomy.

NO PATIENT OR PUBLIC CONTRIBUTION

This integrative review did not involve patient or public contributions. The authors reviewed currently published peer-reviewed literature in writing this manuscript.

Experiences of viewing self in the mirror for men and women with dementia as perceived by their caregivers: A phenomenological study

AIM

To explore and discuss the perceptions and experiences of caregivers who rendered care to persons with dementia who viewed themselves in the mirror.

BACKGROUND

Considerations must be given to caring for those with dementia due to the steady rise of adults 65 and older living with dementia. A literature review revealed limited experiential knowledge concerning aspects of mirror-viewing for persons with dementia.

METHODS

This phenomenological hermeneutic study was analyzed using Ricoeur's theory of interpretation. Eighteen participants who cared for individuals with dementia in the home, and long-term care facilities took part in the study. A semi-structured interview guide with open- ended questions facilitated an open dialogue about their experiences while caring for persons with dementia when they view themselves in the mirror. Two questions guiding the study were: 1) What are caregivers' perceptions of what they see and believe when they observe dementia patients whom they care view themselves in a mirror? 2) How do the caregivers' perceptions of that experience change over time as the dementia worsens?

RESULTS

The structural analysis uncovered a considerable difference between the numbers of mirrors available in the homes as compared to the long-term care facilities. Two phenomenological findings were uncovered: 1) decision to look in the mirror and 2) viewing self in the mirror. Six subsequent subthemes; mirror as a tool, wanting to look presentable, self- recognition, self-confirmation seeing another and the latent stage were revealed.

CONCLUSION

A mirror assessment is needed for individuals who have dementia.

A Study of the Amputee Experience of Viewing Self in the Mirror

Purpose

To describe the trajectory of viewing self in a mirror after an ampu-tation and participants’ perceptions of what health care professionals should know about mirrors.

Design

Hermeneutic phenomenology

Methods

Focus groups were conducted to collect the research data.

Findings

The mirror experience had three key moments: decision, seeing, and consent. The trajectory of viewing self in a mirror had four key themes: mirror shock, mirror anguish, recognizing self, and acceptance: a new normal. Participants’ recommendations for introducing the mirror after an amputation and using a mirror to avoid skin breakdown and infection, and correct gait and balance are described.

Conclusions

This study provides a unique viewpoint into the world of those who have suffered amputation of a limb.

Clinical Relevance

Rehabilitation nurses and other health care professionals are encouraged through these participants to consider the effect and value of mirrors when caring for those who have had an amputation.

The "Princess Mirror": Exemplars of the Use of the Mirror in Nursing Practice

PROBLEM

Incorporating mirrors into nursing is a relatively new field of research and practice. The focus of two studies was to explore (a) the meaning of women's mirror experiences following a mastectomy and (b) the experience of viewing self in the mirror for women who were terminally ill. The goal of the research was to establish a conceptual foundation for the development of nursing mirror interventions.

METHODS

Open-ended questions and dialogical engagement in one-to-one audio-taped interviews were used in both studies. Ricoeur's hermeneutic phenomenology was used to analyze the findings.

FINDINGS

Four concepts were uncovered in the experience of viewing self in the mirror: decision, seeing, understanding, and consent.

CONCLUSION

Exemplar composite case studies across the care continuum are provided as examples of the way in which mirrors may be utilized in nursing practice.

Who is that stranger in the mirror? The mirror experience for elderly patients with dementia

Use of the mirror is an everyday phenomenon for most individuals. There seems to be limited evidence-based studies that address mirror viewing and the appropriate use of mirrors for patients with dementia. Using a case study, the purpose of this study is to begin a dialogue with the nursing community on practical nursing interventions and the need for research in this area.

Sensory environment on health-related outcomes of hospital patients

BACKGROUND

Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care.

OBJECTIVES

To assess the effect of hospital environments on adult patient health-related outcomes.

SEARCH METHODS

We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes.

DATA COLLECTION AND ANALYSIS

Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study.

MAIN RESULTS

Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm.

AUTHORS' CONCLUSIONS

Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.

The ethical community consultation model as preparation for nursing research: a case study

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for dialogue and the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies.

Therapeutic mirror interventions: an integrated review of the literature

The mirror is an object that shows one a reflected image of body areas. There appears to be limited nursing literature about the role of a nurse in the use of a mirror. There is, however, literature of the therapeutic use of mirrors in medicine, neurology, psychiatry, psychology, physical medicine and rehabilitation, and rheumatology. The objective of this article is to review the basic elements and the underlying theoretical framework of mirror interventions. In 2007 to 2008, a keyword, abstract, and title search was conducted for therapeutic mirror studies between the years 1998 and 2008. A multidisciplinary, integrated review approach was used when it became apparent that there were limited nursing studies. Qualitative and quantitative strategies for reviewing evidence were used, and a narrative synthesis approach was used to guide the comprehensive synthesis. Underlying theoretical models were identified, and five elements of mirror interventions were synthesized from the literature.

Assessing the mirrors in long-term care homes: a preliminary survey

A preliminary survey of the mirrors available to residents was conducted in 10 long-term care homes. The framework underlying the study was Lawton's theory that the planned environment functions to maintain, support, and stimulate. The findings were discouraging. Some facilities had no mirrors available for bedbound residents or wheelchair users. In most facilities, a resident could not view his or her lower body in a mirror. The majority of mirrors were obstructed from view. This pilot study suggests a need for future mirror research. Implications for nursing are discussed, and placement of mirrors is described.