Social challenges of visible scarring after severe burn: A qualitative analysis

Gender differences in relation to stigmatization and depressive symptoms after burns

OBJECTIVES

The aim of this study was to investigate the moderating role of gender in the relationship between burn severity, perceived stigmatization and depressive symptoms at multiple time points postburn.

MATERIALS AND METHODS

This multi-center study included data from two cohorts. Cohort 1 consisted of 215 burn survivors, participating in a longitudinal study with measures at 3 and 12 months postburn. Cohort 2 consisted of 180 burn survivors cross-sectionally assessed at 5 - 7 years postburn. Both cohorts completed self-reported measures of perceived stigmatization and depressive symptoms. The number of acute surgeries (i.e., no surgery, 1 surgery or 2 or more surgeries) was used as indicator of burn severity. Relations between number of surgeries, depressive symptoms, and perceived stigmatization, including possible indirect effects, were evaluated with gender-specific path models.

RESULTS

In both men and women, number of surgical operations was related to higher levels of depressive symptoms and perceived stigmatization at 3 months after burn. In women, number of operations was still directly related to both constructs at 12 months after burn, which was cross-sectionally confirmed in the 5-7 years after burn cohort. In men, from 3 to 12 months after burn, depressive symptoms and perceived stigmatization were bidirectionally related, and, through these effects, number of surgeries was indirectly related to both outcomes. In the cross-sectional 5-7 years after burn cohort, number of operations was related to stigma but not to depressive symptoms of men.

CONCLUSION

Number of operations had a different effect on psychosocial adaptation of male and female burn survivors. In women, a persistent direct link from number of operations to both depressive symptoms and perceived stigmatization was found over time. In men, the effect of number of operations was most evident in the short-term, after which perceived stigmatization and depressive symptoms became interrelated. This indicates that burn severity remains a factor of significance in psychological adjustment in women, whereas in men, this significance seems to decrease over time.

The impact of burn injuries on indigenous populations: A literature review

INTRODUCTION

Ethnic minorities experience disparities in prevention and treatment of burn injury. Research focused on burn injuries in Indigenous populations is limited. This review summarizes literature on burn injuries in Indigenous populations to be considered to inform new research.

METHODS

A search was conducted in CINAHL, Ovid MEDLINE, PSYCinfo and SocINDEX. for "burn OR scars OR scald OR deformity OR disfigurement" and "Aboriginal OR Indigenous OR First Nation OR American Indian OR Maori OR Native OR Torres Strait Islander OR Amerindian OR Inuit OR Metis OR Pacific Islander". Inclusion 1) peer reviewed studies of burns in Indigenous persons 2) in English. Exclusion 1) no data specific to Indigenous burns 2) not peer reviewed 3) not in full text 4) protocol publications.

RESULTS

The search identified 1091 studies with 51 for review. Sixteen were excluded. The 35 included publications were published between 1987 and 2022. Findings indicated higher incidence of injury and poorer outcomes amongst Indigenous people. Indigenous people suffered more flame and inhalation burns, had longer lengths of stay, and more complications including hypertrophic scarring. Australian Indigenous patients struggle with a lack of culturally safe communication and support for aftercare.

CONCLUSION

Racial disparities exist in burn injury incidence and outcome for Indigenous persons. Qualitative research in this area will help providers better understand the experiences of Indigenous burn patients to develop more culturally competent care. We are currently developing a study using qualitative hermeneutic methodology to learn about the experiences of Indigenous burn survivors' injuries, recovery, and social reintegration.

Photographs in burn patient diaries: A qualitative study of patients' and nurses' experiences

OBJECTIVE

To explore burn patients' and burn intensive care nurses' experiences of the photos in patient diaries.

DESIGN

A qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20-77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38-61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ).

SETTING

A Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades.

FINDINGS

Three main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery.

CONCLUSION

Both the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients' pathway of treatment, care and recovery.

IMPLICATION FOR CLINICAL PRACTICE

Tailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients' entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.

'It's just my knee': a qualitative study investigating the process of reframing and young athletes' perceived quality of life between anterior cruciate ligament injury and surgery

OBJECTIVES

To understand the factors influencing young athletes' perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery.

DESIGN

Qualitative descriptive study using semi-structured interviews and thematic analysis of data.

SETTING

Tertiary sports medicine clinic with patients recruited from the practices of three specialist orthopaedic surgeons.

PARTICIPANTS

Twenty athletes aged 14-25 provided consent to participate in the study and completed interviews prior to their ACL reconstruction surgery. Participants were eligible to participate if they were scheduled to undergo ACL reconstruction, were 25 years of age or younger, identified as athletes (participated in any level of organised sport), could communicate in English and agreed to be audio recorded. Participants were not eligible if they had experienced a multiligament injury or fracture.

RESULTS

Young athletes shared common factors that made up their QOL; social connections and support, sport, health, and independence. However, participants' perceptions of their current QOL were quite variable (13-95/100 on a Visual Analogue Scale). Participants who were able to reframe their injury experience by shifting focus to the positive or unaffected aspects of their lives tended to have more favourable perceptions of their QOL than participants who shifted focus to the losses associated with injury.

CONCLUSIONS

Young athletes who have experienced an ACL injury define their QOL based on social support, sport, health and independence. Individual processes of adaptation and cognitive reframing in response to an ACL injury may exert a greater influence on postinjury QOL than the physical ramifications of the injury itself. Understanding individual perceptions may help target potential interventions or supports to enhance athletes' adaptation to injury.

Investigation of pre-discharge learning needs and affecting factors in individuals with burns

BACKGROUND

In discharge phase process, supporting patients to develop their own self-care strategies will increase their self-management skills and reduce complications and other health problems that may arise.

AIM

The aim of the study is to examine the learning needs of individuals with burns regarding pre-discharge care and treatment and the factors affecting them.

METHOD

Data from this cross-sectional study was collected with the "Descriptive Characteristics Form" and "Patient Learning Needs Scale (PLNS)". The study population consisted of patients hospitalized in the adult burn unit of a university hospital in eastern Turkey between May and October 2021.

RESULTS

In the present study, it was observed that the pre-discharge learning needs of the patients were at a high level according to the mean score of the general score of the PLNS. Education level, marital status, companion experience and body mass index effected PLNS.

CONCLUSIONS

In light of the results, it is recommended that discharge training be planned individually and determined according to the individual's learning needs and affecting factors.

In Vivo Study of the Effects of Propranolol, Timolol, and Minoxidil on Burn Wound Healing in Wistar Rats

Propranolol, timolol, and minoxidil have all shown benefits in treatment of burn injury and other skin wounds. The study evaluated their effects on full-thickness thermal skin burns in a Wistar rat model. Performed on 50 female rats; two dorsal skin burns were created on each animal. On the next day, the rats were divided into 5 groups (n = 10); each has received a specific treatment daily for 14 days: group I-topical vehicle (control), group II-topical silver sulfadiazine (SSD), group III-oral propranolol (5.5 mg) associated with topical vehicle, group IV-topical timolol 1% cream, and group V-topical minoxidil 5% cream. Wound contraction rates, malondialdehyde (MDA), glutathione (GSH, GSSG), and catalase activity in skin and/or serum were evaluated, and histopathological analyses were performed. Propranolol did not show advantages in necrosis prevention and wound contraction and healing, and did not reduce oxidative stress. It impaired keratinocyte migration, and promoted ulceration, chronic inflammation, and fibrosis, yet reducing the necrotic zone. Timolol prevented necrosis and promoted contraction and healing, increased antioxidant capacity and promoted keratinocyte migration and neo capillarization in comparison to the other treatments. Minoxidil reduced necrosis and enhanced contraction, resulting in positive outcomes after 1 week of treatment regarding local antioxidant defense, keratinocyte migration, neo capillarization, chronic inflammation, and fibrosis rates. However, after 2 weeks, it resulted in contrasting outcomes. In conclusion, topical timolol promoted wound contraction and healing, reducing local oxidative stress and improving keratinocyte migration, bringing arguments for potential benefits in skin epithelization.

Rehabilitation Management of the Burned Hand

Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.

Perceived stigmatization and fear of negative evaluation: Two distinct pathways to body image dissatisfaction and self-esteem in burn survivors

OBJECTIVE

Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative evaluation.

DESIGN & MAIN OUTCOME MEASURES

Burn survivors (N = 224) completed the Fear of Negative Evaluation scale (FNE) and the Perceived Stigmatization Questionnaire (PSQ) at 3 months post-burn, and the Rosenberg Self-Esteem scale (RSE) and the Satisfaction with Appearance scale (SWAP) at 6 months post-burn. Path analysis was used to test the relationships.

RESULTS

Body image dissatisfaction and self-esteem were moderately associated. Burn severity was directly and indirectly associated with body image dissatisfaction through perceived stigmatization. Female gender and age were indirectly associated with body image dissatisfaction though fear of negative evaluation. Age was indirectly associated with both perceived stigmatization and fear of negative evaluation. Perceived stigmatization and fear of negative evaluation were associated with self-esteem through body image dissatisfaction, the first indirectly and the latter both directly and indirectly.

CONCLUSIONS

Findings highlight that both burn-specific factors and psychological vulnerability should be taken into account to deal with social challenges that may affect body image and self-esteem after burns.

Exploration of individuals perspectives of recovery following severe hand burn injuries

INTRODUCTION

Burns to one or both hands can impact how a person interacts with the world around them. Research regarding the specific impact of hand burn injuries and the experiences of individuals who have sustained hand burn injuries remains limited.

OBJECTIVE

The aim of this study was to explore the lived experiences of people with severe hand burn injuries, including their return to daily activities.

METHODS

This study used an interpretive description approach, incorporating 23 semi-structured interviews with people who had sustained severe hand burn injuries.

RESULTS

A major theme, "changes over time ", was identified and reflected the progressive nature of the experience over time. This was present in all three sub-themes: physical recovery, activities of daily living recovery, and psychosocial impact. Participants described a dual process of managing the recovery of the burn injury and burn rehabilitation interventions, whilst simultaneously learning to live with their injury and finding ways to engage in their occupations to the best of their abilities.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

The findings of the study suggest that burns recovery could be described in terms of performance rather than impairment and needs to be continuously monitored overtime.

Exploring tattoo artists' understanding of decorative non-medical professional tattooing as a method of scar camouflage and decoration

Research surrounding the use of decorative tattooing by non-medical professional tattooists as a form of scar camouflage or decoration is limited. This study provides critical and deepening insights into tattoo artists' experiences of tattooing scars, to help inform a more in-depth understanding of its uses from a health and wellbeing perspective. Specifically, it aimed to explore qualitatively, the different methods and techniques used by non-medical tattoo professionals to cover up or decorate scars, which can have a psychological impact on those affected. Six tattoo artists from legitimate UK based studios were identified through snowballing and purposive sampling methods. Data collection involved semi-structured telephone interviews. The data was then transcribed, and thematic analysis was then performed. Five themes were identified: Personal Opinion of Scar Camouflage Tattooing, Tattooing Methods, Scars and Tattooing Risks, Positive Impact, and Understanding of Customer Experience. These themes were then broken down into more specific sub-themes. The discussion considers these findings in relation to theory and existing literature, for example, around understanding of role, and makes recommendations for future study in this field.

A meta-ethnography of developing and living with post-burn scars

INTRODUCTION

Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars.

DESIGN

A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis.

RESULTS

Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self.

CONCLUSION

Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes.

CLINICAL RELEVANCE

Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.

Body image and psychosocial well-being among UK military personnel and veterans who sustained appearance-altering conflict injuries

A modest but significant number of military personnel sustained injuries during deployments resulting in an altered-appearance (e.g., limb loss and/or scarring). Civilian research indicates that appearance-altering injuries can affect psychosocial wellbeing, yet little is known about the impact of such injuries among injured personnel. This study aimed to understand the psychosocial impact of appearance-altering injuries and possible support needs among UK military personnel and veterans. Semi-structured interviews with 23 military participants who sustained appearance-altering injuries during deployments or training since 1969 were conducted. The interviews were analyzed using reflexive thematic analysis, identifying six master themes. These themes indicate that in the context of broader recovery experiences, military personnel and veterans experience a variety of psychosocial difficulties related to their changed appearance. While some of these are consistent with evidence from civilians, military-related nuances in the challenges, protective experiences, coping approaches, and preferences for support are evident. Personnel and veterans with appearance-altering injuries may require specific support for adjusting to their changed appearance and related difficulties. However, barriers to acknowledging appearance concerns were identified. Implications for support provision and future research are discussed.

Social network responses to victims of potentially traumatic events: A systematic review using qualitative evidence synthesis

Background

A substantial number of qualitative studies examined how adult victims of potentially traumatic events (PTEs) experienced support provided by family members, friends, colleagues, and other significant others in the informal network. Importantly, the large majority of qualitative studies focused on the perceived support of victims of specific events such as sexual offences, partner violence, homicide, accidents and disasters. Although it is likely that across specific PTEs there are similarities as well as differences in experienced support from the informal network, to date no systematic review synthesized the results of qualitative studies on support from the informal network following various types of PTEs. The aim of the present systematic review is to fill this gap in the scientific knowledge, which is also highly relevant for victim services, policymakers, and the informal network.

Methods

A literature search of qualitative studies was conducted using the electronic databases of PubMed, Web of Science, CINAHL, Psych INFO, Scopus, Criminal Justice Abstracts and Picarta. The quality of the identified studies was assessed with the Consolidated Criteria for Reporting Qualitative research (COREQ) checklist, followed by analysis of the results of the identified studies using Qualitative Evidence Synthesis.

Findings

Seventy-five papers were included in the synthesis, involving 2799 victims of PTEs such as accidents, disasters, homicide, intimate partner violence (IPV), and sexual offences. Saturation was only achieved for IPV. Overall, four major categories of perceived social support were identified, namely, support perceived as supportive, supportive but insufficient, unsupportive, and absent from informal support providers, which included friends, family, neighbors, (if applicable) offender’s family, religious group members, work/school colleagues, fellow victims, the local community, and the social network in general. Across the PTE groups, there were similarities in experiencing positive forms of support (particularly empathy and sharing experiences) as well as negative forms of support (abandonment, avoidance, lack of empathy, and not experiencing support despite victim’s request for help). There were also differences across PTE groups, in particular, victims of sexual and intimate partner violence mentioned a number of other supportive (mobilizing support, no unsupportive responses) and non-supportive (e.g., justification or normalization of violence and minimizing responses) responses.

Conclusions

The review showed that different actors within the social informal network can play an important role in providing support after victims experience violence, homicide, accidents, and disasters. However, the review revealed that the large majority of qualitative studies were aimed at victims of IPV, and only for this type of PTE was saturation achieved. This indicates that, although this synthesis identified several similarities and differences, it is still too early to draw more definitive conclusions on similarities and differences in experienced social support after various PTEs and that future qualitative studies focusing on other PTEs are much needed.

The psychosocial burden of visible disfigurement following traumatic injury

Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.

Stigma and illness uncertainty among patients with visible burn scars: A cross-sectional study

The purpose of this research was to understand the current status of stigma and illness uncertainty in patients with visible burns and explore the correlation between them. Measures to help patients alleviate shame and uncertainty in illness are also discussed. A cross-sectional study was conducted in a tertiary hospital from November 2020 to March 2021 for patients with burns on exposed parts of the face, neck, or limbs. The scales used in this study include demographic data questionnaires, the Social Impact Scale (SIS), and the Mishel Uncertainty in Illness Scale for Adults (MUIS-A). A two-tailed independent t-test was used to evaluate the differences in the respondents' sociodemographic characteristics, stigma, and illness uncertainty. The total stigma and illness uncertainty scores of 146 patients were 57.03 ± 6.762 and 68.59 ± 12.901, respectively. Spearman correlation analysis showed that stigma was positively correlated with illness uncertainty (r = 0.398, p < 0.01). Multiple regression analysis showed a relationship between stigma and uncertainty of illness (B = 0.215, p = 0.000), itching (B = 2.555, p = 0.01), residence (B = 2.545, p = 0.029), and age (B = 0.074, p = 0.037). The stigma level of patients with visible burns increased with increasing uncertainty regarding illness. Therefore, reducing the patients' uncertainty in illness is a way to intervene in stigma.

The cultural adaptation and validation of Turkish version of the satisfaction with appearance scale (SWAP-TR)

AIM

The aim of this study was to translate, culturally adapt and validate the Satisfaction with Appearance Scale (SWAP) into Turkish to be used in the context of pediatric burn care.

METHOD

This methodological study was conducted in two stages as Language Adaptation and Psychometric study. In the first stage, the Turkish scale was obtained after expert translations. A pilot study was conducted. After back-translation, and the scale was finalized. In the second stage, the scale was administered to 145 children with burns. Body Appreciation Scale for Children (BASC) was applied to the same group for correlation analysis with the scale.

RESULTS

A structure explaining 65.98 % of the total variance was obtained. Cronbach's alpha values in the range of 0.995-1000 were quite reliable. A statistically significant correlation was determined between the test and retest applications for all the items (0.99-1.00) in the positive direction (p < 0.001). There is a linear negative moderate correlation between BASC scores and the scores of the SWAP-TR scale (r = -0.621 p<0.001). The dissatisfaction scores of children with face, hand and leg burns are significantly higher than the other groups.

CONCLUSIONS

SWAP-TR is a reliable and valid instrument for use in a Turkish speaking children with burns. It is recommended to study the validity of this scale in other age groups with burns in Turkey.

Investigation of the relationship between social appearance anxiety and perceived social support in patients with burns

INTRODUCTION

Since burns affect body image, they cause appearance anxiety. Interventions designed to reduce appearance anxiety that can cause psychological problems such as depression are important. This study aimed to determine the social appearance anxiety of individuals following burns and the factors affecting it and to examine the relationship between social appearance anxiety and perceived social support.

METHODS

This descriptive study was conducted between November 2018 and November 2019 with 106 adult patients with burns. Data were collected using a Personal Information Form, the Social Appearance Anxiety Scale, and the Multidimensional Scale of Perceived Social Support. Shapiro-Wilk test, Independent Two Samples T-Test, One Way Analysis of Variance, Duncan's test, Pearson's correlation analysis, multiple linear regression analysis, the Q-Q plot, and the Durbin-Watson statistics were used in data analysis.

RESULTS

The social appearance anxiety scores were moderate (39.38 ± 17.71). Being single; having a high level of education; burns on the face, head, or neck; burn-related amputation; and passing the one-week after injury period were found to significantly increase social appearance anxiety (p < 0.05). Although the perceived social support scores of the individuals with burns were high (68.34 ± 18.08), they were found to have no correlation with social appearance anxiety (p > 0.05).

CONCLUSIONS

The results of this study show that social support does not affect social appearance anxiety. In this respect, we recommend that interventions such as reconstruction and professional psychological support initiatives be prioritized for individuals with burn trauma who are evaluated to have high social appearance anxiety by the appearance anxiety scales.

Society, family, and individual characteristics as double-edged swords in the social reintegration of Iranian female survivors from unintentional severe burns: a qualitative study of enablers and barriers

Background

Reintegrating to society is a significant challenge during burn survivors’ rehabilitation.

Aim

This study aims to describe what Iranian female survivors from unintentional severe burns experience as enablers and barriers of social reintegration (SR).

Methods

Fourteen adult female burn survivors whose burns were unintentional participated in this qualitative study. Data were gathered through semi-structured face-to-face or telephone interviews and analyzed using inductive content analysis.

Results

Thirteen subcategories and six categories were emerged. Categories and subcategories of enablers content area were as follows: positive impact of society on SR (normal treatment of society, instrumental support), positive impact of family on SR (magnifying personal abilities assets, empathy and emotional support), and positive impact of personal characteristics on SR (coping with others stares, right to have a normal social life). Categories and subcategories of Barriers content area were as follows: negative impact of society on SR (being questioned in public, incorrect judgment about intent of burns, burns as a contagious disease), negative impact of family on SR (embarrassment of appearing in public with the survivor, family mistrust), and negative impact of intra-personal factors on SR (exaggeration of the post-burn changes, being over-sensitive to the others looks). From the deep interpretation of the data two overarching themes were emerged: “acceptance of the new normal by the society and the individual” and “being encompassed by misconceptions and mistreatments”.

Conclusions

Society, family and the individual characteristics have a dual role to play in the success of social reintegration in Iranian female unintentional burn survivors.

Determining the Independent Risk Factors for Worse SCAR-Q Scores and Future Scar Revision Surgery

BACKGROUND

Scar revisions have been increasing in number. Patient-reported outcome measures are one tool to aid scar modulation decision-making. The aims of this study were to determine patient, scar, and clinical risk factors for (1) low SCAR-Q Appearance, Symptom, and Psychosocial Impact scores and how this differs for children; and (2) the potential need for future scar revision surgery to better identify such patients in a clinical setting.

METHODS

A multicenter international cross-sectional cohort study based on survey data of participants with traumatic, surgical, and burn scars attending plastic, hand, and burn clinics in four countries was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Univariate analysis to identify risk factors and multivariable logistic analysis to select risk factors were completed. Collinearity for nonindependent factors and C statistic for model discrimination were also calculated.

RESULTS

Seven hundred thirty-one participants completed the study booklet, and 546 participants (74.7 percent) had full data. Independent risk factors were determined to be a bothersome scar and perception of scarring badly for all three scales. Risk factors for self-reporting the need for future surgery included a health condition, scarring badly, scar diagnosis, prior scar revision, and low Psychosocial Impact scores. We did not identify evidence of multicollinearity. C statistics were high (0.81 to 0.84).

CONCLUSIONS

This study is the first multicenter international study to examine independent risk factors for low patient-reported outcome measure scores and the potential need for future scar revision surgery. Patients that perceive themselves as scarring badly and having a bothersome scar were at a higher risk of scar appearance concern, an increased symptom burden, and poorer psychosocial impact scores.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study

Background

Scar assessment plays a key role during burns aftercare, to monitor scar remodelling and patients’ psychosocial well-being. To aid assessment, subjective scar assessment scales are available that use health-care professionals’ and patients’ opinions to score scar characteristics. The subjective scales are more widely used in clinical practice over objective scar measures. To date, there is no research that considers patients’ views on scar assessment and the role of subjective and objective assessment tools. Therefore, the aim of this qualitative study was to explore patients’ perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation.

Methods

Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring. Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital, Birmingham, UK. Topics covered during interview included patient experience of scar assessment, the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars. A thematic analysis using the Framework Method was conducted.

Results

Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment. These are: patient-led care; continuity in care; learning how to self-manage scarring; and psychological assessment. Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies, indicating their potential patient-centred contributions. The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools. Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial functioning. However, minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose. Patients perceived objective tools to be of primary use for health-care professionals, though the measures may aid patients’ understanding of scar properties.

Conclusions

Scar assessment tools should be used to support, rather than replace, health-care professionals’ subjective judgements of scarring. Adapting the way in which clinicians introduce and use scar assessment tools, according to patient needs, can support a patient-centred approach to scar assessment.

Relationship between self-esteem and perceived social support in burn patients in Sina Hospital of Tabriz

AIM

Visible scars and damage to self-esteem make it difficult to endure difficult conditions and have some detrimental psychological and physical consequences for patients with burns. Social support plays an important role in enhancing the mental image and self-esteem of burn patients in the rehabilitation stages of burn patients. The aim of this study was to determine the relationship between perceived social support and self-esteem in burn patients referred to Sina Hospital in Tabriz in 2019-2018.

DESIGN

Descriptive correlational study.

METHODS

In this descriptive correlational study, 120 patients with different degrees of burn were selected using the convenience sampling method. After obtaining validity and reliability, the data were collected using demographic questionnaires, Rosenberg self-esteem and Zimet Multi-dimensional Perceived Social Support. Then, they were analysed using descriptive and analytical tests and SPSS software.

RESULTS

There was a positive and significant correlation between the main variables of the research (p < .001, r = 0.288). Duration of hospitalization, percentage of burns and education were effective factors in self-esteem (p < .005). Based on the findings, more support for burn patients will increase patients' self-esteem and greater adaptation, as well as a better return to their lives in the rehabilitation phase.

"More than Scabs and Stitches": An Interview Study of Burn Survivors' Perspectives on Treatment and Recovery

Sustaining a burn injury often results in a life-long recovery process. Survivors are impacted by changes in their mobility, appearance, and ability to carry out activities of daily living. In this study, we examined survivors' accounts of their treatment and recovery in order to identify specific factors that have had significant impacts on their well-being. With this knowledge, we may be better equipped to optimize the care of burn patients. We conducted inductive, thematic analysis on transcripts of in-depth, semi-structured interviews with 11 burn survivors. Participants were purposefully selected for variability in age, gender, injury size and mechanism, participation in peer support, and rurality. Survivors reported varied perceptions of care quality and provider relationships. Ongoing issues with skin and mobility continued to impact their activities of daily living. Many survivors reported that they did not have a clear understanding or realistic expectations of the recovery process. Wound care was often described as overwhelming and provoked fear for many. Even years later, trauma from burn injury can continue to evolve, creating fears and impediments to daily living for survivors. To help patients understand the realistic course of recovery, providers should focus on communicating the nature of injury and anticipated recovery, developing protocols to better identify survivors facing barriers to care, and referring survivors for further support.

Suicidality After Burn Injuries: A Systematic Review

Burn survivors may be at increased risk for suicide due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as evaluate risk and protective factors. PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Web Science databases were searched using search terms regarding suicide, suicidality, and burn. Fourteen full-text manuscripts and two published abstracts were included in the review. Overall, burn survivors demonstrate elevated suicidal ideations and a higher lifetime prevalence of suicide attempts compared to the general population. There is mixed evidence as to rates of completed suicide postburn injury, though rates appear to be relatively low. Risk factors include pain at discharge, perceived level of disfigurement, premorbid psychiatric comorbidities, and past suicide attempts. Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors, which is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, posttraumatic stress disorder, social isolation, and depression which are linked to suicidality in the general population. Suicide risk screening should be included as an integral part of burn survivors' care, and more research is needed to better understand the magnitude of this phenomenon and offer targeted interventions to vulnerable individuals.

The impact of injury: The experiences of children and families after a child's traumatic injury

Objective:

To explore the experiences of children and families after a child’s traumatic injury (Injury Severity Score >8).

Design:

Qualitative interview study.

Setting:

Two children’s major trauma centres in England.

Participants:

32 participants: 13 children with traumatic injuries, their parents/guardians (n = 14) and five parents whose injured child did not participate.

Methods:

Semi-structured interviews exploring the emotional, social, practical and physical impacts of children’s injuries, analysed by thematic analysis.

Results:

Interviews were conducted a median of 8.5 months (IQR 9.3) post-injury. Injuries affected the head, chest, abdomen, spine, limbs or multiple body parts. Injured children struggled with changes to their appearance, physical activity restrictions and late onset physical symptoms, which developed after hospital discharge when activity levels increased. Social participation was affected by activity restrictions, concerns about their appearance and interruptions to friendships. Psychological impacts, particularly post-traumatic stress type symptoms often affected both children and parents. Parents’ responsibilities suddenly increased, which affected family relationships and roles, their ability to work and carry out daily tasks. Rapid hospital discharge was wanted, but participants often felt vulnerable on return home. They valued continued contact with a healthcare professional and practical supports from family and friends, which enabled resumption of their usual lives.

Conclusions:

Injured children experience changes to their appearance, friendships, physical activity levels and develop new physical and mental health symptoms after hospital discharge. Such challenges can be addressed by the provision of advice about potential symptoms, alternative activities during recovery, strategies to build resilience and how to access services after hospital discharge.

Ensuring that the outcome domains proposed for use in burns research are relevant to adult burn patients: a systematic review of qualitative research evidence

Background

There have been several attempts to define core outcome domains for use in research focused on adult burns. Some have been based in expert opinion, whilst others have used primary qualitative research to understand patients' perspectives on outcomes. To date there has not been a systematic review of qualitative research in burns to identify a comprehensive list of patient-centred outcome domains. We therefore conducted a systematic review of qualitative research studies in adult burns.

Methods

We searched multiple databases for English-language, peer-reviewed, qualitative research papers. We used search strategies devised using the SPIDER tool for qualitative synthesis. Our review utilized an iterative three-step approach: (1) outcome-focused coding; (2) development of descriptive accounts of outcome-relevant issues; and (3) revisiting studies and the broader theoretical literature in order to frame the review findings.

Results

Forty-one articles were included. We categorized papers according to their primary focus. The category with the most papers was adaptation to life following burn injury (n = 13). We defined 19 outcome domains across the 41 articles: (1) sense of self; (2) emotional and psychological morbidity; (3) sensory; (4) scarring and scar characteristics; (5) impact on relationships; (6) mobility and range of joint motion; (7) work; (8) activities of daily living and self-care; (9) treatment burden; (10) engagement in activities; (11) wound healing and infection; (12) other physical manifestations; (13) financial impact; (14) impact on spouses and family members; (15) analgesia and side effects; (16) cognitive skills; (17) length of hospital stay; (18) access to healthcare; and (19) speech and communication. We suggest that sense of self is a core concern for patients that, to date, has not been clearly conceptualized in the burns outcome domain literature.

Conclusions

This outcome domain framework identifies domains that are not covered in previous attempts to outline core outcome domains for adult burn research. It does so with reference to existing theoretical perspectives from the sociology and psychology of medicine. We propose that this framework can be used as a basis to ensure that outcome assessment is patient-centred. Sense of self requires further consideration as a core outcome domain.

Fear avoidance beliefs and behaviors of burn survivors: A mixed methods approach

The Fear-Avoidance Model was developed with patients who had sustained neck and back injuries and describes a cascade of events after pain that is perceived as threatening, which may lead to avoidance of valued and meaningful life activities. The literature examining burn survivors suggests they may experience fear-avoidance, however, their lived experience has yet to be thoroughly explored and the evaluation tool that has been used is four items extracted from the Tampa Scale of Kinesiophobia that were modified for burn survivors, but never formally validated with this population. Therefore, the aim of this study was to explore, through a mixed methods approach, the lived experience of burn survivors with respect to fear-avoidance and determine whether the reduced four question Tampa Scale of Kinesiophobia (4TSK) reflects and accurately measures their experience. Burn survivors (n = 17) who had undergone surgical debridement and grafting were recruited. They completed the reduced 4TSK and participated in an in-depth interview to explore their lived experience regarding fear-avoidance and their opinions on the relevance of the questions. The interviews were analyzed using a thematic-analysis approach. Five major themes that represented the lived experience of fear-avoidance in burn survivors were identified: perceived vulnerability to re-injury, others as fear influencers, difficulties & hardships during recovery, engagement in activity, and active thoughts. Based upon the interviews researchers identified 9 potential fear-avoidant participants, which differed from the screening results from the reduced 4TSK (n = 12). Overall, this study demonstrated the potential uniqueness of the burn survivor population and provided insight into their lived experience of fear of movement or activities.

"On the Recovery Journey:" An Integrative Review of the Needs of Burn Patients From Immediate Pre-Discharge to Post-Discharge Period Using the Omaha System

BACKGROUND

To establish a conceptual understanding of the needs of burn patients, the specific research question asked is: "What are the needs of burn patients from 1-week pre-discharge to the post-discharge period?"

METHODS

Whittemore and Knafl's integrative review approach was used to answer the review question. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, and Scopus. Thirty-two primary studies were retained at the end of the screening process. Directed content analysis was undertaken, with the Omaha system as an organizing framework.

RESULTS

Recovery after burns is not a linear process, but an intricate one filled with varied needs in the physiological (pain, skin, neuro-musculo-skeletal, and infection), psychosocial (social contact, role changes, spirituality, grief, mental health, and sexuality), health-related behavior (nutrition, sleep and rest patterns, and physical activity), and environmental (income) domains of the Omaha system. The nature and intensity of these needs change over time, suggesting that recovery for the burn patient is an ongoing process.

CONCLUSIONS

Several needs exist from 1 week before discharge to the post-discharge period. The mutual relationship and evolving nature of these needs create an avenue for a flexible, regular, holistic transitional program, similar to the support offered to persons living with chronic conditions.

CLINICAL RELEVANCE

Hospital discharge does not imply an end to the recovery of burn patients, and burn survivors still require holistic care even after discharge. The review shows the applicability of the Omaha system in exploring and classifying the needs of burn survivors and situates nursing at the core of such a program. It is possible that a nurse-led program of care needs to be considered.

Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) Study

Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery. This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total BSA or burns to critical areas (hands, feet, face, or genitals) were eligible to participate. Multivariate linear regression analyses were used to determine predictors of the Social Activities and Social Interactions scale scores. A total of 599 people completed the Social Interactions and Social Activities scales. Of these, 77% identified as White Non-Hispanic, 55% were female, 55% were unmarried, and 80% had burns to critical areas. Participants had a mean age of 45 years, a mean time since burn injury of 15 years, and a mean burn size of 41% total BSA. Younger age (P < .01) and being married/living with a significant other (P ≤ .01) were associated with higher Social Activities and Social Interactions scale scores. Individual item responses reveal that survivors had lower scores on items related to participating in outdoor activities (30.4%) or feeling uncomfortable with their appearance (32.4% report dressing to avoid stares). Social interactions and activities are long-term challenges for burn survivors. It is important for clinicians to identify patients who may struggle with social recovery in order to focus on future community-based interventions.

Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesis

BACKGROUND

Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care.

AIM

To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration.

DESIGN

A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676).

DATA SOURCES

Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.'s tool was used for quality appraisal.

RESULTS

A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients' comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units.

CONCLUSION

This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.

The Effect of Facial Burns on Long-Term Outcomes in Young Adults: A 5-Year Study

Long-term functional outcomes in young adults with facial burns remain poorly studied. This 5-year (2003-2008) prospective multicenter study includes burn survivors (age 19-30 years) who completed the Young Adult Burn Outcome Questionnaire (YABOQ) from 0 to 36 months after baseline survey administration. A composite canonical score was developed from 15 YABOQ domains using discriminant analysis, maximizing the difference at the baseline between burn-injured patients with face involved and not involved. A generalized linear model with the generalized estimation equation technique was used to track the changing pattern of the composite score over time. Individual domain scores with high correlation to the canonical score were used to evaluate recovery patterns in facial burns. A total of 153 burned (31% with face burns) and 112 nonburned subjects completed 620 questionnaires. Canonical analysis showed that early postburn, facial burns were associated with a difference in outcome, but this overall difference diminished over time. Regression analysis showed that for survivors with facial injury, Emotion and Sexual Function scores were persistently lower (worse), while Religion scores were persistently higher. Satisfaction with Role was initially better than the nonface burned group, but over time got worse, while Perceived Appearance was initially worse in the face burned group but this difference diminished over time. Social Function Limited by Appearance was initially similar between the groups, but over time the group with face burns scored lower. The overall difference in recovery between survivors with and without facial burns diminished over time while the individual domains had various patterns of recovery.

The use of simulation and moulage in undergraduate diagnostic radiography education: A burns scenario

INTRODUCTION

There is a national drive to increase allied health professions simulation training. However, there is a paucity of literature within diagnostic radiography in relation to clinical simulation. No research could be found regarding the impact of simulation in radiography with complex clinical burns scenarios. This research aims to explore the perceptions of radiography undergraduate students regarding their preparedness for the complex care requirements in imaging examinations of clinical burns cases using a mixed methods approach.

METHOD

A small-scale simulation-based teaching session was developed in a Scottish HEI, using role play and moulage to create realism. Twenty-eight undergraduate student radiographers participated in the scenario. Students completed pre and post-scenario questionnaires using Likert scale and free response data. Focus groups were undertaken three months after the simulation to obtain rich qualitative data. Common themes were identified via a process of initial coding and a 6-phase thematic analysis.

RESULTS

Thematic analysis demonstrated a marked increased perception of preparedness post-scenario; students felt more prepared to undertake their role in the imaging of complex care patients (Likert scoring increased with both mode and median post-scenario). Common themes that were identified were patient centeredness, realism and learning.

CONCLUSION

Within this limited pilot project, the use of simulation was an effective means of preparing students to understand their role within the complex care setting (with respect to the traumatic realism of burns) in preparedness for professional practice. Additionally, students related to the practical understanding of the complexity of human factors that exist within clinical practice.

Cosmetic camouflage improves quality of life among patients with skin disfigurement: A systematic review

This study systematically reviewed the impact of cosmetic camouflage use on different psychosocial outcomes in patients with disfiguring skin disorders. Electronic databases and reference lists were searched in February 2018 for studies reporting the impact of cosmetic camouflage on different quality of life (QoL) outcomes. Eighteen studies met the inclusion criteria: six randomized controlled trials, two quasi-experimental studies, nine single group 'before and after' interventions, and one comparative study with single post-intervention measurement. Quality appraisal of included studies was undertaken using the Joanna Briggs critical appraisal tools. While the studies varied in design, those included in this review indicated significant improvement in QoL after the use of cosmetic camouflage. The mean reduction in Dermatological Life Quality Index scores ranged from 1.4 to 6.4 signifying improvement in QoL of participants after treatment with cosmetic camouflage. Cosmetic camouflage can be an effective therapy in improving QoL among patients with skin disfigurement.

Long-term mental health outcomes after unintentional burns sustained during childhood: a retrospective cohort study

Background

Burns are a devastating injury that can cause physical and psychological issues. Limited data exist on long-term mental health (MH) after unintentional burns sustained during childhood. This study assessed long-term MH admissions after paediatric burns.

Methods

This retrospective cohort study included all children (< 18 years) hospitalised for a first burn (n = 11,967) in Western Australia, 1980-2012, and a frequency matched uninjured comparison cohort (n = 46,548). Linked hospital, MH and death data were examined. Multivariable negative binomial regression modelling was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI).

Results

The burn cohort had a significantly higher adjusted rate of post-burn MH admissions compared to the uninjured cohort (IRR, 95% CI: 2.55, 2.07-3.15). Post-burn MH admission rates were twice as high for those younger than 5 years at index burn (IRR, 95% CI 2.06, 1.54-2.74), three times higher for those 5-9 years and 15-18 years (IRR, 95% CI: 3.21, 1.92-5.37 and 3.37, 2.13-5.33, respectively) and almost five times higher for those aged 10-14 (IRR, 95% CI: 4.90, 3.10-7.76), when compared with respective ages of uninjured children. The burn cohort had higher admission rates for mood and anxiety disorders (IRR, 95% CI: 2.79, 2.20-3.53), psychotic disorders (IRR, 95% CI: 2.82, 1.97-4.03) and mental and behavioural conditions relating to drug and alcohol abuse (IRR, 95% CI: 4.25, 3.39-5.32).

Conclusions

Ongoing MH support is indicated for paediatric burn patients for a prolonged period after discharge to potentially prevent psychiatric morbidity and associated academic, social and psychological issues.

The Associations of Gender With Social Participation of Burn Survivors: A Life Impact Burn Recovery Evaluation Profile Study

Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. Burn injury may also lead to serious psychosocial challenges that have not been adequately studied and addressed. Specifically, there has been limited research into the associations of burn injury on community reintegration based on gender. This work analyzed data from 601 burn survivors who completed field testing of a new measure of social participation for burn survivors, the Life Impact Burn Recovery Evaluation (LIBRE) Profile. Differences in item responses between men and women were examined. Scores on the six LIBRE Profile scales were then compared between men and women using analysis of variance and adjusted linear multivariate regression modeling. Overall, men scored significantly better than women on four of the six LIBRE Profile scales: Sexual Relationships, Social Interactions, Work & Employment, and Romantic Relationships. Differences were not substantially reduced after adjustment for demographic characteristics and burn size. Men scored better than women in most of the areas measured by the LIBRE Profile. These gender differences are potentially important for managing burn patients during the post-injury recovery period.

Towards a clinical and empirical definition of burn scarring: A template analysis using qualitative data

OBJECTIVE

This study aimed to describe the nature, scope or meaning of the concept 'burn scar', from the perspective of adults and children with burn scarring, caregivers of children with burn scarring and health professionals who were considered experts in the treatment of burn scarring. The impact of the identified characteristics on burn scar health-related quality of life (HRQOL) was also examined.

METHOD

Using a phenomenological qualitative approach, 43 transcripts from semi-structured interviews with people with burn scars (n=10 adults and n=11 children), their caregivers (n=9) and health professionals (n=13) were analyzed using template analysis.

RESULTS

Ten characteristics of burn scars were identified by health professionals: 'stretchability', 'hardness', 'raised', 'thickness', 'surface area', 'scar sensitivity', 'scar surface appearance', 'hydration', 'fragility', and 'color'. However, 'thickness', 'scar surface area' and 'hydration' were not described by children with burn scars and 'scar surface area' was not described by adults with burn scars or caregivers. All groups (adults, children, caregivers and health professional) perceived that the burn scar characteristics of 'stretchability' and 'scar sensitivity' impacted upon all indicators of burn scar HRQOL. The burn scar characteristics of 'fragility', 'scar surface appearance' and 'color' were largely perceived by all groups to impact upon the emotional and physical indicators of burn scar HRQOL alone.

CONCLUSIONS

This study identified there are differences in the burn scar characteristics considered important by health professionals and those characteristics that adult/child/caregivers perceived to impact on indicators of burn scar HRQOL. It is recommended that outcome measures of burn scarring include the burn scar characteristics of 'stretchability' and 'scar sensitivity' at a minimum. The inclusion of 'fragility', 'scar surface appearance' and 'color' should also be considered.

The provision of specialist psychosocial support for people with visible differences: A European survey

A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.

Women's recovery, negotiation of appearance, and social reintegration following a burn

The gendered nature of postburn coping has received scant research attention in South Africa, a country that has a high rate of burns with significant concentrations among women. In this study, narratives that emerged from in-depth interviews with seven women were examined. The narratives emphasized essential needs of these burn survivors for personal support, the complexities of negotiating intimate relationships, struggles with the humiliation from family and friends, in some instances strained relationships with children, the support found through religious beliefs and institutions, and often frustratingly slow psychological acceptance of scars. These difficulties faced by women survivors of burns have highlighted the need to include religion/spirituality, intimate male partners, and women's children into the psychological recovery process, in an attempt to assist women's journey to psychological and emotional healing after burn.

Increased burn healing time is associated with higher Vancouver Scar Scale score

Increased burn wound healing time has been shown to influence abnormal scarring. This study hypothesised that scar severity increases commensurate to the increase in time to healing (TTH) of the wound. Wound healing and scar data from burn patients treated by the Burn Service of Western Australia at Royal Perth Hospital were examined. The relationship between TTH and scar severity, as assessed by the modified Vancouver Scar Scale (mVSS), was modelled using regression analysis. Interaction terms evaluated the effect of surgery and total body surface area - burn (TBSA) on the main relationship. Maximum likelihood estimation was used to account for potential bias from missing independent variable data. The sample had a median age of 34 years, TTH of 24 days, TBSA of 3% and length of stay of five days, 70% were men and 71% had burn surgery. For each additional day of TTH, the mVSS score increased by 0.11 points (P ≤ 0.001) per day in the first 21 days and 0.02 points per day thereafter (P = 0.004). The relationship remained stable in spite of TBSA or surgical intervention. Investigation of the effect of missing data revealed the primary model underestimated the strength of the association. An increase in TTH within 21 days of injury is associated with an increase in mVSS or reduced scar quality. The results confirm that efforts should be directed toward healing burn wounds as early as possible.

Social Support and Resilience Among Patients with Burn Injury in Lahore, Pakistan

INTRODUCTION

Social support and ego resiliency play a great role in maintaining the physical and mental health of patients with burn injuries. The present study has been designed to compare ego resiliency levels and the degree of social support in patients with a burn injury and their healthy counterparts.

METHODS

This study was conducted in two teaching hospitals in Lahore, Pakistan from May 2015 to July 2015. A total of 80 burn patients presenting in outpatient departments of general surgery, plastic surgery, and burn centers of these hospitals were surveyed conveniently, and for comparison, 80 patients presenting in outpatient departments with minor ailments, for routine checkups or follow-ups were recruited. The questionnaire comprised three sections: demographics, the Urdu versions of the Ego Resiliency Scale (ER-89), and the Multidimensional Scale of Perceived Social Support (MSPSS). All data were analyzed in SPSS v. 20 (IBM Corp., Armonk, NY).

RESULTS

Patients with a burn injury were associated with lower scores on the social support scale as well as its subscales assessing support from the significant other, family and friends than their healthy counterparts. However, no significant differences in scores on the ego resiliency scale were reported between these two groups.

CONCLUSION

Patients with a burn injury perceived low social support levels from society, which negatively affects their health outcomes. However, their resilience levels were not significantly different from their healthy counterparts.