Shedding the Layers: Exploring the Impact of the Burn Camp Experience on Adolescent Campers??? Body Image

The role of burn camp in the recovery of young people from burn injury: A qualitative study using long-term follow-up interviews with parents and participants

BACKGROUND

Children and adolescents recovering from burn injury are at heightened risk of psychosocial problems. An integrative form of psychosocial intervention is burn camp. However, evidence about burn camp effectiveness is equivocal.

OBJECTIVES

This study examined the role of therapeutic camp experiences in the recovery journeys of children and adolescents who had experienced burn injury and been treated in a tertiary pediatric hospital in Brisbane, Australia.

METHODS

Retrospective semi-structured interviews were conducted with youths and parents. Inductive reflexive thematic analysis was used with pooled interview data.

RESULTS

The participants were eight youths who attended at least one burns camp (between 2009 and 2019) and 15 parents of youth campers. An overwhelming majority (96%) reported a positive experience of camp, that they would return, and that they recommended the camp to other youth with burns. The four strengths of the camp experience were fun, adventurous activities; social relatedness (friendships, socializing); camp setting and experience; and acceptance. The four impacts of the camp on youth campers were normalizing ("I'm not the only one", shared experience); social support (making new friendships, social confidence, mentoring others); psychological recovery (happier, mentally stronger, more resilient, independence building); and confidence (increased self-confidence, increased social confidence, leadership development).

CONCLUSIONS

Although this is the first known research about burn camp in Australia, the findings are similar to a handful of other qualitative studies about burn camp experiences and impacts. Recommendations include future research on aspects of camp experiences that contribute to targeted outcomes, the role of staff and previous camp participants as mentors, and comparisons with other psychosocial interventions for youth burn survivors.

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.

Pediatric Burn Care: How Burn Camps Survived and Thrived During the Coronavirus Pandemic

Burn camps play a vital role in the recovery of burn survivors by allowing them to develop the confidence and skill sets needed to reintegrate back into society. During the COVID-19 pandemic, burn camps across the United States and Canada could not hold any in-person activities. They had to either pause burn camps or quickly adapt to a virtual online platform. A 37-item electronic survey was developed and emailed to burn camp directors in the United States and Canada to determine what adaptations were necessary during the pandemic. This survey allowed directors to provide details on many facets such as camp format, successes observed, and challenges encountered. Twenty-one of 34 (62%) burn camp organizations completed the survey. Thirteen of the 21 (62%) respondents held virtual burn camps in 2020 while everyone else canceled their camps in 2020. The mean number of camps offered per organization decreased from 6.3 in 2019 to 4.7 in 2020. The average number of burn survivors and family members participating also dropped in that same period (2019 aggregate mean = 229.2 vs 2020 aggregate mean = 151.4). Components of virtual camp included video conferencing platforms, "camp-in-a-box" activities, and some prerecorded sessions. Most camp directors believed that their campers were satisfied with the virtual format. Factors allowing for a successful virtual camp included an effective online platform, scheduling adequate duration of programs, and appropriate staffing levels. Most common barriers to an effective virtual camp were participant engagement, special needs/accessibility concerns, and staff effectiveness in this format. While challenging, burn camps can be held in a virtual format successfully with proper planning, staff training, and support of campers and their families.

The Impact of Peer Support Group Programs on Psychosocial Outcomes for Burn Survivors and Caregivers: A Review of the Literature

Peer support group programs are often recommended for burn survivors as a way to facilitate their psychosocial recovery and reintegration into the community. Such programs provide opportunities for burn patients and their caretakers to access emotional and informational support from healthcare providers and other survivors in inpatient or outpatient settings. Despite their popularity, however, there is little information currently available on the efficacy of these groups. In response, we reviewed the existing literature on peer support group programs and their impacts on psychosocial outcomes for burn survivors and their caregivers. A systematic review of the literature utilizing PubMed, PsycINFO, and Medline databases was conducted for articles published between 1990 and 2018. Twenty-five articles including inpatient, outpatient, integrative peer support groups, and burn camps met our inclusion criteria. All inpatient peer support group program articles (n = 4) reported associations with psychosocial improvements. Integrative peer support group program articles (n = 2) reported associations with social integration and reduction in post-traumatic stress and anxiety. All outpatient peer support group program articles (n = 8) demonstrated associations with psychosocial outcomes involving life satisfaction, acceptance of self, and reduced levels of isolation. Findings were less consistent for burn camps: eight articles suggested improvements in psychological outcomes while three articles reported no significant psychosocial effects. Although these results are encouraging, further study is indicated both to replicate these findings, and to determine the optimal implementation of inpatient and outpatient peer support programs.

Challenges Facing Women Survivors of Self-Immolation in the Kurdish Regions of Iran: A Qualitative Study

OBJECTIVES

Women confront many problems after self-immolation, so the purpose of this study was to explore the challenges facing women survivors of self-immolation in the Kurdish Regions of Iran.

METHOD

This study used a qualitative approach and conventional content analysis. Data were collected through semi-structured interviews with 19 Kurdish women who attempted self-immolation in Iran. They were sampled through purposeful sampling and snowball sampling. The Lincoln and Guba criteria were used to strengthen the research.

RESULTS

The results of data analysis were categorized into five main categories: 1-psychological problems, 2-lack of social and legal supportive structures, 3-incomplete treatment, 4-poor self-care, and 5-social problems. These categories consist of 19 subcategories.

CONCLUSION

Having been rescued from self-immolation, the women confront many challenges returning to normal life. Reducing these women's problems and paving the way for their return to life requires multi-dimensional and community-based interventions. Therefore, all social organizations and institutes can cooperate and each of them paves part of the way.

Burn camps for burns survivors-Realising the benefits for early adjustment: A systematic review

OBJECTIVES

Child and adolescent burn survivors benefit from skills to cope with the physical and mental challenges associated with their injuries. Burn camps can offer an opportunity to build these skills. In this study, we systematically review the best available evidence on burn camps in order to better assess their impact on burn survivors.

METHOD

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 815 articles on recreational therapeutic camps for burn survivors were retrieved from PubMed, PsycINFO, CINAHL and Scopus restricted to the English language and published before or by May 2018. Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for non-randomized experimental studies were used to assess the methodological rigour of the quantitative studies.

RESULTS

Quantitative data did not support any long-lasting impacts on psychosocial wellbeing. Qualitative data showed children, parents and staff all perceived benefits from camp attendance, including companionship and belonging.

CONCLUSION

Further research is required to understand the lack on congruence between qualitative and quantitative data. Qualitative data suggests burn camps are beneficial for children with burn injuries.

An evaluation of the impact of a burn camp on children and young people's concerns about social situations, satisfaction with appearance and behaviour

INTRODUCTION

This evaluation aimed to assess the impact of a burn camp on children and young people's concerns about social situations, satisfaction with appearance and behaviour.

METHODS

Young people completed the Perceived Stigmatisation Questionnaire (PSQ), Social Comfort Questionnaire (SCQ) and Satisfaction with Appearance Scale (SWAP) one month before camp (n=23), on the last day of camp (n=21) and at a three-month follow-up (n=13). Parents completed the Strengths and Difficulties Questionnaire (SDQ) one month before camp (n = 22) and at follow-up (n=12). Parents and young people also completed open-ended questions before camp and at the follow-up.

RESULTS

Results in this evaluation were mixed. While parents' reported scores on the SDQ were poorer after camp, young people's reported outcomes on all three measures improved at the end of camp. PSQ and SWAP scores were maintained and improved, respectively, at the follow-up. Qualitative responses were generally consistent with these scores. Significant improvements were found between the scores before camp and at the three-month follow-up for both the SWAP and PSQ. These results indicate that the burn camp may help to improve young people's satisfaction with their appearance and concerns about social situations. However, there was no comparison group and there was a significant loss of participants at follow-up.

CONCLUSION

Burn camps may therefore offer a range of psychosocial benefits to young people with burn injuries. This was the first evaluation to demonstrate a positive impact of a burn camp on satisfaction with appearance and concerns about social situations using outcome measures validated with the burns population.

Preserving self-concept in the burn survivors: a qualitative study

Background:

Burn injury is a devastating experience affecting all aspects of a person's essence, including his/her identity and perception. These patients require complex cognitive efforts to redefine their identity to deal with difficult condition after burn injury and preserve self-concept. The experience of life after burn injury is generally a solitary one, closely related to the patients’ cultural and religious context. Therefore, this study was conducted aiming at investigating burn patients’ experiences regarding how to preserve self-concept in life after burn injury in Iran.

Materials and Methods:

This qualitative study was carried out using qualitative content analysis and in-depth unstructured interviews with 17 surviving burn subjects.

Results:

During the qualitative content analysis process, the concept of “locating” as the essence of the participants’ experience was extracted as follows: (A) self-exploration (exploring the changes in one's life), (B) others’ exploration (exploring the changes in the life of family members and the relationship between self and others), (C) position evaluation (self-position analysis), and (D) self-concept preservation.

Conclusion:

The present study has developed new understandings of mental experiences of burn patients’ self-concept by describing the concept of “self-locating”. It helps us in classifying and understanding the concepts described in comprehensive theories developed in this area. They do this by focusing on what burn patients experience for choosing self-preservation strategies and having a meaningful life. The finding can be used as a conceptual framework for palliative care program in Iran.

Paediatric burns: from the voice of the child

INTRODUCTION

Despite burns being common in children, research into the psychological experience and trauma remains limited. Improvements in the professional understanding of children's experiences will assist in improving holistic care.

PURPOSE

This study uses phenomenology, a qualitative methodology to explore the psychological experiences following a burn injury in children.

METHODS

In-depth interviews were conducted six months after burn with 12 (six girls and six boys) children who underwent surgery for a burn. The children were aged eight to 15 years. The interview examined the overall experience of children and included probing questions exploring participants' perceptions, thoughts and feelings. Transcripts were analysed according to the seven-step Coliazzi method. Relationships between themes were explored to identify core concepts.

RESULTS

The findings demonstrated that trauma was central to the burn experience and comprised two phases: the burn trauma and the recovery trauma. Six themes emerged as a result of this experience: ongoing recurrent trauma; returning to normal activities; behavioural changes; scarring-the permanent reminder; family and adaptation.

CONCLUSION

This research has clinical implications as its findings can be used to inform clinical care at all stages of the burn journey. These research conclusions could be used to develop comprehensive information and support management plans for children. This would complement and support the surgical and medical treatment plan, providing direction for comprehensive service delivery and improved psychosocial outcomes in children.

Body image of children and adolescents with chronic illness: a meta-analytic comparison with healthy peers

This meta-analysis integrates results from 330 studies on differences between body image of children and adolescents with and without chronic physical illness. Young people with a chronic illness had a less positive body image than their healthy peers although the average size of differences was small (g=-.30 standard deviation units). A comparison of diseases showed that young people with obesity (g=-.79), cystic fibrosis (g=-.50), scoliosis (g=-.41), asthma (g=-.37), growth hormone deficits (g=-.35), spina bifida (g=-.23), cancer (g=-.20), and diabetes (g=-.17) evaluated their body less positively than their healthy peers. Furthermore, levels of body dissatisfaction varied by age at onset of the disease, method for assessing body image, ethnicity, year of publication, and comparison group. Recommendations are stated for reducing effects of chronic illness on the body image of people with chronic illness.

Restorying the self: an exploration of young burn survivors' narratives of resilience

The results of this exploratory study reflect a shift from public health studies that aim to examine the risk and prevalence of burn injury, toward eliciting survivors' subjective meaning-making processes beyond the injury event. We drew on a narrative framework to explore how young survivors' experiences of burn injury led to reconstructions of self and shifts in thinking about others and the world. Although participants' narratives revealed elements of heightened self-awareness, need for acceptance, and desire for recognition, these stood alongside counter narratives denoting positive, transformative, and resilient aspects of healing that reflected a rebirth of the self, life having purpose, and psychospiritual growth. A multidimensional and relational framework for resilience acknowledges the "deficient," but also recognizes the pathways to growth, healing, meaning, and purpose. This shift toward person-centered meanings has value in informing interventions beyond the immediate "wound care," toward the survivors' lifelong (re)negotiation of identity, appearance, psychological adjustment, and social reintegration.

A Pan-European evaluation of residential burns camps for children and young people

INTRODUCTION

Residential camps for children who have experienced a severe burn have existed for over 20 years. The idea stemmed from recognition that children with burns face additional challenges, both physical and psychological, and therefore need long-term psychosocial support away from the acute care setting. Whilst individual programmes have published positive evaluation findings, there have been no cross-regional evaluations undertaken to date.

METHODS

Five European burn camp programmes agreed to take part in a cross-regional study to assess the benefits as reported by participants. Shared objectives included: giving children the opportunity to experience success through overcoming challenging activities, enhancing self-esteem and confidence and enabling children to share their experiences of having a burn with peers and staff in a supportive environment. Each site collected qualitative feedback from children, parents and staff using a common framework. Simple Likert scale data were also collected. Each site coded responses into themes which were then collated at one site.

RESULTS

104 children, 57 parent/carers and 50 staff took part in the cross-regional evaluation. Children were aged between 5 and 18 years. 98% of children reported that they had enjoyed camp, in particular the activities and the sense of achievement they brought, along with the ability to gain support and friendship from peers and staff. A large proportion felt that they had benefitted from having the opportunity to share their experiences of having a burn with peers, leaving them feeling less isolated. In addition some comments related to boosting confidence and self-esteem and mastering new skills. Parent/carers again cited the increase in their child's confidence in self and appearance as key benefits of the camps. Staff reports also included the benefits for burn care teams by increasing awareness of patient needs and improving multidisciplinary team working.

DISCUSSION

The study highlighted the generic benefits of burn camps by collapsing themes across five different sites. Whilst this minimised the localised differences between camps, further research could be used to analyse these subtle differences in greater detail. Some consideration was made of the language barriers between sites which could have effected the interpretation of some of the individual themes. A multi-methodological approach could be used to reduce this effect in future.

Life after burn injury: striving for regained freedom

Focusing beyond survival, the priority of modern burn care is optimal quality of life. Our aim with this study, which was informed by phenomenology, was to describe and identify invariant meanings in the experience of life after major burn injury. Fourteen adults having sustained a major burn were interviewed, on average, 14 months postinjury, and asked about their experience of important aspects of life. The accident meant facing an extreme situation that demanded vigilance, appropriate action, and the need for assistance. The aftermath of the burn injury and treatment included having to put significant effort into creating coherence in their disrupted personal life stories. Continuing life meant accepting the unchangeable, including going through recurrent processes of enduring, grief, fatalism, comparisons with others, and new feelings of gratefulness. Furthermore, a continuous struggle to change what was changeable, to achieve personal goals, independence, relationships with others, and a meaningful life, were all efforts to regain freedom, aiming for a life as it was before--and sometimes even better.

Impact of a pediatric residential burn camp experience on burn survivors' perceptions of self and attitudes regarding the camp community

Summer camp is reported to be a positive and valuable experience for burn and nonburned children. Objective studies comparing the effectiveness, similarities, and differences of rehabilitative vs recreational camps are limited. The aim of this study, year 1, was to assess the effect of burn camp on self-esteem and integration as reported by burn children via the Rosenberg Self-Esteem Scale and a community integration survey. During year 2, burn campers completed these measures again and their self-esteem and integration scores were compared with a group of nonburn campers. The first year results showed significant improvement in burn camper's self-esteem from the beginning to end of camp and successful integration into the camp community. During year 2, burn surviving children reported significantly lower self-esteem before camp than the comparison group, but after camp, burn children's self-esteem was comparable with that of nonburn campers. White non-Hispanic campers reported more sustained improvement in self-esteem than other ethnic groups. Burn campers reported a high level of integration into the camp across sex, years since burn, years at camp, or ethnicity, scoring slightly higher than the comparison group. Age was positively correlated with integration among the burn, but not the nonburn campers. Helping children deal with their burn injuries through a rehabilitative program such as burn camp appears to provide benefit for child burn survivors.

The challenge of evaluating rehabilitative activity holidays for burn-injured children: qualitative and quantitative outcome data from a Burns Camp over a five-year period

Specialized holidays for burn-injured children are currently considered an important part of their rehabilitation. These holidays, or Camps, aim to help children face the challenges of their burn injury and treatment in a fun and supportive environment. Manchester Children's Burns Camps have been run by professionals from the Burns Unit at Booth Hall Children's Hospital together with volunteers since 1983. Formal evaluation has been a crucial component of these Camps since 1999. The purpose of this study was to summarize the findings of the evaluation process over the last 5 years, and to discuss any issues raised by the results. Standardized measures were administered to 97 children and their parents over this time period. These measures, designed to assess self-esteem, social relationships and general emotional and behavioural well-being, were completed before and after the children attended the Camp. The quantitative data showed little consistent evidence of change on these measures over the 5 years. However, the qualitative data shows consistent themes of increased confidence and improved coping with the burn injury, amongst others. The discrepancy between the quantitative and qualitative results is discussed, and implications and challenges for further evaluation of Burns Camps are raised.