What is missed in self-immolated patients' care?: a grounded theory study

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.

Drivers and consequences of self-immolation in parts of Iran, Iraq and Uzbekistan: A systematic review of qualitative evidence

OBJECTIVES

The prevalence of self-immolation is significantly higher in some Middle Eastern and Central Asian Islamic countries than in Western countries. Self-immolation typically occurs among females and can be either an attempt at suicide or an act of protest. This systematic review examined the drivers and consequences of self-immolation in Asian Islamic countries from the perspective of those affected by it, including survivors, family and health care staff in order to understand its higher prevalence in these countries.

METHOD

A systematic review of qualitative studies was conducted in June 2018, using five electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, Scopus and PsycINFO. Of the 236 papers identified, seven met the inclusion criteria. Authors independently rated the reporting of included qualitative studies and thematic analysis was used to analyse the data.

RESULTS

The drivers of self-immolation included marital and familial conflict, male-dominated culture, mental health disorders and economic and social factors. Survivors chose self-immolation in order to express their sense of a lack of control and mostly utilised this method due to its accessibility. The consequences of self-immolation were social isolation, regret, and physical and psychological impacts.

CONCLUSIONS

The reasons for self-immolation, its prevalence and the demographics of those who choose this means vary significantly between Asian Islamic and Western countries. This review confirmed the impact of culture, tradition, and societal structures and relationships on people's decisions to self-immolate. Education about the consequences of self-immolation may reduce the use of this method.

Maintaining Equilibrium: Socialization and Gendered Identities of Iranian Male Nurses

The aim of this study was to explore the process of Iranian male nurses’ professional socialization and how they negotiate a gendered identity. A purposive sample of 22 male nurses was recruited from six public hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Study data were collected by conducting semi-structured interviews. Data collection was continued until reaching data saturation. Totally, 25 interviews were conducted. Data analysis was carried out using Corbin and Strauss’s techniques for qualitative data analysis. The core category of the study, that is, the socialization process of male nurses who participated in the study, was “maintaining equilibrium.” Our participants’ strategies for socialization included informing, conforming, and self-establishing. The study findings can be used for developing effective strategies for male staff recruitment and retention.

Rigorous, robust and systematic: Qualitative research and its contribution to burn care. An integrative review

Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research.

Occupational Mental Health: A Study of Work-Related Mental Health among Clinical Nurses

OBJECTIVE

This paper reports a study performed to investigate and assess the mental health as well as the demographic characteristics of nurses to examine their mental health status based on four physical, anxiety, social-function and depression items.

MATERIALS AND METHODS

This descriptive cross-sectional study was accomplished on 86 nurses working at three hospitals, affiliated to Iranian health ministry, in Ilam city(western Iran) all the cases were selected by purposeful sampling method. Data was collected by a two-part questionnaire containing individual data and GHQ -28 Standardized Questionnaire. The GHO-28 was developed by Goldberg, in 1978, as a screening tool to detect those likely to have or be at risk of developing psychiatric disorders. The GHQ-28 is a 28-item measure of emotional distress in medical settings. Analysis was done by SPSS 18 software.

RESULTS

The majority of participants were females(50.6 vs.49.4) of 35-40 years old(27.2% ), 84 percent were married(vs.16%), 35.8 percent with 10-15 years of record(vs.33.3% less than 5), 22.2% with 5-10, and 8.6% with more than 15-years of work record. The majority of participants have worked in surgical wards of hospitals. The analysis of GHQ results showed that 43.2%(n=35) of participants were suspected to suffer from mental disorders(vs.56.8% n=46 healthy participants); of all the suspected cases, 12.3% were supposed to have physical symptoms, 16% anxiety symptoms, 42% social dysfunction, and 6.2% symptoms of depression. In general, the participants demonstrated a Mean±SD of mental health score equal to 23.65±9.43.

CONCLUSION

Research results showed that the high prevalence of depression, anxiety and stress symptoms among nurses is alarming. It was concluded that providing efficient adequate and appropriate support services for this group can result in more healthy nurses as well as promotion of public health.