Family-based education and follow-up program for patients with burns: A mixed assessment study.

BACKGROUND: Burn injuries are a major cause of morbidity and mortality worldwide, affecting not only the patients but also their families. Family-based education and follow-up program are interventions that aim to improve the quality of life and psychosocial outcomes of patients with burns and their families. However, we find a lack of evidence on the effectiveness and feasibility of these programs in different settings and populations. This study aimed to evaluate the features of the family-based education and follow-up program (FBEFP), a pilot project that was developed and implemented at the Tabriz Sina Teaching Hospital in 2020 to improve its burn care system. DESIGN: A mixed-methods approach was used to collect and analyze both quantitative and qualitative data from various sources, such as, questionnaires, medical records, interviews and observation notes, to assess the content, process, and outcome of the program. The study followed the three steps of the CDC's framework for program evaluation: describing the program, measuring its effectiveness, and providing recommendations for improvement. RESULTS: The results of this study revealed the positive impacts of the FBEFP on the patients' physical, psychological, and social outcomes and quality of life. 4.8% of the people in the follow-up group were re-admitted, while this amount was 7.2% in the group without follow-up. Although the number of readmissions was less in the non-follow-up group, statistically no significant difference was observed between the two ratios before and after follow-up. In order to evaluate satisfaction rates, In the follow-up group, 72 patients and in the non-follow-up group, 38 patients were reached. After converting these data to normal distribution, using t-tests, it was determined that the difference between the two studied groups was highly significant. In other words, the follow-up process had favorable results on satisfaction of the studied people. However, the study also identified some challenges and barriers in implementing the program, such as lack of resources, staff training, and family involvement. CONCLUSION: FBEFP is a promising intervention that enhances the well-being of patients with burns and their families. However, more evidence is needed to support its effectiveness and feasibility in different contexts and populations. The study also provided valuable insights into the benefits and challenges of implementing a Family-Based Education and Follow-up Program for patients with burns in a low-resource setting. The study contributed to the development of guidelines and recommendations for future research and practice in this field.

Burn self-stigma: A hybrid concept analysis.

AIM: As burn self-stigma has not been addressed fully, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences in burn survivors. METHODS: Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged. RESULTS: We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented. CONCLUSION: Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted.

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.

Second Victim Experience and Support Tool: Persian translation and psychometric characteristics evaluation.

BACKGROUND: Healthcare providers involved in an unexpected adverse patient safety event are affected by negative outcomes of the event and are called 'second victims'. The Second Victim Experience and Support Tool has been introduced as a reliable and valid measure to assess the second victim responses and to support recourses of healthcare professionals. AIM: The core objective of this survey was to assess the psychometric attributes of the scale within Iranian nurse. METHODS: Having translated the scale based on the WHO guidelines and assessing its face validity, a board of 8 specialists assessed the content validity of the measure. In order to assess the psychometric characteristics of the questionnaire, a survey was conducted in 5 university-affiliated hospitals of Urmia. Confirmatory factor analysis is adopted to assess the construct validity. The internal consistency and test-retest reliability of the scale were determined. RESULTS: The Persian version of the scale consists of 29 items and 9 subscales. Confirmatory factor analysis illustrated that the scale reflects a foolproof construct validity. Cronbach α coefficients revealed the reliability of the scale (0.68-0.88). CONCLUSIONS: The survey proves to be a reliable and valid measure to evaluate the second victim responses and conceivable support resources of Iranian nurses or other Persian-speaking healthcare professionals of the region. IMPLICATIONS FOR HEALTH POLICY AND PRACTICE: Health policymakers ought to build up large-scale surveys to determine the degree of second victimization of healthcare professionals so as to offer suitable support systems. Taking the scale into account would improve evaluation of the benefits of second victim support initiatives in nursing practice.

Relationship between patient safety culture and job burnout in Iranian nurses: Assessing the mediating role of second victim experience using structural equation modelling.

AIM: The study examined the mediating effect of the second victim experience between safety culture and burnout in Iranian nurses. METHODS: A convenience sample of 298 nurses from five teaching hospitals of Urmia participated in the study. Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and The Second Victim Experience and Support Tool were used to measure the major variables. We adopted structural equation modelling to examine the hypotheses. RESULTS: Safety culture was significantly associated with second victim experience and burnout (p < .01). Second victim experience had a partial mediating role on the relationship between safety culture and burnout (p < .01). The mediating model including major variables showed satisfactory fitness (χ2 /df = 2.11, p < .01, Comparative Fit Index = 0.94, root-mean-square error of approximation = 0.062). CONCLUSIONS: Establishing a safety culture is crucial for decreasing job burnout, and second victim experience has an intervening role clarifying how high level of safety culture reduces burnout. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should plan to promote safety culture and provide sufficient support to staff involved in the patient safety incident, which could reduce staff burnout.

Social support and posttraumatic growth in Iranian burn survivors: The mediating role of spirituality.

BACKGROUND: Social support and spirituality are important issues among burn survivors that appear to affect their posttraumatic growth (PTG). AIM: To investigate the relationship between social support and PTG in Iranian burn survivors, as mediated by their perceptions of spiritual well-being. METHOD: This is a correlation study with a cross-sectional design, and it uses anonymous questionnaires as study instruments (i.e. Posttraumatic Growth Inventory, Spiritual Well-Being Scale and the Multidimensional Scale of Perceived Social Support). A total of 118 questionnaires were sent to participants by post. Nine envelopes were not returned, and seven questionnaires were incompletely filled. Data were collected from 102 burn survivors who had a history of hospitalisation at Imam Khomeini Teaching Hospitals of Urmia, the capital of Western Azerbaijan Province, northwest of Iran. Structural equation modelling and bootstrapping procedures were employed to identify the mediating role of their perceptions of spiritual well-being. RESULTS: The mean scores of social support (ranging from 12 to 84), PTG (ranging from 0 to 105) and the spirituality (ranging from 20 to120) among the participants were 56.96, 78.13 and 92.15, respectively. The results confirmed our hypothesised model. All the latent variables (variables that are not directly observed but are rather inferred from other variables that are observed (directly measured by items of an instrument)) of study were significantly correlated in the predicted directions. Social support and spirituality were significant predictors of PTG. Spirituality partially mediated the relationship between social support and PTG. The mediating role of the spirituality suggests that social support increases PTG, both directly and indirectly. CONCLUSION: The mediating role of spirituality should provide new visions for the augmentation of PTG in burn survivors.

Moral distress and burnout in Iranian nurses: The mediating effect of workplace bullying.

BACKGROUND: Moral distress and workplace bullying are important issues in the nursing workplace that appear to affect nurse's burnout. AIM: To investigate the relationship between moral distress and burnout in Iranian nurses, as mediated by their perceptions of workplace bullying. ETHICAL CONSIDERATIONS: The research was approved by the committee of ethics in research of the Urmia University of Medical Sciences. METHOD: This is a correlation study using a cross-sectional design with anonymous questionnaires as study instruments (i.e. Moral Distress Scale-Revised, Maslach Burnout Inventory and The Negative Acts Questionnaire-Revised). Data were collected from 278 nurses from five teaching hospitals in Urmia, the capital of Western Azerbaijan, northwest of Iran. Structural equation modeling and bootstrapping procedures were employed to recognize the mediating role of their perceptions of workplace bullying. RESULTS: The mean score of moral distress, burnout, and the Negative Acts Questionnaire-Revised Scale among the participants were 91.02 ± 35.26, 79.9 ± 18.27, and 45.4 ± 15.39, respectively. The results confirmed our hypothesized model. All the latent variables of study were significantly correlated in the predicted directions. The moral distress and bullying were significant predictors of burnout. Perception of bullying partially mediated the relationship between moral distress and burnout. The mediating role of the bullying suggests that moral distress increases burnout, directly and indirectly. CONCLUSION: Nursing administrators should be conscious of the role of moral distress and bullying in the nursing workplace in increasing burnout.

Social participation, social support, and body image in the first year of rehabilitation in burn survivors: A longitudinal, three-wave cross-lagged panel analysis using structural equation modeling.

INTRODUCTION: Psychosocial outcomes of burn survivors in the first year of rehabilitation are not well studied. Considering the interrelationships among psychosocial processes in burn survivors, we assessed three psychosocial variables (i.e., social support, social participation, and body image) simultaneously in a longitudinal study. AIMS: This study aimed at identifying the developmental trajectory of the main study variables and also discovering the causal pathways between social support, body image, and social participation of burn survivors in the first year of rehabilitation. METHODS: One hundred individuals were enrolled in the study. The analysis was based on three waves of data collected at the time of discharge, 6 months after discharge, and 12 months after discharge. We used MSPSS, SWAP, and the p-scale for measuring the variables social support, body image, and social participation, respectively. A repeated-measures analysis of variance (ANOVA) was performed to identify the major differences in the mean levels of the main study variables across the three evaluation times. A structural equation modeling (SEM) approach was implemented in four hypothesized cross-lagged models (M1, M2, M3, and M4) to evaluate the bidirectional relationships among the main variables. All hypothesized models were tested, and their goodness-of-fit indexes were compared to identify the best fitting model. RESULTS: All three main variables worsen during the first six months after burn and then do not return to their earlier level. The M4 (final model) chosen to represent the data showed the best goodness-of-fit indexes (χ2 (9)=51.76, p<.01, RMSEA=0.060, IFI=0.97, and CFI=0.98) among all hypothesized models. The effect of social participation on body image, and vice versa, seems to be relatively constant and steady. Social support at the time of discharge predicted social participation at 12 months after burn, with the relationship mediated by body image at 6 months after burn. CONCLUSION: Our study findings suggest that persistent care should be provided for burn survivors even after discharge.

Hypnosis for reduction of background pain and pain anxiety in men with burns: A blinded, randomised, placebo-controlled study.

INTRODUCTION: 'Background pain' and 'pain anxiety' are among the numerous problems of patients with burns. Non-pharmacological and pharmacological interventions have been used to reduce background pain and pain anxiety. This study compared the effectiveness of hypnosis and 'neutral hypnosis' (as a placebo in the control group) in decreasing the background burn pain and pain anxiety of adult male survivors with burns. DESIGN: This is a blinded, randomised, placebo-controlled study. METHODS: Sixty men with burns were included in the minimisation method (30 individuals in the intervention group and 30 individuals in the control group). Four hypnotherapy sessions were performed every other day for each participant in the intervention group. Four neutral hypnosis sessions were performed every other day in the control group. Burn pain and pain anxiety of the patients in both groups were measured at the end of the second and fourth sessions. Repeated measures ANOVA was used for data analysis. RESULTS: There was no significant difference between the groups in the reduction in background pain intensity. There was a significant reduction in background pain quality and pain anxiety in the intervention group during the four hypnosis sessions. After two hypnotherapy sessions, a significant reduction was observed in the level of background pain quality and pain anxiety of participants. CONCLUSION: Hypnosis is effective in reducing background pain quality and pain anxiety of men with burns.