Strong emotional reactions for doctors working in palliative care: Causes, management and impact. A qualitative study.

OBJECTIVE: Doctors working in palliative care services are exposed to challenging emotional environments almost daily. Strong-emotional reactions experienced in this setting have implications for patient care and doctor wellbeing. Existing research has not focused on doctors working in specialist palliative care. This study aimed to understand what strong emotional reactions are experienced by doctors working in specialist palliative care, the cause of these strong emotional reactions and the impact they have on the lives of palliative care doctors. METHODS: Qualitative descriptive design included grounded theory techniques. Semi-structured, audio-recorded individual interviews explored doctors' memories of strong emotional reactions and challenging aspects in palliative care work, how emotions were managed and affected doctors' lives. SETTING/PARTICIPANTS: Twenty doctors were recruited from a specialist palliative care service within a public health network in Melbourne, Australia, comprising of two inpatient units, a consult service and outpatient clinic. RESULTS: Palliative care doctors experience a myriad of strong emotions in their line of work. Experiences found to elicit strong emotional reactions included patient, family and staff distress and organizational issues. Strong emotional reactions impacted clinical behaviours, patient care and doctors' personal lives. Strategies developed for managing strong emotional reactions included debrief, setting boundaries, avoidance and self-reflection, along with non-work strategies such as time with family. CONCLUSIONS: Whilst emotionally challenging experiences are unavoidable and necessary in a palliative care doctor's development, doctors need to be supported to avoid adversely impacting patient care or their own wellbeing.

Biobrane: a retrospective analysis of outcomes at a specialist adult burns centre.

INTRODUCTION: This study is a retrospective analysis of 168 adult burns patients who received definitive treatment for partial thickness burns with Biobrane at a specialist burns centre. Our aim was to establish whether Biobrane served as a reliable, definitive treatment option or whether further treatment and allocation of surgical and nursing resources was required after application. METHODS: We conducted a retrospective two year chart review (January 1 2007 and December 31 2008) of patients admitted to the Victorian Adult Burns Service, in Melbourne, Australia. RESULTS: Use of Biobrane was associated with the need for further treatment interventions in a total of 74 patients (44%). Of these, Biobrane failure was found to be associated with infection in 28 cases (37.8%) and 48 (65%) patients underwent further surgery. A total of 87 patients (52%) had burns that took greater than three weeks from the time of injury to full re-epithelisation. Factors found to be associated with Biobrane failure were female gender, increasing percentage surface area of Biobrane application and when Biobrane was used in conjunction with split skin grafting to another area. CONCLUSION: The application of Biobrane to burns of mid-dermal or 'indeterminate' depth in our institution has resulted in high rates of return to theatre, positive wound cultures and delayed healing, and the recognition of the need to re-conceptualise the principles of use of this product. The use of Biobrane in smaller mid dermal or mixed depth burns may lead to increased operations and use of other hospital resources, without clear evidence of improved outcomes.