Article

Quantitative and thematic analysis of burns surgeons’ attitudes, beliefs and surgical decision-making in self-harm burn injuries: The use of a questionnaire and hypothetical cases

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background: Self-harm injuries represent a significant minority of attendances within burns services. However, there is minimal research exploring burns surgeons' attitudes and beliefs about self-harm and how treatment decisions are made. Method: Burns surgeons (n=37) completed a questionnaire which measured attitudes and beliefs about self-harm. Surgical decision-making was also explored by prompting surgeons to make treatment decisions for hypothetical case scenarios, and describe their rationale behind their decisions. Results: The majority of surgeons reported positive attitudes about self-harm. However, around one in ten judged patients who self-harm more negatively, around a fifth offer surgery less frequently and almost a quarter believed that surgery should only be offered a limited number of times in repeated self-harm. Unhelpful or inaccurate beliefs (e.g. self-harm is 'attention seeking,' surgery would reinforce the self-harm, and that patients who self-harm tamper with skin grafts) were evident in some surgeons. Thematic analysis of qualitative data describing surgical decisions identified five themes: Equal Access to Care; Multidisciplinary Working; Old or Unhelpful Stories; Concerns about Tampering; and Repeated vs. First Time Self-Harm Episodes. More experienced surgeons were less judgmental, more likely to offer surgical interventions, and less likely to hold unhelpful or inaccurate beliefs compared to junior surgeons. Conclusions: Some surgeons are not acting in line with UK guidance on the management of self-harm injuries. Education on the topic of self-harm is essential in burns services and this may be particularly important early on during surgical careers. Prospective research regarding surgical treatments and outcomes following self-harm is required.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... In relation to self-harm burn injuries, it is known that many UK healthcare professionals in burns and plastic surgery are unaware of the national guidance [9,21] and that a significant minority found compassion difficult and offered conservative management more often than when treating non-intentional injuries [21][22][23]. Furthermore, there exists evidence of unofficial 'rules' amongst some surgeons around how often patients who self-harm should receive surgery, and unhelpful beliefs around self-harm being 'attention seeking' behaviour, surgery reinforcing self-harm behaviour and patients being non-compliant or tampering with skin grafts if these were to be offered. ...
... Furthermore, there exists evidence of unofficial 'rules' amongst some surgeons around how often patients who self-harm should receive surgery, and unhelpful beliefs around self-harm being 'attention seeking' behaviour, surgery reinforcing self-harm behaviour and patients being non-compliant or tampering with skin grafts if these were to be offered. These views were most frequent amongst more junior surgeons [22]. The authors could find no published evidence describing the frequency of offers of surgery and outcomes of surgery on self-harm burn injuries. ...
... The rate of tampering or non-compliance was very low, with frequencies of 7 % overall and 6 % in the surgically-managed group. This differs from the views held by some surgeons [22]. Anecdotally, it is observed that some patients describe deterioration in their mental health prior to the incident, due to increased stressors or changes in life circumstances. ...
Article
Within healthcare generally, patients who self-harm can experience stigma and inequitable medical care. Previous studies have suggested that patients with small self-harm burn injuries may not be treated equally in comparison to non-intentional injuries. Furthermore, there is an absence of literature related to surgical outcomes for self-harm burn injuries. A retrospective cohort study of an adult burns service’s outpatient attendances over a four-year period was completed. Self-harm burn injuries were identified and hospital medical records were used to extract demographic, burn injury, treatment and outcome information. 94 self-harm burn injuries in 58 patients presented over the study period. Of those who presented with self-harm burn injuries, 29% (n=17) of patients presented on more than one occasion, 54% (n=50) of wounds were managed surgically and 80% (n=36) of full thickness injuries were managed surgically. The post-operative course and healing time was similar to what would be expected after non-intentional burn injuries. In 93% (n=54) of all patients presenting with self-harm burn injuries, there was no reported tampering or non-compliance. There was no tampering or non-compliance in 94% (n=47) of those with self-harm burn injuries when wounds were treated surgically. The findings support the view that self-harm burn injuries should be treated in the same way as non-intentional burn injuries and that similar outcomes from treatment can be expected. However, further research is needed to explore this systematically.
... Most of the existing studies focus on the description of the attitudes and experiences of diff erent types of populations, namely adolescents who self-harm (Batejan, Swenson, Jarvi, & Muehlenkamp, 2015;Klineberg, Kelly, Stansfeld, & Bhui, 2013;Rissanen, Kylmä, & Laukkanen, 2008), parents of adolescents who self-harm (Ferrey et al., 2016;Kelada, Whitlock, Hasking, & Melvin, 2016;McDonald, O'Brien, & Jackson, 2007;Oldershaw, Richards, Simic, & Schmidt, 2008;Rissanen, Kylmä, & Laukkanen, 2009), peers (Berger, Hasking & Martin, 2013, 2017Bresin et al., 2013), healthcare professionals (Karman, Kool, Poslawsky, & Van Meijel, 2015;McHale & Felton, 2010;Rai, Shepherd, & O'Boyle, 2019;Rees, Rapport, Thomas, John, & Snooks, 2014;Vine, Shawwhan-Akl, Maude, Jones, & Kimpton, 2017), counsellors (De Stefano, Atkins, Noble, & Heath, 2012;Fox, 2011;Long & Jenkins, 2010), or teachers (Berger, Hasking, & Reupert, 2014;Heath, Toste, & Beettam, 2007;Heath, Toste, Sornberger, & Wagner, 2011). However, there is still a general lack of knowledge concerning the social representations about the functions of deliberate self-harm, since a considerable part of research focused only on the attitudes towards selfharm. ...
Article
Full-text available
This study aimed to describe the social representations about the functions of deliberate self-harm and to compare these representations from adolescents with and without a history of deliberate self-harm and adults without a history of these behaviours. We conducted a qualitative study involving the thematic analysis of forty-one semi-structured interviews. The participants consisted of 11 adolescents with a history of deliberate self-harm, 15 adolescents without a history of deliberate self-harm and 15 adults also without a history of behaviours. The interviewees mentioned eight functions of deliberate self-harm consistent with the existing literature, namely interpersonal functions (Communication Attempt, Interpersonal Boundaries, Interpersonal Influence, and Peer Bonding) and intrapersonal functions (Affect Regulation, Anti-Dissociation, Escape Mechanism, and Self-Punishment). Also, two new functions not described in the literature were mentioned (Introspective Mechanism and Replacement of Suffering). Regarding the differences between the three groups, several disparities emerged. Overall, results revealed that the group of adults referenced more interpersonal functions, while both groups of adolescents emphasized intrapersonal functions. This study provides insight regarding the social representations about the functions of deliberate self-harm, also focusing on the differences between adolescents with and without a history of these behaviours and adults without a history of deliberate self-harm.
Article
Background: The incidence of incisional self-harm of the upper limbs is increasing, and recurrence rates are high. It is not known whether different wound treatment strategies (dressings only vs. surgery) or the operative setting (main theatre vs. non-main theatre) affect wound or mental health-related outcomes. Methods: Four electronic databases (Ovid MEDLINE, OVID EMBASE, PsycINFO and CENTRAL) were searched from inception to 14/09/2021 for studies which describe the management of incisional self-harm wounds of the upper limb(s) in adults and children. Dual-author screening and data extraction were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: In total, 19 studies (1477 patients) were included. Overall, the evidence was limited by a paucity of comparative data on wound management strategy and setting, and poor-quality outcome reporting. Only four studies clearly identified the operative setting for definitive wound management (two in main operating theatres, one in the emergency department and one using both settings, depending on injury severity). Few studies inconsistently reported surgical outcomes (n=9) or mental health outcomes (n=4), hindering evidence synthesis. Conclusion: Further investigation is needed to determine the most cost-effective management strategies and settings for these injuries.
Preprint
Full-text available
Background Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals’ stigmatization toward patients with mental disorders. Methods We conducted a scoping review using Arksey and O’Malley’s framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008–2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. Results A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. Conclusions The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
Article
Introduction Burn care is a relatively small, mutidisciplinary field with variability in practices between centers. Given these factors, survey studies are frequently used to better understand practice variations, establish guidelines, and direct future research. If survey research is poorly designed or reported, it limits the ability to form meaningful conclusions. This study evaluates the quality of survey studies published in burn care and determines areas of improvement to increase generalizability. Methods A systematic review was performed by two independent reviewers. Three databases (PubMed, Scopus, Web of Science) were queried between January 1, 2000 and March 19, 2020. Studies were included if they surveyed any member of the multidisciplinary burn team on a topic related to burn care, and surveys of non-clinicians were excluded. Data related to survey content, methodology, and quality was extracted for analysis. Results Of 247 citations, 144 met inclusion criteria. The number of published surveys increased by an average of 23% annually over the study period (p<0.001). Studies represented a breadth of countries, scopes, themes, and disciplines. Few studies reported using reminders or incentives. The majority did not report survey development steps or validity/reliability, and half did not include the questionnaire in the publication. The median (IQR) response rate of all studies was 54% (32-83). A subgroup analysis of surveys to North American burn directors (N=28) had a response rate of 40% (26-50). Conclusion Survey reporting in the burn care literature is generally inconsistent, limiting the ability to apply this research into practice.
Article
Full-text available
Background Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals’ stigmatization toward patients with mental disorders. Methods We conducted a scoping review using Arksey and O’Malley’s framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May–June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008–2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. Results A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies ( n = 73) and intervention studies ( n = 64). A majority of studies ( N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia ( n = 13), self-harm (n = 13), and eating disorders ( n = 9). Half of the studies focused on health students ( n = 64), primarily nursing students ( n = 26) and medical students ( n = 25), while ( n = 66) focused on health care professionals, primarily emergency staff ( n = 16) and general practitioners ( n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. Conclusions The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
Article
Full-text available
In the Western world, self-inflicted burns are often associated with mental health disorders, and the management, particularly the pain treatment, can often be complicated by the psycho-social background of the patients. The aim was to describe a group of patients with self-inflicted burns by analysing their in-hospital mortality and the use of sedation during procedures. All patients with self-inflicted burns admitted to the Linköping Burn Centre during 2000-2017 were included. The control group consisted of adults (≥17 years) with accidental burns, admitted during the same period. Multivariable logistic and linear regression was used for analysis. Three percent of all patients (47/1601) had self-inflicted burns: most of them were men (60%, 28/47), none was younger than 17 years, and flame was the major cause of injury. Self-inflicted burn patients were younger and had larger burns: mean age (SD) was 42 (16) and 49 (20) years, respectively; mean TBSA (SD) was 29% (26) and 14% (17), respectively. The crude rate of procedures done under sedation was higher (mean (SD) 0.37 (0.23) compared with 0.24 (0.25)) as was crude in-hospital mortality (8/47, 17% compared with 72/1018, 7%). Multivariable analyses showed no difference in the use of sedation for procedures or in-hospital mortality after adjustment for TBSA%, full thickness burns, age and sex. Age and TBSA% were associated with in-hospital mortality, whereas the intentionality of the burn was not. TBSA% and female sex were associated with increased use of sedation for wound care procedures, whereas self-inflicted burns were not.
ResearchGate has not been able to resolve any references for this publication.