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Use of Healthcare, Perceived Health and Patient Satisfaction in Patients with Burns
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A severe burn is a trauma fraught with stress and pain and may change the entire course of life. This thesis focuses on care utilisation, care experiences and patient satisfaction after a severe burn.

The patients studied were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2006. Burn-related health was examined using the Burn Specific Health Scale-Brief (BSHS-B), personality traits with the Swedish universities Scales of Personality (SSP), psychological symptoms using the Hospital Anxiety and Depression scale (HADS), symptoms of posttraumatic stress with the Impact of Event Scale-Revised (IES-R) and satisfaction with care using the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire.

Those utilising care years after injury reported poorer functioning on three of the BSHS-B subscales. Personality traits had a greater impact on care utilisation than injury severity.

Social desirability was lower among care utilisers and was associated with burn-related health aspects.

The participants reported a low level of negative care experiences, the most common of which was Powerlessness.

Most patients were satisfied with care, more with quality of contact with the nursing staff, and less with treatment information. Multiple regressions showed that the BSHS-B Interpersonal relationships subscale was an independent variable related to all measured aspects of patient satisfaction. The highest adjusted R2 was 0.25.

In a prospective assessment with multiple regression analyses, Age and Education, the personality traits of Stress susceptibility, Trait irritability, Detachment and Social desirability, in addition to the post-traumatic stress symptoms Intrusion and Hyperarousal, were predictors of satisfaction with care. The highest adjusted R2 was 0.19.

The thesis has pointed out that interpersonal factors are related to care utilisation as well as satisfaction with care. However, satisfaction with care was only moderately associated with health and individual characteristics, which may imply that the care itself is of major importance.

Place, publisher, year, edition, pages
Uppsala: Universitetsbiblioteket , 2008. , p. 50
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 373
Keywords [en]
Burns, health status, care utilisation, rehabilitation, personality traits, care experiences, patient satisfaction
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-9262ISBN: 978-91-554-7271-9 (print)OAI: oai:DiVA.org:uu-9262DiVA, id: diva2:172471
Public defence
2008-10-03, Enghoffsalen, ing. 50, Akademiska sjukhuset, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2012-03-01Bibliographically approved
List of papers
1. Use of healthcare a long time after severe burn injury: relation to perceived health and personality characteristics
Open this publication in new window or tab >>Use of healthcare a long time after severe burn injury: relation to perceived health and personality characteristics
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2005 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Disability and Rehabilitation, ISSN 0963-8288, Vol. 27, no 15, p. 863-870Article in journal (Refereed) Published
Abstract [en]

Purpose. The aim of the study was to evaluate which factors are associated with the use of healthcare a long time after severe burn injury.

Method. After a review process based on clinical reasoning, 69 former burn patients out of a consecutive group treated at the Uppsala Burn Unit from 1980 – 1995 were visited in their homes and their use of care and support was assessed in a semi-structured interview. Post-burn health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B) and personality was assessed with the Swedish universities Scales of Personality (SSP).

Results.  The participants were injured on average eight years previously. Thirty-four had current contact with healthcare due to their burn injury and had significantly lower scores on three BSHS-B-domains: Simple Abilities, Work and Hand function, and significantly higher scores for the SSP-domain Neuroticism and the SSP-scales Stress Susceptibility, Lack of Assertiveness, and lower scores for Social Desirability. There was no relation to age, gender, time since injury, length of stay, or to the surface area burned.

Conclusions. A routine screening of personality traits as a supplement to long-term follow-ups may help in identifying the patient's need for care.

Keywords
Rehabilitation, burns, personality, follow-up studies
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97493 (URN)10.1080/09638280500030753 (DOI)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2017-12-14Bibliographically approved
2. Social desirability, psychological symptoms and perceived health in burn injured patients
Open this publication in new window or tab >>Social desirability, psychological symptoms and perceived health in burn injured patients
2005 (English)In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 193, no 12, p. 820-824Article in journal (Refereed) Published
Abstract [en]

Social desirability was previously seen as a nuisance in assessment, but today it is regarded as a personality trait with an influence on health. The aim was to explore relations between social desirability and health in former burn patients. Eighty-four burn patients injured on average 3.8 years ago responded to a questionnaire booklet. Social desirability was assessed with the social desirability subscale of the Swedish universities Scales of Personality, which is standardized in a normative sample. The results showed that a subgroup with high degree of social desirability displayed significantly poorer perceived health on the burn-specific health subscales heat sensitivity, work, and body image than normal responders did. There were no differences regarding age, education, injury-related variables, sick leave, or symptoms of anxiety and depression. In conclusion, participants with high social desirability were characterized by postburn problems in outdoor and work-related situations, and more self-consciousness about appearance.

Keywords
body image, personality, social desirability, trauma, work
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97494 (URN)10.1097/01.nmd.0000188976.84146.c3 (DOI)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2017-12-14Bibliographically approved
3. Evaluation of negative emotional care experiences in burn care
Open this publication in new window or tab >>Evaluation of negative emotional care experiences in burn care
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2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 14, p. 1923-1929Article in journal (Refereed) Published
Abstract [en]

AIM AND OBJECTIVE:

To assess recollection of negative emotional experiences during burn care.

BACKGROUND:

Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences.

DESIGN:

Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face-to-face interview.

METHODS:

Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms.

RESULTS:

Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post-traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent.

CONCLUSIONS:

Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction.

RELEVANCE TO CLINICAL PRACTICE:

Although relatively uncommon, negative emotional care experiences should be monitored more closely during care.

Keywords
burn, ethics, intensive care, interview, nursing, questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97495 (URN)10.1111/j.1365-2702.2008.02302.x (DOI)000256635700013 ()18578765 (PubMedID)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2017-12-14Bibliographically approved
4. Patient satisfaction with burn care 1-6 years after injury
Open this publication in new window or tab >>Patient satisfaction with burn care 1-6 years after injury
2008 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, no 6, p. 783-790Article in journal (Refereed) Published
Abstract [en]

Patient satisfaction is an important outcome in health care but has not been studied in relation to burn care. The aim was to explore factors related to satisfaction with care 1-6 years after a burn. Participants were 86 adult burn patients, injured on average 3.6 years previously. The Patient Satisfaction-Results and Quality (PS-RESKVA) was used to assess satisfaction. It has four subscales: Quality of contact with the nursing staff (QCN), Quality of contact with the medical staff (QCM), Adequate treatment information (INF) and Global satisfaction with treatment (GS). Further, data were gathered regarding personality traits and health. Average scores for QCN were significantly higher than scores for the other subscales, and INF received the lowest mean score. In multiple regressions, the PS-RESKVA subscales were associated with better interpersonal relationships (all PS-RESKVA subscales), more sensation seeking (QCM, INF, and GS) and less aggressiveness (QCM and GS). Other variables contributed to a lesser degree. Total amount of explained variance ranged between 18% and 25% for the PS-RESKVA subscales. In summary, satisfaction with burn care was only moderately explained by health and personality characteristics. Further, former patients rated satisfaction with nursing staff higher than other aspects of care, especially information routines.

Keywords
Burns, Information, Nursing, Outcome, Patient satisfaction, Quality
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97496 (URN)10.1016/j.burns.2007.11.001 (DOI)000259017200005 ()18378086 (PubMedID)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2017-12-14Bibliographically approved
5. Prediction of patient satisfaction with care one year after burn
Open this publication in new window or tab >>Prediction of patient satisfaction with care one year after burn
2009 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 35, no 2, p. 194-200Article in journal (Refereed) Published
Abstract [en]

The aim of this prospective study was to find predictors of patient satisfaction with burn care. Sixty-nine consecutive adult patients undergoing acute treatment in a Burn Unit completed the following questionnaires: the Swedish universities Scales of Personality, the Impact of Event Scale-Revised, and the Hospital Anxiety and Depression Scale. Socio-demographic data and burn severity were registered. One year later they completed the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire containing four subscales: quality of contact with nursing staff (QCN), quality of contact with medical staff (QCM), adequate treatment information (INF), and global satisfaction with treatment (GS). Each subscale was treated as a dependent variable in separate multiple regression models. Overall, the explained variance was low to moderate (range adjusted R2 = 0.06-0.19). Variables remaining in the models were: intrusive symptoms, and the personality trait stress susceptibility for QCN; age, education, and symptoms of hyperarousal for QCM; trait irritability for INF; and age and the personality traits detachment and social desirability for GS. In conclusion, psychological and socio-demographic variables predicted satisfaction to some degree, whereas injury severity did not. The low amount of explained variance suggests that other factors, hypothetically related to care itself, determine patient satisfaction as assessed by the PS-RESKVA.

Keywords
Interpersonal, Nursing, Patient satisfaction, Personality traits, Quality
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97497 (URN)10.1016/j.burns.2008.09.001 (DOI)000263703700003 ()19070969 (PubMedID)
Available from: 2008-09-11 Created: 2008-09-11 Last updated: 2017-12-14Bibliographically approved

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