Seyedoshohadaee et al.

359 
Original Article

The Effect of Short-Term Training Course by Nurses

on Body Image in Patients with Burn Injuries
Mahnaz Seyedoshohadaee1, Alice Khachian1*, Naimeh Seyedfatemi2, Mokhtar
Mahmoudi1

1. Department of Medical Surgical Nursing, ABSTRACT

School of Nursing and Midwifery, Iran
University of Medical Sciences, Tehran, BACKGROUND
Iran;
2. Department of Psychiatric Nursing, School
Burn is the fourth most common cause of trauma worldwide and
of Nursing and Midwifery, Iran University is the fourth among the injuries and surgeries requiring medical
of Medical Sciences, Tehran, Iran care. This study was designed to determine the effect of a short-
term training course by nurses on body image in patients with
burn injuries.
METHODS
This study was a semi-experimental single-group survey
assessing before and after interventions. Totally, 130 subjects (65
women and 65 men) were enrolled. The training course was held
in 3 sessions of two hours. The contents of the group training
course (a group of 5 people) were in relation to the body image
and the factors affecting it, and the ways to improve the body
image. The data collection instrument was the satisfaction with
appearance scale (SWAP).
RESULTS
The mean scores of the body image of patients before and after the
intervention were 49.44±11.39 and 41.63±11.89, respectively. There
was a significant difference between the mean scores of body image
before and after educational interventions (T=6.013, P≤0.001). The
mean score of body image in women before and after intervention
was 49.2±10.9 and 41.2±11.65, respectively (T=4.51, P≤0.000). The
mean score of body image in men before and after intervention
was 49.6±11.89 and 42.07±12.19, respectively (T=4.51, P≤0.000).
CONCLUSION
Short-term courses held by nurses were shown to have a significant
role in improving the body image of burn patients.

KEYWORDS
Burns; Psychology; Body image; Training course
*Corresponding Author:
Please cite this paper as:
Alice Khachian,
Seyedoshohadaee M, Khachian A, Seyedfatemi N, Mahmoudi M.
Department of Medical Surgical
The Effect of Short-Term Training Course by Nurses on Body Image
Nursing,
in Patients with Burn Injuries. World J Plast Surg 2019;8(3):359-364.
School of Nursing and Midwifery,
doi: 10.29252/wjps.8.3.359.
Iran University of Medical Sciences,
Rashid Yasami Street, Valiasr Street,
Tehran, Iran. INTRODUCTION
Tel: +98-9123947004
Email: [email protected] Burn is the fourth most common cause of trauma worldwide and
Received: June 4, 2018 is the fourth among the injuries and surgeries requiring medical
Revised: July 17, 2019 care.1 Today, the development of medical sciences, including
Accepted: July 25, 2019 plastic surgeries, fluid therapy and intensive care of burn patients

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360  Nurses’ short-term training course in burns

has resulted in increase of the survival of many In another study conducted recently, Ajoudani
of burn patients who have never had a chance to et al. studied the social support, community
survive in the past.2 This has increased the need presence, and body image in burn patients. In
for long-term care for these patients.3 Deformities this study, 100 patients were followed up for 1
caused by burns, particularly in apparent areas, year after discharge. The results of this study
have led to a tension in the injured person as well showed that the body image in these patients
as a significant change in the performance and was significantly influenced 6 months after
behaviors.4,5 discharge. These results also demonstrated that
One of these disorders is a disturbance in there was a correlation between these three
the body image.6 The body image is a set of variables.13
individuals’ self-conscious and unconscious In another study conducted in Iran,
attitudes toward their own bodies, past attitudes Niroumand-Zandi et al. studied the satisfaction
and perceptions, and it contains their feelings of the body image and the factors affecting it in
about their bodies, functions, appearances and burn patients. The results of this study showed
physical capacities, as well. The body image that social support in family, place of burn, burn
is the perceptions, emotions and thoughts severity, marital status and age are factors that
that individuals have about their own body affect the satisfaction of the body image.14-17
appearances.7 The individuals’ feelings about Although, the body image in burn patients
the bodies and appearances have important and its effects on other aspects of the patients
implications for the assessment and treatment are very important, little research has been
of the patients as a whole and because of this, conducted in relation to the ways to improve
the importance of individuals’ emotions towards body image in these patients, while it has
their appearances and bodies is emphasized in always been mentioned about the importance
the care and treatment of the mentioned patients.8 of improving the body image of these patients.
Today, there is an interest in the assessment Therefore, based on the importance of this issue
of the patients’ body image who has appearance and the limited studies in this regard, the present
changes or deformity as a result of a disease, study was designed with the aim of studying the
because apparent changes can have significant effects of short-term training courses by nurses
effects on self-esteem and body image, and on the body image in patients with burn injuries.
consequently on the continuation of life after
it.4 The body image plays a significant role in MATERIALS AND METHODS
determining the quality of a person’s life9 and
dissatisfaction with the body image has negative This study was a semi-experimental single-
effects on the physical and mental dimensions of group survey conducted in Shahid Motahari
the quality of life.10 Considering the importance Burns Hospital affiliated to Iran University of
of the body image in burn patients, many Medical Sciences and assessed the before and
researchers are interested in this regard. In a after interventions. The enrolled population were
qualitative study conducted in 2013, Hodder women and men aged 18 years and older and had
et al. studied the role of social support in burn burns (above 15%), and were alert without any
patients and its impact on their body images. In history of known psychological diseases, and
this study, nine adult women participated and all were able to answer questions and had been
each identified four items that affected their admitted for at least three days. People who were
body images. These items included acceptance, burned for suicide were not enrolled in the study.
social comparison, talking about appearance The sample size was estimated using the results
concerns, and the gaze of others.11 of other studies with 95% confidence, and 80%
In another study conducted in 2014, Lam et test power, while the sample drop was 10%.
al. showed that the body image of burn patients Finally, 130 patients (65 women and 65 men)
is very significant and it is recommended that were enrolled.
for a better adaption of these people with their After obtaining informed consent from the
problems, care and treatment interventions participants, and receiving official permission
should be undertaken at the right time to and ethical code (ethics code=987) and obtaining
prevent psychological problems in long term.12 permission from the relevant authorities and

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 Seyedoshohadaee et al. 361 

coordinating with the hospital departments, the was estimated as α=0.87 in patients with burn
researcher introduced himself to the research units injuries.18
and explained the research objectives and how This questionnaire was used to examine
to complete the questionnaire. Thirty minutes the body image in people with deformities like
was spent to complete each questionnaire. After scleroderma. The questions were divided into
completing the questionnaires and calculating two sections. Perceived social impact contained
the mean scores for patients with lower grades, 6 questions and subjective dissatisfaction scale
the training course was held for men and women contained 8 questions. Each question was
separately in 3 sessions of two hours (a total of responded on a 7-point Likert, ranging from
6 hours for women and 6 hours for men). The completely disagree (0) to completely agree.7
contents of the group training course (a group Scoring in questions 4-11 was in a reverse
of 5 people) were in relation to the body image manner. The minimum score in this scale was
and the factors affecting it, and the ways of zero and the maximum was 84. A higher score
improving the body image. indicated a greater dissatisfaction with the
At the end of the course, the content was body image. In this study, the mean scores of
given in a small handbook to the participants. women and men with burn injuries before and
A month after the workshop, body image of the after the training course were compared with
patients was re-measured and compared with each other.4,18,19 Data were analyzed using the
pre-intervention scores. All stages of the study Statistical Package for the Social Sciences (SPSS,
were done by the nurses. The data collection Version 20, Chicago, IL, USA) and descriptive
instrument in this study was the satisfaction and inferential statistics were performed to
with appearance scale (SWAP) conducted by analyze the data.
Lawrence et al. (1998). SWAP was a 14-item
questionnaire in order to evaluate the body RESULTS
image of burn patients and was introduced to
the burn center in 1998. This questionnaire was The mean age of the participants was 37.3±9.6
designed to assess the satisfaction of the body years (the mean age in men and women was
image in burn patients. The internal consistency 37±10.3 and 37.6±9, respectively). In terms of

Table 1: Demographic characteristics of participants

Sex Men Women Total
Burn severity NO. Percent NO. Percent NO. Percent
10-20 0 0 1 1.5 1 0.8
21-30 30 46.2 28 43.1 58 44.6
31-40 27 41.5 26 40 53 40.8
41-50 8 12.3 10 15.4 18 30.8
Total 65 50 65 50 130 100
Mean±SD 31.7±7.13
MAX=47, MIN=20
Sex Men Women Total
Age NO. Percent NO. Percent NO. Percent
20-30 21 32.3 14 21.5 35 26.9
31-40 17 26.2 25 38.5 42 32.4
41-50 21 32.3 20 30.8 41 31.5
≥50 6 9.2 6 9.2 12 9.2
Mean±SD 37±10.3 37.6±9 37.6±9.3
Domain 20-35 20-54 20-54
Total 65 50 65 50 130 100
Sex Men Women Total
Job NO. Percent NO. Percent NO. Percent
Employed 41 63 40 61.5 81 62.3
Unemployed/ 24 37 25 38.5 49 37.7
Housewife
Total 65 50 65 50 130 100

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362  Nurses’ short-term training course in burns

Table 2: Frequency distribution of patients’ body image scores before and after intervention
Patients’ body Before After
image scores No. Percent No. Percent
0-28 4 3 15 11.5
29-57 91 70 103 79.2
58-86 35 27 12 9.3
Total 130 100 130 100
Mean 49.44±11.3 41.63±11.8
Results T=6.013, P≤0.000

burn percentage, the mean burn severity was the courses, because it was provided for patients
31.7±7.13 percent. Table 1 shows the demographic more practical and in an easier way.
data of patients participating in this study with Although several studies have pointed to the
more details. The mean scores of the body image importance of body image and its promotion in
of the patients before and after the intervention patients with burn injuries, our searches did not
were 49.44±11.39 and 41.63±11.89, respectively. show any study to assess the effect of educational
Based on the results of paired sample t-test, interventions on improving the body in this
there was a significant difference between the group of patients. However, studies that were
mean scores of body image before and after almost similar to the present study were cited.
educational interventions (T=6.013, P≤0.001). The results of all these studies indicated that the
Table 2 shows the mean scores of body provision of educational services to burn patients
image in patients before and after educational could improve the status in a variety of aspects. In
interventions with more details. The results, a study conducted in 2017, Li et al. denoted to the
when the mean body image before and after effects of a nursing program, including enhanced
educational interventions was analyzed by sex, social support, intensive health education,
showed that the mean scores of body image comprehensive psychological intervention and
in women and in men after intervention to be graded exercise in patients with burn injuries.20
significantly higher than before the intervention. In this study which lasted 5 weeks, the patients
The mean score of body image in women were divided into two groups of 30 patients and
before and after intervention was 49.2±10.9 those who were in the intervention model group
and 41.2±11.65, respectively (T=4.51, P≤0.000). received the intervention program. The results of
The mean score of body image in men before Lin et al. showed that the intervention group had
and after intervention was 49.6±11.89 and significantly better scores than the control group
42.07±12.19, respectively (T=4.51, P≤0.000). for physical function, psychological function and
social function.20 In another study, the effects of
DISCUSSION multimedia education on the quality of life in
patients with burn injuries were studied. In this
Changes in the individuals’ body image has been study, 100 patients were evaluated. Fifty patients
identified as one of NANDA’s nursing diagnosis received the routine care and the other 50 received
in 1973 and nurses must plan an exclusive the multimedia training packages in addition
nursing care for each patient due to changes in to routine care. The quality of life in patients
the body image. Patients with extensive burns before and 3 months after intervention were
are a group of patients who are at high risk of examined. The results of this study demonstrated
impaired body image. The present study was that the quality of life in patients who were in
conducted to study the effects of a short-term the intervention group significantly improved 3
training course by a nurse on the body image months after receiving the educational package
in patients with burn injuries. The results of compared to the control group.21
the present study demonstrated that short-term Treatment and care of patients with
training course significantly affected the body intensive burns usually takes time and requires
image of these patients. The advantage of this teamwork.22,23 However, in many cases in this
study included courses held by nurses. Another regard, the role of nurses is neglected, while
benefit of this study was the short duration of nurses can play a major role in rehabilitation of

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 Seyedoshohadaee et al. 363 

these patients. This issue is seen more widely F. Review of Iranian Traditional Medicine
among developing countries like Iran. In most Aspect on Burn and its treatment. Medical
cases, Iranian nurses only work in the acute History Journal 2013;5:79-96.
phase of the treatment of patients with intensive 2 McRobert J. The psychosocial impact on
burns, and their role in the rehabilitation process patients with altered body image from burns.
is very limited and insignificant. The importance Br J Community Nurs 2012;17:S27-S30.doi:
of nurses’ role in rehabilitation of intensive 10.12968/bjcn.2012.17.sup12.s27.
burns in developing countries is twofold due 3 Smolle C, Cambiaso-Daniel J, Forbes AA,
to the high incidence of burns and the limited Wurzer P, Hundeshagen G, Branski LK,
financial and human resources. One of the Huss F, Kamolz LP. Recent trends in burn
effective actions that nurses can do is to provide epidemiology worldwide: A systematic
educational services for this group of patients.24 review. Burns 2017;43:249-57. doi: 10.1016/j.
As the results of the present study showed, burns.2016.08.013.
holding short-term training courses by nurses 4 Thombs BD, Haines JM, Bresnick MG,
can play a significant role in improving the Magyar-Russell G, Fauerbach JA, Spence RJ.
body image of burn patients. This study has Depression in burn reconstruction patients:
some limitations. One of these limitations is that symptom prevalence and association with
the study was a single-group study. The short body image dissatisfaction and physical
follow-up period is another limitation of this function. Gen Hosp Psychiatry 2007;29:14-
study. Therefore, it is recommended that further 20. doi: 10.1016/j.genhosppsych.2006.09.002.
studies to be conducted considering a control 5 Manafi A, Kohanteb J, Mehrabani D, Japoni A,
group and a longer follow-up period. The body Amini M, Naghmachi M, Zaghi AH, Khalili
image of individuals with burn injuries can N. Active immunization using exotoxin A
affect the treatment process and their survival. confers protection against Pseudomonas
The provision of treatment and care regarding aeruginosa infection in a mouse burn model.
this is very important. The results of this study BMC Microbiol 2009;9:23. doi: 10.1186/1471-
showed that short-term courses held by nurses 2180-9-23.
had a significant role in improving the body 6 Birdsall C, Weinberg K. Adult patients looking
image of burn patients. Due to the extreme at their burn injuries for the first time. J Burn
limitations of studies, it is recommended that Care Rehabil 2001;22:360-4; discussion 58-9.
more similar studies to be conducted in this doi: 10.1097/00004630-200109000-00015.
regard. It is also recommended that the effects of 7 Souto CM, Garcia TR. Construction and
short-term training by nurses on other aspects, validation of a body image rating scale: a
such as physical problems and psychological preliminary study. Int J Nurs Terminol Classif
disorders to be considered as well. 2002;13:117-26.doi: 0.1111/j.1744-618x.2002.
tb00415.x .
ACKNOWLEDGMENT 8 Assuncao FF, Dantas RA, Ciol MA,
Goncalves N, Farina JA, Jr., Rossi LA.
The authors would like to thank the officials Reliability and validity of the body image
of Iran University of Medical Sciences and quality of life inventory: version for Brazilian
the financial support of the Iran University of burn victims. Res Nurs Health 2013;36:299-
Medical Sciences Research Department and 310. doi: 10.1002/nur.21538.
nurses working in Shahid Motahari Hospital for 9 Levine E, Degutis L, Pruzinsky T, Shin J,
their cooperation as well. Persing JA. Quality of life and facial trauma:
psychological and body image effects. Ann
CONFLICT OF INTEREST Plast Surg 2005;54:502-10. doi: 10.1097/01.
sap.0000155282.48465.94.
The authors declare no conflict of interest. 10 Fauerbach JA, Heinberg LJ, Lawrence JW,
Munster AM, Palombo DA, Richter D, Spence
REFERENCES RJ, Stevens SS, Ware L, Muehlberger T.
Effect of early body image dissatisfaction
1 Aliasl J, Barikbin B, Naseri M, Kamalindjad on subsequent psychological and physical
M, Emadi F, Jafari_Dehkordi E, Khoshzaban adjustment after disfiguring injury. Psychosom

www.wjps.ir /Vol.8/No.3/September 2019

364  Nurses’ short-term training course in burns

Med 2000;62:576-82.doi: 10.1097/00006842- A test of the moderating role of importance

200007000-00017. of appearance in the relationship between
11 Hodder K, Chur-Hansen A, Parker A. A perceived scar severity and body-esteem among
Thematic Study of the Role of Social Support adult burn survivors. Body Image 2006;3:101-
in the Body Image of Burn Survivors. Health 11. doi: 10.1016/j.bodyim.2006.01.003.
Psychol Res 2014;2:1196. doi: 10.4081/ 19 Heinberg LJ, Kudel I, White B, Kwan A,
hpr.2014.1196. Medley K, Wigley F, Haythornthwaite J.
12 Lam J, Price LA, Milner S, Fauerbach J, Assessing body image in patients with
Lawrence J, Fogel J. The importance of body systemic sclerosis (scleroderma): validation
image in the speech content of burn survivors. of the adapted Satisfaction with Appearance
J Am Coll Surg 2014;219:e138.doi: 10.1016/j. Scale. Body Image 2007;4:79-86. doi: 10.1016/j.
jamcollsurg.2014.07.755. bodyim.2006.11.002.
13 Ajoudani F, Jasemi M, Lotfi M. Social 20 Li L, Dai JX, Xu L, Huang ZX, Pan Q,
participation, social support, and body Zhang X, Jiang MY, Chen ZH. The effect of
image in the first year of rehabilitation in a rehabilitation nursing intervention model on
burn survivors: A longitudinal, three-wave improving the comprehensive health status of
cross-lagged panel analysis using structural patients with hand burns. Burns 2017;43:877-
equation modeling. Burns 2018;44:1141-50. 85. doi: 10.1016/j.burns.2016.11.003.
doi: 10.1016/j.burns.2018.03.018. 21 Mohaddes Ardebili F, Najafi Ghezeljeh T,
14 Niroumand-Zandi K, Atashrazm Jirandeh Bozorgnejad M, Zarei M, Ghorbani H, Manafi
T, Atashzadeh-Shoorideh F, Hoseinabadi- F. Effect of Multimedia Self-Care Education
farahani M, Talebi E, Bolourchifard F. on Quality of Life in Burn Patients. World J
Relationship between Socio familial support Plast Surg 2017;6:292-7.
with satisfaction of body image in patients 22 Greenfield E. The pivotal role of nursing
with burn. IJPN 2016;3:1-9. personnel in burn care. Indian J Plast
15 Mohammadi AA, Amini M, Mehrabani D, Surg 2010;43:S94-S100. doi: 10.4103/0970-
Kiani Z, Seddigh A. A survey on 30 months 0358.70728.
electrical burns in Shiraz University of Medical 23 Najafi Ghezeljeh T, Mohades Ardebili F,
Sciences Burn Hospital. Burns 2008;34:111-3. Rafii F, Manafi F. The Effect of Massage on
doi: 10.1016/j.burns.2006.12.007. Anticipatory Anxiety and Procedural Pain
16 Mohaddes Ardebili F, Manzari ZS, in Patients with Burn Injury. World J Plast
Bozorgnejad M. Effect of educational program Surg 2017;6:40-7.
based on exercise therapy on burned hand 24 Mamashli L, Mohaddes Ardebili F,
function. World J Plast Surg 2014;3:39-46. Bozorgnejad M, Najafi Ghezeljeh T, Manafi F.
17 Mohadeth Ardebili F, Bozorg Nejad M, The Effect of Self-Care Compact Disk-Based
Manzari ZS. Burn injury in Mottahari Burn Instruction Program on Physical Performance
Center in Tehran, Iran. World J Plast Surg and Quality of Life of Patients with Burn At-
2016;5:77-9. Dismissal. World J Plast Surg 2019;8:25-32.
18 Lawrence JW, Fauerbach JA, Thombs BD. doi: 10.29252/wjps.8.1.25.

www.wjps.ir /Vol.8/No.3/September 2019