The role of resilience in the recovery of the burn-injured patient: an integrative review

Figures & data

Table 1 Six stages of integrative review process

Souza et al’s stages of the integrative review process
Stage 1: Preparing the guiding question
Stage 2: Searching or sampling the literature
Stage 3: Data collection
Stage 4: Critical analysis of the studies included
Stage 5: Discussion of results
Stage 6: Presentation of the integrative review

Notes: Data from Souza et al.¹⁴

Figure 1 Decision trail of included studies.

Table 2 Summary of included studies

Source and country	Design	Purpose	Sample and study population	Data collection method	Method of analysis	Significant findings and outcomes
He et al^Citation18 (People’s Republic of China)	Cross-sectional	To explore the impact of dispositional optimism and psychological resilience on posttraumatic subjective well-being of burn patients and the mediator role of psychological resilience	410 burns patients (309 M; 101 F); mean age 24 years (range: 17–35 years); all burns because of scalds, head and face burns excluded	Revised Life Orientation Test; CD-RISC; Subjective Well-being Scale	Correlation; structural equation modeling	Psychological resilience partially mediates the relationship between dispositional optimism and subjective well-being
Hol aday and McPhearson^Citation8(USA)	Qualitative	To investigate the concept of resilience of burn survivors’ burns	39 severe burn survivors with visible scarring; 21 children and adolescents <18 years; mean age 14.1 years; average years since burn 6.7; 18 adults; mean age 36.8 years; average years since burn 12	Face-to-face interviews	Thematic analysis	Social support, cognitive skills, and psychological resources influence resiliency. Further counseling is recommended to strengthen these strategies to facilitate recovery
Holaday et al^Citation9 (USA)	Cross-sectional; mixed methods; Rorschach study	To determine whether it is possible to identify children and adolescents more likely to be resilient and those more likely to need early intervention	Convenience sample of 40 severely burned children and adolescents aged 8–19 years; (21 M; 19 F); majority with facial burns	Selected statements from the Rorschach Clinician Rating Scale; clinician Likert scale rating of “survivor trait”	Two groups compared utilizing chi-square test and t-test	70% classified as resilient; 30% nonresilient; resilient group > cooperative responses and normal capacity to tolerate stress; nonresilient < group egocentricity index scores and a positive coping deficit index
Lau and Van Niekerk^Citation23(South Africa)	Qualitative informed by social constructionism	To explore how burn survivors construct notions of self and social reality	Purposive sampling; 6 burn survivors (4 M; 2 F) average age 19 years (range: 14–24 years); burns sustained >2 years earlier; sustained injuries during: early lives (n=3) (pre)adolescent years (n=3)	Semistructured interviews	Narrative analysis	Three themes identified: Struggle for recognition – the self as both highly viable and invisible Reconciling or rediscovering the self Turning points: the search for meaning Person-centered meanings have the capacity to inform interventions beyond acuity toward survivors lifelong psychosocial adjustment
McGarry et al^Citation17(Australia)	Cross-sectional	To investigate the impact of exposure to pediatric trauma on parents with children with a burn injury and to identify risk factors and relationships between psychological distress and resilience	63 parents of pediatric burn survivors (46 mothers; 17 fathers, of whom 5 were mother/father dyads). Age of children not reported	CD-RISC; Impact of Events Scale Revised; Depression, Anxiety, and Stress Scale, Screening Tool for Early Predictors of PTSD	t-tests; ANOVA; correlations	Parents reported lower resilience and higher depression and anxiety as compared to the general population; low resilience associated with higher PTSD and stress
Quezada et al^Citation22(Mexico)	Cross-sectional	To explore the roles of both the patients and caregivers’ resilience and posttraumatic stress in pediatric burn survivor adjustment	51 pediatric burn survivor and caregiver dyads. Survivor age range 7–18 years; 29 M mean age 12 years; 22 F mean age 13 years	The Resilience Questionnaire for Children and Adolescents; The Mexican Resilience Scale for Adults; The Davidson Trauma Scale; Burn Injury Data from Medical Records	Correlations and descriptive analysis; structural equation modeling	High levels of survivor and caregiver resilience; low PTSD in caregivers; higher resilience in survivors associated with younger age at time of burn; higher resilience in caregivers associated with lower avoidance and PTSD intrusion symptoms; higher levels of caregiver resilience associated with higher resilience in survivors
Sveen et al^Citation21(Sweden)	Prospective longitudinal study	To investigate whether there are different PTSD symptom trajectories after burns	95 burn-injured adults (72 M; 23 F); mean age 44.7 years (range: 19–89); mean TBSA 23.4% (range of 1%−80%)	Collected at 3, 6 and 12 months postburn. All measures in Swedish: Impact of Event Scale Revised; Hospital Anxiety and Depression Scale; Social Support Questionnaire Short Form; Swedish University Scales of Personality; Coping with Trauma Interview (1 subscale); Structured Clinical Interview for DSM Disorders 1 and II; The List of Threatening Experiences Questionnaire; Burn Injury Data from Medical Records; Structured Interview	t-tests and chi-square test; cluster analysis	Four clusters identified: Resilient (low PTSD decreasing over time); Recovery (high PTSD decreasing over time); Delayed (moderate PTSD increasing over time); Chronic (high PTSD levels over time
Williams et al^Citation10(USA)	Qualitative	To understand how burn survivors adapt and to gain insight through personal descriptions of their recovery process	Purposive sampling; 7 burn survivors (3 M; 4 F); age range at interview 31–51 years; age range injury 2–42 years	Semi structured face-to-face interviews	Drawing from phenomenology and grounded theory to explore common themes	Participant experiences involving determination, independence, courage, compassion, and spiritual transformations are indicators of resiliency. Innate resiliency resides within the human spirit
Xia et al^Citation19(People’s Republic of	Cross-sectional	To investigate the impact of acceptance of disability and psychological resilience on	Convenience sample of 127 hospitalized burns patients (85 M; 42 F); all >18 years; mean	Chinese versions of: PTSD Checklist – Civilian Version; Acceptance of Disability scale; CD-RISC	Student’s t-tests; ANOVA	Lower resilience compared to other trauma subgroups; PTSD negatively correlated with resilience
China) Yang et al^Citation20(People’s Republic of China)	Cross-sectional	PTSD with burn injuries To investigate the factors that influence burn survivors’ resilience during rehabilitation	age and age range not reported Convenience sample of 129 hospitalized burns patients (105 M; 24 F); mean age 34 years (range: 18–60); n=21 had severe burns	Chinese versions of: CD-RISC; Social Support Rating Scale; Simplified Coping Style Questionnaire	Descriptive ; analysis; student’s t-tests; ANOVA; correlations; and linear regression	Higher resilience scores associated with higher burns severity, female sex, active coping, divorced patients, and nongovernment employees; social support not associated with higher resilience

Abbreviations: ANOVA, analysis of variance; CD-RISC, Connor-Davidson Resilience Scale; F, female; M, male; PTSD, posttraumatic stress disorder; TBSA, total burn surface area; DSM, Diagnostic and Statistical Manual of Mental Disorders.

Table 3 Concept matrix mapping themes to source articles

Themes	He et al^Citation18	Holaday and McPhearson^Citation8	Holaday et al^Citation9	Lau and Van Niekerk^Citation23	McGarry et al^Citation17	Quezeda et al^Citation22	Sveen et al^Citation21	Williams et al^Citation10	Xia et al^Citation19	Yang et al^Citation20
Relational strengths (transforming self and others)		√	√	√		√		√		√
Positive coping (optimism)	√	√	√	√			√	√		√
Resistance to trauma symptoms			√		√	√	√		√

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