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Table 3 Themes and categories extracted from the descriptive phenomenological approach

From: Ethical challenges of caring for burn patients: a qualitative study

Theme Category Quotations
Respect for privacy Respect for physical-sexual privacy "Bandaging burns is very time-consuming and can take a long time. After baths, the patients' bodies are in full view of the person who is in charge of bandaging. Even when they are visited by a doctor who is from the opposite sex, the patients feel uncomfortable, especially if the patient is woman and the burn has affected her genitalia or a contiguous area. They feel embarrassed and say that if their caregiver and doctor are of the same gender as them, they will feel more secure" (Participant 3)
Respect for psychological privacy "Some of these patients suffer from personality disorders, so they have tried self-immolation. When they are educating these patients, the caregivers disregard their conditions and personality disorders—if a patient becomes aggressive, they call them with inappropriate names, like crazy, psycho, etc. and deteriorate their psychological status" (Participant 7)
Maintaining confidentiality "Keeping patients' secrets is a basic ethical principle, but it is especially essential in the burns center. Burn patients are more likely to have a history of psychological issues, personality disorders, childhood abuse or various family problems; since in our country, there is a very negative attitude toward such matters, it is important that all their information should remain confidential. The patients do not want anyone to know about their past, except their main caregiver and doctor. Occasionally, medical records are read by non-medical staff, so it is better that ward administrators keep these information confidential" (Participant 9)
Respect for personal identity Respect for personal identity "At times, some families bring sheets of green cloth and ask us to spread them on their patients with extensive burn. Well, such a thing will spread infection and is not safe for the patient. We try to explain this to these families, but they do not listen and say it is a part of their beliefs, which can heal their patient. No matter how hard we try, they refuse to listen. Well, sometimes nurses who are under pressure at work may lose their temper and say things that are considered as offensive to the patients and their families. In short, we have learned how to stop them from putting the cloth on their patients by persuading them to just put it beside them; using this way, we maintain the patients' dignity as best as we can" (Participant 12)
Avoidance of pitying behaviors "It is not right for nurses to take uncalled for pity on such patients and cast pitying looks at them. Pitying behaviors undermine the patients' self-esteem and can make them feel disinclined to cooperate with the nurses or even demonstrate aggressive behaviors" (Participant 20)
Avoidance of discrimination "Occasionally, the medical team and the nurses differentiate between self-immolation survivors and those whose burns are caused by an accident, and they care for them and treat them differently. They do not communicate much with the patients who have tried self-immolation and let the ward counselors and psychologists take care of them. They have more extensive relationships with the patients who are victims of fire accidents and treat them with more compassion. These kinds of behaviors are disturbing to the patients" (Participant 14)
Clinical challenges Lack of time and loss of hope "The nurses get to spend longer hours with the patients, which inevitably makes the patients feel more comfortable with them compared to the other members of their treatment team; they prefer to talk to and have more contact with their nurses. The problem is that workload in the burns center is high, bandaging and administration of medications can take hours, and the nurse end up with little time for having any clinical interaction with the patients. This can frustrate the patients and diminish their interactions with the healthcare team. Additionally, this is a serious issue in providing ethical and methodical care to burn patients" (Participant 18)
Defective teamwork "Sometimes, there is not enough coordination between the activities of the treatment team. For example, the psychologist or physiotherapist start their rounds when it is time for a patient's bandaging or medication and insist that they should communicate with the patient or they intend to interact with a patient who has just had a painful dressing. Well, at such times, patients are willing to interact with no one. Patients are more willing to interact in the evening and at night, but those are the times when there is no resident psychologist in the hospital. This lack of coordination in teamwork disrupts caregiving (Participant 1)
Euthanasia "The patients with severe burns are in great pain and have no hope for survival or living a high-quality life again. Some of them keep asking their caregivers, especially the nurses who have the most interaction with them, to stop trying to save them and prolonging their agony. Passive euthanasia is not legal in our country and the treatment team is challenged by how to respond to such requests" (Participant 16)