The stigma of burns Perceptions of burned patients’ relatives when facing discharge from hospital L.A. Rossi a, * , V. da S.C. Vila b , M.M.F. Zago a , E. Ferreira c a Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeira ˜o Preto, WHO Collaborating Center for Nursing Research Development, Universidade de Sa ˜o Paulo, Av. Bandeirantes, 3900, CEP 14040-902 Ribeira ˜o Preto, Sa ˜o Paulo, Brazil b Departamento de Enfermagem e Fisioterapia da Universidade Cato ´lica de Goia ´s, Sa ˜o Paulo, Brazil c Unidade de Queimados da Faculdade de Medicina de Ribeira ˜o Preto, Universidade de Sa ˜o Paulo, Brazil Accepted 13 July 2004 Abstract The objective of this ethnographic study was to investigate the cultural meanings reported by 25 relatives of burned patients about their loved one’s impending hospital discharge. Data were collected by means of participant observation and semi-structured interviews conducted during hospital visiting hours, and support group meetings with relatives. The following inter-related phases were considered in the analysis process: reading of the material and data reduction (selection of data using the objective of the study as a guide), data display, conclusion outlining, and verification. Following this process, the data were coded and similar codes were grouped into categories. It was found that the relatives of burned patients felt afraid when faced with the prospect of hospital discharge. Their descriptions reveal the family’s feelings and attitudes in face of other people’s reactions, and in face of the patient’s own reactions in the context of possible changes in their social roles. # 2004 Elsevier Ltd and ISBI. All rights reserved. Keywords: Burns; Culture; Rehabilitation 1. Introduction In the recent years, advancements in the treatment of burns have resulted in a higher rate of survival of patients with serious injuries. Many of them suffer major sequelae. Even when they become independent, such patients require gradual adjustments to the psychological stress of the acute and traumatic changes in their lifestyles [1]. The development of this type of trauma includes three phases. The resuscitation phase, which corresponds to the first 48–72 h following the burn, is characterized by uncertainty regarding potential outcomes and the struggle for survival [2]. In this critical care phase, the most common psychological and psychiatric symptoms are delirium followed by anxiety, sleep disturbance, and confusion [3]. Patients also experience discomfort, pain and fear [1]. At this stage, the patient’s attention is focused on survival and the physiological factors on which it depends [4]. The second phase, acute rehabilitation, begins with the improvement of physical conditions and is the period when the patient is submitted to surgery and when various other painful procedures are carried out, such as, wound cleansing and dressings. The patient may exhibit depression, anxiety, and acute stress disorder or other psychological difficulties such as nightmares, sleep problems, and behavioral regression [5]. In this phase, the family members display fear and anxiety stemming from the performance of procedures and expectations concerning their results. Finally, the long-term rehabilitation phase of recovery begins when patients leave the hospital [5] and face other www.elsevier.com/locate/burns Burns 31 (2005) 37–44 * Corresponding author. Fax: +55 16 6333271. E-mail address: rizzardo@glete.eerp.usp.br (L.A. Rossi). 0305-4179/$30.00 # 2004 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2004.07.006