burns 45 (2019) 1605 –1613

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Effects of religious and spiritual care on burn

patients’ pain intensity and satisfaction with pain
control during dressing changes

Nafiseh Keivan a, Reza Daryabeigi b , Nasrollah Alimohammadi c, *

a
Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
b
Adult Health Nursing Department, Ulcer Repair Research Center, Faculty of Nursing and Midwifery, Isfahan
University of Medical Sciences, Isfahan, Iran
c
Critical Care Nursing Department, Ulcer Repair Research Center, Faculty of Nursing and Midwifery, Isfahan
University of Medical Sciences, Isfahan, Iran

article info abstract

Article history: Objective: Spiritual care, beside other nursing interventions, creates a balance in body, psyche
Accepted 2 July 2019 and soul in order to holistically recover one's health. This research aims to study the effects of
a religious and spiritual care program on the intensity of pain and the satisfaction with pain
control during the dressing changes for the burn patients in a hospital in Iran in 2017.
Methods: This research is a clinical trial study conducting 68 burn patients. The samples were
Keywords: randomly divided into ‘experimental’ and ‘control’ groups. The experiment consists of three
Religious-spiritual care sessions of spiritual care carried out by the help of the nurse, a clergy and the patient’s
Burn companion. These sessions have been done before, during and after the dressing change. The
Pain pain intensity and the satisfaction with pain control are measured by VAS1 and NRS2 devices.
Satisfaction The data is analyzed via SPSS version 20 and through the statistical exams of independent t-
Dressing change test, paired t-test, chi-squared test and Mann-Whitney exam.
Results: Before the intervention, there was no significant difference in the average rate of pain
(P = 0.25) and the satisfaction with pain control (P = 0.59) between the experimental and the
control groups. While, after the spiritual care program was conducted, there appeared a
significant difference (P < 0.001): there was a substantial reduction of pain intensity in the
experimental group and the satisfaction with pain control in this group increased as well.
Conclusions: A religious and spiritual care can help decrease the pain intensity caused by the
dressing change and can increase the satisfaction of these patients with pain control.
Therefore, it is recommended that the nurses apply the spiritual cares to alleviate the pain
and to increase the satisfaction with pain control in burn patients.
© 2019 Elsevier Ltd and ISBI. All rights reserved.

* Correspondence author.
E-mail address: Alimohammadi@nm.mui.ac.ir (N. Alimohammadi).
1
Visual Analogue Scale
2
Numerical Rating Scale
https://doi.org/10.1016/j.burns.2019.07.001
0305-4179/© 2019 Elsevier Ltd and ISBI. All rights reserved.
1606 burns 45 (2019) 1605 –1613
1. Introduction
Burn is the fourth frequent cause of trauma in the world [1]. It
involves painful and stressful experiences that arise from the
wound and its treatment procedures [2].
In Iran, about 724 thousand people are burned per year, 382
thousand of whom are hospitalized and about 2920 of whom
die due to the intensity of burn. This number is so high that
burn is known as the sixth cause of death in Iran. On the other
hand, these statistics show that the burn level experience is
much higher in Iran compared to the statistic results in the
world [3,4].
Burn, which is among the 5–12% of the most frequent
accidents in the world, can be mortal and can cause problems
like pain, physical deficiencies and psychological and eco-
nomic problems [5]. In fact, burn injury is the most painful
trauma one can undergo [6]. This pain does not merely arise
from the wound itself, but mostly from the procedures such as
dressing change, unsuitable dressing and also from cleansing
the wound [7]. That is why an effective alleviation of pain is
assumed as a principal challenge to deal with for the
healthcare of this domain [8].
In most hospitals, in spite of strong drugs and painkillers
prescribed to sedate the pain of the burn patients, the pain
alleviation has still remained a main challenge [9,10]. That is
because in spite of these drugs, the degree of pain resulting
from dressing changes is moderate to severe [11]. Hence,
despite their availability and popular use, the medical pain-
killers are not the only solution to control the pain. The non-
medical methods, which have a lower risk, may also be applied
at the same time as the medical ones to sedate the pain in a
more efficient way [12].
The patients’ responses to pain or suffering may be heavily
influenced by their religious and cultural backgrounds [13].
This matter highlights the importance of religious and
spiritual cares. The psychological associations in America
recommend that the physicians get informed about the
religious and spiritual tendencies of their patients. This
recommendation is based upon the idea that the care which
must be provided for a patient is beyond merely curing the
patient and includes meeting his/her different needs. There-
fore, since religion responds to and fulfills many of human's
needs and his/her existential lack, many patients demand
their spiritual and religious needs to be met as well [14,15].
Today, the cultural, religious, and social differences in
different societies are a considerable challenge for the health
care system. Understanding the unique perspective and
beliefs of each patient is an essential component of providing
competent health care. Among the religions and cultural
variations, Islam is a living religion with an estimated one
billion followers worldwide in 120 Islamic and non-Islamic
countries (Muslims, being those who practice the religion of
Islam) [16]. In Islamic scholars’ view, beside the material
dimension, a human has an immaterial structure called spirit
(divine soul), which forms his noble dimension. This structure
has a divine nature and a tendency toward God. This fact
indicates that from the viewpoint of Islamic scholars, nursing
and taking care of patients could include considerations of
both material and immaterial structures [17].
Spiritual care is a health care program which is supposed to
increase the life quality and to promote the feeling of
wellbeing, and it thus decreases disappointment and hope-
lessness of the patients [18]. In an international conference on
this subject, spirituality was defined as the aspect of humanity
that refers to the way individuals seek and express meaning
and purpose, and the way they experience their connected-
ness to the moment, self, others, nature, and to the significant
or the sacred. Religious factors are also an important aspect of
spirituality [19]. Spiritual care responds to human's basic and
principal questions like the meaning of life, pain, suffering and
death.
According to the psychological definitions, religion is the
effect of the emotions and events that every person may
experience in solitude and free from any dependence so that a
relationship is created between the person and that whom he/
she considers devine. This relation is created through the heart
or the reason or the religious deeds and rituals [20]. Various
studies have shown that religion is a supportive power that
helps to decrease the psychological pressures and to increase
the satisfaction with life. Nevertheless, it was diagnosed that
the nurses do not pay attention to the religious/spiritual aspect
of the burn patients and that the patients’ spiritual and
emotional sides are mostly ignored [21]. That is why the
nursing system needs to adopt new theories to satisfy the
religious and spiritual needs of the patients. Practicing
religious cares such as prayer, religious vows and attending
sacred religious places helps the patients to tolerate the pain
and to control their pain and stress in a more efficient way.
Encouraging the patients who need to do prayers and religious
deeds to do so is thus considered an effective way in the cure
process [22].
In spite of the interconnection throughout history between
religion, spirituality and medical practices, only in the last
decades has the scientific literature demonstrated the impor-
tant role of religiosity and spirituality in the physical and
mental health of the patients [23]. Unfortunately, in spite of the
growth in a general interest in the spiritual aspect of the
patients and despite the significant role of religiosity and
spirituality in different parts of health career, no attention has
been paid to this matter in pain control satisfaction domain of
the burn patients. On the other hand, in spite of all the
researches done about the advantages of spirituality for
patients in pain, the effect of spirituality on pain control still
needs to be studied [21,24]. Therefore, this study targets to
analyze the influence of a religious and spiritual care program
on both the pain intensity and the satisfaction with pain
control of burn patients in Islamic Republic of Iran as a country
with Muslim population.
2. Materials and methods
2.1. Patients and settings
This research (coded 396208 in Isfahan University of Medical
Sciences) is a randomized clinical trial study which has been
done in Imam Musa Kazem Hospital of Isfahan in the general
burn and intensive care units. The quantity of the sample, with a
safety coefficient of 95% in the test, i.e. 1.96, and the test power
 burns 45 (2019) 1605 –1613 1607

coefficient of 80%, i.e. 0.84, consists of 32 persons per group. In
general, 64 persons were taken into account for this study. The
samples were divided into two groups of ‘experimental’ and
‘control’ by using random number table.
2.2. Inclusion and exclusion criteria
The criteria of selection of the patients were: being a Muslim,
willingness to take part in the research [25], no addiction to
drugs and narcotics [26], being aged more than 18 [27], having a
burn level of more than 20%, being in acute phase (from 24 to
72 h after the burning), capable to speak and communicate
with a full consciousness and awareness about the people,
time and place [28], not to be hearing or visually impaired [8]
and not suffering mental and cognitive disturbances like
delirium and dementia [9]. The criteria for exclusion from the
study consisted of: no more willingness to participate, getting
into an emergency state (such as respiratory distress, a fall of
the consciousness level, fluid and electrolyte disorders) [28],
and not participating in at least one session of the spiritual care
program.
2.3. Instrument selection and application
The data was gathered and analyzed through demographic
checklist, Visual Analogue Scale (VAS) and Numerical Rating
Scale (NRS). The checklist involved personal and clinical
information gathered through questions about gender, age,
marital status, education, occupation, and the reason, area,
depth and percentage of burn. The morphine intake was
studied as well because 5 mg of morphine was prescribed for
some of the patients before the dressing change. To measure
the pain intensity, VAS was used. VAS is a pain measurement
instrument which is a horizontal 10 cm line with word anchors
at the extremes: i.e. “no pain” on one end and “worst possible
pain” on the other [12]. It is a widely used tool the
standardization of which is proved due to its validity and
reliability [26,28,29]. The samples were asked to mark the
points of the scale on the horizontal line, which show the
severity of their pain, or to say its number to the researcher.
Then that distance was estimated, and the level of pain
intensity was calculated. To measure the patient's satisfaction
with pain control, NRS was used which is scaled from 0 to 10,
where zero stands for dissatisfaction with pain control and ten
means a full satisfaction with pain control [30].
2.4. Procedures
In order to respect the ethical issues, the researcher asked for a
written permission from those in charge in the hospital, and
also from the patients about the participation while explaining
the aims of the research to them. Thereafter, the spiritual care
program provided by the researcher was confirmed by the
faculty members of the department of theology and Islamic
studies as well as the department of nursing of University of
Isfahan. The spiritual care program was implemented for three
days (Tables 1–3).
As far as the control group was concerned, beside the
routine control cares of the pain, this group received three 45–
60 min sessions done by a research colleague not familiar with
the research procedure. The sessions were held along three
days, where they shared and expressed freely their feelings,
memories and their experiences on care matters and
problems.
Regarding the experimental group, all information (includ-
ing demographic data, the information related to burn,
morphine intake, the pain intensity measurements and the
satisfaction with pain control) was gathered through the
questionnaires and inquiry before the spiritual care program.
Then, data was analyzed via SPSS version 20 and through the
statistical exams of independent t-test, paired t-test,
chi-squared test and Mann–Whitney exam. Tables 1–3 show
what the experimental group received exactly as religious/
spiritual procedure in each session.
2.5. Statistical analysis
Data was summarized using mean SD and frequency for
quantitative and qualitative variables. Patients’ basic infor-
mation, demographic data, pain intensity and satisfaction
with pain control were presented with descriptive statistics,
with chi-squared test and independent t-test. Independent
t-test was used for comparison of age and burn percentages.
Chi-square test was used for comparison of qualitative

Table 1 – Contents of the spiritual care in first session.

First session:
Before the dressing change:
(around 20–30 min before)
During the dressing change:
After the dressing change:
The nurse researcher was present on the patient's bed with a supportive approach, creating a therapeutic
relationship with the patient. She did the following:
 Established a good relationship with the patient based on confidence, sympathy, understanding and
honesty
 Assured the patient about the confidentiality of the conversations [31].
 Let the patient express himself/herself freely and with no restrain
 Listened attentively, patiently and without any prejudgment to the patient's worries and anxieties as
well as his/her physical and psychological problems [32].
 Provided the patient with any necessary moral or psychological support [31] (either by pressing his/her
hand, or by smiling or using humor and anecdotes in case or through any relevant supportive
counseling, etc.)
Recorded verses of Quran were played for the patients.
The presence of a family member or a close friend there for the patient [33].
1608 burns 45 (2019) 1605 –1613

Table 2 – Contents of the spiritual care in second session.

Second session:
Before the dressing change:
(around 20–30 min before)
During the dressing change:
After the dressing change:
The nurse researcher was present on the patient's bed with a supportive approach, she did the following:
 Developed a good relationship with the patient [33]
 Encouraged the patient to express his/her religious beliefs [34]
 Helped and guided the patient to find a meaning in the disease according to the destiny, and, thus, to see
that all the events happen within God's will. (In believing optimistically in God's program for the world
and for each person, the Muslim patient could be saved from disappointment, pessimism and nihilistic
thoughts which could happen after the burn trauma.)
 Encouraged the patient to pray and to read holy texts [33]
 Gave any possible and needed moral, spiritual or psychological support to the patient (either by pressing
his/her hand, or by smiling or using humor and anecdotes in case or through any relevant supportive
psychological counseling, etc.)
Some recorded verses of Quran were played for the patients.
A clergy was present to talk about the religious philosophy of pain and troubles in the world and the reward
one gets in the other world for tolerating them. This makes the patience and tolerance toward the pain a
holy action for the believer patients [35].

variables such as gender and marital status. The Mann–
Whitney exam was used for comparison of education and also
the depth of burn. All the tests were two-sided, and p < 0.05
was considered statistically significant. All calculations were
performed with the statistical software SPSS Version 20.
3. Results
3.1. The Patients’ basic demographic and clinical
characteristics
depth and the percentage of burn and also the morphine intake
(Tables 4–6).
3.2. Pain intensity
The average score and the standard deviation of the pain
intensity of the two groups were not significantly different
before the study (p > 0.05). However, after the study, the
average score of pain intensity was significantly less in the
experimental group than in the control group (p < 0.05)
(Table 7).

The results demonstrated that the patients in experimental
and control groups were not significantly different in terms of
demographic data, neither in terms of the characteristics
related to the burn. These data were about gender, age, marital
status, education, occupation, and the reason, the area, the
3.3. Satisfaction with pain control
The independent t-test exam showed that the average score
of the satisfaction with pain control was not significantly
different in the two groups before the study (p > 0.05). While

Table 3 – Contents of the spiritual care in third session.

Third session:
Before the dressing change:
(around 20–30 min before)
During the dressing change:
After the dressing change:
The nurse researcher was present on the patient's bed with a supportive approach, she did the following:
 Created a trusting relationship with the patient
 Encouraged the patient to repent for his/her sins [36].
 Provided the patient with any necessary moral or psychological support (either by pressing his/her
hand, or by smiling or using humor and anecdotes in case or through any relevant psychological
counseling, etc.)
 Gave hope and empowered and encouraged the patient's internal forces (by complimenting on his/her
skills and abilities, depicting a bright future for him/her etc.)
 Suggested positive sentences and healthy constructive thoughts
 Encouraged the patient to pass time with those whose presence is peaceful and soothing for the him/her
 Assured the patient about the availability and accessibility of the nurse for any moral and psychological
support [34].
Some recorded verses of Quran were played for the patients.
A clergy was present on the patient's bed in order to:
 Answer the patient's religious questions and concerns
 Talk about the religious philosophy of pain and the reward one gets in the world hereafter for
undergoing them
 Pray for the patient [34]
 Recount the life of religious models and prophets like Abraham, Jacob, Joseph, Muhammad and etc. The
goal is to make the patient see these figures as a model and to tolerate the pain more easily having these
examples which have also undergone hardships in mind.
 burns 45 (2019) 1605 –1613 1609

Table 4 – The average of age and the percentage of burn in the two groups.
Variation Experimental group Control group Independent t-test

Mean Standard deviation Mean Standard deviation t P

Age 33.94 13.76 34.12 9 0.06 0.95
Percentage of burn 48.50 17.20 46.28 14.09 0.56 0.57

Table 5 – Demographic data.

Variation Experimental group Control group x2 P

Quantity Percentage Quantity Percentage

Gender
Female 12 37.5 15 46.9 0.58 0.45
Male 20 62.5 17 53.1
Marital status
Single 10 31.2 8 25 – 0.44
Married 22 68.8 23 71.9
Divorced 0 0 1 3.1
Education
Illiterate 2 6.2 2 6.2 0.90 Z = 0.13
Below high school diploma 15 46.9 13 40.6
High school diploma 6 18.8 12 37.6
University education 9 28.1 5 15.6
Job
Governmental employed 4 12.5 4 12.5 0.38 –
Self-employed 13 40.6 12 37.5
Retired 2 6.2 2 6.2
Housewife 10 31.2 13 40.62
Unemployed 3 9.5 1 3.1

Table 6 – The distribution of the frequency of the reason of burn, the area of burn, the level of burn, and the amount of the
morphine used in both groups.
Variation Experimental group Control group x2 P

Quantity Percentage Quantity Percentage

Mechanism
Electric 4 12.5 6 18.8 – 0.63
Chemical 1 3.1 2 6.2
Thermal 27 84.4 24 75
Burn sites
Torso and the upper organs 19 59.4 14 43.8 – 0.26
Torso and the lower organs 0 0 1 3.1
Torso and the upper and lower organs 13 40.6 17 53.1
Depth
2 11 34.4 13 40.6 Z = 0.51 0.61
2&3 21 65.6 19 59.4
Morphine intake 27 84.4 25 78.1 0.41 0.52

Table 7 – The average score of pain intensity caused by dressing change during different moments for both groups.
Time Experimental group Control group Independent t-test

Mean Standard deviation Mean Standard deviation t P

Pre intervention 8.50 1.64 7.74 2.18 1.16 0.25
First session post intervention 6.94 2.29 8.25 2.13 2.38 0.02
Second session after the study 6.03 2.12 8.44 1.74 4.97 <0.001
The third session after the study 4.44 2.33 8.34 2.09 7.07 <0.001
The variation analysis exam in repeating F 22.92 1.05
the observations P <0.001 0.38
1610 burns 45 (2019) 1605 –1613
Table 8 – The average score of the satisfaction with pain control in both groups before and after the study.
Time Experimental group
Mean Standard deviation
Before the study 2.16 0.50
After the study 6.53 0.44
this score raised significantly in the experimental group
after the study (p < 0.05). The paired t-test also demonstrat-
ed that the average score of the satisfaction with pain
control has raised in experimental group after the experi-
ment compared to this score in the same group before the
experiment (p < 0.05). Nevertheless, these scores have not
significantly changed in the control group after the study
(p < 0.05) (Table 8).
4. Discussion
Management of the pain caused by burn has always been a
challenging issue [11]. In the last century, there have been
dramatic shifts in our approach toward understanding,
assessment, and management of pain [24]. In recent years, a
great deal of attention has been paid to the mind, the body, the
spirit and the psyche of human in order to develop a holistic
treatment [37]. Thereby, the attention to spirituality has been
recognized as a part of the holistic nursing care which can
enhance the patients’ satisfaction effectively [38].
Many studies show the relation between the attention paid
to the spiritual and religious needs of the patients and their
general spiritual and psychological well-being which helps to
cope better with pain. Nabolsi and Carson, for example, found
that the patients’ faith and spiritual beliefs may facilitate
coping with illness and may strengthen their inner strength,
hope, acceptance, and self-care, and would help them
understand that life has a meaning [39]. More recent evidence
also suggests that the use of spirituality and religiosity can be
regarded as an active and positive coping process with
beneficial effects [40]. For instance, in case of those patients
who deal with persistent pain, the use of positive spiritual
coping practices, such as asking God for strength and support,
help to adjust better to pain and to have a significantly better
mental health [24]. In this regard, Beckelman et al. studied
people with heart disease between 2004 and 2005 and
indicated that spiritual well-being is inversely associated with
depression [41]. Bussing also demonstrated the role of spiritual
beliefs in reducing depression, pain and social isolation, and in
increasing life satisfaction [42]. Hosseini et al.’s findings
showed that spiritual care could reduce anxiety in Shia
Muslim patients undergoing CABG (Coronary Artery Bypass
Graft) [43].
According to Booker’s study on pain, human beings need
spiritual interventions to control and deal with their pain [44].
However, despite the growing interest in spirituality and its
wide adoption by some sections of the health profession such
as palliative care, it has received little attention in the field of
pain management in particular [24]. Hence, through a concrete
approach, the present study has tried to measure the influence
Control group Independent t-test
Mean Standard deviation t p
2.53 0.46 0.54 0.59
2.25 0.40 7.17 <0.001
of the religious and spiritual care on both the pain intensity
and the satisfaction with pain control at the time of the
dressing change in the burn patients suffering an intense pain.
The results demonstrate a fall in pain intensity and a
consequent rise in the satisfaction of the patients with pain
control after the experimental interventions.
Various studies all over the world have shown that religion
is a supportive power that helps to decrease the psychological
pressures and to increase the satisfaction with life. The use of
spiritual practices in treatment has more often been related to
improved tolerance of both acute [45] and chronic [46] pain
rather than to reduced intensity of pain. However, a review of
studies using mindfulness-based interventions that often
include a meditation component found that some studies also
report a reduction in pain intensity [47]. In one study
investigating the effectiveness of meditation, the positive
effect of meditation was dependent on having a spiritual focus.
Participants were divided into groups that used relaxation and
either a secular or a spiritual meditation that included the use
of phrases with spiritual (but not necessarily religious)
content. The group that used the meditation with spiritual
content demonstrated a significantly greater improvement in
mood and spiritual well-being, and the pain tolerance was
increased to nearly the double of that of the other group [48].
Accordingly, the pain intensity is much less for the patients
who see God as forgiving, merciful and caring than for those
who have a vengeful angry ignoring image of God [24]. A study
on the role of pastoral care in the treatment of patients with
burn injury showed that the patients under religious care had a
higher TBSA (Total Body Surface Area), longer stay, more
physician and facility charges and more mortality (p < 0.001).
This study concludes with affirming the religious affiliation as
a possible marker of a better treatment and suggests to finally
consider the spiritual needs of the burn patients [49]. Several
other studies have found that those who consider themselves
spiritual and religious or engage in religious activities score
better in terms of mood, well-being, and pain intensity than
those who do not regard themselves as spiritual or religious
[50,51]. Although some of these studies suggest an association
between the spiritual/religious activity and lower levels of pain
intensity, the overall evidence suggests that the spiritual well-
being has a stronger link with higher pain tolerance and higher
levels of psychological well-being, including satisfaction in
general [52].
In the present study, according to the independent t-test,
the average score of pain intensity in dressing change has been
shown to be significantly lower in the experimental group than
in the control group (p < 0.05) after the intervention. The
average point of pain intensity in the experimental group had
been 8.5 and has decreased to 4.44 after the spiritual care
program has been applied. This is while the average pain
 burns 45 (2019) 1605 –1613
intensity score of the control group has raised from 7.74 to 8.34.
The researcher thus concludes that the religious/spiritual care
can have an effective role in sedating the pain of the burn
patients.
In a study that affirms the findings of the present research,
Jahanizadeh et al. have shown the effect of the spiritual care on
decreasing the pain intensity of the patients suffering breast
cancer [53]. Also, a study on the effect of the recitation of God’s
name, Allah, on pain and stress of dressing change for the burn
patients (like what has been done through the recitation of
Quran’s verses in the present research) shows the positive
effect of this recitation on these Muslim patients [54].
With regards to the satisfaction with pain control, nearly no
study has been done to measure and analyze this factor in burn
patients who have received a spiritual care program. A few
researches have studied the satisfaction in general and with a
limited experimental intervention for burn patients. For
example, one of the aims of Bishop et al’s review study was
to show that the presence of family members during the
patients’ dressing change can enhance the satisfaction of the
patients and their family and can therefore reduce the pain,
anxiety and the amount of the drugs taken [55]. In the present
study, too, the researcher has benefited from the presence and
support of a family member in the first session after the
dressing change as a spiritual approach and the results
confirm the enhance of the satisfaction with pain control in
these burn patients.
The average point of the satisfaction with pain control of
the patients in this research is calculated with NRS. This
score has raised from 2.16 to 6.53 in the experimental group
and has slightly changed from 2.53 to 2.25 in the control
group. Hence, according to the independent t-test and the
paired t-test results, the average point of the satisfaction
with pain control in the experimental group has really raised
after the experimental intervention (p < 0.05) while it has
stayed quite steady in the control group. Due to its
relationship with pain intensity, the assessment of the
satisfaction of the patients with the pain is influential on the
quality of the treatment and must thus be taken into
consideration by the medical teams.
5. Conclusion
This study demonstrates that a religious/spiritual care can be
considered an effective nursing intervention, which reduces
pain and increases satisfaction with pain control. Due to its
efficiency, security and simplicity, this care program should
be taken in to consideration as a suitable complementary
method in the treatment of burn patients. Nevertheless, this
method is limited to and dependent on the personal beliefs of
the patients towards spirituality and religion and the
difference in their spiritual needs that may influence the
pain. This aspect, however, was out of the control and
analysis of this research. Thus, regarding the results of this
study on one hand, and its limitations on the other, studies
on the same subject, though with greater quantity of
samples, longer duration than three days and on patients
of other religions is recommended.
1611
Author agreement
All authors have seen and approved the final version of the
manuscript being submitted. The article is the authors’
original work, has not received prior publication and is not
under consideration for publication elsewhere.
Funding
The study was partially funded by the Isfahan University of
Medical Sciences and partially by the first author personally.
Conflicts of interest
The authors declare no conflicts of interest
Acknowledgements
This article has been extracted from the thesis coded 396208 in
Isfahan University of Medical Sciences. We would like to
acknowledge and thank the dear patients who accepted to be
our samples of study, the managers and personnel of Imam
Musa Kazem burn hospital, the Research Center of the Faculty
of Nursing and Midwifery in Isfahan University of Medical
Sciences, Mr Kolivand (the clergy of the center), Parviz Nadimi
(research colleague) and Shafigheh Keivan (the translator) for
their help and support in this study.
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