|Year : 2015 | Volume
| Issue : 2 | Page : 72-75
Challenges in Caring for a Burn Survivor
Neethu Thomas1, Nirmala M Emmanuel2
1 IIIyear BSc (N) Student, College of Nursing, CMC, Vellore, India
2 Associate Professor, College of Nursing, CMC, Vellore, India
|Date of Web Publication||23-May-2020|
Source of Support: None, Conflict of Interest: None
Burns whether small or big, leaves a patient with increased nursing care demands to resume the normal or optimal living. Acute phase of burn provides more challenges regarding the physical care where as the rehabilitative phase requires more of psychological and social care. Throughout the period of recovery both in acute and rehabilitative phase a nurse needs to focus on the various dimensions of care such as physical, mental, social, and spiritual aspects to ensure a complete recovery of a patient with burns. This article presents the various challenges in caring for a burn survivor based on the nursing care demands such as physical, mental, and social health care needs and the nurses’ role in meeting these demands.
Keywords: burns, burn survivor, holistic health, nurses’ role, nursing care, challenges
|How to cite this article:|
Thomas N, Emmanuel NM. Challenges in Caring for a Burn Survivor. Indian J Cont Nsg Edn 2015;16:72-5
| Introduction|| |
Survival following burns is improving with the advancement in medical management. But, caring for the burn survivors is still a challenge. The impact of burns on the patient is tremendous that it requires intensive management to help the survivor to return to optimal health. As health is defined as the complete state of physical, mental, and social wellbeing and not merely the absence of the disease or infirmity (World Health Organization, 2003), nurses need to focus on all these dimensions of health. More than the physical impairment, the psychological insult leads to decreased quality of life. The challenges faced by the burn survivor are also multidimensional and requires comprehensive care (see [Figure 1]).
| 1. Physical Care|| |
A burn survivor always faces physical discomforts. Some of the physical problems include presence of chronic wounds, contractures, functional disability, chronic pain, and impaired nutrition.
1.1. Chronic pain
Ongoing pain is a complaint often expressed by a burn survivor. Untreated pain may lead to immobility and contractures. Pain management is more individualized and specific based on the nature of pain and the tolerance of the patient (Model Systems Knowledge Translation Center, 2011). Appropriate analgesics supplemented with non- pharmacological management such as distraction and stimulation should be used to effectively manage pain.
1.2. Chronic wounds
Chronic wounds are a major concern in care of a burn survivor. Infection and delayed wound healing are the problems of a chronic wound. During the acute phase the patient needs to be stabilized nutritionally and protected from exposure to microorganisms in order to minimize infection and delay in wound healing. The advancement in wound care has contributed to quick recovery of burns. Apart from the traditional methods of dressing, newer technologies such as growth factors, skin substitutes, and gene and stem cell therapy has enhanced the wound healing process (Falanga, 2005).
As part of healing and scarring of the burn wounds, contractures are a common sequele. But this can be prevented by appropriate positioning and splinting of the wounds from the first phase of burns. Whether minor or major all type of burns patient require proper splinting with adequate support of the affected part and the joints to prevent contractures. Early exercise and stretching of the joints is important to prevent stiffness (Procter, 2010). Patients should be encouraged to do the activities of daily living to regain the normal functions of joints and muscles. If needed assistance has to be provided from the health team or the family members to ensure normal movement and positioning at all times. Developed contractures require reconstructive surgeries to improve the appearance and optimize the functions ofthe parts affected by contractures.
1.4. Functional disability
The disfigurement and contractures have led to functional disability among many patients. Inability to face the society has led to deployment among most burn survivors. The physical impairment as well as the emotional involvement of burn affects the normal functioning of patients affected with burns (Agbenorku, 2013). Early management of contractures and mainly its prevention can solve this issue. Constant education and guidance in early mobilization can prevent the disability.
1.5. Altered nutrition
Altered nutrition is a commonest problem in patients with burn due to the elevation in the metabolic rate, protein wastage, and the increase in demand for repair of tissues. Adequate nutritional support is the key component of burn care. This will prevent weight loss, promote wound healing, and prevent infection. Recommended daily energy intake of an adult burn patient is 25 calories per kilogram plus 40 calories per each percent of burn area. Enteral nutrition is highly recommended as it can reduce the burn-related increase in secretion of catabolic hormones and hence maintain the gut mucosal integrity. To reduce proteolysis and improve the lean body mass, high carbohydrate low fat diet is recommended. Protein and fluid support is provided based on the protein and fluid loss. Vitamin and mineral supplements should also be considered for patients with burns. Especially in major burns, the patient will suffer from acute trace- element deficiencies because of the large exudative loss. Vitamin E and D, Selenium, Zinc, and Copper need to be evaluated and replaced appropriately (NutritionMD, 2015).
| 2. Mental Care|| |
The physical disfigurement and pain has contributed to the psychological issues among burn survivors (Blakeney & Creson, 2002). Majority of patients present with depression, anxiety, and post-traumatic stress.
Depression is widely seen among post burn patients. A case series conducted at the department of Burn, Pakistan Ordinance Factory Hospital, Wah Cantt, revealed that 58% of them had depression following burn injury. Depression is a risk factor as well as an outcome of the burn injury (Arif & Ramprasad, 2013). Some of the causes contributing to depression include the functional disability, unemployment, limited socialization, and preexisting psychological conditions (De Sousa, Sonavane, & Kurvey, 2013).
Another common psychological reaction of patients with burn injury is anxiety which is more prevalent among children and adolescents (Noronha & Faust, 2007). Depression and anxiety go together. Majority of the patients with depression present with anxiety. A study among burns patient in a tertiary care center in India showed that 34% of the patients had both anxiety and depression (Arif & Ramprasad, 2013). Anxiety may be due to the grieving of their lost appearance, guilt, and the burn wound however small or big.
2.3. Post-traumatic stress
“A traumatic event is defined by the DSM-IV, (Diagnostic and Statistical Manual for Psychiatry 4th Edition), as an event in which the person witnessed or was confronted with an event that involved actual or threatened death or serious injury to self or others, and that the event was responded to with intense fear, helplessness, or horror”. Some of the manifestations of traumatic stress includes sleep disorders, social withdrawal, avoidance, fear, nightmares, and unable to recall important aspects of the trauma (European Society for Traumatic Stress Studies, 2015). Burn is a trauma which leads to stress among the patients and require close monitoring and follow up.
| 3. Social Care|| |
Patients affected with burns, face severe social disturbance. Many patients withdraw themselves from the family members and society due to shame, guilt, and disturbed body image. The social impact of burns on an individual includes unemployment, impaired relationship, and decreased leisure or recreation.
3.1. Work / Employment
Many of the burn survivors are left unemployed. Very few post burn patients have the motivation to continue work or adapt to new employment based on the deformity. A systematic review on burn survivor and their work status revealed that nearly 28% of the survivors never resumed any form of work or employment and many others resumed their job or some form of work after 40 months (Mason et al., 2012). Unemployment may lead to economic crisis in families which in turn affects the relationship with spouse and children. Patients with major burns will require rehabilitation and long stay in hospital which again will mount the financial burden.
Scar formation and contractures lead to disturbed body image in patients following burns. The disturbance in the image and self esteem affects the socialization of these patients (De Sousa et al., 2013). Burn patients will avoid people with the fear of being hated by others due to the affected appearance. People also raise a lot of question to the burn survivors and may sometimes show faces due to the distorted appearance that has resulted from scars (Model System Knowledge Translation System, 2011).
Majority of patients with following burns, whether small or big wound withdraw themselves and stop engaging in recreational activities. The post-traumatic stress, physical appearance, and the functional disability restrict them from enjoying the recreational activities. Hence change of mode of recreation and leisure time work should be encouraged to meet the diversional needs of the patient.
| Nurses’ Role|| |
Nursing care is challenging and requires multidimensional approach. Nurses will have to coordinate with the other health team members in order to provide comprehensive care for the burn survivors. The main focus of care would include pain management, nutritional care, wound care, and infection control. Psychological aspects should also be focused as the patients will undergo tremendous emotional problems. The impact of physical and psychological issues on the social well being is another area or concern while caring for a burn survivor.
A thorough assessment of the patient and multi- disciplinary team (MDT) approach in caring is the only way to achieve optimal recovery of a burn survivor. Nurses need to co-ordinate their work with the dietician, plastic surgeon, physical therapist, occupational therapist, chaplain, counselor, psychiatrist, and a social worker. Family also plays an important role in the care as a both in the giving and receiving end. Members of the family of majority of burn survivors also become a victim to the incident. It affects the socialization, economic status, and causes severe psychological trauma. Hence the family members, especially the spouse and children of the burn victim should be cared for. Their needs should also be considered while planning for care. At the same time the family members help the health team members to continue the treatment at home.
| Conclusion|| |
Effect of burns on an individual is traumatizing. More than the physical injury the consequence of the injury on the mental and social wellbeing is significant. With the advancement in medical care most ofthe burn victims survive but the care demands are increasing. A multi-disciplinary team approach is the ideal way to care for a burn survivor. Nurses can provide efficient and excellent care by coordinating their work with the other health care professionals.
Conflicts of Interest: Authors have declared no conflicts of interest.
| References|| |
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, 5(2). 78-86.
Alvi, T., Assad, F., Aurangzeb, & Malik, M. A. N. (2009). Anxiety and depression in burn patients. Journal of Ayub Medical CollegeAbbottabad
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De Sousa, A., Sonavane, S., & Kurvey, A. (2013). Psychological issues in adult burn patients. Delhi Psychiatry Journal
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Mason, S. T., Esselman, P., Fraser, R., Schomer, K., Truitt, A., Johnson, K. (2012). Return to work after burn injury: A systematic review. Journal of Burn Care and Research
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Noronha, D. O., & Faust, J. (2007). Identifying the variables impacting post-burn psychological adjustment: A meta- analysis. Journal of Paediatric Psychology, 32