Burn injuries have a significant impact and effect on the body system, which often causes long lasting distress, pain, and anxiety. Appropriate management by nurses, family caregivers, and healthcare providers is essential in taking care of a patient’s health with burn injuries. The fundamental goal of care giving is to “do no harm“. Caregivers need to prepare themselves to stay focused and safe while caring for the patients. Providing emotional and peer support is incredibly important. Visibility and communication keep caregivers connected to each other and to patients—which is essential for assessment, information, and directions.
Patient needs in hospital
Burn injuries are traumatic and devastating causing insult on the body. Comprehensive early assessments like airway and breathing, circulation, pain and wound assessment, (Total Body Surface Area (TBSA) burnt, depth of injury) and management are vital to ensure clinical issues and deterioration.
- First aid, which is effective for up to three hours post time of injury, is an important initial aspect of care as it assists with pain relief as well as minimising tissue damage progression.
- Fluid loss via damaged tissue can result in burn shocks; therefore adequate fluid has to be administered to the patient.
- Pre medication/ Pain relief is vital to ensure the comfort of the patient, maximise wound healing and minimise the risk of mental trauma as well as post-traumatic stress.
Preparation of patient and family/caregiver
- Burn wound followed by dressing may produce anxiety and distress in the patient. It is substantial to know the patients physical and emotional status before the procedure, specifically for pain management.
- Hospitals must ensure good communication with the family prior to and during the procedures and thorough wound assessment should be explained, to help them understand the patient’s condition.
- Involving the family throughout the procedure would avoid disruption and would be a support to the patients.
- Children undergoing play therapy prior to the procedure may assist in explaining and preparing the patient for the burn dressing change.
To avoid stress and pain during dressing- adhesive remover or water use will be helpful for the gentle removal of dressings without causing damage in healing burn wound and should be as atraumatic as possible. Dressings should cover all areas and secure where tissue damage has occurred but not unburnt skin as maceration may occur.
Wound area has to be cleaned using a soft wipe with normal saline or water, which is rinsed off and allowed to dry so as to not affect bacterial growth. Debridement of blisters allows wound bed assessment and appropriate dressing application. The wound and surrounding skin should be dry before applying the dressing
Hygiene influences basic wound healing by preventing nosocomial infection from severe burns. Some patients are hesitant to bathe when wearing a dressing. Many studies report that showering can be safe and effective for post-patients. The therapeutic bath should be a part of the treatment plan for burns, ensuring the patient’s personal hygiene and nutrition which plays a vital role in healing, minimising complications of the wound and meeting the metabolic demands associated with patients with burns.
Management of Itch-
Everyone recovering from major burns has problems with itching—especially on or around the burn, graft, or donor site. Itching is a normal part of healing.
Avoiding scratching as scratching will damage fragile, healing skin, particularly in patients who have had skin grafts to treat burns. Fragrance free moisturiser and distraction will play a big role in patient comfort and may assist in itch reduction.
The scar development of post burn injury can be reduced by:
- Regular bathing and showering
- Fragrance free moisturiser applied at least two times a day on the healed skin.
Burns over joints may be at high risk of contracture development, impacting both growth and mobility. Pressure therapy in the form of tubefast, tapes, pressure garments and silicone can be applied. For patients who have sustained a burn injury Physiotherapy (PT) or Occupational therapy (OT) may be necessary. The nursing caregiver should monitor for pressure areas when such garments are in use and report concerns back to PT/OT.
For paediatric patients splints and positioning regimes can be uncomfortable and distressing. What is important is to educate both patient and family about the fact that position of comfort is likely to result in contractures. Strategies that would support splinting and positioning regimes include:
– Play therapy, Regular analgesia, distraction and rewards (i.e. sticker charts), consistency in care, ongoing education and positive reinforcement.
Discharge planning is a process of deciding when a patient needs a smooth move from one level of care to another during the process of recovery.
The evaluation of patient from pain management and itch plan, includes plans and procedures (changes for outpatients dressing) on-
- Home care of burn wound or need of another care facility support
- Information about medications and nutritional requirements
- PT/OT recommendations
- Medical review and arranging for follow-up appointments or tests
Excellent planning and good follow-up can improve the patient’s health, reduce readmissions, and decrease healthcare costs. Studies have shown that improvements in hospital discharge planning can improve patient outcome as they move to the next level of care.
Needs of caregiver (Nursing staff/Family member) in hospital
Caregivers are an important and active part of the health care team. Families/primary caregivers should be given a thorough explanation of the procedure in treating the patients as individuals and empowered to make choices about their own care. They also carry an important role in the acute and chronic rehabilitative phases.
Caregivers have to be more comfortable in doing their work. If the supplies and equipment they use are intuitive and familiar then remember not to impede on the processes and time-sensitive nature for patients care. Family caregivers perform the role of essential conduit between patient and all hospital professionals.
Caregivers should provide safe and accurate clinical or personal care to their patients. Visibility is ranked higher in conversations with caregivers, and it improves work processes and the quality of caregiving.
Thus, hospitals, nursing care, and family caregivers are committed to being responsible for the early recovery of the burn patients by satisfying their needs.