patient's physical and psychological recovery (Fauerbach, Lezotte, & Hills, 2005).
Patients who experience a burn injury tend to have high rates of involvement in risky
behaviors (eg, alcohol and substance abuse, depression) before the injury (Morton et
al., 2005). They may also have poor coping skills. Coping styles and perceived threat of
death at the time of the burn injury are strong predictors of how well the patient
recovers psychologically in the postburn period (Willebrand, Anderson & Ekselius,
2004). Intrusive thoughts of the burn event and reliving it over and over may also occur
and can indicate posttraumatic stress disorder.
Much of the patient's energy goes into maintaining vital physical functions and wound
healing in the early postburn weeks, leaving little emotional energy for coping in a
more effective manner. The nurse can assist the patient to develop effective coping
strategies by setting specific expectations for behavior, promoting truthful
communication to build trust, helping the patient practice appropriate strategies, and
giving positive reinforcement when appropriate. Most importantly, the nurse and all
members of the health care team must demonstrate acceptance of the patient.
The patient frequently vents feelings of anger. At times the anger may be directed
inward because of a sense of guilt, perhaps for causing the fire or even for surviving
when loved ones perished. The anger may be directed outward toward those who
escaped unharmed or toward those who are now providing care. One way to help the
patient handle these emotions is to enlist someone to whom the patient can vent
feelings without fear of retaliation. A nurse, social worker, psychiatric liaison nurse, or
spiritual advisor who is not involved in direct care activities may fill this role
successfully.
Patients with burn injuries are very dependent on health care team members during the
long period of treatment and recovery. However, even when physically unable to
contribute much to self-care, they should be included in decisions regarding care and
encouraged to assert their individuality in terms of preferences and recognition of their
unique identities. As the patient improves in mobility and strength, the nurse works
with the patient to set realistic expectations for self-care, including self-feeding,
assistance with wound care procedures, exercise, and planning for the future. Many
patients respond positively to the use of contractual agreements and other strategies that
recognize their independence and their specific role as part of the health care team
moving toward the goal of self-care. Consultation with psychiatric/mental health care
providers may be helpful to assist the patient in developing effective coping strategies.
Supporting Patient and Family Processes
Family functioning is disrupted with burn injury. One of the nurse's responsibilities is
to support the patient and family and to address their spoken and unspoken concerns.
Family members need to be instructed about ways that they can support the patient as
adaptation to burn trauma occurs. The family also needs support from the health care
team. The burn injury has tremendous psychological, economic, and practical impact
on the patient and family. Referrals for social services or psychological counseling
should be made as appropriate. This support continues into the rehabilitation phase.
Patients who experience major burns are commonly sent to burn centers far from home.
Because burn injuries are sudden and unexpected, family roles are disrupted. Therefore,
both the patient and the family need thorough information about the patient's burn care
and expected course of treatment. Patient and family education begins at the initiation
of burn management. Barriers to learning are assessed and considered in teaching. The
preferred learning styles of both the patient and family are assessed. This information is
used to tailor teaching activities. The nurse assesses the ability of the patient and family
to grasp and cope with the information. Verbal information is supplemented by videos,