When caring for a patient with a burn injury, the nurse needs to be aware that there are
prejudices and misunderstandings in society about those who are viewed as different.
Opportunities and accommodations available to others are often denied those who are
disfigured. Such amenities include social participation, employment, prestige, various
roles, and status. The health care team must actively promote a healthy body image and
self-concept in patients with burn injuries so that they can accept or challenge others'
perceptions of those who are disfigured or disabled. Survivors themselves must show
others who they are, how they function, and how they want to be treated.
The nurse can help patients practice their responses to people who may stare or inquire
about their injury once they are discharged from the hospital. The nurse can help
patients build self-esteem by recognizing their uniqueness—for example, with small
gestures such as providing a birthday cake, combing the patient's hair before visiting
hours, giving information about the availability of a cosmetician to enhance
appearance, and teaching the patient ways to direct attention away from a disfigured
body to the self within. Consultants such as psychologists, social workers, vocational
counselors, and teachers are valuable participants in assisting burn patients to regain
their self-esteem.
Monitoring and Managing Potential Complications
Contractures
With early and aggressive physical and occupational therapy, contractures are rarely a
long-term complication. However, surgical intervention is indicated if a full range of
motion in the burn patient is not achieved. (See Chapter 11 for a discussion of
prevention of contractures.)
Impaired Psychological Adaptation to the Burn Injury
Some patients, particularly those with limited coping skills or psychological function or
a history of psychiatric problems before the burn injury, may not achieve adequate
psychological adaptation to the burn injury. Psychological counseling or psychiatric
referral may be made to assess the patient's emotional status, to help the patient develop
coping skills, and to intervene if major psychological issues or ineffective coping is
identified.
Promoting Home and Community-Based Care
Teaching Patients Self-Care
As the inpatient phase of recovery becomes shorter, the focus of rehabilitative
interventions is directed toward outpatient care or care in a rehabilitation center. In the
long term, much of the care of healing burns will be performed by the patient and
others at home. Throughout the phases of burn care, efforts are made to prepare the
patient and family for the care that will continue at home. They are instructed about the
measures and procedures that they will need to perform. For example, patients
commonly have small areas of clean, open wounds that are healing slowly. They are
instructed to wash these areas daily with mild soap and water and to apply the
prescribed topical agent or dressing.
In addition to instructions about wound care, patients and families require careful
written and verbal instructions about pain management, nutrition, and prevention of
complications. Information about specific exercises and use of pressure garments and