NUR2300: Burn Injuries

Ali Almalki

University:

Date:

Burn Injuries Burn injuries often have a significant impact on all aspects of the patient’s life, leaving them with a variety of psychosocial as well as physical handicaps. Extensive research evidence indicates that burn patients suffer profound social and psychological effects such as anxiety and depression, with long-term implications on the patient’s recovery and quality of life. Accordingly, it has been suggested that burn patients should undergo both long and short term systematic mental health care, in order to minimize and avert these psychopathological responses. Moreover, psychological interventions helps burn patients and staff to reduce burdensome as well as decline depressive symptoms. Notably, dissatisfaction tendencies with post-burn body image and appearance, have been pinpointed as a leading cause of psychological impacts, resulting to protracted recovery and impaired social life. According to Thombs et al. (2007) burn scars following a deep dermal injury are often cosmetically disfiguring and impel the scarred individual to deal with an alteration both in body image and appearance. The patient is also forced to adjust to significant impairments in motion and limitations of activities. However, according to Henry (2011), it is the disfigurement or change in appearance and body image that has a profound impact on the patient. Lau & Van Niekerk (2011) note that the alteration in appearance from ordinary to a conspicuous one is often abrupt and adjustment becomes complex as the patient is forced to confront personally, the alterations as well as, deal with the reaction of others to the disfiguring conditions. Further, disfiguring burns in many cases, elicit psychosocial problems especially in the area of social functioning which impairs the quality of life of the individual (Henry, 2011). Empirical evidence suggests that dissatisfaction with body image and appearance may elicit problems in social interactions where the patients avoid or experience difficulties in making friends, meeting new people, developing intimate relationships, and engaging in sexual activity (Thombs, et al, 2007; Corry, et al. 2009; Lau & Van Niekerk, 2011; Thombs et al. 2008; Henry, 2011). Moreover, other psychosocial issues such as loss of social network, demoralization, stigmatization, loneliness, isolation, and bereavement associated with disfigurement may emerge leading to “‘social death”. Additionally, Corry et al. (2009), state that dissatisfaction with body image and appearance results in a declined quality of life hence the need for structured mental adjustment (Corry, Pruzinsky, & Rumsey, 2009, p. 539). Lau & Van Niekerk (2011) recommend that long term psychological care should help the patient accept and adjust to the altered appearance and social reintegration. Corry et al. (2009) emphasize that psychological recovery of the burn patient must parallel their physical recovery. This requires a systematic approach to mental health care to address the complex psychological needs of burn patients and help them regain a sense of control and safety. This tiered approach must begin with the entire burn care team where they are tasked with identifying and recognizing the psychological needs of the patient (Thombs, et al., 2008). At the second level, professionals with specific expertise such as nursing, physiotherapy, counselling, social work , occupational therapy among others are tasked with conducting basic screening and identifying any psychological distress as well as the social care needs of the patients and their family (Lau & Van Niekerk, 2011). At the third level, trained psychosocial burn specialists conduct an assessment of the patient for psychological distress and social care needs after they have been admitted. Research shows that a psychological survey must be addressed at this stage, to elicit any preexisting psychological sequel or comorbidities while upholding the patient’s psychological status (Corry, Pruzinsky, & Rumsey, 2009). At this level also, the psycho-social burn specialist also treats basic psychopathology symptoms such as risk, mental health problems, capacity and substance abuse. At level four, mental health specialists like clinical psychologists and psychotherapists diagnose and treat both typical and atypical traumatic stress as well as potential psychopathology. At level five, psychosocial care coordinators take leadership of the psychosocial rehabilitation process of the patient, by the entire burn team. Notably, the recurrent theme in this structured care approach of the burn patient is high levels of collaboration among care providers and professionals. Thombs et al.(2007)stress that while providing this structured care , practitioners must ensure that interventions factor in all the patient needs identified at all stages of the care continuum. According to Corry et al. (2009) psychological interventions leads to a declined patient and staff burdensome by helping burn patients cope with body image dissatisfaction. This is upheld by Thombs et al. (2007) who found that psychological screening was important in developing body image satisfaction among burn patients and subsequently decline depression symptoms (Thombs, et al., 2007). Further, empirical evidence suggests that mental health care should incorporate both short and long term care approaches to facilitate the patient’s reentry the society. Thombs et al. (2008) identify two main long term approaches that may facilitate the burn patient’s transition back into the society and restore functionality. These include cognitive therapy that helps the patient with body image dissatisfaction issues to change their body image schema; and social skills training intended at improving the patient’s social interactions and enhance their self-esteem. Further, Lau & Van Niekerk (2011), identify community interventions aimed at changing attitudes and providing information regarding disfigurement as another way of enhancing the quality of life of the burn survivor. Moreover, evidence points to the positive correlation between a supportive social network and improved quality of life in burn survivors (Lau & Van Niekerk, 2011). Additionally, the patient may require psychiatric outpatient care to help them cope with psychopathological responses such as anger, depression and anxiety (Henry, 2011). Studies also suggest that since burn patients are often as a whole under continual medical care from the incident, practitioners should focus on early detection of psychopathological risk factors as well as early onset pathology as part of the comprehensive treatment program (Henry, 2011; Thombs, et al, 2007; Thombs, et al, 2008). According to extensive literature, depression induced by post burns appearance could significantly affect the social reintegration process of the patient (Corry, et al 2009; Henry, 2011; Lau & Van Niekerk, 2011). Burn researchers concur that disfigurement, particularly facial injury may result in difficulties in social interactions, hence provoking serious issues in social life (Thombs, et al, 2007; Corry, et al. 2009; Lau & Van Niekerk, 2011; Thombs et al. 2008; Henry, 2011). In addition to the objective features of disfigurement, subjective measures such as self-esteem and body image act as a mediator between bodily change and negative social reintegration outcomes. Henry (2011) notes that pre burn characteristics like introversion and shame proneness may result in psychosocial problems (Henry, 2011). These factors consequently make some patients more vulnerable and susceptible to the consequences of disfigurement which culminate in depression and social withdrawal (Henry, 2011). The main aim of reintegrating the patient into the society is to help them regain control and functionality. As such they should be adequately prepared though counselling, established support groups and therapeutic interventions to address depression and post-traumatic stress symptoms (Corry, Pruzinsky, & Rumsey, 2009). The patient must continue with rehabilitative care as part of their psychiatric outpatient care to monitor their coping and adjustment strategies (Lau & Van Niekerk, 2011). Other approaches include access to self –help modules for both patients and their families that may enhance their self-esteem and improve their body image schemas. Successful reintegration into the society is marked by a combination of resilience, acceptance and healing for the patient. In conclusion, extensive evidence discussed herein points to the profound social and psychological effects experienced by a burn patient. Indeed, all the literature discussed herein, burn researchers and experts seem to agree on the importance of psychological and mental care that should parallel physical wound care. Moreover, most studies highlight on the necessity of collaborative care among the various specialists providing care to burn patients. Dissatisfaction with body image and appearance in the post burn phase has been identified as the key mediator in the development of psychopathological issues in burn patients such as anxiety depressions and fear. Furthermore, appearance has also been linked to problems in the social reintegration process of the patient and a significant decline in quality life. Accordingly, it is critical that patients have access to structured psychological interventions that seek to boost their self-esteem and facilitate acceptance and positive psychosocial adjustment. With regard to recommendations, research evidence discussed herein has offered a variety of interventions that can assist burn patients make a positive recovery. These include cognitive therapies and social skill training to improve depressive symptoms, self-esteem and body image schemas, structured mental health screening, structured self-help modules, peer support groups and community interventions. The consensus is that the continuum of care should be conducted in the community mental health setting by providing counselling services, active listening and consistent psychological support; to ensure the patient and their family return to their normal life, with minimal impact from the injury.

References
Corry, N., Pruzinsky, & Rumsey, N. (2009). Quality of life and psychosocial adjustment to burn injury: Social functioning, body image, and health policy perspectives. International Review of Psychiatry, 21(6), 539–548.
Henry, S. (2011). Disfigurement and visible difference: The impact upon personal and personality development and the implications for therapy. Person-Centered & Experiential Psychotherapies, 10(4), 274-285.
Lau , U., & Van Niekerk, A. (2011). Restorying the Self: An Exploration of Young Burn Survivors’ Narratives of Resilience. Qualitative Health Research, 21(9), 1165-1181.
Thombs, B., Haines, J., Magyar-Russell, G., Fauerbach, J., Spencer, R., & Bresnick, M. (2007). Depression in burn reconstruction patients: symptom prevalence and association with body image dissatisfaction and physical function. General Hospital Psychiatry, 29 , 14– 20.
Thombs, B., Notes, L., Lawrence, J., Magyar-Russell, G., Bresnick, M., & Fauerbach, J. (2008). From survival to socialization: A longitudinal study of body image in survivors of severe burn injury. Journal of Psychosomatic Research, 64 , 205–212.