Being a family member of a burn survivor – Experiences and needs

Effects of a nurse-led aftercare telehealth programme on sleep and psychological outcomes of adult burn survivors: A randomized controlled trial

INTRODUCTION

Burn survivors often experience a plethora of post-burn residual needs following their discharge including psychological issues and poor sleep. These needs are often overlooked with a significant focus on resolving physical issues. Aftercare support is particularly limited. The emergence of the Coronavirus pandemic worsened the situation as burn survivors were unable to return to utilise available services outpatient basis. Thus, an innovative nurse-led aftercare programme was developed and delivered via WeChat social medial platform. The current study sought to examine the effects of the intervention on anxiety, depression, and sleep pattern among adult burn survivors.

METHODS

This is a randomised controlled trial. Sixty adult burn survivors were randomly assigned to intervention and control groups. Participants in the intervention group received the nurse-led aftercare programme which involved pre-discharge support and active follow-up on WeChat over an 8-week period and an additional 4 weeks to examine the sustained effects of the intervention. Data were collected at three timepoints: baseline (T0), post-intervention (T1), and follow-up (T2). Generalised estimating equation was employed to ascertain the group, time, and interaction effects.

RESULTS

Using Bonferroni corrected p value (0.017), Anxiety and depression improved at T1 and sustained at T2 with mean scores demonstrating a reduction in both variables and total score. No statistically significant improvement was however observed regarding sleep.

CONCLUSION

Continuous, comprehensive support is required by burn survivors following discharge to improve psychological outcomes. Delivering aftercare via WeChat should be considered a feasible option to supporting burn survivors following discharge.

Family-based education and follow-up program for patients with burns: A mixed assessment study

BACKGROUND

Burn injuries are a major cause of morbidity and mortality worldwide, affecting not only the patients but also their families. Family-based education and follow-up program are interventions that aim to improve the quality of life and psychosocial outcomes of patients with burns and their families. However, we find a lack of evidence on the effectiveness and feasibility of these programs in different settings and populations. This study aimed to evaluate the features of the family-based education and follow-up program (FBEFP), a pilot project that was developed and implemented at the Tabriz Sina Teaching Hospital in 2020 to improve its burn care system.

DESIGN

A mixed-methods approach was used to collect and analyze both quantitative and qualitative data from various sources, such as, questionnaires, medical records, interviews and observation notes, to assess the content, process, and outcome of the program. The study followed the three steps of the CDC's framework for program evaluation: describing the program, measuring its effectiveness, and providing recommendations for improvement.

RESULTS

The results of this study revealed the positive impacts of the FBEFP on the patients' physical, psychological, and social outcomes and quality of life. 4.8% of the people in the follow-up group were re-admitted, while this amount was 7.2% in the group without follow-up. Although the number of readmissions was less in the non-follow-up group, statistically no significant difference was observed between the two ratios before and after follow-up. In order to evaluate satisfaction rates, In the follow-up group, 72 patients and in the non-follow-up group, 38 patients were reached. After converting these data to normal distribution, using t-tests, it was determined that the difference between the two studied groups was highly significant. In other words, the follow-up process had favorable results on satisfaction of the studied people. However, the study also identified some challenges and barriers in implementing the program, such as lack of resources, staff training, and family involvement.

CONCLUSION

FBEFP is a promising intervention that enhances the well-being of patients with burns and their families. However, more evidence is needed to support its effectiveness and feasibility in different contexts and populations. The study also provided valuable insights into the benefits and challenges of implementing a Family-Based Education and Follow-up Program for patients with burns in a low-resource setting. The study contributed to the development of guidelines and recommendations for future research and practice in this field.

Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.

A Qualitative Analysis on the Experiences of Mothers of Children in Burn Intensive Care Unit: "She burned on the outside, me inside..."

Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers' experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semistructured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data. The experiences of the mothers were classified in four contexts as a result of the interpretative phenomenological analysis; "first reactions to burn trauma" related to the awareness that the child has been burned, "being a mother in the burn intensive care unit" related to caring for the child as a companion in the burn intensive care unit, "coping" related to how they cope with the problems throughout the whole process, and "requirements" regarding the subjects it needs in the process. It was determined that mothers went through a physically and emotionally challenging process from the beginning of the burn trauma and throughout the intensive care unit. During this challenging process, it was observed that mothers could not use effective coping methods and did not receive the necessary professional support. In line with these results, it is recommended that psychological support programs be applied to the mothers and that care focused on the needs of the mothers should be provided.

Iranian Men's Sexual Life Issues After Their Wives' Burn: A Qualitative Content Analysis Study

Physical and psychological complications of burn injuries reduce the victims' sexual quality of life and challenge their partners' sexual satisfaction. There is no information about men's sexual issues and behaviors. Previous studies did not address the impact of women's burns on their husbands' sexual lives. Therefore, this qualitative study aimed to characterize the sexual experiences of Iranian men after their wives' burns. The study was performed on 16 men with surviving spouses of major burn using criterion-based purposive sampling. Semistructured interviews were analyzed using a qualitative content analysis approach. The results showed men's sexual issues with three main themes and eight subthemes: 1) sexual desire restrictors (annoying scars, imposing roles, and wives' sexual coldness), 2) degradation of marital sex (reduced frequency of sexual intercourses, temptation of extramarital affairs), and 3) effort to maintain sex (sexual self-sacrifice, sexual pretending, sexual precautions). According to men's experiences, female sexual coldness, temptation for extramarital affairs, and sexual pretense were related to couples' poor knowledge of sexual discourse. Thus, health professionals can use context-oriented educational program to promote the couples' sexual knowledge and health after burns.

Impact of long-term outcomes on the caregivers of burn survivors

This prospective longitudinal study investigated the changes in caregiving burden, post-traumatic stress disorder (PTSD), and quality of life (QoL) of primary caregivers of burn survivors 48 h, 3 months, 6 months, and 12 months after the burn event. We also explored and identified relevant factors associated with these metrics. We collected data regarding the sociodemographic and injury characteristics of 69 caregivers and their survivors. Their responses were recorded to the Caregiver Burden Scale (CBS), Impact of Events Scale for Burn (IESB), and Short Form-36 questionnaires. Temporal changes in the CBS, IESB, and SF-36 scores and their differences were analyzed using the generalized estimating equation. Among the caregivers of children, QoL decreased with increasing children's total burn surface area (TBSA) and length of hospital stays, caregivers being female, decreasing caregivers' age, increasing the time required to travel to and from the hospital, and increasing global and subjective burdens. Among the caregivers of adults, QoL decreased with increasing survivors' TBSA and caregivers' PTSD. Based on these results, several recommendations for implementation in clinical practice include integrating caregivers into care plans and encouraging active participation, providing learning and consultation channels, and encouraging caregivers to schedule breaks from caregiving activities.

Challenges of nurses and family members of burn patients: Integrative review

AIMS

To identify the challenges facing burn care nurses and burn patients' family members and to explore the relationship between the above challenges.

DESIGN

Whittemore and Knafl's integrative review.

METHODS

Databases used for this review included Cochrane Library, Web of Science, PubMed and Embase. The original research published from January 2010 to November 2021 was selected. Studies reporting the challenges of family members or nurses of burn patients identified through extensive database search were considered for inclusion. The Mixed-Method Appraisal-Tool was applied for the evaluation of the quality of the literature. The analysis approach used was content analysis.

RESULTS

Of the 2746 identified studies, 17 studies were included. Key findings related to the challenges facing nurses and family members of burn patients were extracted. The themes relating to burn care nurses included ethical and religious issues, clinical issues, work-life imbalance and limited support. The themes relating to family members included family's different views on prognosis and treatment, work-life imbalance, psychological issues and lack of multifaceted support. The challenges for the formal and informal caregivers are similar and there is existence of some shared concerns. If the above challenges are not resolved, support for the burn patients may be adversely affected. Corresponding measures should be taken to overcome such challenges.

Wound Pain as a Determinant of Function in Patients Hospitalised for Burns

Burn wounds most often occur on visible parts of the body. They therefore cause fear of disfigurement and rejection by those around them. In addition, they cause pain. The main aim of this study was to analyse factors affecting the functioning of patients hospitalised for burns. The study included 57 patients hospitalised for burns. Each person was surveyed twice: on day seven after admission and on the day of discharge from the hospital. The following research tools were used: a personal questionnaire to collect clinical data and the scales of the Katz Activities of Daily Living (ADL), the short-form McGill Pain Questionnaire (SF-MPQ), the Beck Depression Inventory (BDI) and the Satisfaction with Appearance Scale (SWAP). On the discharge day, compared to day 7, there was an improvement in the patient's level of functioning in all areas analysed. Pain intensity (p < 0.0001), depression (p < 0.0001) and dissatisfaction with appearance (p = 0.0239) decreased significantly. Improvements in daily functioning were also obtained (p < 0.0001). Multiple regression was performed to estimate the effect of selected variables on patients' level of functioning. Burn area (p = 0.0126), pain level (questionnaire part B: p = 0.0004 and questionnaire part C: p = 0.0208) and gender (p = 0.0413) had a significant impact on the level of daily functioning. Pain complaints are the most crucial predictor affecting the functional status and depression levels in burn wound patients. Increased levels of depression promote dissatisfaction with one's appearance.

Posttraumatic stress symptoms and interpersonal processes in burn survivors and their partners

Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other.Objective: The aim of this study was to investigate bidirectional relationships between survivor's and partner's PTSD symptoms and two interpersonal processes: partner-oriented 'self-regulation', which is avoidance-oriented, and 'expressed concern', which is approach-oriented.Method: In this longitudinal multi-centre study, 119 burn survivors and their partners participated. Measures of PTSD symptoms, self-regulation, and expressed concern were administered in the acute phase following the burns, and follow-ups took place up to 18 months postburn. Intra- and interpersonal effects were examined in a random intercept cross-lagged panel model. Exploratory effects of burn severity were also investigated.Results: Within individuals, survivor's expressed concern predicted later higher levels of survivor's PTSD symptoms. In their partners, self-regulation and PTSD symptoms reinforced each other in the early phase postburn. Between the two couple members, partner's expressed concern predicted later lower levels of survivor's PTSD symptoms. Exploratory regression analyses showed that burn severity moderated the effect of survivor's self-regulation on survivor's PTSD symptoms, indicating that self-regulation was continuously related to higher levels of PTSD symptoms over time within more severely burned survivors, but not in less severely burned survivors.Conclusion: PTSD symptoms and self-regulation reinforced each other in partners and possibly also in more severely burned survivors. Partner's expressed concern was related to lower levels of survivor's PTSD symptoms, whereas survivor's expressed concern was related to higher levels of survivor's PTSD symptoms. These findings emphasize the importance of screening for and monitoring PTSD symptoms in burn survivors and their partner and of encouraging couple's self-disclosure.

The experiences of 'significant others' supporting people with severe burn injury: An integrative literature review

BACKGROUND

Severe burn injury is a traumatic experience for both patients and their significant others. Although research has focused on the experience of people with burn injury, there is a paucity of research focusing on the experiences of the significant other. Significant others are frequently expected to advocate and make decisions on behalf of the patient, which may have an impact on their psychological wellbeing. An understanding of the experiences of significant others will inform strategies to better support their needs.

OBJECTIVES

The aim of this integrative literature review was to critically examine research related to the experiences of significant others supporting a patient with a severe burn injury in the hospital.

METHODS

CINAHL Plus with Full Text (EBSCO), MEDLINE ALL (Ovid), Scopus, and APA PsycINFO were searched up to December 2019 for English language studies using search terms burns, significant other, ICU, and psychological impact. Records were independently screened and assessed for methodological quality, and the data were synthesised.

RESULTS

Nine articles were included in the review. Three used a quantitative approach, and six were qualitative studies. Three major themes were identified, namely, (i) psychological consequences and emotional trauma, (ii) redefining relationships, and (iii) coping strategies.

CONCLUSION

The review identified that significant others experience adverse psychological consequences including post-traumatic stress, anxiety, and depression. The burn injury resulted in a redefining of relationships with others and particularly with the patient through this shared experience. Significant others found ways to adapt to stressors, including taking control of the situation and seeking greater involvement in the patient's care.

Prevalence and course of posttraumatic stress disorder symptoms in partners of burn survivors

Background: Partners of burn survivors may develop posttraumatic stress disorder (PTSD) symptoms in response to the potential life threatening nature of the burn event and the burn survivor's medical treatment. Objective: This longitudinal study examined the prevalence, course and potential predictors of partners' PTSD symptoms up to 18 months post-burn. Methods: Participants were 111 partners of adult burn survivors. In a multi-centre study, PTSD symptoms were assessed with the Impact of Event Scale-Revised during the acute phase and subsequently at 3, 6, 12 and 18 months post-burn. Partners' appraisal of life threat, anger, guilt and level of rumination were assessed as potential predictors of PTSD symptoms in an exploratory piecewise latent growth model. Results: Acute PTSD symptoms in the clinical range were reported by 30% of the partners, which decreased to 4% at 18 months post-burn. Higher acute PTSD symptoms were related to perceived life threat and higher levels of anger, guilt, and rumination. Over time, mean symptom levels decreased, especially in partners with high levels of acute PTSD symptoms, perceived life threat and rumination. From three months onward, PTSD symptoms decreased less in partners of more severely burned survivors. At 18 months post-burn, higher levels of PTSD symptoms were related to higher acute PTSD symptoms and more severe burns. Conclusions: One in three partners reported clinical levels of acute PTSD symptoms, of which the majority recovered over time. Perceived life threat, feelings of anger and guilt, and rumination may indicate the presence of acute PTSD symptoms, whereas more severe burns predict long-term PTSD symptom levels. The results highlight the need to screen for acute PTSD symptoms and offer psychological help to partners to alleviate acute elevated stress levels if indicated.

Exploring The Background, Context And Stressors Of Caregiving To Elderly Burned Patients: A Qualitative Inquiry

Elderly persons are at risk of experiencing burns and require support from both formal and informal caregivers. Informal caregiving in this situation has been minimally explored. Guided by the Stress Process Model, this study aimed at exploring the background, context, and stressors of informal caregivers of elderly burned persons during hospitalisation. A qualitative descriptive design was utilised. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalisation. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six sub-categories emerged which characterise the background, context, and stressors of informal caregiving to elderly burn patients. All the injuries occurred in the home setting and its sudden nature led to varied post-burn emotional responses which characterised the context of burns caregiving. Primary stressors that emerged were related to the injury, actual caregiving demand, and concerns regarding increasing frailty levels. Secondary stressors identified were financial concerns and lifestyle changes. The findings suggest that the occurrence of burn injury served as a precursor to post-burn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures and financial issues were key concerns which emphasise the need for psychosocial/ transitional support, innovative healthcare financing measures and continuing education on burns prevention in the home setting.

"Managing uncertainty": Experiences of family members of burn patients from injury occurrence to the end-of-life period

BACKGROUND

Although mortality rates associated with burns have decreased, there is still a significant number of persons who may not survive severe forms of the injury and thus, undergo comfort/end of life care. The experiences of family members of persons whose injuries are deemed unsurvivable remain minimally explored and there is a general lack of practice guidelines and recommendations to support them at the end-of-life period.

AIM

To explore the experiences of family members whose relatives died in the burn unit to inform the development of practice recommendations.

METHODS

Qualitative description was employed for this study. Convenience sampling was used to recruit 23 family members of injured persons who died in the burn unit. Face to face semi-structured interviews were conducted and followed up with telephone interviews. The interviews were audio-recorded, transcribed verbatim and thematic analysis performed inductively.

RESULTS

Three themes emerged: reactions following injury occurrence, navigating through the experience, and managing uncertainties about survival. The sudden nature of the injury led to feelings of self-blame, guilt, helplessness, and grief and these escalated at the end of life. As the family members journeyed through their uncertainties regarding the outcomes of care, they had a feeling of being a part of the patient's suffering. Family members received little professional support in coming to terms with their loss in the post-bereavement period.

CONCLUSIONS

Family members experience distress following the occurrence of burns and at the endof-life period. Practice recommendations should focus on communication, bereavement, and post-bereavement support.

Issues and concerns of family members of burn patients: A scoping review

INTRODUCTION

The issues and concerns that emerge in the families of burn patients have received minimal attention.

OBJECTIVE

To map out what is known about the challenges facing the family members of burn patients.

METHODS

The review followed the PRISMA Extension guidelines for scoping reviews and the review approach by Arksey and O'Malley to synthesize the available evidence. Twenty-six (26) papers from various database searches were identified and included in the review. The citation retrieval and retention methods are reported in a PRISMA statement.

RESULTS

Although most of the studies included parents (n=21), the evidence suggests that the shared concerns of family members include taking on new roles, and psychosocial and financial issues. Uniquely, parents had to endure blame, shame and guilt; partners/spouses were faced with difficulties in re-establishing an emotional connection with the patient; siblings simultaneously expressed jealousy and feelings of being outsiders; and children with a burn parent had to deal with feelings of exclusion from the care delivery process. Aside from these individuals, friends, neighbours and in-laws may also assume a caregiving role, with grandparents playing a supporting role. Family members are unprepared for their roles, as they are forced into them suddenly. Although distress may occur among family members, its determinants, severity, pattern and recovery process remain unclear.

CONCLUSION

A burn is a family injury that creates the need for family-centred care. Future studies need to explore the nature of psychological distress, family members' recovery pathways, and how family members can prepare for their roles in the period after discharge.

A concept analysis of burn care in nursing

BACKGROUND

Burn is a life-threatening injury that requires long-term treatment and concomitant hospital stay. Relevant clinical studies in burns have been accomplished and published in the literature. However, none of these studies reported the concept analysis of burn care in nursing. Therefore, analysing the concept of burn care acts as an imperative strategy to provide comprehensive management of burn injury.

OBJECTIVE

The study aims to describe the concept of burn care in nursing.

METHOD

Walker and Avant's method (2013) was used to achieve the objective of the study.

FINDINGS

A model of burn care in nursing was generated that consists of assessment and diagnosis, intervention and evaluation. In addition, the biopsychosocial model developed by George L. Engel (1977) was also integrated to examine how these aspects play a significant role in burn care.

CONCLUSION

Implementing the concept of burn care will improve the quality of nursing care, cosmetic outcomes and vice versa, reduce the comorbidities on burn injury.

The psychosocial complexities of acute burn patients in an Australian trauma hospital

INTRODUCTION

Psychosocial risk and protective factors specific to acute burn patients have been shown to impact on longer-term health outcomes. Yet the nature and impact of such factors throughout the acute hospital admission phase have not been extensively examined to date. This study analysed the psychosocial pre-admission, hospitalisation and discharge factors for a sample of burn patients at an Australian specialist acute burns unit (The Alfred) and the relationship with their admission length.

METHODS

A retrospective audit was undertaken of psychosocial factors documented in patient medical records, Victorian Adult Burns Service registry data, and social work files (January-December 2014).

RESULTS

Two hundred and forty-nine patients were identified, with a mean age of 42.83 years and a preponderance of men (73.9%). The majority (71%) had a low burn severity (<10%), and an average of eight psychosocial factors. Independent of the severity of the burn, two psychosocial domains were strongly predictive of length of stay - coping with treatment and discharge planning - along with pre-existing psychosocial factors and family support.

CONCLUSION

A diversity of psychosocial factors was identified, highlighting the clinical complexity of this patient group. Given three domains of admission-related psychosocial factors were predictive of the length of patient stay, more targeted psychosocial interventions in these areas may ensure patients and their families are supported more effectively throughout an admission, and length of stay costs may also be reduced.