Psychosocial aspects of burn injuries

Abstract

With the increased survival of patients with large burns comes a new focus on the psychological challenges and recovery that such patients must face.Most burn centres employ social workers, vocational counsellors, and psychologists as part of the multidisciplinary burn team.Physiological recovery of burn patients is seen as a continual process divided into three stages-resuscitative or critical, acute, and long term rehabilitation.The psychological needs of burn patients differ at each stage. Resuscitative or critical stageThe psychological characteristics of this stage include stressors of the intensive care environment, uncertainty about outcome, and a struggle for survival.The intensive care environment can be both overstimulating and understimulating with the monotony of lying in a hospital bed for weeks.Cognitive changes such as extreme drowsiness, confusion, and disorientation are common during this phase.More severe cognitive changes such as delirium and brief psychotic reactions also occur, usually as a result of infections, alcohol withdrawal, metabolic complications, or high doses of drugs.Patients may also be intubated, which greatly limits direct communication. TreatmentIn depth psychological intervention is of minimal value at this phase, since physical survival is the primary goal.Patients should be encouraged to cope with the frighteningly unusual circumstances of the intensive care unit through whatever defences are available to them, even primitive strategies such as denial and repression.Supportive psychological interventions should focus on immediate concerns, such as sleep, pain control, and protecting patients' coping strategies.Non{pharmacological approaches to pain control, such as hypnosis and relaxation, can be effective.Medical staff can also effectively intervene during this early stage of recovery by working with a patient's family members.Family members may be anxious and distressed while observing the patient undergo treatment, which fosters the same response in the patient.It is important to help family members understand this effect and help them to convey a sense of hope and calmness to the patient.