Introduction

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 stage

The 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.

With the increased survival of patients with large burns, there is increased focus on the psychological challenges and recovery that such patients must face

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.