Clinical Review ABC of burns

Psychosocial aspects of burn injuries

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7462.391 (Published 12 August 2004) Cite this as: BMJ 2004;329:391
  1. Shelley A Wiechman,
  2. David R Patterson

    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.


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    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.

    Treatment

    In 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.

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    Psychological characteristics of critical stage of recovery from a burn

    Medical staff can also effectively intervene during this early stage of recovery by working with a patient's family members. …

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