Nursing management of the burn-injured person

Introduction

Providing care to the burn-injured patient is a very challenging and, ultimately, rewarding profession for a nurse. The repertoire of skills needed is varied and includes comprehensive clinical assessment and monitoring, pain management, wound care and psychosocial support. The burn nurse cares for the burn survivor throughout the continuum of care, from entry into the hospital through to discharge home and reintegration into the community.

Further research into the practice of burn nursing is crucial to identify new knowledge to guide best practices. This chapter is written to assist the nurse in providing comprehensive care to the burn-injured person and his/her family.

General definition and description

Incidence

Each year, an estimated 500,000 people seek care for burns in the United States and approximately 40,000 require hospitalization, greater than half of whom require care in specialized burn units or centres [1,2]. Of those requiring hospital care, about 4500 die from their injuries. In Canada, about 50,000 people are injured and an estimated 4,000 are hospitalized, of whom about 450 die from their injuries. In both

Marc G. Jeschke et al. (eds.), Handbook of Burns

countries, children 4 years of age and younger and adults over the age of 55, about two-thirds of the total, form the largest group of fatalities.

Prevention

Many burn injuries can be prevented and nurses have the opportunity to serve as advocates and educators in the area of burn and fire prevention. Worldwide, there has been a slow but steady decrease in the number of burns occurring annually. The focus of burn prevention programs has shifted from concentrating on individual blame and changing individual behaviours to include more legislative changes. There are several factors considered responsible for the steady decline in incidence. One factor is the raising of public awareness through fire department and burn centre-initiated burn education and fire prevention programs (Burn Awareness Week in February and Fire Prevention Week in October). Pamphlets and posters continue to be widely distributed though community mall displays, doctors’ offices, public health departments, day care facilities and schools. Another factor involves those attempts aimed at having a positive impact upon government legislation for items, such as safe temperature levels for hot water heaters, childrens’ flame-retardant sleepwear, self-extinguishing cigarettes and “child-proof” cigarette lighters. There is also increased awareness and use of fire sprinklers,

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along with smoke and carbon monoxide detectors. Safer new home construction and stricter workplace safety standards are additional factors contributing to the decrease in burn injuries.

Classification

Burn complexity can range from a relatively minor, uncomplicated injury to a life-threatening, multisystem trauma. The American Burn Association (ABA) has a useful classification system that rates burn injury magnitude from minor to moderate uncomplicated to major (Table 1). This system takes into account the depth and extent of the injury, the location of the burns on the body and the person’s overall medical history. With advances in burn care over the years and the establishment of specialized facilities staffed by skilled, multidisciplinary burn team members, more patients with severe injuries are surviving. However, survival is no longer enough. The ultimate challenge for the burn team is to support and guide the burned person and his/her family towards a complete and acceptable level of recovery, both physically and psychosocially.

Etiology and risk factors

The causes of burn injuries are numerous and found in both the home, leisure and workplace settings (Table 2). At home, people are most frequently

burned in the kitchen and bathroom, while involved in activities such as cooking, bathing or smoking. Campfires, trailers and boats serve as recreational sources for burn injuries, while industrial settings are common sites for workplace injuries, involving electricity, chemicals and explosions.

Burn injuries occur throughout the world, but predominantly to women in the developing world,

Table 2. Causes of burn injuries