Psychosocial Considerations for a Patient with Burn Injuries Case Discussion

Original Editor - Lilly Webster

Top Contributors - Ewa Jaraczewska and Jess Bell  

Patient Presentation

Patient's Present and Past Medical History

Oleksandr is a 40-year-old male involved in a house fire two days ago. He sustained 55% TBSA (Total Body Surface Area) burns to his face, chest, right upper extremity (RUE) and right lower extremity (RLE).  His burns are a mix of superficial, partial and full thickness. He also has findings of soot around his nares and mouth. Oleksandr was initially treated at his local hospital and then transferred to a regional burn centre that is 100 kilometres from his home.

Oleksander's past medical history includes type II diabetes, which is currently well controlled, depression and daily tobacco use. The patient smoked one pack of cigarettes a day.

Social History

Olekasander lives with his wife and 2 children, who were not home during the fire and are living out of the country. He works as an electrician. His house was destroyed in the fire and is no longer inhabitable. His brother lives 100 kilometres from the regional burn centre but stays with Oleksandr in the hospital.

Family Involvement in Patient's Care

Part of Oleksandr's sessions within the hospital included the physical therapist showing his brother Oleksandr's stretching program and how to assist Oleksandr with his basic mobility tasks such as getting in and out of bed, going from sitting to standing, and walking with the walker. Once a week, a Facetime session with his family, including his children, was incorporated into a therapy session so that Oleksandr could show them what he was doing in his sessions and he could have support and encouragement from them.  

Since his family was out of the country, they had limited psychological support outside of the friends they were living with and the support they received from the rehabilitation team. During therapy sessions, the physical therapist was able to provide basic psychological first aid to his family. Oleksandr had access to a psychologist weekly, and as needed, the psychologist would sometimes be present during difficult physical therapy sessions to help provide psychological support for Oleksandr.

Discharge Considerations

Oleksandr was discharged to his brother's home. His brother was able to have community members modify the home to have an accessible entrance with a ramp and create a first-floor set-up for Oleksandr to live in to make navigating his environment easy for him.

Caregiver Training

Oleksandr's brother was his primary caregiver. Before leaving the hospital, Oleksandr's brother was provided caregiver training on the following:

• providing physical assistance for all basic mobility tasks  and activities of daily living
• basic wound care including changing dressings and wrapping with compression where appropriate
• how to assist Oleksandr with his stretching program
• signs and symptoms of infection and other indications to return to the hospital

From a physical therapy perspective, the highest priority for caregiver training was how to assist Oleksandr with his basic mobility to continue to make functional gains and improve his independence with mobility and activities of daily living.

Resources

• Shokre ES, Mohammed SEM., Elhapashy HMM, Elsharkawy NB, Ramadan OME, Abdelaziz EM. The effectiveness of the psychosocial empowerment program in early adjustment among adult burn survivors. BMC Nurs 2024; 23(45 ).
• Woolard A, Bullman I, Allahham A, Long T, Milroy H, Wood F, Martin L. Resilience and Posttraumatic Growth after Burn: A Review of Barriers, Enablers, and Interventions to Improve Psychological Recovery. European Burn Journal. 2022; 3(1):89-121.