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 who sustained 55% TBSA (Total Body Surface Area) burns to his face, chest, right upper extremity (RUE) and right lower extremity (RLE) in a house fire two days ago. His burns are a mix of superficial, partial and full thickness. He also has additional 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, smoking one pack of cigarettes per day.

Social History

Olekasander normally lives with his wife and two children. However, his family were not home during the fire as they are currently living out of the country. Olekasander 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 is currently staying with Oleksandr in the hospital.

Family Involvement in the Patient's Care

During Oleksandr's physical therapy sessions in the hospital, the physical therapist is able to show Oleksandr's brother his stretching programme and how to assist Oleksandr with basic mobility tasks, such as getting in and out of bed, transferring from sitting to standing, and walking with a walker. Once a week, A Facetime call with Oleksandr's family, including his children, is incorporated into a therapy session, so that Oleksandr can show them what he was doing in his sessions. These sessions also mean that Oleksandr can receive support and encouragement from his family.  

Since Oleksandr's family is currently out of the country, they have limited access to psychological support outside of the friends they are living with and the support they receive from the rehabilitation team. During therapy sessions, the physical therapist is able to provide basic psychological first aid to his family.

Oleksandr has access to a psychologist weekly. The psychologist can also sometimes be present during difficult physical therapy sessions to help provide psychological support for Oleksandr.

Discharge Considerations

When Oleksandr is ready for discharged, he is discharged to his brother's home. Community members have helped modify his brother's home, so it now has an accessible entrance with a ramp and a first-floor set-up for Oleksandr to live in. This has made it easy for Oleksandr to navigate his environment.

Caregiver Training

Oleksandr's brother is now Oleksandr's 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 programme
• 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.