Burns and nursing care

Introduction:

Family centered care is a concept which developed in the countries that  have economic advantages. The great social awareness lead to it as it has main focus on the needs of children as both developmental and psychological needs have to meet and on the family role in improving their children wellbeing and health. (Massimo et al. 2009) Children almost all of them are liable to be burnt as during everyday activities, children could be burnt. Burns injury includes those resulting from fires, chemicals, scalds, radiation, hot things and electricity. The most common burns are scald ones resulting from hot tubes, hot food or drinks as it mostly happen in children under five years old. Burns resulting from fire occur more in older children. Most burns are not very big and fortunately, they are spontaneously cured and can be well dealt with by the general pediatric practitioner in outpatient settings. Yet there are also some big burns that may need long term sequelaes and have infections, for example, scarring is. This makes it essential for providers to learn well burn management and treatment so as to reduce the dangers of their adverse outcomes. (Katrina et al 2013) During changing the dressings, burns nursing staff invite members of patients' families to attend dressing change which is a step to check how far it is useful for plan of care of the patient to bring families to be present and to see if this increases communication and education regarding the plan of care of the patients and if it raises the readiness of patients for discharge and raises their satisfaction. (Sundara 2011; Pieper et al 2007) This assignment presents a discussion for family centered nursing care as a definition as well as children burns, types, causes, trends and burns risk factors. The assignment explains how children and their families are affected by the burns' bio psychosocial impact and presents an evaluation for family centered  care as a positive model for burnt children care.     

A burn could be defined as an injury in any tissue mainly occur due to heat, electricity, radioactivity, friction, radiation or chemicals. (WHO 2012). Smeltzer and others (2010) suggest that burns happen when there is a transferring for heat from a place to another. Protein denaturation, coagulation or cellular contents ionization can cause tissue destruction that includes upper airways mucosa and skin. Damage can occur in deep tissues as viscera due to contacting deeply with heat or by electrical burns. There are results from skin disruption as infections, scarring, hypothermia, changes in body image, functions and looking besides compromised immunity. To define nursing care, it could be said as those medications or procedure that are prepared for presenting comfort to the patients and relieving their pains, distress and any symptoms, it also refer to what is included of hydration and oral nutrition. .(Schantz 2007) Family centred care was defined by Shields and others (2006) as a method for providing children with care as well as their families via services of health that prepare care plans that include the family as care recipients and not only the person or the child. (Shields et al 2006, p.1318)          

Explore in depth the risk factors for, developmental trends and causes of burns in children nationally and internationally.

Burn injuries patterns may differ in various communities according to different factors such as gender, age, sex, local customs, incomes and circumistances whether environmental or social as they affect them. (Al-Shehri 2008). Burns in childhood are preventable by the percentage of 90%. There are underlying problems as overcrowding, informal housing and having no electricity. Contact burns, flames, electrical, chemicals, hot liquid burns and hot tubes are the most common causes of children burns with various frequencies and the most frequent being burnt are toddlers and infants. (Niekerk et  al 2006) At homes the danger of burns increases by some hazards. A safe home environment is important which could be available by aware parents. Of these hazards are ovens, hot liquids, hot taps, lighters, matches, fires, chemical outlets and electricity or drinking hot drinks. There is a higher risk at homes of smokers, alcoholics and drug takers. 28% of the fires that cause death refers to cigarettes. Alcohol causes about 23.24% as a helping facto of minor burn injury as in WA prospective review in addition to a percentage of 44% related death rates. Another risk factor for burns is kinds of open fires. More burns are caused due to campfire ashes and coals which are still hot more than open flame fires. Children aged under five years are more liable to burns due to environmental hazards they are not well acquainted with. (Rea and Wood 2005; Edelman 2007) The mean age in Saudi Arabia was 5.97 with a ratio of 1.5:1 male to female. Scalding was the most common of causes as rated(81.7%). There are about 92.8% of the patients were injured by burns with 25% burnt on all the body skin. Toddlers are more liable to be burnt by scald burns. (Gari et al 2012) Children under five global burns are about quarter to half of the total of burns visiting burn centres. Most burns in children happen as home accidents a the most kind in young children is scalds. (Tarim et al. 2005). As hot water is the main cause for such scalds, there are also some caused by other hot liquids. Burns resulting from household appliances as stoves, hot ovens, open fires and irons are also frequent in children. Electrical devices as cords, electric machines, plugs and outlets also cause burns to young children.   (Ramakrishnan et al. 2005).Type of burns is affected by the child developmental progress between 0-15 age on the physical and neurogical levels and also there is an effect made by the ability of a child to protect himself or herself. (Robert et al. 2007).

Provide a very brief overview of the types of burns.

Classifying burns into types depends on the depth of the burn as well as the space affected. The affected area of the body is referred to as (%TBSA) ranging from <1% to 100%. A chart is usually used to estimate how far the pediatric burnt area is extended and it is based on Lund and Browder diagram as it makes compensation for the changes in the proportions of the body as being commensurate with growth. (Lee and Herndon 2007). As burns calculated with size 06e in small places, the rule used is the palm of the child with fingers state for 1% of all surface of the body. As to the burn depth, it depends on the affected skin layer. There are two layers in the skin which are epidermis and dermis. (Sheridan and Thompkins 2007). It could be referred to the dermal layer in further classification as papillary dermis(upper) and the (lower layer) reticular dermis. The traditional classification for burns is as degrees first, second and third as burns could be superficial, partially thick or fully thick. When burns affect the underlying tissues as muscles they are called fourth degree ones. (Bessy 2007; Greenhalgh 2007).

Analyze the bio-psychosocial impact of burns on children and their families.

Severe pains are very painful than all injuries and it is horrible to see a burnt child. The limitations on the survivors of paediatric burns on quality of life on the long seem affecting social relating more than affecting functions. Results qualitative synthesis stated that prevalence was in anxiety of child, behavioural problems and stress reactions in the months following the burning. Parents were found to have guilt feelings, depression and posttraumatic stress with high rates. There are studies to suggest there are psychological long term problems in children as social difficulties, anxiety, depression and social functioning difficulties. These cross sectional studies found little evidence on the relation between burns and problems as low self estimation, behavioural problems or body image change. Studies regarding family outcomes on long term suggest parents' substantial subgroups have psychological problems. The factors that were reported as most consistent were the Child peritraumatic ones as pain, anxiety  and psychological reactions and the most reported factors as consistent were family functioning as connected with outcomes of child. Studies which are more recent suggested that there may be an indirect effect of burn severity on the psychological outcomes of the injured child. Reviewed studies limitations, methodological strengths and clinical implications were discussed as well as the future research directions. (Phillips et al 2007; Blakeney et al 2008; De Sousa 2010; Bakker et al 2013). Many studies say that the image of the body has many dimensions as self perception and thinking of how others see one's appearance. There is integration for one's strength beliefs, sexuality, physical sensation, movements, facial expressions and physical boundaries. There may be alterations in burns survivors in all previous areas. All children experience body image developmental stage effects which occurs in burnt children too. Clinical observations are the basis for literature on burnt children body image as well as scant empirical data. Studies results show how difficult it was to assess body image of burnt children. Among children who are not in clinics , social anxiety is a very important factor affecting social and emotional functioning. Rejected children are having more anxiety than the accepted ones among peers. Children who are rejected have lower self esteem and higher anxiety than the socially accepted ones. (Bakker et al 2013; Nitescu et al 2012; Moi et al 2008)

Consider also the emotional impact on the nurse when caring for a child with burns.

In nurses there is a group of emotions associating nursing practice and they are affected by how nurses can meet the needs of patients. Nurses who have a sense of wellbeing are able to relieve patients' pain and be positive in sharing in care. Hilliard and O'Neill (2010) suggests that the emotional response of nurses towards patients could have an effect on the nursing practice they have. Among children injuries, burns are of the most distressing ones. It is a challenge when nurses care for burnt children and their families with all emotions they suffer as anxious, depression, pain and disfigurement. There are intensive procedures to be practiced by nurses in burn units and they could be painful as changing wounds dressing and debridement of wounds. It is noticed in literature that nurses suffer emotionally when they could not help patients well. Feelings of guilt, helplessness, anger and stress are expressed by nurses being unable to aid patients with pain and stop their pain. Nurses have to manage their emotions and control them as they do not have to suffer long term negative effects of their work in challenging situations and be stressed and anxious. The emotional impact of burns on nurses have been discussed in few studies. (Hilliard and O'Neill 2010) Although nurses expressed the negative emotions they suffered, they also expressed positive ones as being satisfied and happy when relieving a patient's pain and providing aid to a person feeling pains. Yet literature existing state only negative emotions that nurses suffer. Comfort was expressed by participants due to the positive emotions that helped children be better with nurses knowledge about managing pain and stopped the suffering from emotional challenges associating the job. Nurses satisfaction is expressed when patients have positive outcomes because nurses see the results on their patients who reached best expectations. (Archibald 2006; Camhi and Cohn 2007) Nurses working in busy work environments suffered limitations in their ability to help children emotionally which is a difficult situation to accept. Parents also need emotional aids from nurses as well as children in hospitals as today care considers parents as part of the care process as partners. (Coyne 2008; Gustafsson et al 2009). Parents' care for their children needs to be compromised if nurses time was not enough to provide them with the required emotional care. Board (2005) stated that children in hospitals were comforted with having a chance to talk with nurses and this made their hospital experience a better one that helped them get rid of anxiety. Livesley (2005) states that the word 'stepback' used as a metaphor (p158) refers to nurses hiding their feelings from children as a way to control their emotions to let children be relaxed. This step-back helped nurses to be away from anxiety and stress and it is better than decreasing being more sensitive with children and this helped them provide aid better to children. (Sahraian et al 2008)

Evaluate the family centered model of care as a positive approach in caring for children with burns.

Since along time, patient focused care was a part of nursing but it is recent to learn how important is the role of families in providing their children with care they need. To define family centered care, it could be referred to as an approach which is innovative towards healthcare planning, delivery and evaluation. It could be shared within many partners such as patients of the healthcare, providers and patients' families. Patients and families health care can be applied on all aged patients and could be performed in any health care system. There is few data regarding the interventions of the family centered care of burnt children although there are many practices adopted many years ago to improve the family centered health care as palliative care, pediatric critical care units and children units. Critical care patients' families need good opportunities for communications and proximity to patients with the medical team as well as with nurses. Family needs or some of them may be met by involving them into the health care program .   (Bishop et al 2013), Sproul et al (2009) found that 87.8%  of  patients with burns stated that the support of their families was very important and helped them recover sooner. Risk of psychological problems on the long term can also be reduced by family assist as financial problems, posttraumatic stress disorders, depression and anxiety that affect burn survivors. . (Wu et al 2009; Park et al 2008; Wallis et al 2006) The concept of participation is mainly met by applying the family centered care as a model which occurs when families attend time of dressing changing so as to be a chance for families education on care in a burns unit. (Bishop et al 2013) When potential changes are discussed in units, apprehension was expressed by both nurses and physicians as being seen and watched while changing dressings. There were many concerning voices about giving interest to giving families the opportunity to watch dressing changing. These concerning voices raised the interests of leader nurses to tell all nursing staff about the vitality of educating both patients and their families which helps in having better patients outcomes. There must be addressing for patients and families different needs as patents' spiritual and emotional needs. This addressing includes a collection of interventions by a team of specialists to provide the patient and the family with the proper education. There must be further investigations for burn patients discharge preparation.  (Sundara 2011; Sproul et al 2009; Farrell et al 2006; Pieper et al 2007) Difficulties and benefits are probable to occur associating the family centered care provision as how much the patient's family is seen in responsibility of the care of their child. In some cases, there were interpretations for family centered care as if it was a care practiced by parents as if they were a child care experts and getting advice from the health provider just as consultant. Families feel they are the most  responsible yet they have great expectations. Both planned or unplanned children hospitalization is tiring and stressful for families whatever functional and organized they were. Stress may affect both families and providers when there is an adjustment in each one's roles. Studies suggest educating families more and providing them with required information can reduce stress levels. Yet, involving families can lead to extra stress and anxiety which could be on short terms at least on both family and child. Parents' expectations may go far beyond reality of the care they could present to their children or they are not ready to hear some specific information regarding their child case.  (Zhou et al 2012; Shields et al 2012; Shields et al 2006)

Conclusion

Family centered care is a recent expression that refers to involving families into the health care process to improve the patient's status and assisting their patient while being in hospital and after that. Burn injuries include those injuries occurring due to open fires or at home accidents as resulting from hot liquids, stoves, hot irons, chemicals or electricity.  A burn is an injury in body's skin or tissue and it has three degrees and the fourth when the burn hurts deep muscles. A burn occurs in children in environments that are not safe enough so parents need to be well educated about how to protect their children and how to manage burns. Types of burns differ according to many factors as gender, age, economical level or the environment itself. Children burns are very severe in pains and in changing the body image. The psychological effects of burns can be depression, social withdrawing, anxiety or other psychological problems. There must be care given by nurses to children burnt but nurses have to be aware of how to control their emotions in the interventions as some nurses feel guilt or dissatisfaction by their work when losing the ability to relieve patients' pains. Families need to be well educated about how to be part of the family centered care model by being present in nursing practices as changing dressings. Families' emotions and psychological reactions also should be cared by nurses so as not to affect the injured patients on the long term. The family centered care model is a successful positive model as applied on the children with burns and their families. Responsibility should not be all on families but roles must be well divided on patients, families and care providers. Future researches and studies are suggested as literature is not enough regarding family centered care model.