Healing from burn injuries psychologically

Psychological aspects of burn care

Patients enter the recovery phase of their hospital care once their survival is assured and they are no longer facing life-saving surgeries, nor need to be in intensive care.

This phase typically encompasses the noncritical remainder of the acute hospitalization and is characterized by intensive physical and occupational therapy, fewer smaller surgical procedures, and a growing awareness of the injuries impact and long-term implications.

Patients often become depressed, and up to 30% experience symptoms of posttraumatic stress disorder PTSD.

In addition to the physical damage, burn victims have also suffered psychological damage. Severe burns almost always occur in sudden and frightening situations, like an explosion or an auto accident. The unexpected trauma, the person’s helplessness, and the enduring pain that makes the events impossible to forget are conditions that give rise to PTSD, Post Traumatic Stress Disorder. During the phase of in hospital care upwards of 30 per cent of burn injury patients show symptoms of PTSD such as flashbacks, hypervigilance and hyperarousal, fearfulness, and sleep disturbances. Medication and individual counseling can be very helpful with these painful symptoms.

Healing and rehabilitation

Once a burn injury patient’s condition is no longer critical, the patient will still require a long period of hospital care. Successful treatment of burns requires continuously preventing infection, dealing with infection as it occurs, and continued treatment of wounds, supporting the growth of new tissue while suppressing the formation of scar tissue as much as possible.

In burn care, the patient's attitude and motivation are two of the most powerful factors influencing recovery rehabilitation. Many burn experts weight these two elements as more important than the specific physical injury.

This is the phase in treatment in which the patient and family begin to take the full measure of the burn injuries, the surgeries and rehabilitation required, and the implications for the patient’s life. To be successful the rehab program must set realistic goals, and the injured patient and family members must be part of the treatment planning.

Coming to terms with their injuries and doing the physically and emotionally demanding work of physical and occupational therapy makes this part of treatment very taxing both for the patient and the therapists. Setting the appropriate pace, demanding enough to keep up with the healing process and necessary surgical procedures, yet not so aggressive as to be too painful or discouraging, requires continued fine-tuning between patient and therapist. Both children and adults appreciate a predictable daily schedule, and regular meetings to discuss progress. The appropriate use of pain and anti-anxiety medications, gentle encouragement and patience, and a respect for the patient’s individual needs and responses are essential elements in a successful rehabilitation program.

Prior to hospital discharge, a burn survivor should be able to stand, to move around, and to feed and toilet himself.

Going home

Many burn survivors say that the first year to eighteen months after leaving the hospital is the most difficult time of their recovery. They must adjust to their new limitations and needs at home and at work or school. If they have PTSD, the symptoms may continue. Many patients experience significant depression. They are likely to still be working at their rehabilitation, with goals of maintaining and extending range of motion and building strength. They may also be facing reconstructive surgeries and scar management.

A support group of other burn survivors can be invaluable. People who have been there, and lived through what the new survivor is experiencing, can help the new survivor believe that recovery is possible and that the future is worth working for. Many survivors also make use of psychotherapy to help them deal with the challenges of this period.