Role of the nursing professional in the hospital
care of burn patients
Rol del profesional de enfermería en la
atención hospitalaria de pacientes con quemaduras
Alina Rosa Soria-Acosta
ua.alinasoria@uniandes.edu.ec
Universidad Regional Autónoma de Los Andes. UNIANDES, Ambato – Ecuador.
https://orcid.org/0000-0002-7870-1582
ABSTRACT
The
objective of the research work is to examine the role of the nursing
professional in the hospital care of burn patients. It consisted of a
descriptive documentary work with bibliographic design, applying a
bibliographic review of the information. Sepsis is the main cause of death in
burn patients. Interventions are challenging due to the lack of specific
guidelines. All types of burns involve a risk of complications. The main needs
associated with the behavioral state are those related to feeding, rest and
communication, the same needs for which interventions have been established to
reduce problems such as lack of appetite, insomnia and communication problems
in general, interventions that are oriented to a professional and humanitarian
behavior that will benefit the patient's recovery.
Descriptors: clinical
medicine; health
services; nursing. (Source: UNESCO Thesaurus).
RESUMEN
El trabajo investigativo tiene por objetivo examinar
el rol del profesional de enfermería en la atención hospitalaria de pacientes
con quemaduras. Consistió en un trabajo descriptivo documental con diseño
bibliográfico, aplicándose una revisión bibliográfica de la información. La sepsis es la principal causa de muerte en pacientes quemados. Las
intervenciones son desafiantes debido a la falta de pautas
específicas. Todos los tipos de quemaduras implican un riesgo de
complicaciones. Las principales necesidades asociadas al estado
comportamental como son las referentes a la alimentación, descanso, y a la
comunicación, mismas necesidades ante las cuales se han establecido
intervenciones direccionadas a disminuir los problemas como inapetencia,
insomnio y en general los problemas de comunicación, intervenciones que se
orientas a un comportamiento profesional y humanitarias que beneficiaran a la
recuperación del paciente.
Descriptores: medicina
clínica; servicio de salud; servicio de enfermería. (Fuente: Tesauro UNESCO).
Research articles section
INTRODUCTION
The term burn refers to the alteration or
deterioration of the integrity of a tissue produced by an external causal agent
among which are mentioned heat, chemical substances, radiation, sun and
friction; mention is made of the time of exposure to these agents. Among the
other characteristics to take into account are the anatomical area exposed, the
extension and depth, and the temperature of the causal agent, all of which
together condition the evolution and the conduct to be adopted (Ramírez-Meza et
al. 2021).
The American Burn Association (ABA) reports that the
distribution of burn patients is mainly men and children (68%). The main
etiologies of injury include fire (43 %), scalds (34 %), contact (9 %),
chemical (7 %) and electrical (3 %).
Statistically, events are estimated to occur in the home (78 %),
recreational environments (9 %), occupational (8 %) and vehicular (5 %).
Regarding mortality, important data shows that worldwide burns cause
approximately 265,000 deaths each year. And it places burns among the 10
leading causes of death for all age groups. In a June 2021 study, it is
estimated that, in the United States, there are more than 200 patients per year
with burn injuries distributed in 130 specialized centers (Carey et al. 2021),
(Barrera-Magaña, 2017).
It is possible to verify the intervention performed,
according to previous clinical case studies: that the adequate establishment of
a nursing care plan, after the initial assessment, supported by the realization
of nursing diagnoses through the NANDA (North American Nursing Diagnosis
Association) and at the same time that the care that will be provided to the
patient should be planned taking into account the specificity of the case in
individualizing it, emphasizing the priorities, and visualizing the expected
results, through the NOC (Nursing Outcomes Classification). It is worth mentioning the importance of
taking into consideration the interventions to be performed to achieve the
outcomes, through the NICs (Nursing Interventions Classification) (Kornhaber et al. 2019), (Bayuo et
al. 2019).
The Contemporary Burn Survival study of 2018, reports
how the reduction in mortality, in burn patients, which can be attributed to
the various modifications and evolution of standard protocols of care in the
burn center, which has made it possible to improve the outlook for burned
persons, taking into account protocols for the management of inhalation
injuries, nutrition, resuscitation, and other therapeutic measures such as
early excision and grafting, per-surgical care of them, behaviors in which the
nursing staff gives a sustained contribution (Capek et al. 2018).
For such reason, it is considered that the
intervention of nursing professionals is one of the fundamental tools in the
multidisciplinary management of the burn patient. With it facilitated the
development of individualized plans for the management of each patient,
detecting the main needs. It is worth mentioning that infections of burn
injuries are one of the main causes of morbidity and mortality in burn
patients. Therefore, it is considered very useful to standardize patient care
in order to act in the best possible way and avoid such complications (Vinaik
et al. 2020).
The aim of this research is to examine the role of the
nursing professional in the hospital care of burn patients.
METHOD
The research work consisted of
a descriptive documentary work with bibliographic design, applying a
bibliographic review of the information, from which the synthesis of the most
relevant information is elaborated, in a population of 18 scientific articles,
located in at least one of the following databases: Scopus, Scielo, WOS,
Redalyc, PubMed, Lilacs, Latindex 2.0.
This review will include all
articles in which burn patients are included, in both sexes and without
distinction of race, ethnicity or age groups. In addition, articles that do not
appear in the mentioned databases, undergraduate theses and articles from
non-indexed information sources such as newspapers, interviews, etc. will be
excluded. All patients with diagnoses other than burns will be excluded from
this article.
ANALYSIS OF RESULTS
Regarding the initial care, the analysis has focused
on observing the action approach as nursing staff emphasizing:
Therefore; the premise of developing an
individualized approach in the burn patient in order to improve care in
patients of older age group is manifested, it mentions in the same way that the
risk of mortality simply increases with age, so that even small burns can cause
worse outcomes along the axis of aging, so that age correlates negatively with
outcome (Jeschke et al. 2016).
As a mention to keep in mind that burn patients need
preferential hospital care, for children under 1 year, 1 to 2 years with
involvement in more than 5% of the SCT, burns in special anatomical areas such
as face, hands, feet, genitalia, perineum or large joints, electrical burns,
chemical, inhalation in burns by fire or hot liquids, circumferential burns on
the limbs or thorax, with simultaneous trauma, injuries with contaminated, or
patients in need of therapeutic measures that exceed the capacity of the health
unit, in order to avoid associated complications (Culleiton
& Simon, et al. 2014).
For an initial assessment of the burned patient, the
body surface area affected (TBSA) is estimated, for which the nursing staff
must be able to perform an accurate assessment to estimate the TBSA burned, for
which there are numerous resources such as: the "rule of nines", Lund
and Browder Charts, and palmar surface area (PSA), however referring to the
percentage of involvement, when taking into account that The percentage of PSA
in relation to TBSA decreases as the BMI increases (Butz et al. 2015).
Sepsis is the leading cause of death in burn
patients. Interventions are challenging due to the lack of specific guidelines.
All types of burns carry a risk of complications. Interventions should include
burn care, administration of medications, ongoing monitoring for the
development of infections, infection prevention measures, and (if necessary) treatment
of sepsis. Sepsis in burn patients is different from the non-burn population.
Efforts are needed to develop more accurate diagnostic strategies and
guidelines to trigger prompt treatment through sepsis-specific bundles
(Manning, 2018).
Infection is the most common complication after
severe burns and has a propensity to progress to sepsis, then septic shock and
multiorgan dysfunction syndrome (MODS). Improved outcomes in acute burn care
depend on early detection of infection to allow rapid interventions. The
diagnosis of sepsis in severe burns is especially challenging because typical
clinical signs are masked by the hypermetabolic state and systemic inflammation
induced by the burn itself. Although gold standard methods for early detection
of sepsis in burn patients have not yet been identified, a better understanding
and proper application of available diagnostic criteria and assays are critical
to providing effective care for patients with severe burns (Torres et al.
2021).
Regarding the hospitalized patient and systematized
nursing care, the evidence shows us the different approaches to be taken into
account which are mentioned: The need for an adequate documentation system for
nurses is shown, hence the focus and importance of NANDA. Because the study
shows that as nursing staff, care is focused on the needs of physicians, the
needs of patients are not evaluated, which was determined by observing the
records themselves that are focused on the basis of the procedures that
physicians have requested. It also shows the lack of training in this regard,
which clarifies the picture of an important field in the growth of our
intervention in the area of burn patients (Khajehgoodari
et al. 2020).
The main nursing diagnoses for burn patients:
impaired gas exchange and ineffective respiration, as a nursing care measure,
the focus is on maintaining a permeable airway, adequate oxygenation,
aspiration of secretions, and/or observation of tissue filling; deficient fluid
volume, adequate fluid replacement, control of excreta intake and monitoring of
tissue perfusion are performed as interventions (Lima et al. 2013). Regarding the risk of infections, periodic
cures are standardized with asepsis and antisepsis techniques and preventive
therapeutic isolation. In relation to pain support, administer prescribed
analgesics, position changes, adequately moisturize exposed areas; assist
patients to avoid mobility impairment with position changes and elevation of
strict body surfaces if necessary. Establishing a diagnosis is of utmost
importance. So it is necessary to re-establish the steps of and recording of
the nursing process (Lima et al. 2013).
Burn injuries in children can have a significant
psychosocial impact on parents. However, the stress involved in caring for a
child after a burn can often go unnoticed and does not necessarily cause
parents to seek help (Heath et al. 2019). Knowledge of past trauma can help
identify a vulnerable population to ensure successful burn recovery. The ACE
burden of parents of burned children may affect the ACE burden of their
children. Burned children with more ACE tend to have significantly more needs
and more family distress. Knowledge of past trauma can help identify a
vulnerable population to ensure successful burn recovery (Ong et al. 2021).
In children, effective first aid for burns will
minimize burn progression and alleviate pain. Proper wound care will promote
optimal healing and enhance favorable outcomes. Although a minor burn may not
meet initial referral criteria for transfer to a specialized burn center,
primary care physicians are encouraged to refer if there are any concerns
regarding wound healing, pain management, or scarring, or if management advice
is required (Tran et al. 2019).
CONCLUSION
The main needs associated with the behavioral state
are those related to feeding, rest and communication, the same needs for which
interventions have been established to reduce problems such as lack of
appetite, insomnia and communication problems in general, interventions that
are oriented to a professional and humane behavior that will benefit the
patient's recovery. The disjunctive of all these interventions is aimed at
reducing complications, the main ones being, as mentioned in the bibliographic
support, infections and sepsis.
FINANCING
Non-monetary
CONFLICT
OF INTEREST
There
is no conflict of interest with persons or institutions related to the
research.
ACKNOWLEDGMENTS
To the
Universidad Regional Autónoma de Los Andes. UNIANDES, Ambato - Ecuador.
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