Liaison Psychiatric Nursing Intervention for Psychosocial Adjustment of Patients with Burns

Abstract

Severe burn injuries are devastating, sudden and unpredictable forms of trauma that may affect the victim both physically and psychologically. The psychosocial difficulties may include problems managing pain, itching and discomfort; problems with post-traumatic stress; mental health difficulties; grief and loss issues; and body image and sexuality issues. Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry deals with the interface between physical and psychological health. Therefore, it could be of major help to burn patients. This study was aimed at developing a liaison psychiatric nursing intervention for psychosocial adjustment of patients with burns. It was hypothesized that a liaison psychiatric nursing intervention will have a positive effect on the psychosocial adjustment of these patients. This quasi-experimental study was conducted at the outpatient clinic of burns, at El-Demerdash Hospital affiliated to Ain Shams University. It included a consecutive sample of 50 patients with burn regardless the type or stage of burns. Data were collected using an interview questionnaire form, and the coping with Burns Questionnaire. The study intervention consisted of a liaison psychiatric nursing program for psychosocial adjustment of patients with burns developed by the researcher to help the burned patients in meeting their psychosocial needs, and accordingly they can adjust their psychosocial patterns. It was implemented in 16 sessions. Upon completion of the intervention program, the posttest was done using the same pretest tools. The study was carried out from June to September 2013. The main study findings were as follows.  The study sample consisted of 49 adult burn patients (one patient died), mostly males (61.2%), with preparatory/ secondary education (61.2%), and having sufficient income (55.1%).  The duration of burns ranged between 2 and 12 months, mostly second degree (53.1%), with a surface area of 30% or more (59.2%), and associated problems as infections (53.1%) and ulcers (56%).  Patients had generally low levels of use of coping strategies before the intervention. At the post-intervention phase, all types of coping strategies demonstrated statistically significant increases except for those of avoidance and self-control.  In total, only 20.4% of the patients were using some type of coping before the intervention. This increased to 85.7% after the intervention (p<0.001).  The level of stress decreased from 34.7% before to 2% after the intervention (p<0.001).  The patients whose age was 30 years or older (p=0.02), and whose burn injury was accidental (p=0.01) demonstrated better post-intervention coping.  Weak to moderate statistically significant positive correlations were revealed between the assessment and positive action strategies and most of the other coping strategies.  Stress had weak to strong statistically significant negative correlations with all types of coping strategies except avoidance.  At the post-intervention phase there were statistically significant moderate to strong negative correlations between the total coping score and all of the domains of stress.  Multivariate analysis revealed that patient’s baseline score of coping, age, and burn surface area were the statistically significant independent positive predictors of the post-intervention coping score, while being married, having associated problems or permanent disability were negative predictors.  Patient’s baseline score of stress was the only statistically significant independent negative predictor of stress score, while the burn surface area was a positive predictor.