Smärta, infektion och återanpassning till livet efter en brännskada

Detta är en avhandling från Stockholm : Karolinska Institutet, Department of Molecular Medicine and Surgery

Sammanfattning: A burn injury is an unforeseen event that includes a physical as well as a psychological trauma for the person afflicted. The trauma is experienced differently by individuals as do perceived problems during care, rehabilitation and throughout the remainder of life. Patients hospitalised for burn injuries in general experience severe pain on a daily basis, immediately after the injury and during the healing of the burn wound. Clinical experience indicates that the intensity of pain often seems to increase by wound infection. The overall aim of this study was to investigate if patients experienced increased pain intensity in conjunction with wound infection, to describe burn patients' experiences of pain during burn care, and experiences of adapting to life after burn injury. Study I was based on a retrospective design and included 165 burn patients, 60 of whom were diagnosed with infection. Data was collected from a burn care computer registry. The study method in study II and III was qualitative and interviews were conducted with 12 adult burn patients (8 men, 4 women) 6-12 months post-burn and interviews were analysed inspired by Kvales method for structuring analysis. The results of study I showed significantly higher self reported pain intensity at the diagnosis of wound infection in the morning assessments than reported by those without infection. The patients' experiences and memories of pain during the trajectory of care were clearly described during the interviews (Study II) and 4 themes were identified for pain: becoming aware of pain; allowing oneself to feel pain; different pain experiences; and fragile body. Four themes were also identified for coping and it is evident that the patients often have to carry the pain experience by themselves to a large extent. The experience of burn patients was central and one important point that came across was how they perceived life today (Study III). The analysis revealed three main themes: fragile body, coping and the reflections on burn care. The interpreted whole focuses on the experience of living life after a burn, which is described in the main theme struggling with the consequences of burn injury. Clinical implications from the study indicate that pain treatment for burn injury needs more attention to meet individual needs of the patients and that more focus should be given to any occurring inexplicable increase in pain intensity and to inspect the burn wounds earlier. There is also a need for an increased focus of the psychosocial support needs for patients treated for burns in order to enhance coping and to help patients to return to normal life. Nurses are the professionals that work closest to the patients during their hospital stay they need skills and awareness to assess issues of importance to patients in order to be able to meet their individual needs during burn care; if this is done properly it will aid patients in the recovery period after hospitalisation

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