Nursing Severe Burn Injury Patients: Emotional

International Journal of Medicine and Medical Sciences, ISSN: 2051-5731, Vol.47, Issue.1

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Nursing Severe Burn Injury Patients: Emotional Impact on Nurses Negble M Burns Ward D2C, Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana

Agbenorku P Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

Ampomah E.A Burns Ward D2C, Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana

Hoyte-Williams P.E. Reconstructive Plastic Surgery & Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana Corresponding author Email: [email protected]

ABSTRACT Introduction: Nursing practice is generally inevitable and generates some form of emotional response in nurses. Since nurses are the major caretakers of patients with various kinds of ailment admitted at the hospital, they are more likely to be exposed to human suffering be it health, physical or emotional than other health professionals. Aim: The aim of this study is to explore the impact of chronic occupational stressors in nursing severe burns patients and to make recommendations for further practice and research. Methodology: The descriptive crosssectional survey describes the impact of nursing severe burns patients. Questionnaires and interviews were used to generate data about personal and professional experiences of nurses who work in the Burns Ward in Komfo Anokye Teaching Hospital, Ghana. Results: Participants described burns nursing as extremely challenging due to the physical and emotional demands. Nurses had to go through a lot of stress before they are able to adapt. They used emotional detachment in order to conduct painful and lengthy burns wound dressings and also develop the coping skills within longer period of working years. Conclusion: Nurses in this environment must be supported to recognize and manage their physical, emotional and social responses to their work.

Keywords-Nursing, Severe burns, Patients, Impact, Emotional

1. INTRODUCTION There is limited information that explores the experiences of burns nurses caring for severely burnt patients [1], [2]. The nature of nursing practice is such that it inevitably generates some form of emotional response in nurses. Nurses are more likely to be exposed to human suffering than other health professionals. Chronic exposure in this occupational environment has implications for nurses’ health and well being [2], [3], [4]. It is well documented that burns nurses experience many occupational stressors

working with severe burns injury patients [3], [5]. Burns nursing has been described as both emotionally challenging and confronting [1], [3], [6], [7]. Clinical settings such as burns units are stressful occupational environments in which burns staff are in need of emotional and clinical support [8]. Murji et al. [4], suggested that chronic occupational stressors have resulted in emotional exhaustion, depersonalisation and reduced self esteem. Burns nurses are continually exposed to patients who suffer for extended periods of time [2]. Exposure to patients’ pain and disfigurement has resulted in emotional distress and desensitisation to pain, having implications for both the care of the patient and the nurses’ well being [1] ,[2] ,[3] ,[4] ,[7] ,[9] ,[10]. Yet, there is little support available for nurses addressing the issue of how to manage emotions as a result of performing painful procedures on burns patients [10]. A study conducted by Lewis et al. [1] which investigated stressors and coping among burns unit nurses also identified the following as the most stressful factors experienced: Pain and infliction of pain, Inappropriate behaviour from patients, Complex critical patients, Mortalities, Conflicts with the medical team. The nurses in their study conveyed that occupation stressors affected their personal home life in which irritability, preoccupation, impatience and fatigue were identified as manifestations of stress. They investigated anxiety levels of nursing staff and found that 59 percent of nurses expressed that they occasionally experienced anxiety prior to the commencement of their shift. This anxiety manifested itself in the form of sleep disturbances, stomach pains, headaches, moodiness and fatigue. Steenkamp and van de Merwe [7] investigated the psychosocial function of nurses in a burns unit, which surprisingly found that the only sources of stress that held any significance were heavy patient workloads and insufficient remuneration.

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Steenkamp and van de Merwe [7] found out that teamwork, good working relations, talking to co-workers and maintaining a sense of humour were the most frequently used strategies to cope with stress associated with the work environment in which these findings are supported by other authors [1] ,[11]. It identified teamwork as the burns unit’s greatest assets. A supportive nursing team helps to reduce nurses’ perceptions of job stress [12], [13]. Participants relied heavily on colleagues for emotional support. However, workload commitments sometimes limited the amount of support available. Olofsson et al. [14] cautions that supporting colleagues may exacerbate nurses’ own emotional distress. Scheduled staff meetings may provide a forum at which nurses can share the responsibility of supporting each other. These meetings also offer an opportunity to discuss positive nursing outcomes, rather than focusing only on negative incidents, and can be a means of facilitating clinical learning by considering how practice can be improved [3]. The purpose of this descriptive cross-sectional survey was to explore the impact of nursing severe burn injury patients over extended periods and make recommendations for further practice.

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who work in a severe burns injury unit in Komfo Anokye Teaching Hospital, Ghana. The use of questionnaires and interviews were used to generate data about the participants’ personal and professional experiences’ of nursing severe burns injury patients. Twenty (20) nurses working on a burn unit were randomly selected and interviewed to elicit their experiences.

3. LIMITATIONS This study used a small sample from one site, and therefore the findings are specific to that setting. Some of the researchers fall within the sample group therefore can be a bit bias.

4. ETHICAL CLEARANCE Ethical clearance for this study was obtained from the KNUST School of Medical Sciences/KATH Committee on Human Research, Publication and Ethics, Kumasi, Ghana.

5. RESULTS AND DISCUSSION Participants experience on the unit varied from 1 to 10 years and above, with ages spanning from 25–59 years. Length of experience varied, as did seniority, with positions ranging from staff nurse (SN) to principal nursing officer (PNO). Table 1 shows the distribution of participants according to their age, level of experience and positions held at the period of research.

2. METHOD/STUDY SETTING The study design is descriptive cross-sectional survey. Qualitative form of research method underpins this study. Purposeful sampling was utilized to select participants

Table 1.0 Demographic characteristics of Participants Age range

Frequency (n=20)

Percentage

20-29 30-39 40-49 51-59

8 6 3 3

40 30 15 15

5 8 3 2 2

25 40 15 10 10

9 6 2 3

45 30 10 15

Rank Staff Nurse Senior Staff Nurse Nursing Officer Senior Nursing Officer Principal Nursing Officer Years of working experience 1-3 4-6 7-9 10 and above

Participants described burns nursing as extremely challenging due to the physical and psychosocial stressors. The graph below illustrates the level of anxiety

experienced by nurses based on their physical, emotional and health indicators.



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collaborative teamwork with the medical team compared to a discordant leader [17]. The following suggestions have been recommended and their consideration for implementation would be a great process for reducing anxiety among burns wound patient nurses. Burns nurses need to engage in teamwork and support to be well integrated into the work. Nurses with adaptation problems and new recruits should go through sections of training by a clinical psychologist or psychiatrist. There should be special benefits in the form of incentives and short vacations to calm down stressed nerves. There should also be adequate staff in the burns units.

6. CONCLUSION Figure 1.0 Manifestation of anxiety In general, 75% of the participants agreed that they experienced anxiety during the day. Anxiety manifestation varied among participants in the form of sleep disturbances, headache, moodiness and fatigue as indicated by Lewis et al. [1]. From the current study, multiple response on manifestation of anxiety revealed 55% (n=11) of the participants reported sleep disturbance; 30% (n=6) reported headache, 20 %( n=4) reported the state of moodiness and 70% (n=14) reported fatigue (Figure 1.0). Almost all (90%) indicated that occupational stressors affected their personal home life in which irritability, preoccupation, impatience and fatigue were manifestations of stress. The findings therefore was in conformity with Lewis et al. [2] Nagy’s comparison of the effects of patients’ pain on burns and neonatal nurses also demonstrated considerably higher anxiety regarding patients’ pain compared with neonatal nurses, inferring that pain was a significant source of anxiety for burn nurses. Sixty percent (60%) admitted that during long hours of dressing changes they experienced muscloskeletal disorders in the neck, shoulder or back. They usually complained of risk of deformity during later life and the impact of occupational stressors manifested as hardiness. According to Kobasa [15] hardiness is a constellation of personality traits by high level of personal control, commitment and challenge in responding to daily life. Emotional intelligence has been identified as a significant skill for a successful nursing career [16] having an empowering positive impact on nurses' professional performance, job satisfaction [17], and coping abilities [18]. It has become an area of interest for nurses and is described as embracing one's emotional awareness in relations to one's self and others, encompassing professional efficiency and emotional management [19]. It involves 'the ability to monitor one's own and others' feelings and emotions, to discriminate among them and to use this information to guide one's thinking and actions' [20]. Nurses whose leader has a high level of emotional intelligence report significantly less emotional exhaustion, better emotional wellbeing and an effective and

The findings offer insights into the challenging aspects of nursing severe burns patients. Nurses in this environment must be supported to recognize and manage their physical, emotional and social responses to their work. The extent to which busy workloads limited nurses’ opportunity to attend to patient’s and relatives’ emotional needs generated considerable distress and tension for nurses in this study. The major impact manifested in the form of psychosomatic disorder.

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