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Volume: 1 Issue: 4 December 2021

FULL TEXT

CASE REPORT
Nursing Care of a Patient After Burn According to Orem’s Self-Care Theory: A Case Report

ABSTRACT

OBJECTIVES: Burn injuries result in lifelong physical and psychological scars, cause pain, and affect mental health, quality of life, ability to return to work, and death. Although the medical point of view is important for the burn nurse to contribute to patient care, theoretical nursing care should be encouraged. In this case report, we describe a patient with severe burns who received nursing care according to Orem s Self-Care Insufficiency Theory.
MATERIALS AND METHODS: The 18-year-old male patient received second-degree and third-degree burns of 75% of total body surface area while using thinner to light a heater at work. Burn injuries covered his legs, arms, front body, back body, and certain parts of the face. The patient was transferred to Ankara Baskent University Hospital Burn Intensive Care Unit where he was hospitalized for 85 days. During this period, the patient underwent many surgical treatments, including escharotomy, debridement, and graft surgeries.
RESULTS: Thirteen nursing diagnoses were made during his hospital stay. These diagnoses were risk of infection, fear, self-care deficit, risk of bleeding, acute pain, anxiety, impaired physical mobility, disturbed body image, deficient knowledge, impaired skin integrity, sleep pattern disturbance, deficient fluid volume, and imbalanced nutrition of less than body requirements. Contractures developed in the patient s legs, preventing him from walking upright. The patient was discharged with continuation of physical therapy, which included pain control during training, maintenance of movement and exercise, giving information about outpatient follow-up, skin care, protection from sun, and nutrition.
CONCLUSIONS: With the nursing care applied and in accordance with Orem’s Self-Care Insufficiency Theory, apart from the surgical treatments, the patient ’s lack of knowledge was eliminated, his anxiety level was reduced, his fear was eliminated, his diet was adjusted, and his self-confidence was increased. At discharge, the patient was confident of his care.


KEY WORDS: Case report, Chemical burn, Nursing theory

INTRODUCTION
Burn injuries are acute injuries that include a high proportion of health care-related trauma worldwide.1 The World Health Organization defines burns as injury to the skin or other organic tissues, mainly caused by contact with heat or radiation, radioactivity, electricity, friction, or chemicals.2 Burn injuries are among the important causes of mortality and morbidity in Turkey and around the world.3,4 Burn injuries can develop due to different etiological reasons and can cause psychosocial problems such as depression, deterioration in body image, itching, posttraumatic stress disorder, delirium, and problems in sexual life.5-8 For these patients, it is important for a multidisciplinary team to cooperate and work in harmony in the care and treatment of the burn patient, allowing holistic care.5,8 Orem’s Theory of Self-Care Disability is the most relevant to burn care and can provide a starting point for theoretical use in burn nursing care.9 In this study, we describe a patient with burn injuries who received nursing care according to Orem’s Self-Care Insufficiency Theory.

OREM’S THEORY OF SELF-CARE DISABILITY
Self-care is described as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the help of a healthcare provider.”10 Self-care theory explains why self-care is necessary for the continuity of life. According to Orem, people have the power to plan for themselves and others’ needs and to take care of themselves. Perceptual, cognitive, interpersonal, and psychomotor features are required for an effective self-care power.11,12 Orem’s concept of health is a guide in describing the important effects of the holistic approach on the health and healing process of individuals.13 Orem’s theory consists of 3 interrelated parts.14 (1) The self-care theory explains why self-care is essential for the continuity of life.11,12 Self-care behaviors are physical activity, compliance with nutritional therapy, participation in care, compliance with drug treatments, and regular dressings. (2) The self-care deficiency theory is about why and when nursing is needed and the person who cannot meet their self-care needs because of limitations.15 (3) According to the theory of the nursing system, the nurse helps individuals who cannot do self-care and teaches their family and friends how to help them.15

The theory also explains 6 subconcepts (self-care, therapeutic self-care needs, self-care power, lack of self-care, nursing power, and nursing system) and an environmental concept.11

MATERIALS AND METHODS
In February 2021, an 18-year-old patient who received burn injuries from thinner that he used while trying to light a stove was admitted to our department. The patient had second-degree and third-degree flame burns of 75% of total body surface area. The patient was agitated and described a lot of pain.

Table 1 shows the vital signs and physical and neurological examination results of the patient during admission to the intensive care unit.16 Laboratory findings are shown in Table 2.

Data were collected after verbal consent and written consent were obtained from the patient, and the study was conducted with permission from the Başkent University Ankara Hospital Non-Invasive Clinical Research Ethics Committee.

RESULTS
Patient’s level of remembering event
The patient extinguished himself after burning and then extinguished the fire in the workplace. He was the one who informed everyone.

Patient’s understanding of the situation
When the patient first presented to our department, he was worried because of the burns on his face. He stated that he was afraid because he thought that he would not recover. He stated that if there is a mark on his face, he may be excluded by others and will not have a welcoming environment. When his face became the fastest healing place, his belief in himself and that he would get better increased. With this motivation, he tried to eat better and participate in our mobilized treatment. He stated that the long treatment period was tiring and that he had lost hope because he thought that he was making slow progress, and he experienced stress.

The family’s perception of the situation
His father would visit the unit as much as possible, get information about his son from the doctors, and meet with his son and talk about what they will do when he is discharged. He never stopped communicating.

Nutrition
The patient, who was fed with diets high in protein, consumed all meals with our help. In addition to his meals, he consumed snacks and fruits brought by his family.

Pain
Morphine via intravenous patient-controlled analgesia was infused at 0.3 mg/hour due to the increase in pain levels after dressing and surgical interventions.

Communication
The patient’s perceptual ability was high, and he liked talking.

Universal self-care requirements
A person’s daily life needs should focus on the normal maintenance of needs.15 The universal self-care requirements of this patient with flame burn were as follows. For air needs, the patient had no inhalation injury; his respiratory rate was 19 breaths/minute and his oxygen saturation level was 98% without oxygen. For water needs, daily fluid intake was calculated as oral plus intravenous intake of 3500 to 4000 cm3. With regard to excretion and defecation, color and amount of urine appeared at normal levels in the patient who had a urinary catheter during his stay in the intensive care unit. There was stool output of at least 1 per day. With regard to activity and rest, because surgical procedures that required immobility were not performed, regular mobilization was provided twice per day. Respiratory cough exercise was provided, and exercises recommended by the physiotherapists were applied. For sleep, the patient, who had irregularities in sleep cycles, had difficulty falling asleep. With regard to risk of danger, the patient had an Itaki Fall Risk Scale score of 12. With regard to social activity, the patient did not like watching television.

Developmental self-care requirements
Growth and development are a part of the life process of an individual. In the patient, these focused on supporting life.15

The patient started working at an early age to help his family. The patient seemed worried and anxious due to his experiences and exhibited timid behaviors as a result of his burns. He was trying to participate in his care with support from his nurses and was striving to be better; however, he exhibited anxiety because of what he had experienced. An attempt was made to strengthen the psychological resilience of the patient. He constantly asked questions about his current situation and wanted to get information. We aimed to have the nurses approach the patient in a professional manner and provide the information he wanted. Considering the young age of our patient, he was able to cope with his situation. He never gave up.

Self-care requirements in health deviation
Orem defines health deviations as personal care needs that manifest themselves in the presence of problems, diseases, and treatment in front of individual recovery. Current complaints can be evaluated within this subgroup.15

Our patients required dressing changes, and plans for risk of infection due to open wounds and risk of contraction in the extremities were made. The privacy of the patient was important during dressing changes and care. The patient was started on pharmacological treatment to prevent pain-induced mobilization and improve quality of life. The patient was able to accept the changes in his lifestyle and fulfill his self-care needs under the nurse’s guidance. For this reason, it was required for the nurse to follow the patient closely, monitor for signs of infection, and make the patient move in bed. The patient stated that, at first, he had distrust of the hospital employees, but this distrust became trust over time.

A total of 13 nursing diagnoses were made during our patient’s stay in our hospital (Table 3).17

CONCLUSIONS
Our patient stayed in our clinic for a total of 85 days, and he underwent numerous dressing and surgical procedures. Dressings of our patient were changed every day, and these procedures were performed under anesthesia. Within the scope of this case report, in which we included Orem’s Theory of Self-Care Insufficiency for nursing care, we made a total of 13 nursing diagnoses for our patient. With the nursing care applied, other than with regard to surgical procedures and treatments, our patient’s pain, lack of knowledge, and fear were relieved; his anxiety level was reduced; his nutrition and fluid intake were regulated with adjustments to his diet; and his participation in care and treatment increased, which helped his self-confidence. Contractures developed in our patient’s legs that prevented him from walking upright. Our patient was discharged but with continued physical therapy, which included pain control during training, maintenance of movement and exercise, giving information about outpatient follow-up, skin care, protection from sun rays, and nutrition.

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Volume : 1
Issue : 4
Pages : 186 - 191


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From the 1Baskent University Hospital, Department of Nursing Directorate Services; the 2Baskent University, Faculty of Health Services Vocational School, Department of Medical Services and Techniques; and the 3Baskent University, Department of Surgical Medical Sciences, Department of General Surgery, Ankara, Turkey
Acknowledgements: The authors have not received any funding or grants in support of the presented research or for the preparation of this work and have no declarations of potential conflicts of interests.
Corresponding author: Elif Ünlü, Department of Nursing Directorate Services, Baskent University Hospital, 06490 Ankara, Turkey
E-mail: elifunlu06@icloud.com