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Volume: 1 Issue: 4 December 2021

FULL TEXT

CASE REPORT
Nursing Care of a Patient Followed in the Intensive Care Unit in the Acute Period After Electrical Burn According to Gordon’s Functional Health Patterns Model: A Case Study

ABSTRACT

OBJECTIVES: The World Health Organization reported about 265 000 deaths per year from fires alone worldwide, with more deaths from electrical burns, scalds, and other causes of burns. Electrical burns are an important public health problem all over the world and in our country of Turkey. Nursing care for patients with electrical burn injuries and support for the patient’s family throughout recovery involve complex and demanding expertise. In this study, we have presented the nursing care of a patient with electrical burn who was followed in the intensive care unit according to Gordon’s Functional Health Patterns Model.
MATERIALS AND METHODS: A 44-year-old male patient was admitted to the burn unit after he contacted electrical wires while changing a sign on the highway. He had second-degree and third-degree burns on his arms, hands, and feet (28% of total body surface area). The goals during this phase were saving a life, maintaining and protecting the airways, restoring hemodynamic stability, promoting healing, and preventing complications. In the intensive care unit, we provided care, follow-up, and treatment according to Gordon’s Functional Health Patterns Model and multidisciplinary patient care plans.
RESULTS: Nursing care was planned according to effective management of the individual, who had imbalanced nutrition of less than body requirements, deficient fluid volume, constipation risk, self-care deficits, a disturbed sleep pattern, acute pain, interrupted family processes, sexual dysfunction, and anxiety. Nursing diagnoses for interventions were applied, and evaluations were made.
CONCLUSIONS: Nurses can positively affect all phases of patient care. In the case described here, Gordon s Functional Health Patterns model formed the basis of nursing care, resulting in achievement of goals of the planned nursing care.


KEY WORDS: Electrical burn, nursing model, case report

INTRODUCTION
Burns are a serious public health problem both globally and nationally. According to the World Health Organization, over 265 000 people die worldwide every year from fires, with burns accounting for an estimated 180 000 deaths in low- and middle-income countries.1,2 The physical examination is crucial in patients with electrical burns, since those burns can cause life-threatening conditions, particularly related to the cardiovascular system in the acute period.3 Good fluid resuscitation is essential to prevent kidney failure in patients with burns.4,5 Moreover, the heat generated by electrical energy passing through tissues causes damage to important structures, such as nerves, vessels, and muscles in the extremities, which may lead to compartment syndrome in those extremities. Compartment syndrome is an emergency that requires early diagnosis and instant fasciotomy. It is necessary to treat patients with severe electrical burns in burn centers where necrotized tissues can be debrided and wounds can be quickly closed.5-7

The care and treatment processes of patients with electrical burns are complex and challenging. In this context, nurses play a substantial role in the overall management of patients with burns; it is therefore essential for nurses to know the different protocols used for care of patients with burns. The nursing management of patients with burns includes psychological support and medical care for the patient and their families. The optimal care of patients with burns requires a multidisciplinary team approach.5,6 In this study, we have described the nursing care for a patient with electrical burn who was followed in the intensive care unit (ICU) according to Gordon’s Functional Health Patterns Model.

Gordon’s Functional Health Patterns Model
In 1987, Marjory Gordon proposed a perspective called “Functional Health Patterns” in her studies on nursing diagnoses to collect and organize information with a strong nursing perspective.8-10 Gordon defined the nursing process of Functional Health Patterns as the sequence of behaviors in a certain period. The model for Functional Health Patterns emphasizes critical thinking and clinical decision-making. It consists of 11 patterns related to human health and life: health perception-health management pattern, nutritional-metabolic pattern, elimination pattern, activity-exercise pattern, sleep-rest pattern, cognitive-perceptual pattern, self-perception/self-concept pattern, role-relationship pattern, sexuality-reproductive pattern, coping-stress tolerance pattern, and value-belief pattern.10-12

Health perception-health management pattern
This pattern involves how patients perceive and manage their health and well-being and whether they have any health problems. The first step to evaluation of a patient’s health is to conduct interviews consisting of planned and focused conversations between the nurse and patient. These interviews are aimed at revealing the patient’s perception of health, functional status, and knowledge of health, recovery, and other factors. These evaluation interviews make it possible to identify the patient’s specific interests and perceptions about health, illness, health management practices, and health care. The interview is also a tool for gathering demographic data and information on social background and support systems. Data and information gathered from the evaluation interview provide a basis for clinical decisions and diagnoses.

Nutritional-metabolic pattern
This pattern involves the patient’s pattern of food and fluid consumption relative to metabolic needs.

Elimination pattern
This pattern involves the patient’s pattern of secretion through the bowel, bladder, and skin.

Activity-exercise pattern
This pattern involves the patient’s pattern of activities, exercise, leisure, and recreation.

Sleep-rest pattern
This pattern involves the patient’s pattern of sleep, rest, and relaxation. The nurse should evaluate the patient’s sleep and rest in detail.

Cognitive-perceptual pattern
This pattern involves the patient’s emotional perception and cognition. Identifying sensory, perceptual, and cognitive patterns requires an understanding of processes and structures related to vision, hearing, taste, smell, touch, pain perception, language, and thinking. This pattern includes an understanding of the relevant sensory organs, peripheral nervous system, and central nervous system.

Self-perception/self-concept pattern
This pattern involves the patient’s pattern of self-perception, such as mood, control, competence, and body image.

Role-relationship pattern
This pattern involves role engagements and relationship patterns, revealing how the patient’s perceptions affect their behavioral and emotional responses.

Sexuality-reproductive pattern
This pattern involves the patient’s satisfaction and dissatisfaction with sexuality and reproduction.

Coping-stress tolerance pattern
This pattern involves the patient’s effectiveness in coping and tolerating stress in general.

Value-belief pattern
This pattern involves the patient’s values and beliefs, including spiritual and/or goals that guide choices or decisions.10-13

It is possible to apply the Functional Health Patterns model with an extensive scope since this model represents the functional characteristics of humans. A pattern should be evaluated by considering all other patterns, thus allowing a holistic approach when considering the patient.

MATERIALS AND METHODS
A 44-years-old male patient presented to our burn treatment center in April 2021 after contact with electrical wires while changing a sign on the highway. He did not have any systemic diseases. Our primary aim was to save the patient’s life, maintain his airways, and provide hemodynamic stability and pain control. To prevent compartment syndrome, we performed fasciotomy immediately; we then evaluated laboratory findings and performed intravenous hydration, performed blood and blood product replacement, and started the patient on sodium bicarbonate infusion. To ensure optimal management of burn wounds, we met tissue oxygen requirements at the maximum level with nasal oxygen and inhalation treatments. The patient also received special medical nutrition products containing protein, carbohydrates, fats, vitamins, and minerals. Table 1 shows results of vital sign, physical, and neurologic examinations of the patient at admission to the ICU.14 Table 2 shows the patient’s laboratory findings and medications.

Data were collected after verbal consent and written consent were obtained from the patient. The study was approved by the Non-Invasive Clinical Research Ethics Committee of the Baskent University Ankara Hospital.

RESULTS
Health perception-health management pattern
In the ICU, the patient stated that he accepted the treatment and that he thought he would be healthier after the treatment.

Nutritional-metabolic pattern
We observed that the patient ate less than his body’s albumin requirement and that his appetite had decreased since hospitalization. We planned a supportive nutrition program for the patient in cooperation with a dietitian.

Elimination pattern
The patient, who had met his need for defecation every day in his daily life, stated that he had a feeling of insufficient elimination after his hospitalization due to limited mobility.

Activity-exercise pattern
The patient was fully dependent on others to perform daily life activities. He could only meet his self-care needs with help due to limited mobility.

Sleep-rest pattern
We observed that the patient could sleep 6 to 7 hours per night and that he slept 3 to 4 hours more during the day with administration of anesthesia during dressing changes. He had difficulty falling asleep due to treatments.

Cognitive-perceptual pattern
We observed that the patient’s pain level was high due to the burn areas and surgical interventions. His pain score was 7 on the Numerical Pain Evaluation Scale. The score decreased over time.

Self-perception/self-concept pattern
During the stay in the ICU, the patient was calm; he smiled when we entered his room to meet his treatment and care needs. He said that he felt bad, but that he knew that this was temporary. He expressed that this would cause changes in his lifestyle, but he was happy to be alive.

Role-relationship pattern
The patient stated that, because he was away from his family during his stay in the hospital, he was upset for not being able to act as a father and husband, and he wondered if everyone was well and safe.

Sexuality-reproductive pattern
The patient stated that there was no problem in his sexual life previously and that he knew about contraception methods. He reported problems in parenthood due to his stay in the hospital.

Coping-stress tolerance pattern
The patient was calm and open to communication in general. However, we observed that he had fears and concerns about staying in the hospital and being away from his family, which created anxiety in him.

Value-belief pattern
The patient stated that he used prayer as a coping method. We observed that he displayed a fatalistic attitude by expressing that everything comes from God and gets better in time. He expressed that he calmed down by praying and that his family and his wife were valuable to him. We observed that the patient’s wife supported him, and he was often calmed with his wife’s support.

Nursing plan
Nursing care was planned to allow the therapeutic regimen to be implemented effectively; the patient required care for imbalanced nutrition, with less than body requirements, deficient fluid volume, constipation risk, self-care deficits, disturbed sleep patterns, acute pain, interrupted family processes, sexual dysfunction, and anxiety. Nursing diagnoses for interventions were applied, and evaluations were made (Table 3).15

DISCUSSION AND CONCLUSIONS
For patients admitted to the ICU after electrical burns, we suggest that it is necessary to evaluate them as a whole, that is, with consideration of physiological, psychological, and social factors and economic status. A holistic approach to nursing care creates positive effects in terms of patient outcomes. We recommend the use of Gordon’s Functional Health Patterns Model in patients with burns.

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Volume : 1
Issue : 4
Pages : 192 - 198


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From the 1Baskent University Hospital, Department of Nursing Directorate Services, Ankara, Turkey; 2Baskent University, Faculty of Health Sciences, Department of Nursing, Ankara, Turkey; and 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: Aylin Günay, Department of Nursing Directorate Services, Baskent University Hospital, 06490 Ankara, Turkey
E-mail: aylinn.gunay@gmail.com