Begin typing your search above and press return to search.
Volume: 1 Issue: 4 December 2021

FULL TEXT

CASE REPORT
Nursing Care of a Patient Followed in the Intensive Care Unit after Burn According to the Roy Adaptation Model: A Case Study

ABSTRACT

OBJECTIVES: Burn injuries are an important health problem that affects not only the physiology of patients but also their psychosocial and socioeconomic life. Deformities and disabilities caused by burns result in stigmatization and rejection, and long-term care requirements with burn treatment have negative economic effects. Here, we evaluated the suitability of the Roy Adaptation Model for a burn patient s nursing care process.
MATERIALS AND METHODS: Our case patient was a 27-year-old man who was a building worker, newly engaged, and living in a single family house with his parents, along with 2 siblings. He presented to our hospital as a result of an explosion of a thinner canister standing next to a stove. Both upper extremities, head, neck, trunk, perineum, and both lower extremities had 55% second-degree deep and third-degree burns in total area. The patient underwent debridement and skin graft surgeries. The patient’s nursing care was integrated in the Roy Adaptation Model.
RESULTS: Nursing care was planned according to physiological mode (according to impaired skin integrity, impaired physical mobility, acute pain, fluid-electrolyte imbalance, risk of infection diagnoses), self-concept mode (according to disturbed body image diagnosis), role performance mode (according to ineffective role performance diagnosis), and interdependence mode (according to change in family processes) processes. For all areas, interventions were applied and evaluations were made.
CONCLUSIONS: Nursing care of our patient receiving burn treatment was conducted in accordance with the 6 steps of adaptation as defined in the Roy Adaptation Model. We found this model suitable for use in patients who are receiving burn treatment.


KEY WORDS: Case report, Chemical burn, Nursing model

INTRODUCTION

A burn is an injury to the skin or other tissues caused by heat or due to radiation, radioactivity, electricity, friction, or contact with chemicals.1 Burns are a serious health problem, especially in low- and middle-income countries, and require prolonged hospital stays and treatment.2,3 According to reports, millions of people receive care for burns every year; in the United States alone, over 450 000 patients presented to emergency and burn centers after fires and inhalation burns in 2016.1,4 The morbidity and mortality rates in patients treated for burns are considerably high. Therefore, practices related to burn management have become prominent. Relevant guides cover such matters as burn care organization, initial evaluation and stabilization, diagnosis and treatment of inhalation burns, fluid and pain management, escharotomy and fasciotomy, burn wound care, surgical treatment, nonsurgical treatment of scars, infection prevention and control, antibiotic management, nutrition, rehabilitation, itching management, ethical issues, and quality improvement.3,5 Burn injuries are important health problems that affect not only the physiology but also the psychosocial and socioeconomic lives of patients. Disfigurement and disability caused by burns often result in stigma and rejection, and prolonged care required for burns has negative economic effects.1

The care of patients with burns in the nursing field concerns both science and art and requires knowledge, skills, and experience.6 In this context, nursing models, which address nursing knowledge and practices in a systematic framework, can guide nurses in terms of ensuring effective communication between members of the profession, provide holistic care to patients, and allow patient-centered nursing care.7 The Roy Adaptation Model, which is widely used in surgical nursing, is aimed at increasing adaptation of patients to their new condition, with a goal of patients having a long life with quality. For this, the patient is assessed in terms of physiological, self-concept, role function, and interdependence modes. Here, we have described the nursing care of a patient followed in the intensive care unit (ICU) after a burn according to the Roy Adaptation Model.

The Roy Adaptation Model
The theory of Sister Callista Roy is based on the “General Systems Theory.” According to Roy, individuals are biopsychosocial creatures, who try to maintain coping systems, including physiological, self-concept, role-function, and interdependence relationships, with others in their environment. Internal and external environments of individuals determine their adaptation level.8,9 On the one hand, there may be tension and conflict in the individual’s internal environment, but the individual may adapt to their external environment and display positive reactions.10 There are 3 types of stimuli that make up the adaptation level of an individual. (1) Focal stimulus is the one that the individual suddenly encounters. It is the first stimulus noticed by the individual. It affects him the most and stands out. (2) Contextual stimuli depend on the conditions caused by an event or situation that positively or negatively affects the individual’s situation and contributes to the focal stimuli’s effect. (3) Residual stimuli are factors related to beliefs and attitudes that have a sustained impact on the individual, based on their experiences. Individuals adapt to stimuli that they encounter throughout their lives with their innate or acquired coping mechanisms.

Within the Roy Adaptation Model, nurses aim to create effective adaptation behaviors in the patient’s physiological, self-concept, role function, and interdependence modes and to reach the patient’s perfect adaptation level by using the patient’s regulatory and cognitive-affective coping mechanisms against environmental stimuli.11,12 Nurses should aim to manage primarily the focal stimulus and then the influencing stimulus/stimuli in patient care by helping to meet the needs of individuals in these adaptation modes. In assessing nursing interventions for patients, if the patient exhibits positive behaviors, it means that the nursing interventions are effective and patients are coping and recovering; otherwise, interventions should be considered ineffective or insufficient and new interventions should be planned.

MATERIALS AND METHODS

The patient was a 27-year-old man (height 167 cm and weight 59 kg). He was a construction worker and newly engaged. He lived in a detached house with his parents and 2 siblings. He was taken to a state hospital after explosion of a thinner canister standing next to a stove. He had second-degree deep and third-degree burns on both upper extremities, head, neck, trunk, perineum, and both lower extremities (55% of his body in total; Table 1).13 In addition, he had suspected inhalation damage, as head, neck, and nose hair had burned. The patient received a tetanus vaccine, intravenous hydration, and antibiotic prophylaxis. After his analgesia control, he was referred to our university hospital for examination and treatment because the ICU of that hospital was full.

Table 2 shows the patient’s vital signs and results of physical and neurological examinations upon admission to our center’s ICU. Table 3 shows his laboratory finding and medication. After admission to our center’s ICU, we started the patient on oxygen inhalation therapy. He received intravenous hydration, analgesia, and temperature control, and wound cultures were sampled. After escharotomy was performed, we inserted a subclavian catheter and administered medication. To ensure optimal management of burn wounds, we provided special medical nutrition products containing protein, carbohydrates, fats, vitamins, and minerals. In addition, we provided nasal oxygen and inhalation treatments at the maximum level of oxygen required by the tissues. We started low-molecular-weight heparin for deep vein thrombosis prophylaxis, proton pump inhibitors to prevent stress ulcers, and albumin to prevent hypoalbuminemia. We changed the dressings daily. The patient underwent debridement and skin graft operations on days 2, 12, 19, and 23 of hospitalization. His wounds started to heal within 1 month after the operation, and we opened the dressings on his hands. However, the dressings of both legs remained closed due to the grafts applied.

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

RESULTS

The patient stated that he missed his family and home very much while he was in the hospital and that he wanted to return to his old life as soon as possible. We observed that he had psychosocial problems. He said things like, “Nurses finish their shift and go home every day, I cannot go home” and “I used to love watching TV at home, I don’t even feel like watching it here.” He had negative thoughts about his body image at first (“I don’t want my mother and fiancée to visit me, I don’t want them to see me like that”) and then started to have positive thoughts (“Today, when my hand dressings were opened, I thought things were getting better; it made me very happy to see my hands open”). Figure 1 presents the integration of the patient’s nursing care into the Roy Adaptation Model. We performed nursing care of the patient according to the adaptation modes defined in the Roy Adaptation Model, as shown in Table 3.14

DISCUSSION

Our patient, who required burn treatment, was provided nursing care in line with the 6 steps specified for the adaptation modes in the Roy Adaptation Model. Our nursing diagnoses included disrupted skin integrity, disrupted physical mobility, acute pain, fluid-electrolyte imbalance, and infection risk in the physiological mode; disrupted body image in the self-concept mode; ineffective role performance in the ​​role performance mode; and change in family processes in the interdependence mode. We implemented nursing interventions in line with the goals. The patient’s adaptation paved the way for success of the nursing process and patient care. In this respect, we concluded that it is appropriate to use the Roy Adaptation Model for patients receiving burn treatment. Our recommendation is to structure the nursing care plan and patient education according to this Model to ensure patient adaptation to the burn treatment process. In this context, there is a need for further studies that examine the patient’s adaptation and quality of life according to the Roy Adaptation Model.

REFERENCES

  1. World Health Organization. Burns fact sheet; 2018. Accessed October 21, 2021. https://www.who.int/news-room/fact-sheets/detail/burns
    CrossRef - PubMed
  2. Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean Region: a systematic review. BMC Public Health. 2010;10:83. doi:10.1186/1471-2458-10-83
    CrossRef - PubMed
  3. Vural F, Özer Özlü NG. Yanıklı hasta bakımında güncel rehberlerin önerileri. HEAD. 2020;17(2):187-193.
    CrossRef - PubMed
  4. American Burn Association. Burn incidence and treatment in the United States; 2016. Accessed January 8, 2021. http://ameriburn.org/who-we-are/media/burn-incidence-fact-sheet.
    CrossRef - PubMed
  5. ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee. ISBI Practice Guidelines for Burn Care. Burns. 2016;42(5):953-1021. doi:10.1016/j.burns.2016.05.013
    CrossRef - PubMed
  6. Eti Aslan F, Oyur Çelik G. Yanık bakımı. In: Eti Aslan F, Olgun N, eds. Emergency Care in Adults. Akademisyen Kitabevi; 2014:393-413.
    CrossRef - PubMed
  7. Kaya Ç, Bilik Ö. Amputasyon ameliyatı uygulanan bir hastanın roy uyum modeli’ne göre yapılandırılmış hemşirelik bakımı. HEAD. 2020;17:131-139.
    CrossRef - PubMed
  8. Roy CS. 2009. The Roy Adaptation Model. 3rd ed. Pearson Education; 2009.
    CrossRef - PubMed
  9. Roy CS. Elements of the Roy Adaptation Model. The Roy Adaptation Model. 3rd ed. Pearson Education; 2009.
    CrossRef - PubMed
  10. Pektekin, Ç. Hemşirelik felsefesi. Kuramlar-bakım modelleri ve politik yaklaşımlar. İstanbul Med Yayıncılık. 2013:111-109.
    CrossRef - PubMed
  11. Karayurt O, Iseri O, Erol F. Liver transplantation from dark to light; a qualitative study based on Roy Fit Model. Dokuz Eylul Univ Fac Nurs Electronic J. 2014;7(4):257-264.
    CrossRef - PubMed
  12. Ursavaş FE, Karayurt Ö, İşeri Ö. Nursing approach based on Roy Adaptation Model in a patient undergoing breast conserving surgery for breast cancer. J Breast Health. 2014;10(3):134-140. doi:10.5152/tjbh.2014.1910
    CrossRef - PubMed
  13. Lund CC, Browder NC. The estimation of areas of burns. Surg Gynecol Obstet. 1944;79:352-358.
    CrossRef - PubMed
  14. Carpenito-Moyet LJ. Erdemir F, trans-ed. Manual of Nursing Diagnoses. 3rd ed. Nobel; 2012.
    CrossRef - PubMed


Volume : 1
Issue : 4
Pages : 199 - 205


PDF VIEW [278] KB.
FULL PDF VIEW

From the 1Department of Nursing Directorate Services and the 2Faculty of Health Sciences, Department of Nursing, Baskent University, 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