In the Jul/Aug issue we spoke to Louise Rodgers who works in the Queen Victoria Hospital Burns Unit about the roles involved in rehabilitating a patient.
From a young age we are taught that beauty isn’t skin deep. It’s what’s on the inside that counts.
And while that is true, a traumatic burn resulting in scarring is a difficult pill to swallow. From physical to emotional scars, the process of burn recovery is a long and difficult one, personal to each individual sufferer.
At the Queen Victoria Hospital, its burns service is renowned for its world-class multi-disciplinary specialist burns team helping adults and children who have suffered a traumatising burn. Based in West Sussex, it provides non-surgical, surgical and rehabilitative care as well as a successful burns outreach service to patients from Sussex, Kent, Surrey and South London.
One OT on the ground is Louise Rodgers, who leads the occupational therapy team on the unit, and takes The OT Magazine through the sensitive process, from referral to discharge and the emotional journey it takes both the patient and medical staff on.
“Daily handovers from the burns ward highlight new burn injured patients who will need to be functionally assessed,” Louise began.
“Patients who do not have to be admitted to the ward are referred to the occupational therapy team from nurses in the outpatient dressing clinics.
“So that could be if they are in the critical care unit or the burns ward. We complete an outcome assessment that’s been designed by therapists working in burns. If the burn is over a joint, we’ll look at positioning or splinting. We try to start as soon as possible with functional goals like washing and dressing. For example, brushing hair is a small goal but it will help start the rehabilitation process. Patients will step down from the critical care unit to the ward where we will continue working on functional tasks. We will look at hobbies that might be important to them to help regain function, especially of their hands. We also review mobility and start discharge planning, making sure their home environment is set up with any potential equipment.
“Once they are discharged they come back to the outpatient clinic where OTs will review and see how they are progressing. We then set new goals and look at whether splints need to be changed and if functional tasks are still problematic. When they are healed we take them through to the scar management clinic. Here, the OT looks at anything that will help in minimising scars in terms of massaging techniques, moisturising, pressure garments and desensitisation. We look at if they have returned to work or school and their normal daily lives. Potentially they could be under our care for a few years if they are going under reconstructive surgery.
“Something I really love about this area is having the privilege of seeing someone from day one through the whole process of their treatment,” Louise shared.
But it takes a village and a lot of cross-discipline thinking, from physio work to dietary experts according to Louise.
“We have a team of psychological therapists who work in the unit and we do lots of joint sessions with them.
“We work very closely with the physiotherapists as well, with many patients receiving joint sessions to help them achieve their goals. We also work with dieticians, speech and language therapists, play specialists and patients may have their own mental health teams already. We will organise case conferences before discharge and try to get all the important members of the team there. The patient will be there, and they can choose if they want family to also attend. The clinicians working closely with the patient will be there and then we’ll invite people from outside the hospital such as their mental health team or a support worker,” the OT lead explained.
Following a person’s recovery and supporting them at such a close level can see health professionals become emotionally invested and keep their own head above water.
“Having really good close working relationships with others is so important,” Louise said, nodding to the background efforts away from the patient.
“We regularly have informal reflective sessions where if we have a bit of a long or emotional session, the burns therapy team which is made up of OTs and physiotherapists are there to help you. Our psychological therapists also offer support to staff as well as patients. If you have a patient that may be challenging to work with, we debrief to make sure we learned from that experience and also don’t go home with thoughts of not being able to cope at work. We also have close working relationships with burns therapists in other parts of the country which can be supportive when treating complex patients.”
While surgical and non-surgical treatments are necessary to ensure the burn heals to its full capability, Louise stressed the importance of the holistic occupational influence on rehab and recovery and making the process meaningful to the individual.
“It’s really important we hone in on what the patient views as meaningful to them.
“We as a team would love to work on all aspects of OT with a patient but actually, if it’s not important to them it may not be the right thing to do. We’ve had patients who have said, “I don’t mind someone coming in to help me get washed and dressed, because I really want out of the house and to go pick my daughter up from school and that is my aim,” so we work on that and our treatment will reflect that goal.
“We work closely with the London and South East Burns Network and we have two rehabilitation beds for patients referred via that network. This is a facility where there are two en suite rooms with a shared kitchen and lounge area. Patients use this facility to help in the transition from a supportive hospital environment to going home. Staff are still there to support the patients, but the focus is on giving them independence and confidence to leave hospital.
“An important part of the rehabilitation process is addressing patients’ psychosocial recovery. We work on goals around being able to step outside of the hospital environment and complete tasks such a shopping, using public transport and eating out. Patients adopt coping strategies to help, for example when people look at them and ask about their injuries,” Louise explained.
In the past couple of years, reports of harrowing acid attacks have become prominent in the media, with tragic stories hitting the headlines, but it is hard to really know how much of it has been sensationalised, with Louise telling us that at Queen Victoria, they haven’t seen a sharp rise, but more populated areas may have.
“At Queen Victoria Hospital we haven’t really seen an increase in the number referred to us although we have seen an increase in it being talked about in the media. However, we have always had patients who have sustained chemical injuries here both from accidental and deliberate causes. I think the real increase within our network has been in Chelsea and Westminster Hospital and St Andrews Hospital which covers the capital more, so it seems to be more of a link with bigger cities,” she posed.
But overall, Louise believes first and foremost their role is to help someone adjust to the situation and circumstances as well as possible and adjust to their new life as best they can.
“It’s helping people find their new normal,” Louise concluded.
“Evidence shows that it doesn’t matter what size of injury that someone can have, any size can affect their emotional wellbeing.”