BURN CARE
CLINICAL ACTIVITIES
The interdisciplinary team who follow the children through their physical growth and psychological development are continuously striving to meet the challenges of complex burn-related problems for the growing child and developing adolescent, as well as for the families of children so injured.
Members of this team come from several clinical areas:
NURSING
MEDICAL STAFF
RESPIRATORY THERAPY
PSYCHOLOGY & PSYCHIATRY
MICROBIOLOGY
WELLNESS & EXERCISE CENTER
Objectives:
A. To provide family-centered care
B. To promote normal growth and development by providing play and
social opportunities
C. To reduce stress and anxiety through play, education, and emotional
support
D. To address and support reintegration needs
E. To elicit coping skills
F. To normalize the hospital environment
Responsibilities of the Child Life Staff:
A. Play opportunities at beside and playroom that promote growth in
all developmental domains
B. Pre-operative and procedural teaching and support
C. Education on make-up and skin care techniques
D. Facilitate, direct, and implement school re-entry videos and/or
re-entry visits
E. Camp referrals
F. Plan and implement patient outings and special events/holidays
Communications:
A. Documentation in SHCIS
B. Multidisciplinary discharge planning meetings
C. Complex needs meetings
D. Staff referrals
E. School referrals
F. Physician orders
Media Resources - Graphic Arts Department
Customer Service Area:
A. Customer work request filled out by Graphic Arts personnel.
B. Service performed per posted turn-around schedule.
Medical Photography:
- Patient photography (Acute & Reconstructive)
- (See Patient Rights, Section PR.013)
A. Admissions
B. Dressing changes as per medical/paramedical staff.
C. Operating room as per medical/paramedical staff.
D. Clinical as requested by medical/paramedical staff.
E. Discharge of patient.
F. Clinic as per medical/paramedical staff via photography request
form.
G. Outreach clinic as per photography request form located with
patient's clinic forms.
H. Autopsy.
Other
In-House Services:
A. Slide Duplicates - legal and teaching.
B. Film Processing - color slide E-6 process, black & white film
developing.
C. Passports - for official use only.
D. Public Relations - as directed by Administration/Public Relations.
E. Color, Black & White Slides from Books, X-rays, etc. - In-house
teaching, medical/scientific meetings.
F. Displays/Exhibits - Public relations, medical/scientific.
G. Photographic Printing includes publications, public relations, or
as needed by hospital.
Medical Illustrations:
A. Poster Exhibits - Medical/scientific staff, public relations, and
teaching.
B. Produce & Design Forms - Medical and administrative.
C. Framing & Matting - Photographs, certificates.
D. Produce & Design Certificates - Medical/scientific staff,
administrative.
E. Charts, Graphs, Color Slides - Computer generated in PowerPoint.
Occupational/Physical Therapy
The rehab philosophy is to assist the patient to reach the highest
level of function possible. This requires efforts of the entire
interdisciplinary team. Our therapists are cross-trained and there is
not a difference in patient care between the 2 disciplines.
Evaluations/Assessments:
A. Initial - Evaluation requires physician signature for
performance.
B. Ongoing - Physicians' orders reflect rehabilitative care throughout
hospitalization.
C. Discharge - Referral for outpatient therapy requires physician
signature.
D. Return to Clinic - Outpatient Summary requires physician signature.
Parent/Patient Education:
A. Bandage wrapping and splint application classes are Monday and
Wednesday at 13:30 (staff invited to classes)
B. Educational slide programs are Friday at 13:30. The program
stresses the importance of pressure, splints, activity, exercises, and
positioning. Patients are included in this formal training at age 9
and above. The primary therapist assigned to the patient provides
one-on-one training on exercises.
Communication:
A. Tuesday - Interdisciplinary D/C Planning Meeting.
B. Thursday - Grand Rounds.
C. Monday, Wednesday, Friday - Unit rounds on a daily basis at bedside
with team, 7:00a.m.
D. Saturday, Sunday & Holidays - Unit rounds at 9:30a.m. (or as the
attending physician schedules).
E. Weekend Treatment - Therapists provide priority treatments only.
Only 2 therapists are present on weekends and holidays.
Rehabilitation Referrals:
A. Referral process and paperwork.
Outpatient/Outreach Clinics:
A. All above procedures are tracked and continued in terms of the
patient and family meeting their rehabilitation goals. Outpatient
summaries are updated and provided to patient family and referral source.
Our department participates in outreach clinics to provide follow-up
treatments to patients in their community or surrounding areas. During
these clinics we proved priority therapy needs, i.e. splinting and pressure
therapy, and we make recommendations for the next level of rehab care.
School Re-entries:
A. The department assists with school re-entries so the children's
return to school may be a smooth transition.
Shriners Burns Hospital has a staff of mental health experts who follow every child and family from the time of admission to eventual discharge from the Shriners system - i.e. through the acute admission, as outpatients during clinic visits, and through subsequent admissions until the child is 21 years old or no longer needs our services.
Clinical Services
Staff: Clinical
Psychologist
2 part-time Child Psychiatrists
2 Psychologists
1 Psychology Post-Doctoral Fellow
We also have 1 or more psychology residents at any given time. A full-time school teacher provides schooling for every school-aged child as soon as they are able to participate, either at bedside or in the classroom on the 4th floor. Additionally, a professional counselor works mostly with clinical research, but will occasionally be involved clinically with a patient or family.
Much consideration must be given to a program of rehabilitation for the burn patient, and every patient needs an individually tailored plan of care. There are 4 principles for the rehabilitation of the burn patient:
The program should start
early, preferably the day of injury.
A program of care should
avoid prolonged periods of immobility, and any body part that is able to
move freely should be moved frequently.
Range of motion exercises
should be started the day of injury.
There should be a planned
program of daily activity and rehabilitative care. The plan should be
reviewed daily as rehabilitative needs change.
In February of 2000, the National Institute on Disability and Rehabilitation Research (NIDRR) awarded Dr. David N. Herndon, Chief of Staff, a five-year grant.
One of the principal aims of the grant is to investigate the effect that a three-month exercise program has on muscle strength in children with burn injuries. In conjunction with exercise training, therapeutic drug interventions such as the administration of anabolic agents, will also be studied.
Evidence
strongly suggests that exercise is beneficial in the rehabilitation of many
physical injuries and diseases. It is also believed that exercise will
significantly improve the functional outcome of patients who have suffered
severe burns. However, this has not been substantiated in a well designed,
randomized scientific study.
For this
purpose, the Children’s Wellness Center was created. It is a 500 square
foot facility fully equipped with strength and aerobic exercise equipment
for use by the patients participating in the NIDRR grant. The staff of the
Wellness center is responsible for the implementation of the individualized
exercise-training program and exercise testing of all patients involved in
the NIDRR study.
To date,
more than 200 patients have been tested and approximately 60 patients have
completed the exercise-training program. Results were extremely positive.
Patients that participate in the exercise program increase muscle function
and cardiopulmonary endurance significantly more than patients that did not
participate in the three-month exercise-training program.
Dr. Oscar E. Suman, associate professor at the University of Texas Medical Branch and director of the Children’s Wellness Center at Shriners Hospital for Children, is quick to point out that “It is important to remember that exercise training alone is not a substitute for traditional physical and occupational rehabilitation care. The benefits of exercise are probably additive and not independent of traditional physical and occupational therapy.”
The Children’s Wellness Center will continue to participate in this and other federal and non-federal clinical research studies in which the effects of exercise alone or in combination with various medical interventions are assessed.
Finally, the translation of research to clinical practice is reflected in the fact that exercise as a regular clinical therapeutic modality at the Galveston Hospital for patients age 7 and older, and with greater than 40% total body surface area burned, is starting to be implemented. The implementation of such exercise as cardiopulmonary and skeletal muscle rehabilitation (CPMR) is offered through the Children’s Wellness and Exercise Center under the direction of Dr. Oscar Suman.
Media Resources - Graphic Arts
OUTREACH CLINICS:
Summary of
Patient Care
Programs and Activities
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