Varje år drabbas ett tusental människor i Sverige av allvarlig brännskada, en skada som kommer att förändra deras liv för alltid. Sjuksköterskan kan dagligen möta människor som känner sig stigmatiserade, kanske utan att hon vet om det. Den brännskadade kan inte dölja sitt yttre och sjuksköterskan kan inte låta bli att lägga märke till det. Syftet med denna studie är att belysa hur människor som drabbats av allvarlig brännskada upplever sin livssituation efter skadan. Resultatet är sammanställt genom analys av sex kvalitativa artiklar. I resultatet framkommer tre huvudteman och nio underteman. Det första temat ‖Att uppleva kroppen på ett nytt sätt‖ delas upp i två underteman ‖Minnen av en outhärdlig smärta‖ och ‖En förändrad kropp‖. Det andra temat ‖Starka känslor‖ har fyra underteman som är ‖Att lämna tryggheten på sjukhus‖, ‖En lång väg tillbaka‖, ‖En förändrad syn på livet‖ och ‖Ett liv med minnen, mardrömmar och tillbakablickar‖. Det tredje huvudtemat, ‖Förändring av sociala relationer‖ beskrivs genom undertemana ‖En förändrad yrkesfunktion‖, ‖Förändrade relationer med närstående‖ och ‖Närståendes betydelse på vägen mot acceptans‖. En diskussion förs om hur livsvärlden förändras efter att man har drabbats av allvarlig brännskada. Brännskadan väcker många känslor och tankar och kan leda till en förändrad identitet. Vidare diskuteras även sjuksköterskans roll och hur hon kan lindra lidandet, bland annat genom att stötta anhöriga som har en oerhört viktig roll för den brännskadades välbefinnande. / Program: Sjuksköterskeutbildning

<p><strong>Syfte:</strong> Syftet med litteraturstudien var att beskriva brännskadade personers upplevelser av livet efter en brännskada. <strong>Bakgrund:</strong> En brännskada är ett trauma för både kropp och själ och ett stort lidande för den drabbade. Fysiska förändringar och psykologisk kris gör vägen tillbaka svår. Genom medicinskt kunnande och genom att vara ett medmänskligt stöd har sjuksköterskan en viktig roll under både den fysiska och psykiska läkningsprocessen. <strong>Metod: </strong>Studien är en allmän litteraturstudie baserad på fem kvalitativa vetenskapliga artiklar samt en självbiografi, publicerade mellan år 2003-2008. Analysen innebar att meningsbärande enheter togs ut och sammanfördes till tre huvudkategorier med tillhörande underkategorier. <strong>Resultat:</strong> De brännskadade upplevde att livet efter brännskadan innebar stort lidande och gjorde att de inte längre kunde vara självständiga. De upplevde bristande tillit till sin egen kropp vilket ledde till ett försämrat självförtroende. För att kunna gå vidare i livet var det viktigt att finna vägar för att acceptera och hantera det som hänt. Efter hand kunde livet ses positivt och värderas högre. Flera olika faktorer hade stor betydelse för att de skulle kunna känna trygghet i sitt förändrade liv. <strong>Slutsats: </strong>För att sjuksköterskan ska finnas där som stöd för den brännskadade behövs djupare kunskap inom området, vilket gör att ytterligare forskning är betydelsefull. Kunskapen skulle kunna spridas vidare genom att brännskadade föreläser om sina upplevelser och att de som är insatta i ämnet handleder personal inom hälso- och sjukvård utifrån casemetodik.</p> / <p><strong>Aim:</strong> The purpose was to describe how people with burn injuries experience their life after a burn injury. <strong>Background:</strong> A burn injury is a trauma for both body and soul and a big suffering for the person who is affected. Physical changes and psychological crisis makes it hard to recover. By medical knowledge and through human support nurses have an important role during the physical and psychological healing process. <strong>Method:</strong> This study is a literature overview, based on five qualitative scientific articles and one biography, published between the years 2003-2008. In the analysis meaning units were identified and brought together into main categories and sub categories. <strong>Result:</strong> People with burn injuries experiences that life after the injuries meant a great deal of suffering as well as a loss of independence. They experienced lacking trust in their own body, which lead to impaired self-confidence. To be able to move on in life, they had to find ways to accept and deal with what had happened. Several different factors were of importance to make them feel safety in their changed life. <strong>Conclusions: </strong>For the nurse to be able to be there for people with burn injuries, more knowledge of the subject is needed, which makes further research important. The knowledge could spread by the burn injured holding lectures about his or hers experiences, and by the well-informed tutoring health care staff and students using case methodology.</p>

Bakgrund: Livet förändras för individer som drabbats av en brännskada. Många får beståendeärr och funktionsnedsättning som innebär stora sociala, fysiska och psykiska utmaningar sompåverkar deras liv. Brännskada är ett trauma som uppstår när huden kommer i kontakt medvärme. Huden fungerar som skydd för inre organ, reglerar kroppstemperatur ochvätskemängd, fungerar som känsel och kontaktyta samt infektionsbarriär.Syfte: Syftet var att belysa individers upplevelser av livet efter en brännskada.Metod: En allmän litteraturstudie genomfördes baserad på kvalitativa och kvantitativavetenskapliga artiklar.Resultat: Resultatet visade att individer som drabbats av en brännskada upplevde sin kroppsom främmande och kände sig begränsad i vardagen på grund av funktionsnedsättning ochsynliga ärr. Stödet från närstående var ovärderligt för dessa personer och det hjälpte demgenom den långa rehabiliteringen. Upplevelsen av meningsfullhet var mycket viktigt och detfann individerna genom att ha ett meningsfullt arbete och bli accepterade av samhället.Konklusion: Det sociala nätverket har stor betydelse för individens förmåga att hanteraföljderna efter en brännskada och påverkar även individens psykiska tillstånd. Därför är det avvikt att involvera hela familjen i omvårdnaden. / Background: Life changes for individuals affected by a burn. Many suffer permanent scarsand disabilities with high levels of social, physical and mental challenges that affect theirlives. Burn injury is a trauma that occurs when skin comes into contact with heat. The skinserves as protection for internal organs, regulates body temperature and fluid volume, acts asa touch and contact area and infection barrier.Purpose: The aim was to highlight individual’s experiences of life after a burn injury.Method: A general literature review was conducted based on qualitative and quantitativescientific articles.Results: The results showed that individuals who suffered a burn injury experienced his/herbody as foreign and felt restricted in everyday life because of disabilities, and visible scars.The support from relatives was invaluable for these individuals and it helped them through thelong rehabilitation. The experience of meaningfulness was very important and the individual’sfound it by having meaningful work and be accepted by society.Conclusion: The social network is of great importance for the individual’s ability to deal withthe consequences after a burn injury and also affects the individual’s mental state. Therefore,it is important to involve the whole family in nursing.

Syfte: Syftet med litteraturstudien var att beskriva brännskadade personers upplevelser av livet efter en brännskada. Bakgrund: En brännskada är ett trauma för både kropp och själ och ett stort lidande för den drabbade. Fysiska förändringar och psykologisk kris gör vägen tillbaka svår. Genom medicinskt kunnande och genom att vara ett medmänskligt stöd har sjuksköterskan en viktig roll under både den fysiska och psykiska läkningsprocessen. Metod: Studien är en allmän litteraturstudie baserad på fem kvalitativa vetenskapliga artiklar samt en självbiografi, publicerade mellan år 2003-2008. Analysen innebar att meningsbärande enheter togs ut och sammanfördes till tre huvudkategorier med tillhörande underkategorier. Resultat: De brännskadade upplevde att livet efter brännskadan innebar stort lidande och gjorde att de inte längre kunde vara självständiga. De upplevde bristande tillit till sin egen kropp vilket ledde till ett försämrat självförtroende. För att kunna gå vidare i livet var det viktigt att finna vägar för att acceptera och hantera det som hänt. Efter hand kunde livet ses positivt och värderas högre. Flera olika faktorer hade stor betydelse för att de skulle kunna känna trygghet i sitt förändrade liv. Slutsats: För att sjuksköterskan ska finnas där som stöd för den brännskadade behövs djupare kunskap inom området, vilket gör att ytterligare forskning är betydelsefull. Kunskapen skulle kunna spridas vidare genom att brännskadade föreläser om sina upplevelser och att de som är insatta i ämnet handleder personal inom hälso- och sjukvård utifrån casemetodik. / Aim: The purpose was to describe how people with burn injuries experience their life after a burn injury. Background: A burn injury is a trauma for both body and soul and a big suffering for the person who is affected. Physical changes and psychological crisis makes it hard to recover. By medical knowledge and through human support nurses have an important role during the physical and psychological healing process. Method: This study is a literature overview, based on five qualitative scientific articles and one biography, published between the years 2003-2008. In the analysis meaning units were identified and brought together into main categories and sub categories. Result: People with burn injuries experiences that life after the injuries meant a great deal of suffering as well as a loss of independence. They experienced lacking trust in their own body, which lead to impaired self-confidence. To be able to move on in life, they had to find ways to accept and deal with what had happened. Several different factors were of importance to make them feel safety in their changed life. Conclusions: For the nurse to be able to be there for people with burn injuries, more knowledge of the subject is needed, which makes further research important. The knowledge could spread by the burn injured holding lectures about his or hers experiences, and by the well-informed tutoring health care staff and students using case methodology.

Due to medical advances, there has been an increased number of burn survivors, thus creating a dire need for research on burn recovery. As 70% of burn-injured patients are male, it is especially important to examine how men understand healing from a burn injury. One way to explore this is by investigating men’s stories of healing because it is through and by the experiential space of narrative that individuals are provided with the tools to reflect on and find meaning from their experiences of burn injuries. This thesis examined narratives men constructed about healing from a burn injury. Adult men with 0.5 – 30% total body surface area burned were recruited for an in-depth semi-structured interview, two to fifty-two weeks post-injury. Narrative analysis of the transcripts revealed that men principally constructed a dominant narrative that involved wanting to return to a life that was “normal” as soon as possible. I argue that these stories are indicative of a restitution storyline, that is, they follow a plotline in which the men view themselves as being temporarily injured but soon recovered. I then explore how agency, or more specifically, how agentic behaviours facilitate these narratives about men returning to their pre-injury selves. Men also constructed narratives about boredom, grief and regrets at the same time as the restitution narratives. These narratives indicated distress because they were counter to the stories that the men wanted to construct. The discussion contextualizes the men’s restitution narratives in terms of masculine socialization, and considers the role of agency in informing narrative plotlines. Lastly, recommendations to health care providers who treat men that have survived a burn injury are provided.

Due to medical advances, there has been an increased number of burn survivors, thus creating a dire need for research on burn recovery. As 70% of burn-injured patients are male, it is especially important to examine how men understand healing from a burn injury. One way to explore this is by investigating men’s stories of healing because it is through and by the experiential space of narrative that individuals are provided with the tools to reflect on and find meaning from their experiences of burn injuries. This thesis examined narratives men constructed about healing from a burn injury. Adult men with 0.5 – 30% total body surface area burned were recruited for an in-depth semi-structured interview, two to fifty-two weeks post-injury. Narrative analysis of the transcripts revealed that men principally constructed a dominant narrative that involved wanting to return to a life that was “normal” as soon as possible. I argue that these stories are indicative of a restitution storyline, that is, they follow a plotline in which the men view themselves as being temporarily injured but soon recovered. I then explore how agency, or more specifically, how agentic behaviours facilitate these narratives about men returning to their pre-injury selves. Men also constructed narratives about boredom, grief and regrets at the same time as the restitution narratives. These narratives indicated distress because they were counter to the stories that the men wanted to construct. The discussion contextualizes the men’s restitution narratives in terms of masculine socialization, and considers the role of agency in informing narrative plotlines. Lastly, recommendations to health care providers who treat men that have survived a burn injury are provided.

Bakgrund: En svår brännskada innebär en djup hudskada där kroppens underliggande organ kan komma att påverkas vilket kan resultera i ett kritiskt tillstånd. Skadan kan ge konsekvenser som berör den fysiska, psykiska, sociala och existentiella hälsan. Då en svår brännskada bedöms utifrån varje enskilt fall utgår sjuksköterskans omvårdnadsinsatser från de olika konsekvenser som brännskadan medfört. Med sjuksköterskans holistiska förhållningssätt i omvårdnaden kan det identifieras olika aspekter och faktorer i patientens hälsotillstånd som denne upplever vara av ett lidande. Det är då av vikt att sjuksköterskan ser till patientens hälsorelaterade livskvalitet, då detta beskrivs som ett subjektivt mått på hälsa och utgör således patientens unika upplevelser av sitt välbefinnande. Syfte: Att beskriva den hälsorelaterade livskvaliteten hos vuxna personer efter en svår brännskada. Metod: En litteraturöversikt har gjorts enligt Fribergs analysmetod. Tio vetenskapliga artiklar har valts ut med samtliga bestående av kvantitativ design. Artiklarna har sökts fram i databaserna CINAHL Complete och PubMed. Som en teoretisk utgångspunkt har Katie Erikssons omvårdnadsteori valts ut och använts som en referensram i resultatdiskussionen. Resultat: Tre huvudteman med underteman har identifierats: fysiska aspekter av livskvalitet med underteman ”smärta och rörelseförmåga” och “faktorer som påverkar den fysiska livskvaliteten”, psykosociala aspekter av livskvalitet med underteman “psykisk ohälsa” och “faktorer som påverkar den psykosociala livskvaliteten” samt generella aspekter av livskvalitet med underteman “sjukhustiden, vårdinsatser och tid sedan skadetillfället” och “ålder/kön”. Diskussion: I metoddiskussionen har författarna diskuterat för- och nackdelar med utförandet av denna litteraturöversikt. I resultatdiskussionen har det diskuterats de resultat som har varit mest intresseväckande hos författarna. Dessa har diskuterats utifrån Katie Erikssons omvårdnadsteori, litteraturöversiktens bakgrund och tidigare forskning. / Background: A severe burn is defined as a deep dermal damage in which the body's underlying organs can become affected and can result in a critical condition. The consequences of a burn can affect the physical, psychological, social and existential health. Since a severe burn is evaluated on a case to case basis, the nurse's caring interventions are based on the specific consequences from the burn. With the nurse's holistic approach on caring, he/she can identify different aspects and factors in the patient’s general health of which the patient experiences as suffering. Therefore it is of great importance that the nurse cares for the patient's health-related quality of life, since this is described as a subjective measurement of health and compounds the patient’s unique experiences of his/her wellbeing. Aim: To describe the health-related quality of life among adults with a severe burn injury. Method: A literature review was done in accordance with the Friberg analytical method. Ten scientific articles were selected, all of which consisted of a quantitative design. The articles were found in the CINAHL Complete and PubMed databases. As a theoretical base, Katie Eriksson’s caring theory was selected and used as framework in the results discussion. Results: Three main themes with subthemes were identified; physical aspects of quality of life with subthemes “pain and movement capability” and “factors that affect the physical quality of life”, psychosocial aspects of quality of life” with subthemes “psychological ill-health” and “factors that affect the psychosocial quality of life” and general aspects of quality of life with subthemes “length of hospital stay, caring interventions and time since injury” and “age/gender”. Discussion: In the method discussion the authors have discussed the pros and cons of the execution of this literature review. In the results discussion, the results that were of greater interest to the authors have been discussed, in accordance with Katie Eriksson's caring theory as well as the background in this literature review and previous research.

Objective: Severe burn injuries are associated with a rapid escalating hypermetabolic state and catabolism of muscle mass. To ameliorate this process a standardized approach using pharmacological and non-pharmacological interventions was implemented within a single burns center. Whilst individual components of this standardized package are well documented in the literature, their collective or bundled effect has not as yet been assessed. The aim of this study was to evaluate the efficacy of this standardized bundle of metabolic modulators and assess the safety of including the anabolic steroid oxandrolone within it. Methods: This retrospective observational study constituted all patients in whom the metabolic bundle including oxandrolone therapy was applied. The other elements of the metabolic bundle consisted of early surgical burn excision within seven days to completion, early active mobilization, increased ambient room temperature, expediated carbohydrate and protein rich enteral feeding with glutamine and trace element supplements (such as copper and zinc). Finally, administration of propranolol as a non-selective beta-blocker. Data collection was through review of the patient data management system focusing on the outcome criteria and hepatic blood values. Results: The study looked at fifty consecutive patients meeting the inclusion criteria. Median patient age and burned total body surface area (TBSA) were 62 years [51.75; 73] and 33.75 % [24.75; 51] respectively with an abbreviated burn severity index (ABSI) of 10 [9; 10.25]. Definitive surgical burn wound excision was completed in 44 patients [88 %] within 7 days. 39 patients (78 %) received propranolol over a therapeutic period of 29 days [19; 44]. Glutamine was supplemented in 45 patients (90 %), while zinc and copper were applied to 42 (84 %) and 31 (62 %) respectively. Significant low zinc values were noted at therapeutic onset (6.5 mmol/ l [4.7; 7.9]) requiring sustained substitution over 37.5 days [22; 46.75]). In respect of the inclusion criteria, all patients received oxandrolone at 20mg/day [20; 20]. This was commenced on day 6.5 [4; 14] post burn injury and continued over 26 days [19; 31]. Despite a transitory elevation of hepatic enzyme values (ALT, GGT), these were only clinically relevant (>10µmol/l*S) in 2.4 % and 4.6 % of all measurements respectively. None were sufficiently of concern to merit cessation of treatment. Conclusion: The application of a standardised bundle of metabolic treatment options of severe burns injured patients is reliable, repeatable and safe. Potential concerns of oxandrolone treatment regarding hepatic compromise remain unfounded.:Introduction Epidemiology of severe burns injuries in the Federal Republic of Germany The hypermetabolic and catabolic state Therapeutic approach Non-pharmacological therapy Early surgical intervention Ambient temperature Enteral feeding in burns patients Occupational and physiotherapy in burns patients Pharmacological therapy Insulin Propranolol Oxandrolone Oxandrolone in the Federal Republic of Germany Metabolic bundle Materials and Methods Subjects and study design Ethical approval Burn care protocol Oxandrolone and the metabolic bundle Data collection Statistical analysis Objective of study Publication Summary References Appendix Declaration of independent scientific contribution, conception and execution of publication Declaration of independent scientific contribution towards dissertation Curriculum vitae Acknowledgements and thanks

Alcohol is the most abused drug in the United States and most frequently performed assay in forensic laboratories. Alcohol is routinely present in biological specimens from fatal residential fires and forensic toxicologists must interpret if these individuals are impaired by determination of their blood alcohol concentrations on post-incineration blood collected at autopsy. There is no known data available to confirm or refute blood alcohol concentrations and impairment in fire-related deaths. Ethyl glucuronide (EtG), a non-volatile minor ethanol metabolite, may provide a better biomarker for ethanol consumption prior to burn injury. The literature does not address the possibility that ethanol or EtG concentrations are altered in fire deaths. A Sprague Dawley rat model was employed to determine if ethanol and EtG concentrations in blood, liver, heart, and kidney were altered after burn injuries using two incineration models with varying durations and temperatures. Blood and tissues were analyzed for ethanol by gas chromatography and EtG by enzyme immunoassay. Other measurements including organ weights, lower hindquarter weights, and blood glucose concentrations were chosen for analysis to determine the mechanism by which the blood and organ ethanol and EtG concentrations are altered in burnt corpses. The rodent provided an excellent model for studying the biotransformation of ethanol to EtG and the effects of burn injury on ethanol and EtG concentrations. Our study revealed that blood ethanol concentrations were not significantly altered by burn injury but tissue ethanol concentrations were altered by burn injury. EtG concentrations were found to be altered in blood and tissue specimens in both incineration models. Our data suggest that the change in ethanol and EtG concentrations may be correlated to higher core body temperatures from burn injury and not changes in organ weight. Determining if blood ethanol concentrations are altered in burnt corpses is important for forensic toxicologists to conclude if victims were impaired at the time of death. The knowledge gained from these experiments will help forensic toxicologists by confirming the current interpretation that blood ethanol concentrations are not altered in fire deaths and provide a better understanding for the interpretation of impairment in burn deaths.

<p>Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. </p><p>A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. </p><p>To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.</p>