The initial period of admission

1. Patient's psychologic response

• In order to avoid the bacterial infection, patients with burn injury have to stay in the intensive care unit of burn injury. It makes them feel lonely, fearful and anxiety due to the strange environment and the isolation of the ward.
• Because patients have to live in the isolation ward, their family is unable to give the emotional support any time. Patients must face the treatment by themselves. For losing a sense of security, they often claim for discharge or prolong the meeting time.
• Nightmare

• Denial and anger

2. How should the family member help？

Psychological and Emotional Support

• Appropriate Visitation and Deep Communication: Family members should maintain contact and visit appropriately, offering frequent conversation, companionship, attentive listening, and comfort to the patient. Communication should be tactful, and care should be conveyed with an objective attitude and empathy to make the patient feel valued.
• Recognize and Accept Negative Emotions: Family members should acknowledge and correctly address the patient's reactions, such as crying and low mood, and encourage the patient to talk about their inner feelings
• Assisting with Nightmares: Since burn injuries are often sudden, accidental events, patients may struggle to adjust and experience nightmares. Family members can appropriately share the burden of stress, understanding that nightmares will diminish over time.
• Avoiding Self-Discharge: Family members should be discouraged from requesting self-discharge (Against Medical Advice) due to the patient's inability to adapt to the treatment environment. These emotional reactions typically decrease as the patient becomes familiar with the setting and receives multidisciplinary assistance.

Medical and Care Coordination

• Providing Lifestyle Information: Family members can inform healthcare professionals about the patient's usual specific lifestyle habits to facilitate subsequent care and promote the patient's faster adaptation to the intensive care unit environment.
• Establishing a Supportive Environment: It is essential to ensure the creation of an environment where both the patient and the family feel emotionally safe. 

Treatment stage

1. Patients’ psychological response:

• Pain associated negative thoughts:

• Fears to treatment:

• Self-negation and decline in self-worth:

Patients may experience self-negation due to the loss of physical function and changes in appearance, and their sense of self-worth may decline.

2. How to help the patients while being the family members: 

During the treatment phase, burn patients often experience intense pain during procedures such as dressing changes and surgery, which can lead to negative emotions, rejection of cooperation, and disliking of healthcare staff. Additionally, patients may experience fear related to unknown treatments such as debridement and skin grafting. Procedures like wound care are often described as "terrible and frightening"

• Sustained Psychological Support: Family members must provide continuous psychological support to help patients cope with negative feelings and ensure they do not feel isolated. Strong emotional support is crucial for helping patients maintain emotional stability.
• Encouraging Positive Attitude: Family members should assist the patient in confronting treatment difficulties, encouraging them to maintain a positive attitude towards the healing process. This support is vital for reducing the risk of psychological disorders.
• Collaboration with the Multidisciplinary Team: Family members should collaborate with medical staff and social workers to jointly assist the patient. Given that healthcare professionals have the most contact with the patient and are most familiar with their condition, family members should discuss with them how best to assist the patient with physical and psychological reconstruction during their hospital stay. Optimal patient outcomes are predicated upon the synergistic interaction of diverse clinical expertise.
• Acting as a Communication Bridge/Advocate: Family members should help facilitate communication between the patient and the healthcare team, conveying the patient's concerns, questions, and expectations more clearly. In instances where the patient is unable to effectively communicate with providers due to physical or psychological impairment, the family member plays the crucial role of advocate. This is essential to ensure that decisions made throughout the care process are in line with the patient’s wishes and needs.

Rehabilitation Stage

1. Patients’ psychological response:

• Dependence:

In the injury period, the wounds cause restrictions in patient’s activities. Thus, they are dependent on medical stuff’s help in activities such as taking meals, taking a bath, or wearing clothes.

• Self-acceptance and self-identification:

Patients may learn to accept their physical changes through the process of recovery, and establish a new self-identity.

2. How to help the patients while being the family members:

The rehabilitation phase is a protracted process of burn recovery, which may persist for years, requiring continuous and comprehensive support to address the ongoing physical and psychosocial needs.

Promoting Physical Function and Self-Care

• Encouraging Functional Independence: In daily activities such as eating, bathing, and changing clothes, family members should adhere to the principle of "assist him to do," rather than "do it for him". This approach is crucial for fostering daily self-care capabilities.
• Assisting with Rehabilitation Training: Rehabilitation requires long-term execution. Family members should assist the patient in performing the various exercises instructed by medical staff. These exercises should encompass physical therapy, occupational therapy, and intensive training, including aerobic exercise and resistive exercise. Intensive exercise programs (combining aerobic and resisted exercise) lead to significant improvements in functional, physical, and psychological measures.
• Preventing Limb Contracture: Family members should help the patient maintain functional positioning to sustain limb function and prevent physical deformity or atrophy. It must be remembered: "The most comfortable posture is the posture of atrophy".
• Scar Management and Moisturisation: Family members are typically responsible for performing daily moisturisation and massage. Burn survivors who receive scar massage therapy have been shown to experience an improvement in pruritus (skin itching). Furthermore, massage therapy has been linked to a significant decrease in scar thickness, melanin, erythema, and transepidermal water loss.
• Psychological and Social Reintegration
• Discharge Preparation and Training: Family members should work together with healthcare professionals to complete discharge care preparations. Family caregiver training implemented before discharge has been found to significantly improve caregivers' knowledge and practices related to burn care, which is critical for preventing complications. Structured discharge preparation also significantly reduces anxiety in the caregiver and the patient.
• Addressing Social Challenges: Burn survivors frequently encounter stigmatization and unwanted attention in social settings. Family members should receive guidance on handling these social situations, such as encouraging active coping strategies like positive reframing or humor, instead of avoidance behavior.
• Encouraging Peer Support: Burn survivors commonly experience psychological distress, including Post-Traumatic Stress Disorder (PTSD) (affecting approximately 30%), depression, and anxiety, which may persist for years. Family members should encourage patients to participate in peer support programs, as these programs offer hope, encouragement, and a shared understanding, and are particularly beneficial for community reintegration. Survivors who regularly attended peer support groups had better long-term social-interaction scores.
• Addressing Economic and Transportation Barriers: Lack of family support and financial burden are recognized as risk factors for the development of psychosocial problems in burn patients. Family members should assist in resolving transportation difficulties and economic restrictions, as these factors are key barriers to patients' adherence to necessary follow-up care.