Burn recovery includes addressing any emotional, psychological, and social needs of the survivor and family. Providing support and resources is essential for a smooth transition from the acute phase of injury to rehabilitation and successful social and community reintegration. Priority psychosocial target areas are developing social skills, addressing body image concerns, and providing peer support. Peer support provides a unique perspective of shared experience that can instill hope and assist coping efforts of survivors and family. Health care professionals can be instrumental in connecting survivors to community support organizations. Discussed are considerations for aftercare planning and peer support’s role.
Key points
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Burn recovery includes addressing emotional, psychological, and social needs the survivor and family may be experiencing.
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Supporting optimal healing includes developing an aftercare plan that provides support and access to resources to achieve social and community reintegration of the burn survivor.
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Developing social skills, addressing body image, and accessing peer support are priority needs for burn survivors’ successful community and social reintegration.
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Peer support for burn survivors and their families offers valuable support from the perspective of shared experience that is associated with instilling hope, belongingness, and empowerment.
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Health care professionals can assist burn survivors and families with reintegration within their roles by identifying needs; being aware of resources; and educating, supporting and connecting survivors to peer support across the care continuum.
Aftercare, survivorship, and peer support
The American Burn Association (ABA) reported an annual rate of 486,000 burn injuries in the United States that resulted in 40,000 hospitalizations and a recorded 96.8% survival rate for those admitted to a burn center. The burn injury survival rate has increased the need for a greater understanding and support of the life-long impact of physical and psychological implications of burn injury. More survivors and their families are engaged in postburn healing as they work to rebuild their lives and restore their well-being—a journey that requires greater attention to psychosocial ramifications of the burn.
The healing process often extends years beyond the acute hospitalization. As part of recovery, burn survivors often face challenges such as additional medical care and surgeries, extensive rehabilitation, changes in function or appearance, loss (of jobs, relationships, ability, activities), as well as psychological, emotional, and social complications from the injury. To support the optimal outcome of successful community and social reintegration of the burn survivor, support required to address psychosocial issues needs to be initiated at the start of burn recovery and continue after discharge. Doing so requires a comprehensive aftercare plan that offers ongoing support and connects survivors with accessible resources. This article briefly reviews psychosocial needs of burn survivors, aftercare planning, and the role of peer support in the burn recovery process.
Aftercare, survivorship, and peer support
The American Burn Association (ABA) reported an annual rate of 486,000 burn injuries in the United States that resulted in 40,000 hospitalizations and a recorded 96.8% survival rate for those admitted to a burn center. The burn injury survival rate has increased the need for a greater understanding and support of the life-long impact of physical and psychological implications of burn injury. More survivors and their families are engaged in postburn healing as they work to rebuild their lives and restore their well-being—a journey that requires greater attention to psychosocial ramifications of the burn.
The healing process often extends years beyond the acute hospitalization. As part of recovery, burn survivors often face challenges such as additional medical care and surgeries, extensive rehabilitation, changes in function or appearance, loss (of jobs, relationships, ability, activities), as well as psychological, emotional, and social complications from the injury. To support the optimal outcome of successful community and social reintegration of the burn survivor, support required to address psychosocial issues needs to be initiated at the start of burn recovery and continue after discharge. Doing so requires a comprehensive aftercare plan that offers ongoing support and connects survivors with accessible resources. This article briefly reviews psychosocial needs of burn survivors, aftercare planning, and the role of peer support in the burn recovery process.
Survivorship and recovery
Research shows that survivors of severe burns are at risk for experiencing psychological distress, including symptoms of post-traumatic stress disorder (PTSD), depression, social isolation and discomfort, and decreased quality of life. Burn survivors exposed to life-threatening situations may encounter psychological challenges, no matter the size of the burn. Early identification of need and intervention is important, as psychological difficulties in the initial phase of burn injury have been found to impact psychological health outcomes and quality of life.
Conversely, burn survivors may also undergo post-traumatic growth—even with the presence of symptoms of psychological distress—through contributors such as active coping and support. Post-traumatic growth (PTG) refers to positive changes that one may experience following a trauma and the subsequent coming to terms with the event. Resilience and positive growth are evident in burn survivors’ stories and their activities such as burn prevention, advocacy, and support of other survivors.
Given the complexities of recovery and the potential implications of a burn injury, how can burn survivors’ psychosocial healing and recovery be optimally supported to empower them to get back to living and successfully reintegrate into the community?
The voice and experience of burn survivors provide guidance. The Phoenix Society for Burn Survivors, a national organization that provides peer support, programming, education, and advocacy for burn survivors and others in the burn community, receives ongoing requests from burn survivors for services to support their adjustment and adaptation to their burn and the challenges they face as they return to their communities. Among these, the most sought after resources are related to
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Social re-entry
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Body image and appearance
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Peer support
The focus of these requests corroborate the priorities set by the Aftercare Reintegration Committee (ARC), a joint committee of the American Burn Association and the Phoenix Society for Burn Survivors, which was established to support collaboration between the 2 organizations and to set standards of care and priorities related to the rehabilitation and community/social reintegration of burn survivors after injury. Following a consensus conference attended by a group of burn survivors, family members, health care professionals, and researchers, the priority focus areas outlined to support psychosocial recovery and community/social reintegration of burn survivors were defined as
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Social skills development
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Body image enhancement
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Provision of peer support
The ARC has focused on education and advocacy efforts in these areas ever since that conference via presentations at the American Burn Association annual meetings and other written and conference venues. The American Burn Association also includes burn survivor and reintegration as a special interest group (SIG) topic at each meeting.
Among the studies that support social skill development and training as important to integration and adjustment is a large, ongoing study—the Life Impact Burn Recovery Evaluation (LIBRE). This study investigates 8 domains relating to social impact of burn injury, one of which is entitled “relating with strangers.” The 402 burn survivor respondents scored their outcomes in this domain as the lowest of the 8 domains measured. This suggests the need for support in managing social interactions and developing social skills and social comfort. Patients need to be prepared before discharge with social skills to help their return to the community—a task that can be supported with assistance from the treatment team, social skills programs, and peer support. Quayle developed a social skills program that provides an example of such a program and its impact.
Body image has been shown to be connected with psychosocial adjustment. Body image is also associated with quality of life, sexuality, intimacy, and other relational components. Interventions such as corrective cosmetics or image enhancement can be an additional resource beyond laser and other surgical interventions to assist in addressing this area of need. Health care professionals must be comfortable to ask about the topic, to assist burn survivors in adjusting to and accepting body changes, and/or make referrals to appropriate resources. Lawrence, Fauerbach, and Mason provide helpful additional reading about body image and intervention in their article, Understanding and Improving Body Image after Burn Injury (MSKTC) ( Fig. 1 ).
Peer support is the third priority of focus of the ARC. Peer support has also been the cornerstone of the programs of the Phoenix Society for nearly 40 years and is deeply valued by burn survivors and family members. Peer support is in itself an intervention, and it can also be used to assist with addressing other issues, such as the social skills and body image topics previously reviewed. Because of peer support’s critical role in psychosocial recovery, it will be discussed more in-depth.
Role of peer support in recovery
Recovery from a burn injury can be overwhelming, and it can be difficult for burn survivors to feel hopeful or to envision a good quality of life. Peer support is a valuable psychosocial resource that offers burn survivors and their families an inside perspective of life after a burn injury. Peer supporters in burn care are burn survivors who have been trained and prepared to share their personal stories and recovery experiences with other burn survivors who are in an earlier stage of healing—or a later stage of healing and in need of additional support. Peer support is also available for the family of burn survivors and is provided by their peers, other burn survivor family members.
Mutual aid as a source of support dates back to 1737 to 1840 when Native Americans employed it to address alcoholism. In health care, peer support is used in various settings to the benefit of patients including burn centers and traumatic brain injury and cardiac care units. Peer support may take place face to face, virtually, informally, or through systematic efforts of an organization. In burn care, peer support can occur in a variety of ways, a summary of which is illustrated in Table 1 .
