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Compassion and Resilience: 70 Years of Burn Care at Arkansas Children’s
Published date: October 26, 2023
The Number One Thing
Burn Center Patient Care Manager Nikki Spriggs, RN, BSN, RN, CCRN, has served various roles during her 39-year career, including bedside nurse, wound care specialist and team leader. Over the years, Spriggs has treated thousands of burn survivors and worked alongside many nurses, physicians, physical and occupational therapists, child life specialists and other specialists in the hospital. She said one personality trait is vital when caring for burn survivors. “Absolutely, compassion is the number one thing.”
Compassion drives how Arkansas Children’s team members interact with patients experiencing intense pain, adjusting to life-long scars and learning to cope with limited mobility.
Peper Howard, burn technician at ACH for the past 24 years, described compassion as being “caring, loving and understanding, because the patient – they’re hurting and they’re going through different emotions, and you have to go through those emotions with them.”
Fear of the unknown and frustration - common responses of patients in the early stages of burn treatment - are compounded by ongoing pain. Methods to manage the pain of the injury and pain during treatment have improved over the past seven decades, but some pain is unavoidable. Healing hurts. Burn survivors wonder when the pain will end and how the scars from their injury will impact them. In addition to physical wounds, burns often leave mental wounds - a type of post-traumatic stress disorder (PTSD).
"Some of them can still smell the fire," Howard said. Like others with PTSD, burn survivors may have involuntary reactions to loud noises or other triggers that remind them of the circumstances of their injury.
One of the benefits of having the Burn Center inside ACH is convenient access to other departments and specialists, like psychologists, respiratory therapists and nutritionists. The more severe a burn injury, the more complex the treatment required.
A Lifetime Injury
Whether fire, scalding water, electricity or chemicals like bleach or freon cause the burn, one of the first things the burn care team does is measure the depth of the injury and the percentage of a person's body that has been burned. These measurements help determine immediate treatments, like using IVs to replace fluids, and long-term treatment, like physical and occupational therapy. Unlike a torn ACL that gets surgically repaired and then allowed to heal 1-2 weeks before physical therapy begins, a burn injury requires physical and occupational therapy almost immediately. Burn scars can start constricting and damaging nearby nerves and tissue in as few as 1-4 days, so physical and occupational therapists treat burn injuries as soon as the patient is able.
Mandy Yelvington, MS, OTR/L, BCPR, BT-C, occupational therapist and clinical research coordinator for the Burn Center, said, "We start working with patients immediately after admission. We usually do an evaluation within 12-24 hours after they're in the hospital, so we're seeing them in the very acute stages. We follow them all the way through. I'm still seeing patients I met during my first year here. Burn is a lifetime injury." Yelvington began work at ACH 25 years ago and has been a part of the Burn Center for two decades. "We're always a part of their team and their family," she said.
The Arkansas Children's Burn Team participates in national and international research projects to improve the quality of care provided to burn survivors. Yelvington said the Arkansas Children's Burn Team contributed to an international study that helps physical and occupational therapists forecast and begin immediate treatment based on which part of the body is burned and the severity of the burn.
“We have learned that with how burned skin scars and how burned skin stretches or doesn’t stretch that there’s the opportunity on day one of the injury to foresee where the complications may be six months or a year down the road,” Yelvington said.
The 'predictive care' model also removes some unknowns for burn survivors. Understanding their injuries and the likely outcomes gives them some control over the pieces of their recovery that depend on willpower and the personal motivation to persevere.
Resilience
While compassion is a key trait for the Burn Center team, resilience is critical for burn survivors.
"You have to encourage them to be strong. That road to recovery can really be arduous," said Georgia Franklin, BSN, RN, RN II. She's been a part of the Burn Center for 21 years. Franklin said a burn injury experienced as a child piqued her interest as a student nurse assistant during her first year at ACH. She's an example of how some burn survivors develop resilience by supporting each other.
Burn Center team members provide encouragement during every stage of the healing process, whether the patient is having bandages changed, doing rehabilitation exercises or receiving follow-up care.
Because burns can be a lifetime injury, the Arkansas Children's Burn Center offers ongoing social and emotional support for survivors. Over 30 years ago, Burn Center team members began Camp Sunshine, a 4-day camp for burn survivors ages 4-17. Franklin said for pediatric patients, "going back to school and getting reintroduced into their communities, it was helpful to have some extra support and resources. Those children really needed to be with other children who had been burned and had similar injuries."
The Arkansas Professional Firefighters Association funds the annual event, which Shannon Smith, BSN, RN, Burn Outreach and Aftercare Program Manager, describes as “just a joyous time.” Smith said the event is a reprieve because “[survivors] have to live in a society that can be bullying towards their appearance.” Four days of swimming, field trips and camp activities with others who have had shared experiences leads to lifelong friendships and strong mentoring relationships.
“It’s my safe place,” one Camp Sunshine participant said.
Arkansas Children’s also hosts a young adult retreat for burn survivors ages 17-25 and adult retreats and recurring dinners for survivors. Some survivors opt to be formally trained as mentors through the Phoenix Society for Burn Survivors. The national nonprofit provides training through its Survivors Offering in Assistance in Recovery (SOAR) program.
Those programs for patients of all ages benefit survivors and Burn Center team members. Offering compassion to survivors every day is incredibly taxing for Burn team members. Smith said attending the retreats is a way "to get that compassion refueled." She said it's reenergizing "seeing those burn survivors - the ones that you took care of that were so sick and not able to take care of themselves - seeing them function normally and laughing and transitioning from the burn victim to the burn survivor."
Over the past 70 years, the Arkansas Children’s Burn Center has been committed to constant improvement, providing exceptional care during every stage of a burn survivor’s recovery and strengthening the cycle of compassion and resilience.
Siblings and Survivors: Three Children Burned in a House Fire
Every burn injury is unique and challenging, but some cases are more challenging than others. Children, for example, require treatments appropriate for their developing bodies. ACH Occupational Therapist Mandy Yelvington, MS, OTR/L, BCPR, BT-C, said, "The complicating factor with burn is - that skin that's been burned never stretches like skin that hasn't been, so when [children] hit their growth spurts, their skin doesn't grow with them. They may, for the rest of their life, need reconstructive surgery."
Yelvington said injuries caused by house fires often add to the challenge of multiple patients being admitted simultaneously. In those situations, Burn Center team members provide individualized care to each patient while addressing the emotional needs of family members concerned about each other.
In June 2021, both those challenges presented themselves when three young siblings were transported from a hospital in Tennessee to ACH after being burned in a house fire. MaryLou Crowder, eight years old at the time and the oldest of the three, had burns on over 90% of her body. Her two younger brothers, Jordan Holliman and Cortez Jones, were burned over 70% of their bodies.
Severe injuries require increased coordination between multiple units in the hospital. Team members in the Pediatric Intensive Care Unit (PICU) treated the siblings’ most urgent medical needs – breathing, for example. Endotracheal tubes were inserted, which allowed them to breathe. Alongside the PICU staff, nurses and Burn Center team members added their specialized expertise, assessing the wounds and making treatment plans for the day when the three would be transferred to the inpatient Burn Unit.
Every child required skin grafts because so much of their body had been burned. Grafted skin is delicate. Even lying in bed can add too much pressure to the wound and disrupt healing. The team created specialized supports made of gauze and PVC tubing, which allowed the children to be suspended with very little pressure on the wounds while allowing airflow to keep the skin dry.
Turning the children from their backs to their stomachs required the coordinated efforts of over half a dozen staff members. Every team member involved in treating the siblings said every patient receives the same high level of care, but the teamwork involved with those three children was extraordinary. Georgia Franklin, BSN, RN, RN II, provided wound care and was one of the team leaders during their care. "So many different disciplines came together to help with their care and support them," she said. "We worked with PICU, child life [specialists], OT, PT, respiratory - everyone came together to make sure [the children] would have a good outcome."
Charette Jones, the siblings’ aunt and legal guardian, said, “You couldn’t ask for a better team.”
When asked if she had a favorite nurse or doctor, MaryLou said, "All of them." She recalls one of the highlights of her recovery being "When I could finally Hot Cheetos."
Nearly 18 months after being admitted, MaryLou has relearned how to walk and enjoys playing outside with her brothers, cousins and dog. She wears compression garments because her skin is still healing, and all three still visit the staff in the ACH Burn Unit when they come to the hospital for follow-up care.