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Trauma impacts people's coping mechanisms with their ability to function posing risks to their capacity to manage and respond appropriately to stressors, and to recover. Trauma informed care recognises the needs of survivors by focusing on system-wide design and support during recovery, minimising the risk of re-traumatisation, and maximising choice and empowerment for new adaptations and post-traumatic growth. The principles of TIC are currently not being fully utilised in burns practice, including for severe burns, with the nature, extent and impacts of trauma not being fully understood or acknowledged. Those who sustain a burn injury have an increased risk for developing psychosocial issues that can extend to the family unit, and people with pre-existing mental disorders are more likely to sustain a burns injury, experiencing extended hospitalisation and rehabilitation and being less likely to adhere to burns care. With the application of trauma-informed care within the burns setting, along with an understanding and acknowledging the link between trauma, burns injuries and mental health, health care professionals can minimise potential negative psychological impacts. Investing resources is now essential to effectively address the "trauma deficit" in the area of burns recovery., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Research into recovery and adjustment after burn injury has indicated a link between psychopathological symptoms including traumatic stress, distress, depression and anxiety, and worse psychosocial and physical outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, and symptoms can be ongoing in certain patients for extensive periods, leading to a need for early screening in burns patients for psychological vulnerabilities. One potential factor influencing recovery from the psychological impact of burn injury is adult attachment style, specifically secure and insecure attachment, as this describes how an individual organizes their stress regulation. This cross-sectional study measured: (a) attachment style (via the Relationship Questionnaire [RQ]): (b) negative psychological symptoms (via the Depression Anxiety and Stress Scale [DASS]); and, (c) post-traumatic symptoms (via the Davidson Trauma Scale [DTS]) in a cohort of burns patients (n = 104, 51 analysed) in a severe burns unit in Australia during the acute phase of their recovery. Secure attachment style was inversely related to psychopathological symptoms. Secure participants scored significantly lower scores on the DASS (M = 17.63, SD = 17.07) compared to self-rated insecure participants [(M = 42.38, SD = 34.69), p < .01] and on the DTS (M = 14.22, SD = 15.42) compared to insecure participants [(M = 40.54, SD = 35.72), p < .01]. Similar results were found in analyses controlling for covariates of gender, age and burn severity as potential confounders. This research suggests attachment style may play an important role in psychosocial recovery from severe burn injury., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Objective: To understand health professionals' perspectives of burn care and rehabilitation., Design: Qualitative and semi-structured interviews., Setting: Australian burn and rehabilitation units., Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings., Results: The data portrayed the health professionals' perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care., Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes. Implications for rehabilitation Burn care and rehabilitation remains a complex and challenging area of care. Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase. Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.

Advances in surgical techniques and wound management have improved outcomes for burn patients; however, the psychological impacts on burn survivors have had less attention. There is a higher rate of mental health disorders amongst burns victims, with those with pre-existing mental health conditions likely to have worse outcomes. To implement effective burns care and rehabilitation, knowledge and understanding of mental health issues is required. This position paper discusses the extent to which clinicians currently translate knowledge around mental health and burns into practice to identify enables and inhibitors. Successful knowledge translation requires dissemination and accessibility of information with the capacity and readiness for change. Clinicians and researchers need to identify how translating research to practice can meet the needs of burn survivors. There is a gap in the utilization of evidence concerning mental health and the needs of burns survivors, and we need to understand what we know as compared to what we do. Clinicians are well placed to determine how and why knowledge does not necessarily translate to practice and how they can better accommodate the needs of burn survivors., (© 2018 Australian College of Mental Health Nurses Inc.)

Severe burn injuries are highly traumatic requiring lengthy recovery. High levels of distress in the early stages of treatment have been associated with poor physical and psychosocial recovery outcomes. Identifying traits relating to distress and personal coping styles may aid screening. Type-D, or 'distressed', personality may be such a trait. Type-D personality refers to an ongoing personality organization defined by a tendency to experience greater negative emotions and thoughts while simultaneously socially inhibiting their expression (Denollet et al., 1996 . Type-D has been linked to poor health outcomes in those with cardiovascular disease as well as other populations and has been found to be associated with elevated psychological symptoms. Currently, there are no investigations in the literature looking at Type-D in the severe burns injury population. This study aimed to investigate Type-D in severe burn injury patients, specifically regarding the presence of psychological symptoms in early treatment, using data gathered during a pilot study conducted at a severe burn injury unit. The DS-16, Davidson Trauma scale and Depression Anxiety and Stress Scale scores were analysed along with demographic and clinical data in 54 participants (40 males, 14 females). Participants who were found to have Type-D displayed significantly higher levels of psychopathology. Additionally, Type-D was found to be a significant predictor of psychological symptoms.

Objectives: Burn injuries are complex traumatic events carrying high risks of acute physical and psychosocial morbidity. With greater survival, clinical and research attention has turned to psychosocial recovery outcomes and risk factors. It is timely to summarise current issues in posttraumatic disorders after burn injury for mental health and integrative care clinicians. Posttraumatic stress disorder (PTSD) is a common outcome of severe burn injury. There are difficulties in delivering current best practice treatments to many survivors especially those in rural and remote areas and those with comorbidities. Vicarious traumatization of clinicians, families and carers requires attention and internationally there are moves to psychosocial screening and outcome tracking., Conclusions: The role of the multidisciplinary treatment, integrated and trauma-informed care is essential. While level 1 evidence for PTSD treatments theoretically applies, adaptations that consider comorbidities and treatment contexts are often essential with further research required.

Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Peer support has long been recognised as an essential component of a supportive network for people facing adversity. In particular, burn survivor peer support is a valuable and credible resource available to those rehabilitating from a severe burn. The aim of this study was to explore burn survivors' experiences of providing and receiving inpatient peer support to develop an in-depth understanding of the influence during the rehabilitation journey. In 2011, twenty-one burn survivors were recruited from four severe burn units across Australia. A qualitative phenomenological methodology was used to construct themes depicting survivors' experiences. Participants were selected through purposeful sampling, and data collected through in-depth individual semi-structured interviews. Data were analysed using Colaizzi's phenomenological method of data analysis. Central to burn rehabilitation was the notion of peer support having a significant impact on burn survivors' psychosocial rehabilitation. The emergent theme 'Burn Survivor Peer Support' identified five cluster themes: (1) Encouragement, inspiration and hope (2) Reassurance (3) The Importance of Timing (4) The Same Skin (5) Appropriate Matching. These findings demonstrate that peer support assists with fostering reassurance, hope and motivation in burn rehabilitation. A national network based on a clinician led inpatient burn survivor peer support programme could provide burn survivors across Australia, and in particular remote access locations, with the benefits of peer support necessary to endure the rehabilitation journey., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Although studies have explored the 'lived experience' of burn survivors, little is known about their experiences encountered during rehabilitation. A descriptive phenomenological study was conducted to gain an in-depth insight into burn survivors' experiences' of acknowledgement and acceptance of their injury and the challenges experienced during their rehabilitation journey. A descriptive phenomenological methodology was used to construct themes depicting how burn survivors endeavoured to acknowledge and accept their injury and subsequent altered body image. Twenty men and one woman up to eight years after-burn within Australia were selected through purposeful sampling, and data were collected through in-depth individual interviews conducted in 2011 (N = 21). Interviews were analysed using Colaizzi's method of data analysis. The emergent theme acknowledgement identified four cluster themes that represented how burn survivors came to terms with their injury and an altered body image: (1) reasoning (2) humour (3) the challenge of acceptance (4) self-awareness. Coming to terms with a severe burn is a challenging experience. Reasoning and humour are strategies utilised by burn survivors that facilitate with acknowledgement and acceptance. Understanding these concepts through the burn survivors' perspective will, potentially, facilitate a better understanding of how to best provide for this cohort of patients., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)