Interview with… a burns nurse
Malcolm Bennison, 29, works as a burns nurse at a London hospital. He treats patients with wounds of all degrees of severity
Most people immediately associate burns with fire, but there are so many other common causes – people spilling cups of tea, dropping hot dinners, scalding themselves on hot-water bottles. A person in contact with a warm object for a long space of time can sustain deeper burns. If you spill boiling water on your hand you will limit the damage by quickly pulling your hand away. With something like a hot-water bottle you may fall asleep on it and only wake up hours later.
I wanted to go into burns because I like being specialised rather than a jack of all trades. It’s a really good, close team on the burns ward. It’s an acute ward so the need for teamwork is paramount.
In an average week I will do three or four shifts lasting from 7.15am to 8.30pm. I will normally get up at 5.00am. The start of the day is handover time. The nurse in charge of the previous shift will brief us on the patients. For most wards in London there would normally be six patients to each nurse, if you’re lucky, but the ratio tends to be higher outside London. For burns it’s a smaller ratio: the more acute the patient the smaller the ratio, so it’s four patients per nurse for us.
After the group handover we do a bedside handover. The nurse who looked after your patients will introduce you to them and give you all the information you need and the complaints they are presenting with. When the handover is finished, meds are given out at the same time as breakfast.
Next, we change the dressings. The doctors will come round with the multidisciplinary team to study patients and answer questions. It can be intimidating for patients to have eight people gathered round their bed but we encourage them to ask whatever they need to.
Everyone wants to know how long it will take for their wounds to heal, what they will look like. There are no mirrors on the ward but patients often use their cameraphones to take pictures of themselves.
It is impossible to predict how long the healing process will take: every burn is different. Wounds might degenerate or they might not look like they need surgery initially but that could change.
Diet is an important factor in the healing process. Protein is essential because it helps your body regenerate. All the food is screened by dieticians. People with poor diets, smokers or those with a low appetite are more at risk of low outcomes, healing-wise.
After the doctors have been round we finish off the dressings – depending on the patient this can take two hours or more per patient.
Patients in intensive care have sometimes lost 20 per cent of their body surface area. They may have been in a house fire or it could be a result of self-immolation. They leak a lot of liquid, like when a blister pops you leak fluid. These patients will have a lot of fluid replacement going on.
Most of the intensive care cases are intubated. When you don’t have enough fluid in your body to function you will go into hypovolemic shock [meaning the heart is unable to pump enough blood to the body]. Sometimes you put dozens of litres of fluid into a patient every hour.
All the patients on my ward will be screened by a psychologist, partly because of the often traumatic nature of the injury and partly because people with burns are more likely to have mental health issues. People who are socially isolated and have stopped taking care of themselves might drink and smoke and are more likely to scald themselves and not treat themselves for the burn – a scald on the foot could get infected and the person could then end up on my ward.
People with peripheral neuropathy [impaired sensation] are also more likely to end up on my ward, as are blind people, and children because they have a less developed sense of danger.
The people who come in have often gone through a horrendous experience. A young woman who had been in house fire came in recently. When she came in I didn’t know if she was a man or a woman or young or old because she had lost her hair, had dressings on her face, and was really swollen.
She was intubated and six weeks later she walked out the hospital looking like a healthy young woman. To see her personality come out and shine after she was taken off intubation was really nice.
Interestingly, we all felt a much stronger connection to her than she did to us. We had nursed her through weeks of being unconscious. It was only on the last week that she was out of intensive care and on the normal ward.
She introduced herself and I said, ‘Nice to meet you’, but I was thinking, ‘I’ve been looking after you for the past six weeks’. I didn’t want to tell her that because it can be quite overwhelming for a patient to be reminded they’ve lost all that time in their life.
Nursing is all about finding that connection, though. My favourite definition of nursing is ‘Doing for others what they would want to do for themselves’. You have to help that person form that independence and, as you are looking after them in quite intimate ways, you have to form that connection.
There are some unusual methods we can use to help treat burns. Sometimes if a burn is infected or breaks down, the healing stops. In larvae therapy maggots can be used in wound debridement [cleaning dead and contaminated material from the wound to aid healing].
The maggots are medical grade and are produced in a sterile environment. They come in little pouches; you put them on the wound and they wriggle around and then get fatter from eating the dead tissue. The idea is to get rid of all the dead tissue until you get to the healthy tissue underneath, which the maggots won’t eat.
This method is used as an alternative to surgery for elderly or at-risk patients who we would prefer not to put under anaesthetic. We would always talk this method through with a patient and give them the option of whether or not to do it.
Leech therapy can be used to revascularise [put the blood flow back into] at-risk areas. We had a patient in who had been given a skin graft on his leg but it didn’t take. He then underwent a procedure whereby flesh was taken from the back of of his leg to cover the tendon where skin wouldn’t regrow. The surgeons folded the skin around to the front of his leg with the blood vessels and nerves still intact. They fixed it into place and we then put leeches on the wound.
The leeches acted like a sucking device, pulling the blood up the leg from the foot into the new tissue. It doesn’t matter that some of the blood is getting pulled out by the leeches because as it passes through the new tissue it helps it become healthy by stimulating the blood vessels.
One of the fundamental principles of the NHS is that you support people in need. We all pay for it on the basis that we might get unwell.
I’ve noticed a massive disconnect between the appreciation the public show for it and what you hear from policymakers – that you’re not worth the one per cent pay rise, even though it’s been recommended by the independent NHS Pay Review Body.
Politicians cant help but meddle with the NHS but the people who do the work – nurses, doctors, clinicians – aren’t given a say in how the service is run.
If you work for the NHS you’re automatically politicised; you’re absolutely demonised in almost every Government speech or policy. Everything else has been sold off – the railways, the Post Office; they aren’t run for the public good. The NHS is our last public service. What else do we have?