A day in the life of a children's burns nurse
Tuesday 18 September 2018
Having a child hurt themselves badly enough that they have to go to hospital is most parents’ and carers’ worst nightmare. Luckily, there are people like Kristen Storey who specialise in treating injured children and getting them and their families healthy and home again.
Kristen is a Clinical Nurse Consultant specialising in burns. She works out of the Pegg Leditschke Children’s Burns Centre at the Lady Cilento Children’s Hospital, the state’s leading burns unit for children. With a warm smile and a world-class knowledge in treating children’s injuries, Kristen is part of a large team of specialists that work to make sure children from right across the state recover as well as possible from burns, injuries and other illnesses.
We spent a morning with Kristen at the burns centre’s clinic to observe her at work with her patients and find out what it’s like to work in this specialised field.
A busy morning at the clinic
If there’s one thing everyone knows about children, it’s that they are accident prone. Curious and headstrong, young children have the highest risk of receiving burn injuries, and their delicate skin means they can burn more easily than adults. Kristen estimates that of the 1,200 burns patients the unit sees each year, about 40% are under two. This means that the burns centre is a busy and vital part of the hospital.
Each morning, the burns centre runs a clinic for outpatients to come have their injuries looked at by the nurses and doctors and Allied Health, discuss any needs for ongoing treatment, and have their wounds redressed.
The clinic opens at 7am, and the waiting room is already full of parents and children with various parts of their bodies wrapped up in dressings and bandages. Many of the children are familiar to the staff, having been to the unit when their injuries first happened and sometimes for many appointments afterwards while they’ve healed.
Kristen and the team review the list of appointments for the day, writing the patients’ names up on a large whiteboard, along with details on their injury and which room they’ll be seen in. Then a non-stop morning of patient consultations begins.
It only took a second
After they’ve checked in at reception, Kristen is the first and last person each of her patients see. While every patient has individual needs, the pattern of each appointment is similar: Kristen administers any medication that is needed to reduce the child’s pain or anxiety during the appointment, then she removes dressings from their injury site, cleans the wound if necessary and assesses how it’s healing.
Other specialists drop in to check up on the patient as necessary, including Occupational Therapists, Physiotherapists and Social Workers. The clinic doctor comes to see the injury, track its progress and advise on further treatment, before Kristen re-dresses the wound and provides the family with continued care instructions.
Kristen’s first patient is a little boy with a large scald burn from hot water that covers the inside of one of his arms and the side of his chest. “He pulled down a cup; it only took a second,” says the boy’s dad. For weeks after that split-second incident, he has had to bring his son to numerous hospital visits. It’s a familiar story for Kristen, and she tries to ease the man’s guilt; scalds are the most common burn she sees, with babies and toddlers so quick to pull cups, bowls and saucepans onto themselves the minute their parent’s back is turned.
Carefully, Kristen takes the dressing from the boy’s arm. The skin is bright pink and still raw in some places, but Kristen and the boy’s parents are pleased. “That’s looking so much better!” says dad. After almost a month, his son’s burn is nearly healed.
After Kristen has cleaned the area with warm soapy water, the Occupational Therapist comes in to look at how the boy is healing. While his skin is almost healed over, it’s important that his scarring doesn’t prevent him from using his arm properly as he grows, particularly as his burn covers the joint of his elbow. Scar tissue doesn’t grow and stretch like normal skin, so as a child grows, their scar needs to be managed. Luckily, this burn wasn’t bad enough to require a skin graft, which would see healthy skin from a different area of his body taken and placed over the burn.
The OT is followed by the doctor, on this day Professor Roy Kimble, the Director of the Burns Centre. He’s pleased with the progress and tells the boy’s parents that over time, the bright pink skin will fade and he’ll only be left with a small scar.
Kristen re-dresses the boy’s arm and sends his parents home with a bag of dressings and instructions on how to change the wraps at home before returning for further assessment next week.
As the first of many patients goes home, Kristen heads back to the whiteboard to call through her next patient.
A variety of needs
While the unit staff specialise in burn injuries, their work can vary greatly from patient to patient, depending on their condition, age and temperament.
A couple bring in their newborn baby who has a steam burn on his hand. Everything Kristen does has to be reduced to miniature, from cutting tiny pieces of dressing to lay across each burned finger, to the soft voice she uses with both the child and his parents, who are still shocked that they’re back at the hospital with their new baby so soon.
A little girl is bought in with a burn on her foot that has completely healed. Even though her injury is now better and all her parents need to do is continue putting moisturiser on to help with the itchy new skin, her dad continues to repeat the story of her accidentally touching her foot to the lawnmower muffler after it had been used, how quickly it happened, how bad everyone feels that they didn’t see and stop her.
Guilt is common in the burns unit, Kristen says, and some appointments she ends up directing just as much of the care to the parents. Social workers are part of the unit’s team, their job is to help the parents as well as the children cope with what has happened, knowing that scars don’t always sit just on the surface of the body.
Not all the patients that come to the burns unit will have received a burn. One patient Kristen sees has a wound from an operation on his scalp which requires the kind of dressings and assessment of healing that Kristen is an expert at. Another has serious ulcers on his legs which have developed as a symptom of a genetic condition, that regularly need to be cleaned and have fresh dressings applied. Throughout the year, Kristen may also care for children who have had other diseases and conditions that involved the skin, like meningococcal or severe dermatitis.
Tools of the trade
Throughout the morning, Kristen calls upon a variety of tools as part of her work, from the very high-tech, to the seemingly ordinary and sometimes the unexpected.
You might find some of the items in Kristen’s arsenal in every household pantry: antiseptic solutions like betadine are used to clean open wounds and clear plastic wrap can be used cover up injuries to keep them clean while waiting for the doctor or a specialist to assess them.
For patients that need their wounds covered while they heal, Kristen will use soft, sterile dressings and tape to cover their wounds. To the amazement and relief of her patients, she has a special solution that reduces the stickiness of dressings when it’s time for them to come off at the next appointment.
Other tools are made with this kind of specialised work in mind. The unit has a laser Doppler machine that allows them to assess the depth of a burn by monitoring blood flow under the skin. The team also use a large 3D camera to take pictures of patients’ burns to provide an accurate image of healing. This kind of advanced technology has revolutionised the way paediatric burns can be assessed and treated over the past decade.
And then there’s bubbles. With most of the unit’s patients under the age of two, keeping them still and calming them when they’re scared or in pain is an important part of the job. Halfway through the morning, one of the treatment rooms is filled with cries of a scared and sore little girl. Kristen doubles up with another nurse, and while she carefully undresses and cleans the little girl’s wound, Kristen stands to the side of the bed and blows bubbles with a wand. Then it’s a race for the child and Kristen to pop all the bubbles, while the other nurse’s work goes on undetected.
A tough but rewarding job
Once all the patients have been seen, the morning clinic winds up. Kristen has seen seven patients herself, while the ward has had nearly 30 children come through in total.
After a quick lunchbreak, the team spend the afternoon working with inpatients – children whose injuries are too serious to be at home yet. Tuesdays and Fridays are theatre days, where the team operate on children needing procedures like skin grafts. Around these jobs, Kristen is also coordinating part of a large nursing conference to be held later in the year.
It’s a long day and a hard job. “It can be very traumatic,” says Kristen, “for the children and their families, but for the staff as well.” But it’s clear that Kristen loves her work. “It sounds weird, but I like wounds!” she says, laughing. “I like seeing something heal, being hands-on and being able to actually see the injury getting better.”
And the best part of her job? “Seeing the kids healed at the end. We run a burns camp every year and it’s just great seeing them get to be kids, especially the ones we’ve known for years.”
First aid for burns
Minor burns can be treated at home, but if you have any concerns about a burn, you should see a medical professional, or call 13 HEALTH (13 43 25 84) to speak with a registered nurse. Always call Triple Zero (000) in an emergency situation.
When treating minor burns at home, make sure you and the person who has been burned are in a safe place and won’t be burned again. Remove all clothing and jewellery that isn’t stuck to the burn from around the burn area. Place the burn under cool, running water for 20 minutes.
Cover the area with a sterile, dry dressing (like a band aid) if the burn is oozing, unless on the face. You can give painkillers like paracetamol and anti-inflammatory tablets to help manage pain.
Some popular home remedies might actually do more harm than good for burns, including placing ice on a burn or putting butter or toothpaste on a burn. Ice can damage the sensitive skin around a burn, while other remedies can cause heat to stay in the burn or cause infection.
A child or adult who suffers a serious burn must be treated by medical professionals as soon as possible. Seek immediate medical advice if the burn is:
- larger than a 20 cent piece
- on the face, hands, groin or feet
- deep or becomes infected
- caused by chemicals or electricity
- or if there are signs of an inhalation injury, including blackening around the mouth or nostrils, or swelling of airways.
Thank you to Kristen Storey, the team at the Pegg Leditschke Children’s Burns Centre and Children’s Health Queensland for sharing your stories with us.