Australian New Zealand Burn Association

AUSTRALIAN NEW ZEALAND BURN ASSOCIATION

Proposal for Development of a Burns Rehabilitation Course

2016

Developed by: Zephanie Tyack, Angela Thynne

Date developed: August2016

Contact Details:Zephanie Tyack

Centre for Children’s Burns and Trauma Research

Children’s Health Research Centre,

Graham St, South Brisbane QLD 4101.

Angela Thynne

Occupational Therapist – Private Provider

Royal Brisbane and Womens’ Hospital

Specialist Burns Outpatients

Butterfield St, Herston Q

Description:The proposed Burn Rehabilitation Course has been designed to fit within a newly developed framework of support and education for Allied Health Professionals by ANZBA, including

-A Course Manual

-Burns Rehabilitation Course

In the Burns Rehabilitation Course, health professionals will be introduced to the theoretical and practical aspects of managing a patient with burns who requires rehabilitation. The Burns Rehab Course will include:

-A Course Manual which will be a compulsory component read by every participant prior to attendance at the face to face course. Participants will gain knowledge regarding the epidemiology of burns. The anatomy and physiology of the skin and underlying musculoskeletal system will also be covered to provide a foundation for understanding how these components are affected by a burn and burn rehabilitation. Knowledge of the role of the burns health professional in a variety of settings (i.e. ICU, rehabilitation, surgical wards) will be gained to provide the context for rehabilitation within a continuum of care. A hard copyCourse Manual will be provided to participants of the Burns Rehabilitation Course one month prior to attendance.

-A 1 day face to face course will focus primarily on the practical assessment and intervention of the patient with burns who requires rehabilitation. Topics will be covered from an interdisciplinary perspective. This course will have specific content for rural and regional therapists who provide rehabilitation or who may provide future rehabilitation services to patients with burns including liaison with burn units via telehealth.

Minimum Proposed teaching team:4 ANZBA Trainers (1 x physiotherapist, 1 x occupational therapist, 1 x psychosocial professional, 1 x other)

1 Local Coordinator

Attendees:Any allied health, nursing or medical professional with an interest in developing skills in burn rehabilitation. The Course will be capped at 20 registrants.

Mode of delivery:Hard copy course manual

Face to face lectures and practical sessions

Duration:1 month prior to the rehab course – Course Manual

1 day- face to face Burns Rehab Course

LEARNING OUTCOMES

The ANZBA Burn Rehabilitation course will be a program for rehabilitation professionals with or without experience in burn rehabilitation. The Learning Outcomes will include the following:

Competency Standard / Learning Outcomes
1. Professional Attitudes and Behaviour
1.1 Demonstrates professional knowledge, skills, and attitudes appropriate for burns rehabilitation settings / 8,12
2. Information Gathering and Collaborative Goal Setting
2.1 Performs a relevant comprehensive assessment relevant to burns rehabilitation / 3-12
3. Knowledge and skills
3.1 Demonstrates the knowledge and skills to apply
to burns rehabilitation / 1-12

On successful completion of the course, rehabilitation professionals should be able to:

1. Explain basic concepts of the organisation of the human skin, scarring and contractures and underlying physiological processes;

1. Describe a burn, burn scarring and contractures using correct anatomical and physiological terminology;

1. Explain the role of the burns rehabilitation professional in ICU, acute surgical or other ward, rehabilitation, and community settings;

1. Undertake a comprehensive assessment process encompassing all aspects of burn rehabilitation (e.g., scar management, contracture development, psychosocial considerations, return to function);

1. Describe the symptoms that patients with burn injuries may present with in rehabilitation settings;

1. Understand complexity in patients with burn injuries in rehabilitation settings;

1. Describe the evidence-based interventions that should be considered for different cases, and the clinical reasoning for, and timing of, these interventions;

1. Describe the role of interdisciplinary team members in the management of patients receiving burns rehabilitation, and appropriate interactions between team members for optimum treatment outcome;

1. Understand the long-term health-related quality of life of patients who receive burn rehabilitation, patient perspectives of rehabilitation, and the burden of rehabilitation;

1. Understand factors that predict the success of burns rehabilitation and maximise patient adherence;

1. Understand the way in which interventions need to be tailored for particular groups of patients (i.e., children versus adults, people living in hot, humid areas, people working in outdoor settings or in contaminated environments); and,

1. Understand best methods of communication between burn units and regional/ rural based health professionals (e.g., telehealth, use of relevant assessment and monitoring tools).

PROFESSIONAL ATTRIBUTES

On successful completion of the course participants will have developed an ability to:

Apply localised and profession-specific contexts to delivery of burn care

Establish a mentoring network of burn care professionals

CONTENT

Topics covered within the Course Manual and content are:

-Epidemiology and pathophysiology of burns

-Role of the burn rehabilitation team

-Physical responses and recovery (including epidemiology of physical responses, psychosocial responses to injury and treatment, physical/functional assessment, return to work/school)

-Mental health and psychosocial responses (including epidemiology of mental health issues, psychosocial assessment and intervention including appearance and body image concerns, staff self-care assessment and intervention)

-Burn scarring (pathophysiology of scarring, scar assessment including sensory responses, management of pain, itch and altered sensation)

-Education and communication

-Paediatric considerations (including developmental assessment)

-Complexity of burn rehabilitation (including socioeconomic considerations, comorbidity, burn severity, multidisciplinary/ multicentre care)

-Movement, exercise/ activity, splinting and positioning

-Pressure therapy and silicone products

-Invasive and surgical scar interventions (needling, laser, reconstruction, steroid injections, scar revision, reconstruction)

-Wound management, skin care, skin hydration, scar protection and massage

QUALITY ASSURANCE AND FEEDBACK

The course will be evaluated by participants attending each course. Feedback will be incorporated into revising the course over time.

SCHEDULE

A certificate of completion will be provided to participants who have successfully passed the examination on the day of the course.

A certificate of attendance will be provided to those participants who attend Burns Rehabilitation Course but do not pass the exam and case study. They will be given the opportunity to resit the examination following the course and will be provided with a Certificate of Completion when they have demonstrated successful completion.

REFERENCE MATERIAL

The Course Manual will include a reference list of recent publications, relevant websites and applications, and other education opportunities.

COURSE DEVELOPMENT AND CONTENT REVIEW

A 12 month review from the date of first presentation of the course will be undertaken to allow for an initial review and course revision if necessary. From then on, the course will be reviewed yearly.

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Schedule

Course / Topic / Description / PRESENTATION TOPICS
7.30 – 8.00 am / REGISTRATION
8.00 – 8.10 / WELCOME AND INTRODUCTION
8.10 – 8.40 / Overview of the epidemiology and pathophysiology of burns (5 minutes), physical impairments and burn scarring (10 minutes)
The role of the burn rehabilitation team (5minutes)
Education (5minutes)
Psychosocial responses to burn injury and treatment (5 minutes) / Lecture / Incidence and pathophysiology of burns – repeat of EMSB including first aid, comorbidities (1- 2 slides)
Incidence and prevalence of physical impairments (contractures, heterotrophic ossification, scarring, joint deformities, pain, itch, pigmentary changes) (1 slide)
Pathophysiology of scarring – what is scarring?, prevalence over time, influencing factors, mechanisms
(3-4 slides)
Nutrition, wound management, surgical, head and neck management (2 slides).
Incidence/prevalence of mental health issues (2 slides)
8.40 – 9.10 / Assessment / Lecture / Physical assessment (1 slide)
Psychosocial assessment and staff self-care assessment (2 slides)
Scar assessment including pain and itch (2 slides)
Functional assessment (FIM, return-to-work/school) (1 slide)
Developmental assessment (1 slide)
5 minute break
9.15 – 10.00 / Theory of burn rehabilitation (including mechanisms of action) / Lecture / Movement and exercise (1 slide)
Splinting and positioning (1 slide)
Pressure therapy (taping, pressure garments, bandaging) (1 slide)
Massage (1 slide)
Invasive and surgical scarinterventions (needling, laser, reconstruction, steroid injection) (1 slide)
Wound management (1 slide)
Skin care, skin hydration and scar protection (1 slide)
Silicone products (1 slide)
Management of pain, itch and altered sensation(including pharmacological and non-pharmacological) (1 slide)
10.00- 10.30 / MORNING TEA
10.30 –12.05 / Burn Scar Rehabilitation / Skill Stations (4 x 20 mins) / Station 1: Pressure therapy (bandaging, garments, taping)
Station 2: Contracture management (movement, exercise, splinting and positioning, casting)
Station 3: Psychosocial care
Station 4: Scar management (massage, silicone, skin care/ hydration
12.05 – 12.35 / LUNCH
12.35 – 14.10 / Interactive discussion groups / Group work and assessment / Group 1:Psychosocial
Group 2: Pain, itch and sensation
Group 3: Invasive and reconstructive surgery options
Group 4: Complexity in rehabilitation
10 minute break
14.20 – 15.00 / Examination / Group 1: Multiple choice
Group 2: Case study
15:00 – 15.40 / Examination / Group 1: Case study
Group 2: Multiple choice
Break 10 minutes
15:50 – 16.50 / Feedback / Case study feedback and discussion (2 case studies – 1 paediatric and 1 adult)
16.50 - 17.00 / Close / Closing remarks and presentation of certificates

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course manual AND CONTENT

The Course Manual and content will be developed as per the process outlined in Appendix 1.

The course manual will be provided at least one month prior to the face-to-face course. These will be sent by Express Post in hard copy. Participants will be required to review the course material thoroughly prior to the course in order to complete the exam.

COURSE COMPLETION

The participant will be deemed to have successfully completed the examination if they have a 75% pass. A certificate of completion will be provided to those participants who have passed the examination. Those participants who have not passed the examination will be provided with a certificate of attendance. They will then be sent an open book multiple choice exam and case study. Those identified as notpassing the examination will be offered attendance at another course during the coming 12 months without registration costs.

COSTS

Registrant fees to cover course costs including:

-Administrative support from ANZBA office (e.g. registrations, distribution of pre-reading information, liaison with venue and catering, organisation of face to face course)

-Consumables

-Venue and catering costs (use of current ESMB contacts)

-Cost of up to 4 x flights and overnight accommodation for ANZBA allocated presenters

-Photocopying / postage

CONSUMABLES

There will be several teaching packs developed with compression garments, bandages, contact media, splints, dressings and other consumables – relevant companies will be approached about donations for these packs. Otherwise, consumables will be added to the course costs.

TRAINERS

As per the EMSB Model, trainers will be identified and trained in the course presentation. Each course will have an overall Course Director, who will be responsibleforallocation of lectures, skill stations, interactive discussion groups and examination. Each course will have

-4 ANZBA trainers (one of which will serve as Course Director)

-1 local coordinator

-ANZBA Secretariat support.

Role and responsibilities will be outlined in the Faculty Manual to be developed.

The initial faculty will be developed as per the process in Appendix 2.

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