Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care.

Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.

Mindfulness, Social Support, and Psychological Distress Among Jordanian Burn Patients.

Burn is associated with psychological distress, anxiety, and depression. Social support and mindfulness are considered a strength source for postburn survivors to resume their daily living activities. There is a lack of literature that supported the direct impact of mindfulness on social support and psychological distress among burn survivors. The aim of this study is to examine the impact of mindfulness and social support in enhancing the psychological well-being of burn survivors in Jordan. A cross-sectional descriptive design and convenience sampling technique were utilized to meet the study goal. A self-reported questionnaire was completed by a sample of 212 burn survivors. The questionnaire consists of 3 tools to measure psychological distress, social support, and mindfulness. A significant correlation was found between social support and psychological distress among the Jordanian burn survivors. Mindfulness revealed a distinctive variance in psychological distress among the study participants. In addition, some sociodemographic and clinical data have a relationship with psychological distress. Several factors among burn survivors have influenced their psychological and social support status. Also, mindfulness is important for enhancing psychological well-being and affecting the social support among burn patients.

[Research advances on the application of music therapy in pain management of children with burns].

Pain after burns is a very common problem in children. Severe pain will not only hinder treatment, but also damage children's mental health if not handled in time. Therefore, pain management is very important in treating children with burns. As a safe, effective, and convenient non-drug therapy, music therapy has great advantages in relieving pain and is widely used in a variety of clinical fields. This paper focused on music therapy and its mechanism of pain relief, the current status of research on pain management of pediatric burns, the application and prospect of music therapy in pain management of pediatric burns, etc., to provide reference for clinical application.

A comparison of parent-reported and self-reported psychosocial function scores of the PedsQL for children with non-severe burn.

BACKGROUND: Quality of life of paediatric patients after burn injury is often assessed through parents who may score differently to their child. Non-severe burns are the most common type of burn injury in Western Australia, however, despite low severity and high survival rates, they can cause long term physical and psychosocial problems which need to be detected early in order to provide patients with optimal holistic care. METHODS: Demographic and clinical data were collected from paediatric patients (5-16-year-old) with non-severe burns (<20% total body surface area), and Paediatric quality of life (PedsQL) questionnaires were collected from both the patient and their parent. Two cohorts of patients were assessed: first, those at approximately six months after burn, and second, those more than one-year after burn. Differences between parent-scores and self-scores were analysed using multivariate linear regression to assess the relationship between risk factors and observed differences in PedsQL scores. RESULTS: Parents reported poorer Psychosocial Function (PSF) for younger children (p = 0.01) and for patients from higher socioeconomic status areas (p = 0.05) compared to their children. In the 'Early Recovery Cohort', female patients had significantly different scores to their parents (p < 0.01). In the 'Late Recovery Cohort', parents rated older patients lower than they rated themselves (p = 0.03). CONCLUSION: Age at burn, socioeconomic status, and female gender may increase the discrepancy in quality-of-life assessments between parents and patients.

Art Therapy in Burn Cases: A Review and Case Examples.

ABSTRACT: In this article, we provide an overview of the literature on contributions of art making and medical art therapy for patients with burn injuries. The potential value of art therapy in addressing the complex physical and psychosocial needs of burn patients is discussed through examination of 7 peer-reviewed articles. Two case examples of burn survivors, 1 pediatric and 1 adult, are included to demonstrate the use of art therapy in an inpatient and outpatient setting, respectively. Art therapy and other intervention strategies for overall psychosocial adjustment of burn patients are often underutilized. Further research in art therapy is needed to examine the psychosocial aspects of burns patients and the potential role that medical art therapy may have in a burn care center.

Coping strategies, social support, and mindfulness improve the psychological well-being of Jordanian burn survivors: A descriptive correlational study.

BACKGROUND: Burn injury survivors usually experience multiple psychosocial problems, which occur commonly in low and middle-income countries. However, the previous literature provides limited information about the unique roles of coping strategies, social support, and mindfulness in improving the psychological well-being of burn survivors. Therefore, this study identified the role of coping strategies, social support, and mindfulness in improving the psychological well-being of burn survivors. METHODS: A descriptive correlational study on 224 burn survivors at a large government hospital in Amman, Jordan, was conducted. Participants completed questionnaires about socio-demographic and clinical data, anxiety and depression, social support, mindfulness, and coping. Standard multiple regression was performed to identify the unique role of the main study variables in improving the psychological well-being of burn survivors. RESULTS: Participants were found to have a severe level of psychological distress. Escape avoidance coping had the highest mean score among all other coping strategies, while acceptance of responsibility had the lowest mean score. Regression analysis showed that confrontive coping (ß = -0.224, p=p<0.01), social support (ß = -.212, p=p<0.01), and mindfulness (ß = -.403, p=p<0.01) were significantly associated with less psychological distress. CONCLUSIONS: Therefore, confrontive coping, social support, and mindfulness-based supportive interventions could be helpful in providing enhanced support to burn survivors.

Art therapy in pediatric burn care: A conceptual framework for clinical practice.

Burn injuries are an unexpected traumatic event and can be physically and emotionally devastating for a child and their families. This article presents a conceptual framework for art therapy practice with pediatric burns, founded on the three stages of burn treatment- critical, acute, and rehabilitation. The framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, as well as in medical settings. Based on the stages of burn recovery, and the role of other relevant stakeholders, the framework provides recommendations for clinical practice of art therapy with children sustaining burn injuries, their caregivers and siblings, and healthcare providers. Robust studies including art therapy as interventions are recommended to determine their effectiveness in addressing the specific psychosocial needs in different stages of pediatric burn care.

Psychological Aspects in Early Adjustment After Severe Burn Injury.

Burn injury is one of the most serious traumatic events with possible psychological and psychosocial consequences. Health status perception is one of the main health outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, suggesting that early screening for psychological vulnerabilities may be beneficial. The aim of our study was to identify the personality, clinical, and sociodemographic characteristics related to patient's subjective perception of health, depression, and anxiety in a sample of 52 adult patients with severe burn injury shortly before discharge from specialty burn clinic. Subjective health perception was predicted by depression (ß = -.143, t(47) = -3.94, P < .001) and neuroticism (ß = -.106, t(43) = -4.83, P < .001), and it correlated positively with extraversion (r = .2858, P = .0465) and conscientiousness (r = .3663, P = .0096). Depression was predicted by neuroticism (F(1,49) = 18.4; P < .001) and correlated with attachment avoidance (r = .29, P = .0383) and negatively with extraversion (r = -.32, P = .0220). Anxiety was related to attachment anxiety (F(1,49) = 4.25; P = .045), neuroticism (F(1,49) = 15.75; P < .001), and agreeableness (r = -.36, P = .0101). Unemployed patients experienced higher levels of depression and anxiety. This research suggests that personality traits and adult attachment may play an important role in the acute phase of the recovery from a severe burn injury. These findings can be relevant for early intervention and holistic rehabilitation.

Early experiences using bromelain-based enzymatic debridement in a tertiary burns centre in the United Kingdom: A retrospective case series review.

BACKGROUND: The modern ethos of burn care requires a holistic approach that helps patients to not only survive but also maintain a good quality of life. Bromelain-based enzymatic debridement with Nexobrid™ (NXB) has been shown to selectively debride burnt tissue and allow dermal preservation, which has the potential to reduce surgical burden and improve scarring. In this study, early experience with the use of Nexobrid™ at a tertiary burns centre between July 2016 and December 2019 is presented. In particular, the study assessed whether NXB had changed the acute care delivered to this cohort. METHODS: A retrospective analysis of the patients' records was performed. Results were analysed and presented in the context of current literature. RESULTS: Twenty adult patients (17 male, 3 female) underwent enzymatic debridement with NXB. Median age was 42.5 years. Mean total burn surface area (TBSA) on admission was 20%. Twelve patients were admitted to the intensive care unit, and eight were admitted to the adult burns ward. Mean TBSA treated with NXB was 8.2%, usually within 24 h of admission (mean). All patients had anaesthetist-led analgesia. NXB debridement was successful in 55% of patients, obviating the need for escharotomy in some patients. Sixty percent of all patients required further surgery, and 80% of facial burns treated with NXB required further surgery. Inotrope support was associated with NXB failure (p = 0.015). Mean length of stay was 29 days. DISCUSSION: Current evidence, including our own findings, cannot justify replacing the current surgical standard of care with NXB, but it certainly solidifies enzymatic debridement as a useful adjunct that should form part of the modern burn surgeon's armamentarium.

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients.

BACKGROUND: One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients. METHODS: This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5-10 min before dressing change and 5-10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi­square, Mann-Whitney, Fisher's exact tests, and paired t-test. The Kolmogorov-Smirnov test was used to check the normality of data. RESULTS: The results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days. CONCLUSIONS: Our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU).

BACKGROUND: Burn-specific pain anxiety and sleep disorders are common factors in burned patients that affect wound healing process, as well as the severity of burn pain. This study aimed to investigate the effect of foot reflexology massage on burn-specific pain anxiety and sleep condition of patients hospitalized in the burn ICU. METHOD: In this randomized controlled clinical trial, 52 patients were assigned by permuted block randomization 1:1 to the intervention (n=26) and control (n=26) groups. The intervention group received 20min of foot reflexology massage during 3 days on their third, fourth and fifth days of hospitalization and 15min before changing wound dressings. Patients in the control group merely received routine care. The Burn-Specific Pain Anxiety Scale (BSPAS) was completed for three consecutive days before and after changing wound dressings, and St. Mary's Hospital Sleep Questionnaire (SMHSQ) was filled out for four consecutive days before changing wound dressings for patients in both groups. The data were analyzed by IBM SPSS 16 software, Chicago, independent t, Chi-square, Friedman, Mann-Whitney and Wilcoxon tests. FINDINGS: We found no significant difference between pain-anxiety in the two groups before the intervention. The trend of different days in each groups were compared with Friedman test and showed that pain anxiety (p<0.001), sleep latency (p<0.001), duration of the last day's sleep (p<0.001) and satisfaction of the last night sleep (p<0.001) had a significant difference. In addition, Mann-Whitney test results showed that there were significant differences between the two groups at different times in terms of the above variables (p<0.05). The effect size was=0.82 for pain anxiety between group after the intervention. CONCLUSION: Based on the results, foot reflexology massage can effectively reduce pain anxiety levels and improve sleep quality and quantity of patients with burn injuries; therefore, this non- pharmacological therapeutic method is recommended to be used in the burn ICUs. (Clinical trial's registration code: IRCT20110906007494N27).

The effect of traditional healer intervention prior to allopathic care on pediatric burn mortality in Malawi.

INTRODUCTION: Burn injury is a significant contributor to mortality, especially in low and middle-income countries (LMICs). Patients in many communities throughout sub-Saharan Africa use traditional health practitioners for burn care prior to seeking evaluation at an allopathic burn center. The World Health Organization defines a traditional health practitioner as "a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal and mineral substances and other methods based on social, cultural and religious practices based on indigenous knowledge and belief system." The aim of this study is to determine the prevalence of prior traditional health practitioner treatment and assess its effect on burn injury mortality. METHODS: A retrospective analysis of the prospectively collected Kamuzu Central Hospital (KCH) Burn Surveillance Registry was performed from January 2009 through July 2017. Pediatric patients (<13 years) who were injured with flame or scald burns were included in the study and we compared groups based on patient or family reported use of traditional health practitioners prior to evaluation at Kamuzu Central Hospital. We used propensity score weighted multivariate logistic regression to identify the association with mortality after visiting a traditional healer prior to hospitalization. RESULTS: 1689 patients were included in the study with a mean age of 3.3 years (SD 2.7) and 55.9% were male. Mean percent total body surface area of burn was 16.4% (SD 12.5%) and most burns were related to scald injuries (72.4%). 184 patients (10.9%) used traditional medicine prior to presentation. Only a delay in presentation was associated with prior traditional health practitioner use. After propensity weighted score matching, the odds ratio of mortality after using a prior traditional health practitioner was 1.91 (95% CI 1.09, 3.33). CONCLUSION: The use of traditional health practitioners prior to presentation at a tertiary burn center is associated with an increased odds of mortality after burn injury. These effects may be independent of the potential harms associated with a delay in definitive care. Further work is needed to delineate strategies for integrating with local customs and building improved networks for burn care, especially in rural areas.

The effect of inhalation aromatherapy with damask rose essence on pain intensity and anxiety in burned patients: A single-blind randomized clinical trial.

INTRODUCTION: Pain and anxiety are a major problem of burn patients. Despite the use of different medications, patients still suffer from these two problems. Aromatherapy along with medication may help in alleviating these symptoms. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on pain and anxiety in burn patients. METHODS: This three group clinical trial was conducted on 120 patients with burns less than 30% TBSA. The patients were randomly allocated into three groups, aromatherapy damask rose essence, placebo, and control. The pain intensity was assessed using visual analogue scale prior to intervention, immediately before, and 15 min after dressing. Anxiety was measured using Spielberger Inventory at before intervention and 15 min after dressing, also the prolonged effect of intervention on pain was assessed by number of the analgesics drugs received for four hours after dressing change. The intervention included inhalation of 6 drops of 40% damask rose essential oil in the damask group, and six drops of distilled water in placebo group one hour before dressing change. The control group received no intervention. RESULTS: Baseline state-trait anxiety and pain intensity were similar in these three groups (p > 0.05). We found a significant reduction in pain intensity immediately before and after dressing and state anxiety after dressing in the damask group compared to the placebo and control groups (p < 0.001). However, we found no significant difference between the placebo and control groups in terms of these variables at these times (p > 0.05). Also, we found no significant difference among three groups in frequency of analgesics drugs and trait anxiety after intervention (p > 0.05). CONCLUSION: Inhaled aromatherapy with Damask rose essence reduces subjective pain intensity and state anxiety in burned patients. Therefore, it is recommended considering use of damask rose essence, as an easy and affordable method along with other treatments.

Efficacy and cultural appropriateness of psychosocial interventions for paediatric burn patients and caregivers: a systematic review.

BACKGROUND: Paediatric burns are highly painful and traumatising injuries that are overrepresented among Aboriginal and Torres Strait Islander people. Paediatric burn patients' pain remains poorly managed by pharmacological interventions, leading to increased anxiety, distress, and trauma in patients and their caregivers. Non-pharmacological psychosocial interventions have been suggested as effective in reducing pain and psychological morbidities among paediatric burn patients and their caregivers; however, their degree of effectiveness and appropriateness for Aboriginal and Torres Strait Islander people is unclear. METHODS: A non-date restricted systematic review was conducted through four databases. Studies published in English assessing psychosocial interventions on paediatric burn patients' physical pain along with theirs and/or their caregiver's anxiety, distress, or trauma symptoms were identified and included in this review. Included studies were assessed for their ability to reduce one of the outcomes of interests and for their reflection of Aboriginal and Torres Strait Islander peoples' perspectives of health. RESULTS: Of the 3178 identified references, 17 were eligible. These include distraction based techniques (n = 8), hypnosis/familiar imagery (n = 2), therapeutic approaches (n = 4), and patient preparation/procedural control (n = 3). Distraction techniques incorporating procedural preparation reduced pain, while discharge preparation and increased 'patient control' reduced patient and caregiver anxiety; and internet based Cognitive Behaviour Therapy reduced short-term but not long-term post-traumatic stress symptoms. No interventions reflected Aboriginal and Torres Strait Islander peoples' perspectives of health; and few targeted caregivers or focused on reducing their symptoms. CONCLUSIONS: The development and assessment of psychosocial interventions to appropriately meet the needs of Aboriginal and Torres Strait Islander paediatric burn patients is required.

Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials.

AIM: Present review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients. METHOD: We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases through September 2019 for randomized clinical trials comparing NPIs to a control group. The primary outcomes were general anxiety and pain anxiety. The Cochrane Risk of Bias Tool was used to assess the risk of bias. All data was pooled with Revman 5.3. RESULTS: 20 studies were eligible for quantitative synthesis. Compared to routine care, Music (4 Randomized Clinical Trials (RCTs), Standardized Mean Difference (SMD) = -2.00, 95 % Confidence Interval (CI) = -3.21 to -0.79), massage (4 RCTs, SMD= -1.84, 95 % CI= -2.77 to -0.91), hypnosis (2 RCTs, SMD= -1.06, 95 % CI= -2.90 to 0.78), relaxation (2 RCTs, SMD= -0.77, 95 %CI= -1.52 to -0.02), transcranial direct current stimulation (1 RCT, SMD= -1.92, 95 %CI= -2.54 to -1.30), and therapeutic touch practices (1 RCT, SMD=-0.45 95 %CI= -0.86 to -0.04), were associated with a significant effect on the anxiety of burn patients. Aromatherapy interventions and virtual reality showed no evidence of a reduction in the anxiety. A large amount of heterogeneity exist among trials. Risk of bias varied across studies. Only one study reported on safety issues. CONCLUSION: Due to weak evidence, we are unable to make strong recommendations in favor of NPIs for burn anxiety. Further well-designed large sample size randomized clinical trials are warranted.

Burn Survivor Artist Changes Artistic Approach by Sharing How Other Survivors of Traumatic Events Can Use Art to Heal Themselves by Helping Others Heal.

When creating art, the mind becomes free of physical barriers, no longer feeling broken or different. These same results can be sustained long term over large populations of survivors of traumatic events by grouping individuals into teams to create art of all types with the focus being on helping others. Long-term sustainability can occur with the concept of dedicated centers such as art studios and performing art centers with others that believe in art's healing potential. The simple activity of healing yourself while helping others heal, in whatever large or small way, can help us thrive beyond just surviving. No matter how long ago a traumatic event occurred in someone's life, those lessons learned should be shared with new burn survivors as they go through the long and difficult healing process by having a place that they can go and be with others who have been through the same process.

Psychosocial Interventions Targeting Recovery in Child and Adolescent Burns: A Systematic Review.

Children post-burn injury experience a range of psychosocial sequelae that benefit from early provision of psychosocial support. However, no systematic review exists evaluating the full range of psychological interventions. OBJECTIVE: To critically evaluate psychosocial interventions for children (<18 years old) with burn injuries in improving psychosocial recovery. STUDY DESIGN: All-language studies were identified from inception to March 2018 in six electronic databases and appraised according to PRISMA checklist and Cochrane Risk of Bias Tool for quality. Studies were stratified into three groups: distraction (virtual reality, child life therapy, imagery-based therapy, hypnosis), burn camps, and other (social skills, cognitive behavioral therapy, parent group counseling). RESULTS: Out of a total of 5,456 articles identified, 297 underwent full review resulting in 27 included articles published between 1986 and 2018. Sample sizes ranged from 9 to 266, comprising child and adult participants. A range of interventions and psychosocial outcome measures were found. Several studies (n = 21) reported statistically significant improvements in outcome; the majority were distraction interventions to reduce pain and anxiety. A limited number of studies showing effect was found for cognitive behavioral therapy and parent counseling. Risk of bias was high in studies of burn camps and mixed for all other interventions. CONCLUSIONS: A range of psychosocial interventions and outcome tools exist in pediatric burns. Distraction interventions prior to and/or during dressing changes or physical therapy were shown to effectively reduce pain and anxiety for a wide range of pediatric ages.

The effect of progressive muscle relaxation on anxiety and sleep quality in burn patients: A randomized clinical trial.

BACKGROUND AND OBJECTIVES: Burn patients experience a high level of anxiety and poor sleep quality due to their special physical and psychological conditions. The present study aimed to investigate the effect of progressive muscle relaxation on anxiety and sleep quality in burn patients. METHODOLOGY AND PARTICIPANTS: In this randomized controlled clinical trial, a total of 80 patients admitted to burn ward were enrolled using convenient sampling and randomly assigned to one of the experimental or control groups. In the experimental group, patients were intervened using Jacobson's relaxation technique 20-30min daily for three consecutive days. During this period, the control group received only routine care and treatment. Patients' anxiety and their sleep quality were measured and recorded before and after the intervention using the Spielberger State-Trait Anxiety Inventory (STAI) and St Mary's Hospital Sleep Quality Questionnaire (SMHSQ) respectively. Eventually, data analysis was conducted using SPSS version 20.0 software (IBM Corp., Armonk, N.Y., USA). RESULTS: The findings of the present study showed a statistically significant decrease in anxiety and improvement in sleep quality in the experimental group compared to the control group (P<0.05). CONCLUSION: Relaxation as a complementary method can be used along with modern medicine to reduce anxiety and improve sleep quality in burn patients.

The effect of aromatherapy massage with lavender and chamomile oil on anxiety and sleep quality of patients with burns.

INTRODUCTION: Regarding the importance of anxiety management and improvement of the quality of sleep in patients with burn injuries, this study aimed to determine the effect of aromatherapy massage (using aromatic oils of lavender and chamomile) on the anxiety and sleep quality of the patients with burn injuries. METHOD: In a quasi-experimental study, 105 patients with burns were recruited by convenience sampling method and then assigned into three groups (control, placebo massage, and combined aromatic oil massage). The study intervention was performed 20min before bedtime in three sessions, within a week. The control group was only under daily routine care. The study data were collected using the Persian version of Spielberg's anxiety scale and the Pittsburgh Sleep Quality Inventory. Descriptive and inferential statistical tests were used to analyze the data in SPSS version 20. RESULTS: The results showed a significant difference among the three groups in terms of anxiety score (P<0.001) and in terms of sleep quality after the intervention (P=0.027). CONCLUSION: Since the aromatherapy massage as a non-pharmacological and simple method can improve the anxiety and quality of sleep in patients with burns, it is suggested that nurses and burn medical care team apply it to reduce burn patients' anxiety and promote their sleep quality. Applying massage alone also reduces anxiety in burn survivors.