This scenario is professionally challenging because it requires the Certified Burn Nurse to balance immediate patient care needs with the critical, long-term implications of accurate and timely documentation. The pressure to provide hands-on care can sometimes lead to a perception that documentation can be deferred, but this directly conflicts with regulatory requirements and ethical obligations to maintain a complete and accurate patient record. Careful judgment is required to ensure that documentation reflects the patient’s condition, interventions, and response without compromising the quality of care delivery. The best approach involves immediate, concise, and objective documentation of all observed findings, interventions performed, and the patient’s response, even if brief, at the earliest opportunity. This aligns with the fundamental principles of good clinical practice and regulatory mandates that require contemporaneous record-keeping. Such documentation serves as a legal record, facilitates continuity of care, supports billing and reimbursement, and is essential for quality assurance and research. Regulatory frameworks, such as those governing healthcare record-keeping (e.g., HIPAA in the US, or equivalent professional body guidelines), emphasize the importance of accurate, complete, and timely entries. Ethically, this approach upholds the principle of beneficence by ensuring that all aspects of care are recorded for the patient’s benefit and the integrity of the healthcare system. An incorrect approach involves delaying documentation until the end of the shift or until all immediate patient care tasks are completed. This introduces significant risks. The primary regulatory failure is the potential for inaccurate or incomplete records due to memory lapses or changes in the patient’s condition that are not captured. This can lead to miscommunication among the healthcare team, potentially compromising patient safety and continuity of care. Ethically, this approach fails to uphold the duty of care by not ensuring that the patient’s record accurately reflects their status and the care provided in a timely manner. Another incorrect approach is to rely on verbal communication alone to convey critical information about the patient’s status and interventions to the next shift or other team members, without subsequent written documentation. While verbal handovers are important, they are not a substitute for written records. Regulatory bodies require documented evidence of care. Relying solely on verbal communication creates a significant gap in the legal and clinical record, making it difficult to trace interventions and outcomes. This also fails to meet the ethical standard of maintaining a comprehensive and accessible patient record. A further incorrect approach is to document subjective opinions or assumptions about the patient’s condition or prognosis without objective findings to support them. This can lead to biased care and misinterpretation of the patient’s progress. Regulatory guidelines and ethical principles stress the importance of objective, factual documentation. Subjective entries without factual basis can be challenged legally and ethically, and do not contribute to a clear understanding of the patient’s clinical course. Professionals should adopt a decision-making framework that prioritizes documentation as an integral part of patient care, not an afterthought. This involves understanding the legal and ethical imperatives of accurate record-keeping, integrating documentation into the workflow at the earliest possible moment, and utilizing standardized documentation tools and practices to ensure clarity and completeness. When faced with competing demands, professionals should recognize that timely and accurate documentation is a non-negotiable aspect of safe and effective patient care.

This scenario presents a professional challenge due to the need to balance patient comfort, wound healing efficacy, and the risk of infection or further tissue damage. The choice of debridement technique requires careful consideration of the patient’s overall condition, the wound characteristics, and the available resources, all within the ethical and professional standards of nursing practice. The most appropriate approach involves a comprehensive assessment of the wound and the patient’s overall health status to determine the most suitable debridement method. This includes evaluating the extent and type of necrotic tissue, the presence of infection, the patient’s pain tolerance, and any contraindications for specific techniques. Surgical debridement, when performed by a qualified surgeon, offers the most rapid and definitive removal of devitalized tissue, which is often crucial in preventing sepsis and promoting healing in severe burns. This aligns with the nursing duty of care to provide timely and effective interventions to prevent harm and promote recovery, adhering to principles of beneficence and non-maleficence. Employing mechanical debridement without a thorough assessment of the wound bed and patient’s pain management plan is professionally unacceptable. This method can be painful and may inadvertently damage healthy granulation tissue, potentially delaying healing and increasing the risk of infection. It fails to prioritize patient comfort and can be considered a breach of the duty to minimize harm. Relying solely on enzymatic debridement for a heavily necrotic burn wound without considering the potential for delayed healing or the need for more aggressive intervention is also professionally unsound. While enzymatic debridement can be effective for certain types of necrotic tissue, it is often a slower process and may not be sufficient for extensive, deep burns where rapid removal of devitalized tissue is paramount to prevent systemic complications. This approach risks delaying necessary, more aggressive treatment. Using a wet-to-dry dressing technique without a clear indication or as a primary debridement method for a severe burn is also inappropriate. This technique can cause significant pain and trauma to the wound bed upon removal, leading to further tissue damage and increased risk of infection, contravening the principles of gentle wound care and patient comfort. Professional decision-making in such situations requires a systematic approach: first, conduct a thorough patient and wound assessment; second, consider the evidence-based efficacy and risks of each debridement technique in the context of the specific burn injury; third, consult with the interdisciplinary team, including physicians and wound care specialists, to determine the optimal treatment plan; and finally, prioritize patient comfort and safety throughout the debridement process.

This scenario presents a common challenge in burn nursing: balancing effective pain management with the patient’s overall well-being and the need for timely wound care. The professional challenge lies in individualizing pain management, considering the patient’s subjective experience, the physiological impact of burns, and the potential for adverse effects from interventions. Careful judgment is required to select strategies that are both efficacious and safe, adhering to best practices and ethical considerations. The approach that represents best professional practice involves a multimodal strategy that integrates pharmacological and non-pharmacological interventions, tailored to the patient’s evolving pain levels and specific needs. This includes utilizing scheduled analgesics to prevent breakthrough pain, employing patient-controlled analgesia (PCA) for acute pain episodes, and incorporating non-pharmacological techniques like distraction, relaxation, and therapeutic positioning. This comprehensive approach is supported by ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as it aims to optimize pain relief while minimizing reliance on potentially sedating or addictive medications. Furthermore, it aligns with professional nursing standards that emphasize patient-centered care and the use of evidence-based practices for pain management. An incorrect approach would be to solely rely on as-needed (PRN) opioid administration for pain. This fails to proactively manage pain, leading to unnecessary suffering and potentially escalating pain levels that are harder to control. Ethically, this approach can be seen as a failure of beneficence, as it does not adequately address the patient’s pain. It also risks the patient experiencing significant distress during wound care procedures, which could negatively impact healing and recovery. Another incorrect approach would be to prioritize non-pharmacological methods exclusively, neglecting the significant pain associated with severe burns. While valuable, these methods alone are often insufficient for managing the intense pain of deep partial-thickness or full-thickness burns, especially during procedures like dressing changes. This approach could lead to inadequate pain relief, patient distress, and a breach of the duty to provide effective pain management, potentially violating ethical obligations to alleviate suffering. A further incorrect approach would be to administer high doses of sedatives without a clear indication for their use, solely to reduce perceived patient agitation related to pain. While sedation can be a component of pain management in certain critical situations, its indiscriminate use without a specific rationale can lead to respiratory depression, prolonged recovery, and masking of important physiological cues. This approach risks patient harm (non-maleficence) and may not directly address the underlying pain effectively, potentially leading to a failure to provide appropriate pain relief. Professionals should employ a systematic decision-making process that begins with a thorough pain assessment, including intensity, location, quality, and factors that exacerbate or alleviate the pain. This assessment should be followed by the development of a pain management plan that incorporates a combination of pharmacological and non-pharmacological interventions. Regular reassessment of pain and the effectiveness of interventions is crucial, allowing for adjustments to the plan as the patient’s condition changes. Collaboration with the patient, their family, and the interdisciplinary team is essential to ensure a holistic and effective approach to pain management.

This scenario is professionally challenging because the initial presentation of a burn injury can be misleading, and a rapid, accurate classification is crucial for guiding immediate management and predicting outcomes. Misclassification can lead to delayed or inappropriate treatment, potentially exacerbating tissue damage and increasing the risk of complications. Careful judgment is required to differentiate between the mechanisms of injury, as each necessitates a distinct approach to assessment and intervention. The best professional practice involves a systematic assessment that prioritizes identifying the mechanism of injury based on the patient’s history and the physical characteristics of the burn. This approach is correct because it directly informs the subsequent diagnostic and therapeutic steps. For thermal burns, the focus is on depth and extent; for chemical burns, immediate decontamination is paramount; for electrical burns, internal injury assessment is critical; and for radiation burns, the timeline of exposure and potential systemic effects are key. This aligns with the fundamental ethical principle of beneficence, ensuring the patient receives the most appropriate and effective care from the outset, and adheres to professional guidelines that emphasize a thorough initial evaluation. An incorrect approach would be to solely focus on the visible extent of the burn without considering the potential underlying mechanism. This is professionally unacceptable because it ignores crucial information that dictates specific interventions. For instance, a seemingly superficial chemical burn might cause deeper tissue damage if not properly decontaminated, and failing to recognize this mechanism could lead to severe, irreversible harm. Similarly, overlooking the possibility of an electrical burn due to a lack of obvious external signs could result in missed internal injuries, such as cardiac arrhythmias or rhabdomyolysis, which are life-threatening. Another professionally unacceptable approach is to assume a thermal mechanism for all burns without further investigation, as this would preclude the necessary specialized management for chemical, electrical, or radiation injuries. Professionals should employ a decision-making framework that begins with a comprehensive history, including the circumstances of the injury, the substance involved (if applicable), the duration of exposure, and any protective measures taken. This is followed by a detailed physical examination, paying close attention to the morphology of the burn, any associated signs of systemic involvement, and the patient’s overall condition. Based on this information, the most likely mechanism of injury is identified, guiding the subsequent diagnostic workup and treatment plan. This systematic, mechanism-driven approach ensures that all potential risks are considered and addressed promptly and effectively.

This scenario is professionally challenging because accurately assessing burn depth is critical for determining appropriate treatment, predicting outcomes, and preventing complications. Misclassification can lead to delayed or incorrect interventions, potentially causing increased tissue damage, infection, or long-term functional impairment. The nurse must integrate clinical observation with an understanding of burn pathophysiology to make an informed judgment. The best professional approach involves a systematic assessment of the burn wound characteristics, including color, presence of blisters, capillary refill, sensation, and texture, to classify the burn depth according to established medical criteria. This aligns with the ethical principle of beneficence, ensuring the patient receives the most effective care based on accurate diagnosis. It also adheres to professional standards of practice which mandate thorough patient assessment and documentation. This approach prioritizes patient safety and optimal recovery by guiding immediate and subsequent management decisions. An incorrect approach would be to solely rely on the patient’s subjective report of pain to determine burn depth. While pain is a symptom, it is not a definitive indicator of depth. Superficial burns can be extremely painful, while deeper burns may involve nerve damage and present with less pain, leading to underestimation of severity and delayed appropriate treatment. This fails to meet the standard of care and could violate the duty of care owed to the patient. Another incorrect approach is to assume all burns with intact skin are superficial. This overlooks the possibility of partial-thickness burns that may not have ruptured blisters initially but will develop them. This assumption can lead to inadequate wound care and management, potentially resulting in complications like infection or delayed healing, which is a failure to provide competent care. A further incorrect approach is to focus only on the size of the burn area without considering its depth. While burn size is important for fluid resuscitation and overall management, depth is the primary determinant of tissue damage and the required treatment intensity. Neglecting depth assessment in favor of size alone can lead to misjudging the severity of the injury and implementing an inappropriate treatment plan, thus compromising patient outcomes. Professionals should employ a structured decision-making process that begins with a comprehensive visual and tactile assessment of the burn wound. This should be followed by correlating these findings with established classifications of burn depth (e.g., superficial, superficial partial-thickness, deep partial-thickness, full-thickness). Documentation of these findings and the rationale for the depth classification is essential for continuity of care and communication with the healthcare team. Regular reassessment is also crucial as the burn wound can evolve.

The control framework reveals a scenario where a Certified Burn Nurse must assess a patient’s skin integrity following a thermal injury. This situation is professionally challenging because the nurse must not only understand the immediate physiological response of the skin but also anticipate potential complications and tailor interventions based on a comprehensive risk assessment. Accurate assessment is critical for effective wound management, preventing infection, and promoting optimal healing, all of which are paramount to patient well-being and adherence to professional standards of care. The best professional approach involves a systematic and comprehensive skin assessment that integrates knowledge of skin anatomy and physiology with a risk assessment framework. This approach begins with a thorough visual and tactile examination of the burn area, noting the depth, extent, and characteristics of the injury (e.g., color, presence of blisters, eschar). Crucially, it extends to assessing the surrounding intact skin for signs of compromise, evaluating the patient’s overall physiological status (e.g., hydration, circulation), and identifying factors that may impede healing (e.g., comorbidities, nutritional status, age). This holistic assessment allows for the identification of specific risks, such as infection, dehydration, impaired thermoregulation, and pressure injury development, enabling the nurse to develop a targeted and individualized care plan. This aligns with the ethical imperative to provide competent and patient-centered care, as well as the professional responsibility to adhere to evidence-based practice guidelines for burn management, which emphasize early and accurate assessment. An approach that focuses solely on the immediate appearance of the burn wound without considering the broader physiological context and potential risk factors is professionally deficient. This narrow focus fails to identify underlying issues that could compromise healing or lead to secondary complications, such as systemic infection or fluid imbalance. Such an oversight represents a failure to meet the standard of care expected of a Certified Burn Nurse, potentially leading to adverse patient outcomes and violating the principle of beneficence. Another professionally unacceptable approach is to rely on assumptions or anecdotal evidence rather than a systematic assessment. For instance, assuming a superficial burn will heal without complications or that a patient’s hydration status is adequate without objective assessment can lead to critical errors in judgment and intervention. This disregard for a structured, evidence-based assessment process undermines the nurse’s professional accountability and can result in delayed or inappropriate treatment, contravening the duty of care. Finally, an approach that prioritizes comfort measures over a thorough physiological and risk assessment is also inadequate. While patient comfort is important, it should not supersede the fundamental need to accurately diagnose the extent of the injury and identify all potential risks. Failing to conduct a comprehensive assessment before implementing interventions means that the nurse may be treating symptoms without addressing the root causes of potential complications, thereby failing to provide optimal care. The professional reasoning process for similar situations should involve a continuous cycle of assessment, diagnosis, planning, implementation, and evaluation. Professionals must first activate their knowledge base regarding skin anatomy and physiology in the context of thermal injury. They should then employ a systematic risk assessment tool or framework, integrating subjective and objective data. This data should be analyzed to identify specific patient needs and potential complications. Based on this analysis, an individualized care plan should be developed, implemented, and continuously evaluated for effectiveness, with adjustments made as the patient’s condition evolves. This iterative process ensures that care remains responsive, evidence-based, and patient-centered.

This scenario is professionally challenging because it requires the Certified Burn Nurse to balance immediate patient needs with long-term functional outcomes, particularly concerning the prevention and management of complications like infection, scarring, and contractures. The nurse must anticipate potential risks and implement proactive strategies, demonstrating a commitment to holistic patient care beyond the acute phase of the burn injury. Careful judgment is required to tailor interventions to the individual patient’s burn severity, location, and overall health status, while also adhering to established best practices and guidelines. The best professional approach involves a comprehensive, individualized risk assessment that proactively identifies factors contributing to potential complications. This includes evaluating the burn’s depth, extent, and location, as well as the patient’s age, nutritional status, comorbidities, and adherence potential. Based on this assessment, the nurse develops and implements a personalized care plan that prioritizes infection prevention through meticulous wound care, early mobilization to prevent contractures, and appropriate pressure garment use to minimize hypertrophic scarring. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm) by anticipating and mitigating future complications. It also reflects a commitment to evidence-based practice, as proactive management is demonstrably more effective than reactive treatment of established complications. An incorrect approach would be to solely focus on immediate wound healing without considering long-term functional outcomes. This failure to proactively assess and plan for potential scarring and contractures neglects the patient’s future quality of life and ability to perform daily activities. Ethically, this represents a lapse in beneficence by not fully addressing the patient’s long-term well-being. Another incorrect approach is to delegate the responsibility for assessing and managing long-term complications entirely to other disciplines without direct nursing oversight or contribution to the care plan. While collaboration is essential, the Certified Burn Nurse has a primary responsibility for comprehensive burn care, including anticipating and planning for these specific complications. Failure to actively participate in this aspect of care can lead to fragmented care and missed opportunities for early intervention, potentially violating the principle of fidelity (faithfulness to one’s professional duties). A further incorrect approach is to rely solely on standard protocols without individualizing the risk assessment. While protocols provide a baseline, they may not account for unique patient factors that increase the risk of infection, severe scarring, or contractures. This can lead to suboptimal outcomes if specific risk factors are overlooked, demonstrating a lack of personalized care and potentially failing to meet the standard of care expected of a Certified Burn Nurse. The professional reasoning process for similar situations should involve a systematic approach: first, thoroughly assess the patient and the burn injury, identifying all potential risk factors for complications. Second, prioritize these risks based on their likelihood and potential impact. Third, develop a collaborative, individualized care plan that incorporates evidence-based interventions to mitigate identified risks. Fourth, continuously monitor the patient’s progress, reassess risks, and adjust the care plan as needed. Finally, ensure clear communication and documentation of all assessments, interventions, and outcomes.

The evaluation methodology shows a critical scenario where a Certified Burn Nurse must rapidly and accurately assess a patient with extensive burns, recognizing the potential for life-threatening associated injuries. The challenge lies in the immediate need to prioritize interventions for airway compromise and shock while simultaneously identifying and managing other significant trauma that could exacerbate the patient’s condition or complicate recovery. This requires a systematic, evidence-based approach that integrates burn-specific assessment with general trauma principles. The best approach involves a rapid, systematic head-to-toe assessment, prioritizing airway, breathing, and circulation (ABCDEs) as per established trauma protocols, while concurrently looking for signs of fractures and assessing for inhalation injury. This is correct because it aligns with the fundamental principles of emergency care and trauma management, which dictate that life-threatening conditions must be addressed first. Specifically, the assessment for inhalation injury (e.g., facial burns, soot in the mouth or nose, hoarseness, carbonaceous sputum) and the simultaneous search for fractures (e.g., crepitus, deformity, pain on palpation, inability to move limbs) are crucial for immediate patient stabilization and guiding further diagnostic and therapeutic interventions. This systematic approach ensures that no critical injury is overlooked in the initial, high-pressure phase of care. An incorrect approach would be to focus solely on the burn wounds and fluid resuscitation without a comprehensive assessment for other injuries. This is professionally unacceptable because it risks missing critical, non-burn related trauma such as fractures or internal injuries that could lead to delayed diagnosis, inadequate treatment, and potentially fatal outcomes. It fails to adhere to the holistic patient assessment required in trauma situations. Another incorrect approach would be to delay the assessment of potential inhalation injury until after initial burn wound management is complete. This is a significant ethical and professional failure as airway compromise due to inhalation injury can rapidly escalate, leading to irreversible damage or death. Prompt identification and management of airway issues are paramount and must be integrated into the initial assessment. A further incorrect approach would be to assume that the presence of burns negates the possibility of other significant trauma, such as fractures, and therefore not actively search for them. This demonstrates a lack of comprehensive trauma knowledge and can lead to delayed diagnosis and treatment of fractures, resulting in complications like malunion, nonunion, or compartment syndrome, and increasing the patient’s overall morbidity. Professionals should employ a structured decision-making process that begins with scene safety and immediate life-threat assessment (ABCDEs). This should be followed by a rapid, yet thorough, head-to-toe examination, specifically looking for signs of inhalation injury and fractures, while concurrently managing the burn wounds and initiating appropriate resuscitation. Continuous reassessment and communication with the multidisciplinary team are vital throughout the patient’s journey.

Scenario Analysis: This scenario presents a professional challenge for a Certified Burn Nurse due to the critical need for accurate depth assessment in burn injuries. Misjudging the depth can lead to inappropriate treatment, delayed healing, increased risk of infection, and potentially poorer long-term outcomes for the patient. The challenge lies in integrating subjective clinical observation with objective diagnostic techniques, ensuring patient safety and adherence to best practices in wound care. The nurse must balance the urgency of initial assessment with the need for definitive diagnostic information. Correct Approach Analysis: The best professional practice involves a multi-modal approach that begins with a thorough clinical evaluation, followed by a biopsy when indicated for definitive depth assessment. A comprehensive clinical evaluation includes visual inspection for characteristics like color, blanching, capillary refill, presence of blisters, and sensation. This initial assessment guides immediate management. When clinical assessment is equivocal, particularly in differentiating between partial-thickness and full-thickness burns, a biopsy provides objective histological data to confirm the depth of dermal involvement. This approach aligns with the ethical principle of beneficence, ensuring the patient receives the most accurate diagnosis for optimal treatment planning, and adheres to professional standards of care that advocate for evidence-based diagnostic methods. Incorrect Approaches Analysis: Relying solely on visual inspection without considering a biopsy when clinical signs are ambiguous is professionally unacceptable. This approach risks misclassification of burn depth, potentially leading to under-treatment of deeper burns or over-treatment of superficial ones. Ethically, this fails to uphold the duty of care by not pursuing the most accurate diagnostic information available. Initiating surgical debridement based solely on a preliminary clinical assessment without confirming the burn depth through biopsy, especially in cases of uncertainty, is also professionally unsound. This premature intervention can lead to unnecessary tissue loss and complications. It violates the principle of non-maleficence by potentially causing harm through aggressive treatment based on incomplete data. Delaying any form of definitive depth assessment, including biopsy, until the wound shows signs of infection or delayed healing, is a significant professional failure. This reactive approach neglects the proactive responsibility of the nurse to establish an accurate diagnosis early in the patient’s care. It compromises patient outcomes by allowing potentially serious conditions to progress without timely intervention, thereby failing to meet the standards of competent and ethical nursing practice. Professional Reasoning: Professionals should employ a systematic approach to burn depth assessment. This involves: 1) Initial comprehensive clinical evaluation, noting all observable characteristics. 2) Critical analysis of the clinical findings to determine the likelihood of different burn depths. 3) Identification of any ambiguities or uncertainties in the clinical assessment. 4) Consideration of advanced diagnostic tools, such as biopsy, when clinical assessment is insufficient to guide definitive management. 5) Collaborative decision-making with the healthcare team regarding the necessity and timing of further diagnostic interventions. This structured process ensures that patient care is guided by the most accurate information, minimizing risks and maximizing the potential for positive outcomes.

Scenario Analysis: This scenario presents a significant challenge for a Certified Burn Nurse due to the critical nature of pre-hospital burn care and the inherent limitations of the pre-hospital environment. The nurse must balance immediate life-saving interventions with the need to gather accurate information for definitive care, all while operating under potentially stressful and resource-constrained conditions. The decision-making process is complicated by the potential for rapid patient deterioration, the need to communicate effectively with emergency medical services (EMS) and receiving facilities, and the ethical imperative to provide the best possible care within the given constraints. Correct Approach Analysis: The best professional practice involves prioritizing immediate airway management and fluid resuscitation while simultaneously initiating a rapid, focused assessment to gather essential information for the receiving hospital. This approach is correct because it directly addresses the most life-threatening aspects of severe burns (airway compromise and hypovolemic shock) as per established burn care protocols and guidelines. It also ensures that critical data regarding the burn mechanism, extent, and patient’s initial condition is relayed promptly, enabling the receiving facility to prepare for specialized care. This aligns with the ethical principle of beneficence, acting in the patient’s best interest by addressing immediate threats and facilitating optimal subsequent treatment. Incorrect Approaches Analysis: One incorrect approach involves delaying definitive airway assessment and management until arrival at the hospital, focusing solely on wound care in the pre-hospital setting. This is professionally unacceptable as it violates the fundamental principle of airway management in trauma and burn patients, where early intervention is crucial to prevent irreversible damage and mortality. It also disregards established protocols that emphasize securing the airway as a primary concern. Another incorrect approach is to administer large volumes of intravenous fluids without a clear assessment of the patient’s hemodynamic status and burn size, based solely on the presence of a burn injury. This can lead to fluid overload, pulmonary edema, and other complications, particularly in patients with pre-existing cardiac or renal conditions. It represents a failure to apply critical thinking and evidence-based practice, moving beyond established resuscitation guidelines. A further incorrect approach is to withhold any pain management until arrival at the hospital, citing concerns about masking neurological status or interfering with further assessment. While careful consideration of pain management is necessary, complete withholding of analgesia in a severely burned patient experiencing significant pain is ethically questionable and can lead to increased physiological stress, exacerbating the patient’s condition. Professional guidelines advocate for appropriate pain management tailored to the patient’s condition and the pre-hospital setting. Professional Reasoning: Professionals should employ a systematic approach that integrates immediate life support with ongoing assessment and communication. This involves a rapid primary survey (ABCs – Airway, Breathing, Circulation), followed by a secondary survey focused on burn-specific details. Effective communication with EMS dispatch and the receiving trauma/burn center is paramount for seamless patient transfer and continuity of care. Decision-making should be guided by established protocols, ethical principles, and a thorough understanding of the physiological impact of burns.