Technologies used in the treatment of burn victims in intensive care: a scope review.

OBJECTIVES: to analyze the technologies used by the nursing team in the treatment of skin lesions caused by burns in patients under intensive care. METHODS: this is a scope review conducted on the LILACS, Medline, PubMed, and CINAHL databases without temporal or language restrictions. RESULTS: the highlighted technologies included the use of specialized dressings, biological agents such as probiotics and cyanobacteria, as well as negative pressure therapies and enzymes such as papain and collagenase. Some technologies, such as nanocrystalline silver, demonstrated efficacy in infection control. FINAL CONSIDERATIONS: the study identified essential technologies in burn care, emphasizing the need for further research on "soft" technologies. The findings support the promotion of evidence-based nursing care for burn patients in intensive care and enhance knowledge about effective treatments.

Effect of quality nursing intervention on wound healing in patients with burns: A meta-analysis.

This meta-analysis aimed to explore the effects of quality nursing intervention on wound healing in patients with burns. A computerised search was conducted for randomised controlled trials (RCTs) on the effect of quality nursing intervention on wound healing in patients with burns in the PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases from the date of database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on the inclusion and exclusion criteria. Stata 17.0 software was used for the data analysis. Twenty-nine RCTs involving 2637 patients with burns were included. The meta-analysis revealed that compared with conventional nursing, the implementation of quality nursing intervention in patients with burns significantly shortened the wound healing time (standardised mean difference [SMD] = -2.93, 95% confidence interval [CI]: -3.44 to -2.42, p < 0.001). The incidence of wound infections (odds ratio [OR] = 0.14, 95% CI: 0.07-0.27, p < 0.001) and complications (OR = 0.16, 95% CI: 0.11-0.23, p < 0.001) was also reduced significantly. This meta-analysis shows that applying quality nursing interventions in patients with burns can significantly shorten the wound healing time and reduce the incidence of wound infection and complications, thus promoting early patient recovery.

The Perceived Informational Needs of Family Caregivers of Children Hospitalized in a Burn Department: A Cross-sectional Study.

Children are most vulnerable to burn injuries, and their families are their most important source of support. Therefore, it is necessary to identify the information needs of such parents and support them to help children adapt to the new situation, recover to pre-accident conditions, and reintegrate into school and society. This study aimed to investigate the perceived information needs of family caregivers of children admitted to the burn wards of hospitals. This cross-sectional study was conducted on 200 family caregivers of children admitted to the burn ward of a hospital in Tabriz, Iran. Participants were selected through convenience sampling, and the required data were collected by using questionnaires on socio-demographic information, information needs, information resources, and information acquisition methods. The obtained data were analyzed statistically using descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics (Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests). Results indicated that the greatest informational need among family caregivers was related to the child's condition. The treatment team was identified as the most important source of information for them. It was found that information should be provided in a comprehensive and understandable manner, while maintaining honesty and human dignity. The study findings contribute to our understanding of the specific information needs of family caregivers in managing the medical care of children with burns. These findings can serve as a basis for interventions and support services aimed at meeting the needs of these families and improving the quality of care for children with burns.

The Symptoms and Factors Associated With Posttraumatic Stress Disorder for Burns Nurses: A Cross-Sectional Study From Guangdong Province in China.

The symptoms of posttraumatic stress disorder (PTSD) among medical staff have become a significant issue. Environments related to burns are highly stressful for nurses and can lead to PTSD, thus affecting their mental health. It is vital to consider that the quality of burns care, and the outcomes of such treatments, may be threatened if nurses experience PTSD. We evaluated PTSD symptoms in burns nurses and explored the correlations between demographic characteristics, work-related characteristics, professional identity, turnover intention, and PTSD symptoms. This was a cross-sectional study involving 273 nurses working in the burns unit from Guangdong, China, between July and August 2019. Nurses were recruited from 30 hospitals and completed three validated psychological questionnaires: Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), Professional Identity Scale (PIS) for nurses, and Turnover Intention Questionnaire (TIQ). We also collated information relating to sociodemographic and work-related characteristics. The cutoff point for the PCL-C was defined as 38 points; 17.22% (n = 47) of participants scored higher than or equal to 38. The PCL-C score was negatively correlated with professional identity level (P < .01) and positively correlated with turnover intention (P < .01). The workplace, mean monthly income, experience of workplace violence, and professional identity level were important factors and all associated with the severity of PTSD. PTSD symptoms were common in burns nurses. Attention should be paid to the mental well-being of these staff. Screening processes need to be initiated to identify individuals suffering from PTSD and take appropriate early interventional action.

Exploring the Background, Context, and Stressors of Caregiving to Elderly Burned Patients: A Qualitative Inquiry.

Elderly persons are at risk of experiencing burns and require support from both formal and informal caregivers. Informal caregiving in this situation has been minimally explored. Guided by the Stress Process Model, this study aimed at exploring the background, context, and stressors of informal caregivers of elderly burned persons during hospitalization. A qualitative descriptive design was utilized. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalization. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six subcategories emerged which characterize the background, context, and stressors of informal caregiving to elderly burn patients. All the injuries occurred in the home setting and its sudden nature led to varied postburn emotional responses which characterized the context of burns caregiving. Primary stressors that emerged were related to the injury, actual caregiving demand, and concerns regarding increasing frailty levels. Secondary stressors identified were financial concerns and lifestyle changes. The findings suggest that the occurrence of burn injury served as a precursor to postburn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures, and financial issues were key concerns which emphasize the need for psychosocial/transitional support, innovative healthcare financing measures, and continuing education on burns prevention in the home setting.

Active teaching strategies improve nursing knowledge and skills to assist burn victims.

OBJECTIVE: to evaluate the impact of an educational intervention, on nurses' self-perception, about knowledge and skills for initial care for burn victims. METHODS: a quasi-experimental study of the type before and after, with 18 nurses who assist burn victims. The intervention was carried out for 11 days in face-to-face meetings and online activities, and comprised active case-based learning strategies, simulation training, concept maps and digital portfolio. A structured instrument was used to collect sociodemographic data, and another one related to the knowledge and essential skills to the initial care for burn victims. RESULTS: The average scores found before the intervention ranged from 2.78 to 3.33 and, after the intervention, they ranged from 3.89 to 4.72. Relevant statistical differences (p <0.005) were found in all questions addressed. CONCLUSION: this educational intervention, based on innovative teaching methods, showed a positive impact on nurses' knowledge and skills on initial care for people with burns.

Evaluating the impact of rehabilitation nursing intervention on quality of life in patients with burn injuries: A protocol for systematic review and meta-analysis.

BACKGROUND: Despite the availability of pharmacological intervention, patients with burn injuries experience pain during the treatment of wounds. Supplementary rehabilitation nursing intervention are required to enhance the wellbeing of patients sustaining injuries from burns. The present study aims to conduct a systematic exploration of the impact of rehabilitation nursing intervention on the wellbeing in patients sustaining burn injuries. METHODS: The electronic databases listed below will be searched systematically: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, and WanFang database. All the databases will be searched from their inauguration to November 2020. There will be no language constraints. Independent undertaking by 2 authors will select studies, extract data from selected studies, and assess the quality of the included studies. All disagreements will be resolved through discussion, or by consulting a third independent author. This study will make use of RevMan 5.3 software to perform statistical analysis. RESULTS: The present protocol summarizes high-quality evidence to assess the impact of rehabilitation nursing intervention on the wellbeing of patients sustaining burn injuries. CONCLUSION: The results of the present protocol has the potential to present evidence to assess whether rehabilitation nursing intervention can enhance the wellbeing of patients sustaining burn injuries. REGISTRATION NUMBER: November 17, 2020.osf.io/t6b8c/. (https://osf.io/t6b8c/).

The Effect of Simulation Method on Nursing Students' Burn Patient Care Planning: A Randomized Controlled Trial.

In nursing education, the rate of students to practice for burn patient care is low. This research was carried out as a single-blind randomized control group intervention trial to determine the effectiveness of simulation method performed using high-fidelity human patient simulator in nursing students' burn patient care planning. The research was conducted with randomly selected 61 students including 31 in intervention and 30 in control groups. In the application process of the research, knowledge tests were administered as a pretest, second test, and posttest, and the first and second applications of burn patient care plans were performed with all students. In the research, the application of burn patient scenario was performed only with the intervention group. As a result of the research, it was found that the posttest knowledge scores of the students in the intervention group increased significantly compared with the control group (P < .05). According to the intergroup evaluations, there was no significant difference between the intervention and control groups in terms of care plan scores (P > .05), whereas the scores for the second burn patient care plan of the intervention group were higher compared with those of the control group. The simulation method was found to increase students' knowledge levels, and the employment of the method in nursing education is recommended.

Nurses Can Resuscitate.

Fluid resuscitation in the first 48 hours postburn is crucial in the management of burn shock. The primary purpose of this study was to evaluate nurses' adherence to a nurse-driven fluid resuscitation protocol at one adult burn center. Their secondary goal was to establish that the use of a nursing-driven protocol did not result in over resuscitation. Following implementation of a nurse-driven burn resuscitation protocol, a 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses. All resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow-up with nursing staff was done in real time by the clinical nurse specialist following each burn resuscitation. Twenty-two patients requiring formal fluid resuscitation were included in the review. Patients had a median age of 36.5(IQR: 38.74) years and were predominantly male. They found that in the first 24 hours that patients received 3.47 ml/kg/hr and then in the next 24 hours they received an average of 2.68 ml/kg/hr. All 22 patients' resuscitation was initiated using the Parkland formula in the emergency department, and nurses were successful in consistently adjusting fluid infusions consistent with the protocol. Using a multidisciplinary approach and preparatory and real-time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow-up in real time can improve the process.

A small-scale re-evaluation of the efficacy of silver sulfadiazine for burns.

Burns remain one of the most common injuries contributing to an increase in trauma incidence in hospitals, particularly in developing countries. Therefore, it is essential to identify the appropriate care for these wounds. Silver sulfadiazine has been widely used for the treatment of burns, but its efficacy has not been re-evaluated in recent years. Therefore, this small-scale study aimed at re-evaluating the use of silver sulfadiazine in patients with burns at a hospital in Magelang, Indonesia. A total of seven patients with second- and third-degree burns were involved and received silver sulfadiazine for 5 months (March to July 2020). Data on their wounds were collected three times and evaluated by using the Nursing Outcomes Classification (NOC) observation method. Wound outcomes were evaluated using on the basis of wound healing by secondary intention. Silver sulfadiazine was found to be effective; 85.7% of the wound area showed granulation tissue, and 75-100% of the wound area showed epithelialisation. However, patients complained of pain during silver sulfadiazine treatment. Therefore, additional nursing interventions seem to be needed to manage burns.

Nursing workload in burn intensive care unit.

OBJECTIVES: To measure the nursing workload in the Burn Intensive Care Units and evaluate its association with clinical variables, length of stay, and outcome of hospitalization. METHODS: Cross-sectional study carried out in a Brazilian public large hospital. The study included 33 patients. The nursing workload was assessed using the Nursing Activities Score (NAS) every 24 hours. We performed 447 Nursing Activities Score assessments. For the statistical analysis, Student's t-test, ANOVA, and Spearman's correlation test were used. The considered significant difference was 5% (p ≤ 0.05). RESULTS: The Nursing Activities Score mean was 84% (± 4.4), which corresponded to 20.2 hours. There was an association between the nursing workload and the patient's severity (p <0.010), burned body surface (p = 0.010), and hospitalization outcome (p = 0.020). CONCLUSION: Burn victims, assisted in the ICU, demanded a high nursing workload, which was influenced by clinical aspects and the hospitalization outcome. These findings point to the need to reconsider the nurse staffing related to this care profile.

"On the Recovery Journey:" An Integrative Review of the Needs of Burn Patients From Immediate Pre-Discharge to Post-Discharge Period Using the Omaha System.

BACKGROUND: To establish a conceptual understanding of the needs of burn patients, the specific research question asked is: "What are the needs of burn patients from 1-week pre-discharge to the post-discharge period?" METHODS: Whittemore and Knafl's integrative review approach was used to answer the review question. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, and Scopus. Thirty-two primary studies were retained at the end of the screening process. Directed content analysis was undertaken, with the Omaha system as an organizing framework. RESULTS: Recovery after burns is not a linear process, but an intricate one filled with varied needs in the physiological (pain, skin, neuro-musculo-skeletal, and infection), psychosocial (social contact, role changes, spirituality, grief, mental health, and sexuality), health-related behavior (nutrition, sleep and rest patterns, and physical activity), and environmental (income) domains of the Omaha system. The nature and intensity of these needs change over time, suggesting that recovery for the burn patient is an ongoing process. CONCLUSIONS: Several needs exist from 1 week before discharge to the post-discharge period. The mutual relationship and evolving nature of these needs create an avenue for a flexible, regular, holistic transitional program, similar to the support offered to persons living with chronic conditions. CLINICAL RELEVANCE: Hospital discharge does not imply an end to the recovery of burn patients, and burn survivors still require holistic care even after discharge. The review shows the applicability of the Omaha system in exploring and classifying the needs of burn survivors and situates nursing at the core of such a program. It is possible that a nurse-led program of care needs to be considered.

Nurse Staffing, the Clinical Work Environment, and Burn Patient Mortality.

The complexity of modern burn care requires an integrated team of specialty providers working together to achieve the best possible outcome for each burn survivor. Nurses are central to many aspects of a burn survivor's care, including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Research suggests that in general, hospital nursing resources, defined as nurse staffing and the quality of the work environment, relate to patient mortality. Still, the relationship between those resources and burn mortality has not been previously examined. This study used a multivariable risk-adjusted regression model and a linked, cross-sectional claims database of more than 14,000 adults (≥18 years) thermal burn patients admitted to 653 hospitals to evaluate these relationships. Hospital nursing resources were independently reported by more than 29,000 bedside nurses working in the study hospitals. In the high burn patient-volume hospitals (≥100/y) that care for the most severe burn injuries, each additional patient added to a nurse's workload is associated with 30% higher odds of mortality (P < .05, 95% CI: 1.02-1.94), and improving the work environment is associated with 28% lower odds of death (P < .05, 95% CI: 0.07-0.99). Nursing resources are vital in the care of burn patients and are a critical, yet previously omitted, variable in the evaluation of burn outcomes. Attention to nurse staffing and improvement to the nurse work environment is warranted to promote optimal recovery for burn survivors. Given the influence of nursing on mortality, future research evaluating burn patient outcomes should account for nursing resources.

Nursing Student Experiences of Caring for Burned Patient: From Fearfulness to Normalization.

OBJECTIVES: To describe the care experiences of students in burn units. METHODS: Qualitative research of the phenomenological descriptive type which was conducted with the participation of eight senior nursing students in Shiraz College of Nursing and Midwifery, Iran. The method used for gathering data about Student experiences in Care Services for Burn Cases was the individual semi-structured interview. The Colaizzi method was used for analysing and interpreting the data. RESULTS: Three main themes emerged: the attractive but stressful experience, trying to adjust and metamorphosis in attitude. Taking care of burned patients led to metamorphosis and adaptation to the requirements of burn care due to the students' improved attitudes, awareness and potentials. This finally turned the stressful nature of taking care of a burn patient into an attractive experience for them. CONCLUSIONS: Students with little clinical experience of stressful working situations in burn units faced different challenges. Due to the specific nature of taking care of burned patients, the clinical experiences of nursing students who offer these services are unique.

Use of Tailored Feedback Improves Accuracy of Delirium Documentation in the Burn ICU: Results of a Performance Improvement Initiative.

One of the most widely used tools for delirium assessment in burn intensive care units is the Confusion Assessment Method for the Intensive Care Unit delirium assessment tool. However, some nurses struggle with inaccurate delirium documentation. This performance improvement project was undertaken to assess the impact that routine chart audits with tailored feedback would have on documentation accuracy. An a priori goal of at least 90% documentation accuracy was set by burn leadership at our academic, American Burn Association-verified burn center. For the precorrectional feedback time period, nursing delirium documentation was reviewed for accuracy by the nurse educator. In the postcorrectional feedback time period, an intervention was started, in which the educator sent tailored feedback to nurses with inaccurate delirium documentation. A Poisson regression with robust standard errors was used to compare the proportions of correct delirium documentation for the precorrectional feedback and postcorrectional feedback time periods. The overall rates of correct delirium documentation in the precorrectional feedback time period were 49.15% (SD = 31.86), 95% CI: 36.43 to 66.31. A significant increase was seen in the rates of correct delirium documentation for the postcorrectional feedback time period (91.47% [SD = 8.28], 95% CI: 87.45 to 95.67), P = .0001. In the 4 months prior to starting corrective feedback, zero out of five (0%) audits reached the 90% goal of accurate delirium documentation. In the 8 months in which corrective feedback was being given, 9 out of 15 (60%) audits reached the compliance goal set by leadership. Using corrective feedback improves the accuracy of nursing delirium documentation.

A taxonomy to assess the interaction between nurses and children: Development and reliability.

AIMS AND OBJECTIVES: The aim of this study was to develop a valid and reliable instrument to assess the nurse-child interaction during medical or nursing interventions. BACKGROUND: Communication is an important competency for the professional practice of nurses and physicians. The nurse-patient relationship is fundamental for high-quality care. It has been suggested that if nurses have more skills to interact with children, care will be less distressing and less painful for the children. DESIGN: A qualitative observational psychometric study; the GRRAS checklist was used. METHODS: In-depth video-analyses, taxonomy development (19 videos) and testing it is psychometric properties (10 videos). Three observers micro-analysed video recordings of experienced nurses changing children's wound dressing in a specialised Burn Centre. RESULTS: The nurse-child interaction taxonomy (NCIT) was developed to observe and score the interactional behaviour between nurse and child. The taxonomy has three main patterns: being considerate, attuning oneself, and procedural interventions, subdivided in eight dimensions. These dimensions contain 16 elements that can be observed and scored on a 7-point scale. Intra-rater, inter-rater reliability and agreement were good. CONCLUSIONS: This study shows that interaction between nurses and children can be assessed reliably with the NCIT by an experienced observer or alternatively, scoring by two observers is recommended. RELEVANCE TO CLINICAL PRACTICE: The development of the taxonomy is an important step to find evidence for the best way for nurses to interact with children during nursing interventions or medical events and as such, ultimately, contributes to providing the best care possible.

Effect of Telenursing and Face-to-Face Training Techniques on Quality of Life in Burn Patients: A Clinical Trial.

OBJECTIVE: To compare the effect of telenursing and face-to-face training on the quality of life (QOL) of patients with a burn injury. DESIGN: This clinical trial with pretest-posttest design on 3 groups was conducted in Kermanshah, Iran, from 2017 to 2018. Convenience sampling was used. SETTING: A tertiary hospital in Kermanshah, west of Iran. PARTICIPANTS: A total of 90 patients with burns of grade 2 and 3 after discharge from the hospital were randomly assigned to 3 groups including telenursing (30), face-to-face training (30), and control (30). INTERVENTIONS: Each intervention group received 1-on-1 telephone training and face-to-face training in 8 sessions (2 sessions of 15 to 20min/wk). The control group received regular care. MAIN OUTCOME MEASURES: QOL was evaluated by the Burn Specific Health Scale-Brief (BSHS-B). RESULTS: The mean BSHS-B scores before and after intervention for telenursing, face-to-face, and the control group were 71.43±21.92 and 133.06±11.97; 64.83±26.16 and 124.83±23.05; and 58.63±20.89 and 73.13±33.04, respectively. There was a statistically significant difference among the 3 groups with respect to the training methods after intervention (P<.001). In addition, post hoc test did not show a significant difference between the telenursing and face-to-face groups (P=.244). CONCLUSIONS: Educational methods in the form of telenursing and face-to-face training were effective and promoted QOL in survivors of burn injuries. Both telenursing and face-to-face training can be used to improve the QOL of survivors of burn injuries during the rehabilitation phase.

Predictors of professional quality of life among nursing staff following the Taiwan Formosa Fun Coast explosion.

PURPOSE: The Formosa Fun Coast Explosion was a major public disaster that caused international shock. Nursing staff made an all-out effort to care for patients injured in the explosion, and this may have caused a lot of stress among nurses. This study aimed to explore the predictors of professional quality of life among nursing staff experiencing major disaster events. MATERIAL AND METHODS: This descriptive cross-sectional study was conducted in a medical center in Northern Taiwan in 2016. A total of 165 nurses were enrolled using convenience sampling. Data were collected on the demographic- and work-related characteristics of nurses, and the Perceived Stress Scale and Professional Quality of Life Scale were administered. Analyses included descriptive statistics and regression. The threshold for statistical significance was set at p<0.05. RESULTS: The nurses' length of service in nursing (ß=-0.26, p=0.029) and perceived stress level (ß=0.15, p=0.002) were important predictors of compassion satisfaction, while their age (ß=0.42, p=0.033) and perceived stress level (ß=0.20, p=0.020) were important predictors of compassion fatigue. Compassion fatigue was divided into burnout and secondary trauma. Nurses' age (ß=0.18, p=0.044) and perceived stress level (ß=0.14, p<0.001) were the key predictors of burnout. However, there were no significant predictors of secondary trauma among nurses. CONCLUSIONS: Based on the present findings, it is proposed to reduce the level of stress among nurses to improve their professional quality of life.

Fatores que interferem na cicatrização de queimaduras em adultos: Revisão integrativa da literatura / Factors that interfere in the healing of burn wounds on adults: Integrative literature review

OBJETIVO: Analisar os fatores que interferem no processo de cicatrização de adultos queimados. MÉTODO: Revisão integrativa. A busca dos estudos primários foi realizada em dezembro de 2019, sem delimitação de tempo para a seleção, nas bases de dados PubMed, CINAHL, LILACS, Web of Science e Scopus com os descritores: adult, burnt adult, burns, burn wounds, burn scar, cicatrix, scar quality, predictors e patterns. O Cinhal Headings apresentou como descritores: adult, burn patients, burn, burn care, cicatrix e injury pattern. RESULTADOS: A amostra da revisão foi composta de sete estudos primários. Os principais fatores que interferem no processo de cicatrização de queimaduras foram: porcentagem de superfície queimada, profundidade da lesão, idade, sexo e número de intervenções cirúrgicas. CONCLUSÃO: Os elementos encontrados são fatores avaliados frequentemente na prática clínica e, portanto, o conhecimento sobre a influência desses fatores é essencial para a obtenção de um diagnóstico preciso e precoce.

OBJECTIVE: To analyze the factors that interfere with the healing process of burnt adults. METHODS: Integrative review. The search for primary studies was carried out in December 2019, with no time limit for selection, in the databases PubMed, CINAHL, LILACS, Web of Science and Scopus, with the following descriptors: adult, burnt adult, burns, burn wounds, burn scar, cicatrix, scar quality, predictors and patterns. The Cinhal Headings presented the following as descriptors: adult, burn patients, burn, burn care, cicatrix and injury pattern. RESULTS: The revision sample was composed by seven primary studies. The main factors that interfere in the process of cicatrization of burn wounds were: percentage of burnt surface, wound depth, age, sex, and number of surgical interventions. CONCLUSION: The elements found are factors that are frequently evaluated in clinical practice, and therefore the knowledge about the influence of these factors is essential for obtaining an accurate and early diagnosis.