The role of multiplatform messaging applications in burns care and rehabilitation: A systematic review.

BACKGROUND: Multiplatform messaging applications also referred to as cross-platform instant messaging play an important role in delivery of healthcare and education with its low cost, ease of use and accessibility. AIM: To evaluate the existing evidence regarding the use of multiplatform messaging applications in facilitating consultations and decision-making processes in the context of burns care, as well as to assess the impact of such applications on burns care and rehabilitation. METHOD: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PROSPERO protocol CRD42021265203. The CASP and JBI tools were used to evaluate the quality of the studies. Eight hundred fifty-three papers were retrieved from PubMed, CINAHL, Scopus, EMBASE and LILACS published up to July 2022 (updated August 2023) with no time restrictions applied. RESULTS: An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality. CONCLUSION: Multiplatform messaging applications offer a solution for individuals with burn injuries to stay in direct contact with burn specialist clinicians for their follow-up and subsequent rehabilitation phase of recovery.

Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients.

BACKGROUND: Pain associated with surgical or enzymatic burn wound debridement prevents many burn centres from working outside an operating theatre, creating a burden. Alternatives for general anaesthesia to manage pain in burn patients treated with enzymatic debridements, such as regional anaesthesia, have not been studied in detail. This study explores the different possibilities for pain management during a bedside NexoBrid™ procedure. MATERIAL AND METHODS: We performed a single-centre retrospective study that included 82 paediatric, adolescent, and adult patients with deep dermal and full-thickness burns treated bedside with NexoBrid™ under regional or general anaesthesia. Outcome measures were pain during the NexoBrid™ procedure, the safety of the anaesthesia and the NexoBrid™ procedure, logistics of the bedside NexoBrid™ procedure, and time to wound closure. RESULTS: Forty-three patients in the adult group (43/67, 64%) only presented with burn wounds on one upper or the one or two lower extremities. In 29 of them (29/43, 67%), a NexoBrid™ procedure was performed under regional anaesthesia, which resulted in low pain levels without any adverse events. All seven patients in the paediatric group, where only one upper or one or two lower limbs were involved (7/15, 47%), underwent a NexoBrid™ procedure performed under regional anaesthesia where no adverse events were reported. In these children, the use of regional anaesthesia was associated with a significant decrease in time to wound closure (average treatment effect on the treated = -22.5 days, p = 0.021). CONCLUSION: This study highlights that regional anaesthesia administered at the bedside should be the method of choice for pain management during NexoBrid™ procedures because often, it can be adequately and safely performed in all age groups. This approach will reduce the burden on operating theatres. A flow chart has been developed to guide pain management during a NexoBrid™ procedure.

Pain and Posttraumatic Stress Symptom Clusters: A Cross-Lagged Study.

Pain and posttraumatic stress disorder (PTSD) frequently co-occur but underlying mechanisms are not clear. This study aimed to test the development and maintenance of pain and PTSD symptom clusters, i.e., intrusions, avoidance, and hyperarousal. The longitudinal study included 216 adults with burns. PTSD symptom clusters, indexed by the Impact of Event Scale-Revised (IES-R), and pain, using a graphic numerical rating scale (GNRS), were measured during hospitalization, 3 and 6 months post-burn. Cross-lagged panel analysis was used to test the relationships between pain and PTSD symptom clusters. Cross-lagged results showed that in-hospital intrusions predicted pain and avoidance 3 months post-burn. In-hospital pain predicted intrusions and avoidance 3 months post-burn and a trend was found for hyperarousal (90% CI). In the second wave, intrusions predicted pain and hyperarousal. Pain predicted hyperarousal. This study provides support for an entangled relationship between pain and PTSD symptoms, and particularly subscribes the role of intrusions in this bidirectional relationship. To a lesser extent, hyperarousal was unidirectionally related to pain. These results may subscribe the driving role of PTSD, particularly intrusions, which partly supports the Perpetual Avoidance Model.

Rasch Analysis of the Burn-Specific Pain Anxiety Scale: Evidence for the Abbreviated Version.

The Burn-Specific Pain Anxiety Scale (BSPAS) estimates pain-related anxiety and determines the effect of treatment in patients with burns, especially regarding wound care. This study aimed to analyze the 9-item and the abbreviated 5-item BSPAS by the Rasch model. This prospective study included 161 patients admitted to Dutch burn centres. The BSPAS was administered during hospital stay resulting in 314 self-reports and was analysed using the Rasch unidimensional measurement model 2030 (RUMM 2030). Unidimensionality of the 9-item and 5-item BSPAS was confirmed. Initially, both versions did not fit the model due to response dependency. After creating subtests, fit to the model improved. After deleting 'feeling insecure about my healing' and creating two subtests with three items, fit of the 9-item BSPAS was obtained, while the 5-item BSPAS fitted after creating a subtest with two items. The Rasch model demonstrated that both versions were unidimensional and were able to fit the model after adjusting for response dependency. Moreover, the 5-item BSPAS could be further improved by deleting 'worrying about the possible pain.' A 4-item abbreviated BSPAS (BSPAS-4I) captures pain-related anxiety and is proposed to be used in future studies and daily practice.

The aftermath of burn injury from the child's perspective: A qualitative study.

A burn injury event and subsequent hospitalization are potentially distressing for children. To elucidate the child's experience of pediatric burn injury, children's reflections on the burn event and its aftermath were examined. Semi-structured interviews were conducted with eight children (12-17 years old). Using thematic analysis, interview transcripts were coded and codes were combined into overarching categories. Three categories were identified: vivid memories; the importance of parental support; psychosocial impact and coping. Implications for care are discussed in terms of assessing children's appraisals, paying attention to the parent's role, and preparing families for potential psychological barriers after discharge.

Parents' memories and appraisals after paediatric burn injury: a qualitative study.

Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents' memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents' (intrusive) memories and appraisals, and associated emotions, concerning the injury, the hospitalisation, and its consequences. Method: Approximately three to six months after the burn event, semi-structured interviews were conducted with parents of 18 children (0-16 years old) that had been hospitalised for a burn injury. Thematic analysis was carried out to obtain themes. Results: A central element in parents' memories and appraisals was a sense of external or internal threat. Intrusive memories were predominantly related to the accident and first aid (i.e. threat of the injury), whereas parents' memories about the child's suffering were emotional but not experienced as intrusive. Later appraisals of the burn injury and its consequences included negative appraisals of the child's increased vulnerability, responsibility of self or other, the child's prolonged suffering and (risk of) permanent change, as well as appraisals of positive outcome and recovery. Emotions commonly reported in the context of memories and appraisals were fear, sadness, guilt, and relief. Conclusions: This study offers insight into the traumatic nature of paediatric burn injury from the parent's perspective and provides directions for the delivery of trauma-informed (after)care.

Antecedentes: está bien establecido que una lesión por quemadura pediátrica puede provocar síntomas de estrés postraumático en los padres. El contenido de los recuerdos y de su evaluación por parte de los padres, puede revelar las experiencias traumáticas que necesitan atención.Objetivo: Informar la práctica clínica, el objetivo de este estudio fue examinar cualitativamente los recuerdos (intrusivos) de los padres y sus evaluaciones, y las emociones asociadas, en relación con la lesión, la hospitalización y sus consecuencias.Método: Aproximadamente de tres a seis meses después del evento de quemadura, se realizaron entrevistas semiestructuradas con padres de 18 niños (de 0 a 16 años de edad) que habían sido hospitalizados por una lesión por quemadura. Se realizó un análisis temático para obtener los temas.Resultados: Un elemento central en los recuerdos y evaluaciones de los padres era una sensación de amenaza externa o interna. Los recuerdos intrusivos se relacionaban predominantemente con el accidente y los primeros auxilios (i.e. la amenaza de lesión), mientras que los recuerdos de los padres sobre el sufrimiento del niño eran emocionales, pero no experimentado como intrusivo. Las evaluaciones posteriores de la lesión por quemaduras y sus consecuencias incluyeron evaluaciones negativas del aumento en la vulnerabilidad del niño, responsabilidad de sí mismo o de otro, el sufrimiento prolongado del niño y (el riesgo de) cambio permanente, así como una evaluación de resultados positivos y recuperación. Las emociones comúnmente reportadas en el contexto de los recuerdos y las valoraciones fueron el miedo, la tristeza, la culpa y el alivio.Conclusiones: este estudio ofrece información sobre la naturaleza traumática de la lesión por quemadura pediátrica desde la perspectiva de los padres y brinda instrucciones para brindar atención (posterior) a los traumas.

Assessing and addressing the problem of pain and distress during wound care procedures in paediatric patients with burns.

OBJECTIVE: While the prevalence of burns in children is highest in low and middle-income countries, most research on burn-related pain intensity and distress is carried out in high-income countries. In this study we assessed pain intensity and distress in paediatric patients with burns undergoing wound care procedures without distraction and parental presence in a South-African children's hospital and sought to identify predictors for the outcomes. METHODS: This observational study, carried out as part of a randomized controlled trial, took place at a burns unit in Cape Town, South Africa and included patients between the ages of 0 and 13 years undergoing their first or second wound care procedure. We measured pain intensity and distress using the COMFORT Behavioural scale (COMFORT-B) across four distinct phases of wound care procedures: removal of bandage; washing the wound; administering wound care; putting on new dressings. COMFORT-B scores ≥21 indicate severe pain intensity and distress. RESULTS: 124 patients were included, median age 21.2 months (IQR 14.9-39.5 months), 90% suffered scalds, and median total body surface 8% (IQR 5-14%). Assessment scores for the majority of patients were indicative of severe pain intensity and distress during wound care procedures. Median COMFORT-B scores across the four phases were 24, 25, 25 and 22 respectively. Across the four phases respectively 76%; 89%; 81% and 62% of the patients were indicated with severe pain intensity and distress. Age was a predictor for pain intensity and distress as younger children were assigned higher scores than older children (Unstandardized B -.052; 95% CI -.071 to -.032 p<0.001). CONCLUSIONS: In this study children received wound care procedures without distraction or parental presence and were assessed to have high pain intensity and distress. There is a correlation between age and COMFORT-B scores: younger children show higher distress, indicating a great need for better pain and distress control during wound care procedures. It is difficult to identify whether pain or distress is the specific primary cause for the high COMFORT-B scores.

Parental presence or absence during paediatric burn wound care procedures.

AIM: Differing views on benefits and disadvantages of parental presence during their child's wound care after burn injury leave the topic surrounded by controversies. This study aimed to describe and explain parents' experiences of their presence or absence during wound care. METHODS: Shortly after the burn event, 22 semi-structured interviews were conducted with parents of children (0-16 years old) that underwent hospitalization in one of the three Dutch burn centers. Eighteen of these parents also participated in follow-up interviews three to six months after discharge. Interviews were analyzed using grounded theory methodology. RESULTS: Analyses resulted in themes that were integrated into a model, summarizing key aspects of parental presence during wound care. These aspects include parental cognitions and emotions (e.g., shared distress during wound care), parental abilities and needs (e.g., controlling own emotions, being responsive, and gaining overall control) and the role of burn care professionals. CONCLUSION: Findings emphasize the distressing nature of wound care procedures. Despite the distress, parents expressed their preference to be present. The abilities to control their own emotions and to be responsive to the child's needs were considered beneficial for both the child and the parent. Importantly, being present increased a sense of control in parents that helped them to cope with the situation. For parents not present, the professional was the intermediary to provide information about the healing process that helped parents to deal with the situation. In sum, the proposed model provides avenues for professionals to assess parents' abilities and needs on a daily basis and to adequately support the child and parent during wound care.

Coping with burns: the role of coping self-efficacy in the recovery from traumatic stress following burn injuries.

We conducted a three-wave prospective study among patients with burns (N = 178) to examine the prospective influence of coping self-efficacy (CSE) perceptions on trajectories of posttraumatic stress symptoms in the first 12 months after burn injuries. Using linear growth curve modeling, we corrected for demographics, the number of surgeries during initial admittance, trait coping styles, and changing levels of health-related quality of life. CSE during initial admission was by far the strongest predictor of both initial PTSD symptoms and degree of symptom change with higher CSE levels associated with lower initial symptoms and a steeper decline of symptoms over time. Of the other variables only avoidant coping was associated with higher initial symptom levels, and only emotional expression associated with greater rate of recovery. Current findings suggest that CSE plays a pivotal role in recovery from posttraumatic stress after a burn injury, even when the role of burn-related impairments is taken into consideration. Implications of findings are discussed.

Pain in young children with burns: extent, course and influencing factors.

Little evidence is available on the extent, course and influencing factors of pain in young children with burns. At present, reliable and valid measurement instruments to assess pain behavior in these children are available, implying that valuable insight into these questions can now be obtained. The aim of this study is to document the extent and course of pain behavior with the COMFORT-B, and to assess factors that may influence procedural pain. First, cutpoints for COMFORT-B scores were established by Rasch analysis to assess clinically relevant changes. Second, the extent of background and procedural pain behavior was assessed by descriptive statistics. Third, the course and factors that may influence procedural pain behavior were investigated by latent growth modeling. Trained nurses collected pain behavior data in 168 children (mean age 20 months, mean TBSA 6%, mean length of stay 10 days). Cutpoints of COMFORT-B scores were as follows: 6-13 (mild pain), 14-20 (moderate pain) and 21-30 (severe pain). This study suggests that background pain is more adequately treated than procedural pain. Factors that influenced baseline pain scores and/or the course over 8 days included TBSA, the number of surgical procedures, acetaminophen administration by the referring hospital, and the application of hydrofiber dressings. The implications of these findings are discussed.

Construct validity of two pain behaviour observation measurement instruments for young children with burns by Rasch analysis.

In this study, construct validity of 2 pain behaviour observation measurement instruments for young children aged 1 to 56 months (mean age was 20 months) with burns is assessed by using Rasch analysis. The Rasch model, wherein data should meet the model expectations, assumes that an instrument measures one unidimensional construct, and focuses on the items of measurement instruments. The Pain Observation Scale for Young Children (POCIS) and the COMFORT Behaviour Scale (COMFORT-B) measure background and procedural pain as unidimensional. Adequate measurements for scientific research and daily practice can now be obtained.

Reliability, validity and clinical utility of three types of pain behavioural observation scales for young children with burns aged 0-5 years.

Pain measurement is a prerequisite for individualized pain management and research into pain interventions. There is a need for reliable and valid pain measures for young children with burns. The aim of this study was to investigate whether the pain observation scale for young children (POCIS), the COMFORT behaviour scale (COMFORT-B) and the nurse observational visual analogue scale (VAS obs) are reliable, valid and clinically useful instruments to measure pain in children with burns aged 0-5years. Participating trained nurses (N=102) rated pain of 154 children during hospitalization. Two trained nurses simultaneously assessed pain at fixed intervals by using the previous mentioned measures. Cronbach's alpha for POCIS was .87 for background and .89 for procedural pain. Intraclass Correlation Coefficients (ICCs) were .75 for background and .81 for procedural pain. COMFORT-B observations yielded Cronbach's alpha of .77 for background and .86 for procedural pain and ICCs of .83 for background and .82 for procedural pain. The VAS obs resulted in ICCs of .55 for background and .60 for procedural pain. Correlation coefficient between POCIS and COMFORT-B was .79 (p<.01), Standardized response mean was 1.04 for both POCIS and COMFORT-B. Background pain measured with POCIS and COMFORT-B was lower than procedural pain (p<.001). Nurses found POCIS easier and quicker to use, but COMFORT-B was found to indicate pain more accurately. Both POCIS and COMFORT-B are reliable, valid and practical scales for pain measurement in young children with burns and can be used in practice and research. The VAS obs was found to be unreliable.

Development of a nursing workload measurement instrument in burn care.

Existing workload measurement instruments fail to represent specific nursing activities in a setting where patients are characterized by a diversity of cause, location, extent and depth of burns, of age and of history. They also do not include educational levels and appropriate time standards. The aim of this study was to develop a reliable measurement instrument for nursing workload in burn care, in order to match quality of patient care with staffing needs. In the first phase, a time study by semi-structured interviews and observations was used to assess direct and indirect care activities. A total of 34 nursing activities were identified, defined, connected to educational levels and attached to time standards. Two independent raters completed a test computer program by assessing performed nursing activities in 36 patients. This yielded intra-class correlations of 0.82, indicating good reliability. In the second phase, a computer program was developed to process quantity and quality of available staff and the sum of time standards of nursing activities per patient per day and to calculate the balance. After 1 year of running this program, the database was used to distinguish patients' care demand into five care categories. This instrument justifies the investment of time by nursing staff needed for daily activities in the burn unit. It provides quick insight into the balance between care demand and staffing needs and can be used to optimise resource planning.

Use of a simple relaxation technique in burn care: literature review.

AIM: This paper presents a literature review examining the implications of previous research in order to make evidence-based decisions about the possible use of breathing exercises with adult patients with burns for pain management during wound care. BACKGROUND: Adult patients with burns experience pain during wound care despite pharmacological interventions. Additional interventions are needed to improve the effectiveness of pain management. Relaxation techniques can be considered, for example breathing exercises, music and distraction. A simple breathing relaxation technique is especially relevant because it involves no risk, is easy and quick to learn, equipment does not need to be purchased and it can be employed immediately by the often exhausted and ill patient. However, the effect of breathing exercises on procedural pain during burn wound care has not been investigated. METHOD: The CINAHL, PubMed and Cochrane databases were searched in 2004 in order to answer two questions: are breathing exercises effective in the management of procedural pain in adult burn patients, and what are the implications of previous investigations for future research concerning pain reduction in adult patients with burns during wound care? Eleven papers were included in the review. FINDINGS: The effect of breathing exercises for pain management in patients with burns has not been investigated. Prior to undertaking an effect study, additional basic research is needed. The number of sessions necessary to learn to use the technique should be clarified. A valid and reliable instrument to assess relaxation must be developed. The adequacy of the proposed data collection procedure needs to be assessed. CONCLUSION: It is not possible at this time to base decisions about the use of breathing exercises during wound care in adult patients with burns on research specific to the procedure and patient group. The most suitable relaxation technique for future investigation is concentration on breathing, in combination with jaw relaxation.