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Baiez, Yas Khadher, and Widad K. Mohammed. "Interventional Program on Nurses Practices Regarding Burn Wound Dressing." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 30, 2022): 670–73. http://dx.doi.org/10.53350/pjmhs22165670.
Повний текст джерелаАнотація:
Background: Wound management is a crucial aspect of patient care and the nurse often is faced with the question of which approaches to use to provide an environment that supports healing and prevents complications. Important questions include how different types of wounds should be dressed, what method of debridement to use, whether dressings should be changed using sterile versus unsterile technique, and which adjunctive therapies to select under given circumstances, thus the aim of this study is to evaluate the effect of an intervention program on nurse's practices regarding dressing burn wound. Methodology: A quantitative (one pre experimental) design had been adapted through the present study with the application of pre- post-test approach during the period of 17th October, 2020 to 20th March, 2022. A non-probability (convenient) sample of 24 nurses who work at burns and plastic surgery center at Azady teaching hospital. The interventional program and study instrument is designed based on of the nurse's practice assessment need, review of literature, scientific lecturer and previous study. The content of the program and instrument are evaluated by 16 experts in different field and the reliability of instrument is determined through the use of test and retest, measurement of effectiveness for nursing education program carried out through (24) items concerning clinical guidelines regarding burn management. The analysis of data is performed through the application of descriptive statistic as well as inferential statistic by using statistical package of social science version 22. Result: shows that vast majority of the sample were male, 30-39 years old, high school graduate, less than 5 years of experience. Most of the samples participate in burn courses, one course in number, their courses inside Iraq. Comparisons significant at P<0.01 was high regarding initial survey’s, secondary survey's, total body surface, initial assessment of the depth of the burn wounds, burn wounds, removing dead tissue and cleaning the burn's. Conclusion: study conclude that Nurses' Practice improvements due to applying of the proposed interventional program with relative to demographical characteristics. The study recommends that nurses practice toward burn management should be updated periodically as well as encourage nurses to participate in sessions, conferences and seminar related to care of burn Keywords: Burns; Hydrogels; Peptides; Wound dressings, Skin
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Vohra, Ekta. "577 The Collaboration of Burn Outreach and Wound Care Nurses." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S140. http://dx.doi.org/10.1093/jbcr/irab032.227.
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Abstract Introduction Certified wound care nurses perform a vital role in skin health and management in the hospital setting. During the certification process, minimal time is spent on burn wound education, despite the fact that wound care nurses are consulted for various wound etiologies; one of those being burns. This construct created a need for collaboration between the burn team and wound care nurses. Although all burns are essentially wounds, the reality is that all wounds are not burns. The management of the burn wound is often different from the management of pressure injuries or surgical wounds. In speaking with the wound care nurses at this large urban academic medical center, a knowledge gap was identified in burn wound care education as well as appropriate and timely consultation of the burn team. Methods This knowledge improvement project focused on educating the wound care nurses in assessment and treatment of burns, and the process for burn service consultation. Burn education was provided through in-person didactic presentations. The lecture included burn wound photos with opportunities to classify the potential depth of burn wounds as well as typical complications. Additionally, it discussed when a burn consult is needed. A basic knowledge retrospective pre-posttest method was utilized. Results An educational plan was tailored to meet the learning needs of the wound care nurses to address the knowledge gap. Post test data results were tracked. Post scores were increased, indicating a successful educational intervention. Also, while providing the education, the burn outreach coordinator identified an opportunity to expand the burn center’s presence among colleagues through collaboration with the wound care nurses. The wound nurses made excellent ambassadors for the mission of the burn service. Conclusions Provision of burn education across disciplines may improve recognition of burn wounds and facilitate definitive treatment.
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Snyder, Emily. "557 Introduction of a Pediatric Burn Education Program in an Adult Hospital." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S114. http://dx.doi.org/10.1093/jbcr/irac012.185.
Повний текст джерелаАнотація:
Abstract Introduction At a newly developed burn unit, the program decided to expand further and start admitting pediatric patients. While there are many working parts to this endeavor, we will primarily address staff preparedness. Prior to the introduction of a burn education course entitled Burns in the Pediatric Population, only a handful of nurses had received any hospital-based education for caring for pediatric patients. A previous pediatric course had been taught, however, this course focused primarily on illnesses of childhood. Staff had voiced on many occasions that they felt the education they received was not adequate and felt uncomfortable taking care of pediatric burn patients. Methods All Burn Intensive Care (BICU) nurses, regardless of having received the prior pediatric education, were required to take Burns in the Pediatric Population (n=42). The course content was based on the Burn Nurse Competencies. The course consisted of didactic lectures and hands-on sessions. Each participant was required to take a pre-test before the class and a post-test at the conclusion. The test included knowledge-based questions and self-rated confidence level questions. In addition, each participant was sent a survey three months after the completion of the class to evaluate their knowledge and confidence level. Results At the conclusion of the class, the average test score went from 49.3% to 92.7%. Both the pre-test and post-test had each nurse evaluate their own confidence level for caring for a pediatric patient. Initially, 19.5% of the nurses stated that they had no confidence in caring for a pediatric patient. At the conclusion of the class, all nurses expressed some confidence with caring for a pediatric patient, with the majority, 72.7%, stating they had moderate or high confidence. The return rate of the three-month evaluation was 81% (n=34). The knowledge-based test had an average score of 71%. 30.3% of the staff stated that their confidence in caring for a pediatric patient increased, 54.5% stated their confidence level remained the same, and 15.1% of those returning the survey stated that their confidence level decreased in the three month time period. Conclusions The results from the three-month survey have been utilized to edit and make our pediatric mock codes and course more specific to the needs of the bedside nurses. In addition, we are planning to increase the frequency and the level of participation in our pediatric mock codes. All Burn ICU nurses will need to participate in a pediatric mock code on a semi-annual basis. In addition, there will be a section that is added to each Burn ICU nurse’s annual competency specifically covering pediatric burns.
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Handley, Alison. "Firefighters shadow nurses who treat burns victims." Emergency Nurse 18, no. 3 (June 9, 2010): 6–7. http://dx.doi.org/10.7748/en.18.3.6.s8.
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Jones, Owen. "Measurements of the clinical competence of doctors and nurses to process telemedicine referrals for burns patients." Journal of Telemedicine and Telecare 11, no. 1_suppl (July 2005): 89–90. http://dx.doi.org/10.1258/1357633054461651.
Повний текст джерелаАнотація:
Simulated telemedicine referrals were used to test the ability of groups of clinicians to manage telemedicine referrals of patients with burn injuries. Sixty-one participants recorded burn depth from digital images using a four-point scale. The definitive (‘gold standard’) diagnoses were based on a review by an experienced consultant burns surgeon. Sixty clinical cases that reflected the routine referrals to a specialist burns service were used for the study. The mean kappa scores for the participants ranged from 0.33 to 0.58, indicating poor to good agreement. The scores for the groups all had a similar pattern, with more experienced staff scoring higher than junior staff. The doctors and nurses specializing in burns had higher scores than the general surgical nurses.
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Ali D. Abbas, Ali D. Abbas. "Nurses’ Practices Concerning Isolation Techniques for Patients with Burns At Baghdad Teaching Hospitals." Paripex - Indian Journal Of Research 3, no. 8 (January 15, 2012): 140–47. http://dx.doi.org/10.15373/22501991/august2014/42.
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Lafta, Najat Kaittan, and Khatam M. Al Mosawi. "Evaluation of Nurses Practices about Pain Related Management for Children with Burns Injuries." Pakistan Journal of Medical and Health Sciences 16, no. 3 (March 31, 2022): 620–22. http://dx.doi.org/10.53350/pjmhs22163620.
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Background: Burn injury occurs to the skin or other organic tissue primarily result in from exposure or direct contact to any type of chemical, thermal, electrical, or radiation. Material and Method: The study selected quantitative research " a pre-experimental design" to carry out at Specialized Burn Center at Al-Fayhaa Teaching Hospital in Basra City to evaluate the practice of nurses about pain-related management for children with burns Injuries, the study started from (3th of December 2021 to 20th of March 2022). The Sample of the Study choosing the study sample, the total population was taken into consideration and the excluded sample was determined. A non-probability (Purposive) sample is used to obtain accurate data and are presentative sample was selected for the current study. Results: The results showed that the nurses sample in the study, that 40.0% (12) of the sample at age (21-30) years with mean (1.90) and standard deviation (0.845), the sample gender was equal in number between male and female with mean (1.50) and standard deviation (0.509), 63.3% (19) of them was nursing institute of educational level with mean (1.63) and standard deviation (0.490), 40.0% (12) of the sample at (1-5) years of experience in nursing with mean (2.27) and standard deviation (1.258), Conclusion: The study concluded that the nurses’ practices about pain related management for children with burns injuries was acceptance. Keywords: Evaluation, nurse, burn, pain management
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Hilliard, Carol, and Mary O’Neill. "Nurses’ emotional experience of caring for children with burns." Journal of Clinical Nursing 19, no. 19-20 (June 27, 2010): 2907–15. http://dx.doi.org/10.1111/j.1365-2702.2009.03177.x.
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Kornhaber, Rachel Anne, and Anne Wilson. "Psychosocial Needs of Burns Nurses: A Descriptive Phenomenological Inquiry." Journal of Burn Care & Research 32, no. 2 (March 2011): 286–93. http://dx.doi.org/10.1097/bcr.0b013e31820aaf37.
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Kornhaber, Rachel Anne, and Anne Wilson. "Building Resilience in Burns Nurses: A Descriptive Phenomenological Inquiry." Journal of Burn Care & Research 32, no. 4 (July 2011): 481–88. http://dx.doi.org/10.1097/bcr.0b013e3182223c89.
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Everett, John J., David R. Patterson, Janet A. Marvin, Brenda Montgomery, Nydia Ordonez, and Keri Campbell. "Pain Assessment from Patients With Burns and Their Nurses." Journal of Burn Care & Rehabilitation 15, no. 2 (March 1994): 193–98. http://dx.doi.org/10.1097/00004630-199403000-00018.
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Hagiwara, Yoshiyuki, Keisuke Seki, and Yuwa Takahashi. "Oral chemical burn due to accidental ingestion of calcium oxide food desiccant in a patient with dementia." Journal of International Medical Research 48, no. 4 (April 2020): 030006052092006. http://dx.doi.org/10.1177/0300060520920065.
Повний текст джерелаАнотація:
Oral chemical burns occur when a chemical accidentally enters the mouth, causing burns and ulcers in the oral mucosa, esophagus, stomach, and upper digestive tract if swallowed. Oral chemical burns primarily occur in children because of accidental ingestion. However, a few reports have described advanced-age patients with dementia who developed oral chemical burns. Patients with dementia often exhibit impaired judgment and irregular eating behaviors, at times leading them to ingest nonfood substances. We herein describe a case of an advanced-age patient with dementia who ingested a calcium oxide food desiccant at home and developed chemical burns that were exacerbated by an improperly placed implant-supported complete fixed prosthesis. This case report emphasizes the need for families and nurses who care for patients with dementia to renew their understanding of the danger of accidental ingestion of nonfood substances. Knowledge of the appropriate response to calcium oxide food desiccant ingestion is also important to prevent the occurrence of severe chemical burns.
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Kolacz, Nicole M., Mark T. Jaroch, Monica L. Bear, and Rosanna F. Hess. "The Effect of Burns & Wounds (B&W)/Burdock Leaf Therapy on Burn-Injured Amish Patients." Journal of Holistic Nursing 32, no. 4 (March 25, 2014): 327–40. http://dx.doi.org/10.1177/0898010114525683.
Повний текст джерелаАнотація:
Purpose: The purposes of this pilot study were to measure pain associated with dressing changes, assess the presence of infection, and document healing times of burn-injured Amish in central Ohio using an herbal therapy consisting of Burns and Wounds™ ointment (B&W) and burdock ( Arctium ssp.) leaves. B&W contains honey, lanolin, olive oil, wheat germ oil, marshmallow root, Aloe vera gel, wormwood, comfrey root, white oak bark, lobelia inflata, vegetable glycerin, bees wax, and myrrh. Design: A prospective, case series design guided the study within a community-based participatory research framework. Methods: Amish burn dressers provided burn care. Registered nurses monitored each case and documented findings. Pain scores were noted and burns were inspected for infection during dressing changes; healing times were measured from day of burn to complete closure of the skin. All cases were photographed. Results: Between October 2011 and May 2013, five Amish were enrolled. All had first- and second-degree burns. B&W/burdock leaf dressing changes caused minimal or no pain; none of the burns became infected, and healing times averaged less than 14 days. Conclusion and Implications: The use of this herbal remedy appears to be an acceptable alternative to conventional burn care for these types of burns. The trauma of dressing changes was virtually nonexistent. Nurses working in communities with Amish residents should be aware of this herbal-based method of burn care and monitor its use when feasible.
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Wall, Shelley, and Velisha Ann Perumal-Pillay. "Burning Questions: What Should the Pharmacist Know about Managing Minor Burns?" Pharmacy 10, no. 4 (August 22, 2022): 100. http://dx.doi.org/10.3390/pharmacy10040100.
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Burn injuries are an endemic health concern in developing countries. Globally, Africa has the highest incidence of burn injuries per capita. A total of 2.3% of the South African population suffer burn injuries annually and may present at community pharmacies and primary healthcare (PHC) facilities. Pharmacists and PHC nurses must, therefore, remain abreast with the latest treatments for burn care. This commentary presents the most recent information for assessing burn wounds, first aid, referral guidelines, and identifying toxic shock syndrome in more severe burns cases. The successful management of patients with burns in an outpatient setting is contingent on patient selection. It is important for pharmacists and PHC nurses to know when to treat or refer a patient. Therefore, a set of guidelines for their use in PHC and community pharmacy settings is presented. Appropriate training on the use of these guidelines, would ensure a better assessment of burn wounds, leading to more positive patient outcomes. This commentary is a useful update to continuing professional development and can be utilised in community pharmacies and PHC settings in South Africa and across the African continent in the absence of formalised treatment guidelines for minor burns.
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Madiar, I. "The experience of procedural pain: Burns patients' and nurses' perspectives." Pain 41 (January 1990): S335. http://dx.doi.org/10.1016/0304-3959(90)92786-p.
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Mukhlif, Hanaa, and Kalida Mansour. "Nurses Knowledge and Practices Regarding Aseptic Technique Applied with Burn Patients at Teaching Hospitals in Mosul City." Kufa Journal for Nursing Sciences 11, no. 1 (June 29, 2021): 1–8. http://dx.doi.org/10.36321/kjns.vi20211.466.
Повний текст джерелаАнотація:
Background: Burns is one of the most serious injuries to mankind, considering the difficulty of treating a burn injury.Aims of the study: this study aimed to assess nurses' knowledge and practices regarding aseptic technique applied to burn patients at Teaching Hospitals in Mosul City.Methodology: Descriptive design selected for the assessment of nurses' knowledge and practices regarding aseptic technique applied to burn patients. The period of this study was in the 1\ June \ 2020 to 15 \ January \ 2021. A purposive sample for this study choice (60) nurses who agree to participate in the study. The tool was constructed, and it is composed of the three-part represents the demographic variables, assess the knowledge of nurses, and practices to an applied aseptic technique in managing patients with burns. The answer to the questions in part two is symbolized as (0) for the incorrect answer and (1) for the correct answer. While practices items were: (3) always, (2) for some time, and (1) for never. Performed descriptive statistics and inferential statistical methods were by SPSS (Version 25) by using the data significant at P. value ≤ 0.05.Results: The results represented a higher percentage of age group (26-30) years was 41.7%, the majority of gender was 51.7% males in the study. Most certificates were secondary school nursing. The years of experience between (1-5 years), the nurses have inadequate knowledge and practiced aseptic technique for managing burn patients.Conclusion: The majorities of nurses have insufficient knowledge and used aseptic technique at an inadequate level in practice. The study discovered a significant relationship between nurses' knowledge and practices with their age.Recommendations: To reduce mortality and morbidity, burn patients must be managed using aseptic technique, which necessitates training and adequate facilities
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Snyder, Emily, and Jennifer Rosenthal. "108 Development and Implementation of a Burn Nurse Educator." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S71. http://dx.doi.org/10.1093/jbcr/irac012.111.
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Abstract Introduction Prior to the introduction of the Burn Nurse Educator (BNE), at a growing and newly established burn center, the education of the Burn Trauma ICU staff was completed by the Burn Director and Burn Supervisor. In this burn center, large amounts of education became difficult to create and distribute by the current Burn Director and Burn Supervisor due to the demand of their respective job roles. The role of the BNE was to create initial and ongoing education for the Burn Trauma ICU Staff, Ortho-Trauma staff, ED staff, local EMS agencies, and the community. Methods The Burn Nurse Educator reviewed previous education that was provided to the staff, compared it to the Burn Nurse Competencies established by the American Burn Association, and was able to formulate a new education plan. The Burn Nurse Educator created several burn-based courses. These classes included: Floating into Burn Care, Burn Boot Camp, and Burns in the Pediatric Population. There was also the introduction of mock codes focused on the pediatric burn population. In addition to the formulation of these educational opportunities, the Burn Nurse Educator worked directly with the Quality Improvement Committee to find gaps in care. These gaps were then turned into project improvement plans and additional education was provided to the bedside staff. The Burn Nurse Educator formed relationships with local EMS agencies and was able to provide burn lectures and continuing education. Results Each class offered had a pre and post test administered, all with improved scores. A sample size of 30 nurses who enrolled in Burns in the Pediatric Population had a score increase from 46% to 94%. A sample size of 14 nurses had a score increase of 55% to 80% after enrolling in Floating into Burn Care. A sample size of 30 nurses who enrolled in Burn Boot Camp had a score increase of 71% to 95%. More importantly, the staff expressed a higher level of confidence when caring for a burn patient after these classes. The outreach with local EMS agencies also increased our EMS admits to the hospital, improved knowledge for caring for burn victims, and created a relationship with our local cities EMS. Conclusions It is anticipated that as the program continues to expand, the role of the Burn Nurse Educator will continue to grow and encompass new responsibilities. To ensure each nurse remains competent in their skill set, additional knowledge testing will be completed one year after a nurse has completed a class.
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Singhal, Maneesh. "704 Lessons Learned from a Mass Disaster: Successful Institutional Planning and Preparedness." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S183. http://dx.doi.org/10.1093/jbcr/iraa024.290.
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Abstract Introduction This abstract discusses the experience of a Burn disaster at the largest thermal power plant of the country, which was successfully managed at our center. The experience gained will hopefully help in the planning and management of similar disaster scenes in resource-constrained developing countries. Methods In a National thermal power plant, there was an explosion in the 500-megawatt unit. Hot fuel gases and steam escaped affecting close to 100 people working around the area. Twenty-six people succumbed to death and six victims who sustained burn injuries were referred to our trauma center where they were received about twenty-six hours after the injury. Despite having no infrastructure supporting the treatment of acute burns, proper planning and coordinated effort by all sectors and persons concerned were immediately initiated and ultimately all patients were discharged in a healthy state with no incidence of mortality or significant morbidity from the burns. Results All the six patients were males ranging from 25 to 45 years age and sustained 20% to 45% deep thermal burns over their bodies. All patients were initially evaluated in the emergency where triage was conducted, and four patients out of six were found to have symptoms of respiratory burns and carbon monoxide poisoning. One high dependency unit (HDU) was immediately converted to a burn ICU(Intensive care unit), and all these patients were nursed in isolation. Two patients had severe airway burns and had to be intubated and ventilated. These patients also required hyperbaric oxygen therapy to revert the carbon monoxide poisoning. Out of the six patients, two patients underwent tangential burn wound excision of both upper limbs and skin allograft placement procured from Skin bank. The other four patients underwent debridement, and allograft application subsequently. all the patients recovered from the burn injuries and were discharged with advice to continue rehabilitation at the regional center. This was one of a kind effort where a trauma center was converted to a full-fledged burn ICU to provide the best possible burn care to the victims. A team of 20 people consisting of Plastic Surgeons, Intensivists, Physiotherapists, Nutritionists, Infection Control Nurses, Wound Care Nurses, Hyperbaric oxygen therapist, and other support staff contributed immensely for management of these patients. Conclusions planned cooperation and prepared coordination between the team of doctors and other support staff are the key in the successful management of a disaster. Applicability of Research to Practice In the event of a mass disaster a level 1 trauma center was immediately converted to a facility equipped to handle burns. This experience gained may be useful in the future in the planning and management of similar disaster scenes in developing countries with limited resources.
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De Jong, A. E. E., M. Bremer, R. Deleus, R. S. Van Komen, S. Lauwaert, and N. E. Van Loey. "O18.1 Nurses knowledge and attitude toward pain management in patients with burns." Burns 37 (September 2011): S13. http://dx.doi.org/10.1016/s0305-4179(11)70051-1.
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Castronovo, Courtney, David Smith, and Holly Moynihan. "802 Increasing Collaboration and Communication in Burn Resuscitations Through Education and Simulation." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S238—S239. http://dx.doi.org/10.1093/jbcr/iraa024.379.
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Abstract Introduction Implementing the nurse driven burn resuscitation protocol on severely injured burn patients can often be intimidating to many nurses and there are many opportunities for mathematical errors.These errors have the potential to affect the patients’ fluid resuscitation and outcomes. Nurses often reported discomfort with navigating the protocol while stabilizing the patient.The aim of this inquiry was to see if offering and providing education to the intensive care unit (ICU) and emergency department (ED) nurses would increase their comfort levels initiating, and navigating our nurse driven modified parkland formula. Additionally, we hoped that by providing education to the ED nurses, this would lead to a smoother transition for patient hand-off by increasing collaboration among services. Methods Nurses were surveyed using a 5 point Likert Scale assessing comfort level prior to the education to obtain a baseline. Education was then implemented, and a follow up survey using the same scale was completed 3 months later to assess knowledge retention. Additionally, nurses were given similar practice questions as previously given in the simulation to assess application to practice. Results To date, we have had 14 nurses complete the education. Of those nurses, 2 were from the ED, and 14 were from the ICU. 57% of the nurses had less than 5 years of nursing experience. Of the respondents, there was a large increase noted in nurses comfort levels with accessing the burn admission resources, initiating the burn resuscitation protocol, and titrating the intravenous fluids based on hourly urine output based on the post survey results. Conclusions Continued education and evaluation is needed to determine if education sustains increased caregiver comfort levels, improves resuscitation outcomes, and enhances ED to ICU collaboration. Applicability of Research to Practice Research has shown that simulations for low volume, high acuity patient scenarios increase comfort levels of caregivers while enhancing collaboration, and communication. A study explored the effect of burn specific simulations on patient safety and nursing education. This study concluded that simulations had a profound effect on improving these two factors by practicing technical and communication skills (D’Asta, Homsi, Sforzi, Wilson, & Luca, 2019) D’Asta, F., Homsi, J., Sforzi, I., Wilson, D., & Luca, M. D. (2019). “SIMBurns”: A high-fidelity simulation program in emergency burn management developed through international collaboration. Burns, 45(1), 120–127. doi: 10.1016/j.burns.2018.08.030
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Sudani, Ali A. AL, and Eqbal G. Ali,. "Evaluation of an Educational Program on Nurses' Practices for Children with Burns Injuries attending Burns Specialist Hospital in Baghdad City." IOSR Journal of Nursing and Health Science 06, no. 04 (July 2017): 57–63. http://dx.doi.org/10.9790/1959-0604015763.
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Cooper, Cheryl, Amalia Cochran, and Rebecca Coffey. "39 Nurses Can Resuscitate." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S26—S27. http://dx.doi.org/10.1093/jbcr/iraa024.043.
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Abstract Introduction Fluid resuscitation in the first 48 hours post burn is crucial in the management of burn shock. Hourly titration of fluids is needed to avoid complications of over or under resuscitation which can increase morbidity and mortality. Historically these titrations have been driven by the burn physician; we hypothesized that given protocols with specific resuscitation parameters the burn nurse can accurately resuscitate the burn patient without complications. Methods This quality improvement project at our ABA verified adult Burn Center tracked performance of a nurse-driven protocol for all inpatients with burns who underwent formal fluid resuscitation. Education regarding the nursing-driven protocol was provided to 90 surgical intensive care nurses. Badge buddies with both the Parkland formula and the Modified Albumin formula were made for the staff. Burn order sets were updated to reflect burn resuscitation guidelines with fluid adjustment parameters. A 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses and all resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow up and education reinforcement was done in real time by the clinical nurse specialist following each burn resuscitation. Results Over a one-year period, 23 patients’ resuscitations were tracked and reviewed by the burn quality team. One patient was excluded because of early transition to comfort care. After the initial three tracked resuscitations, the data collection tool was evaluated and modifications made to more effectively capture relevant findings. Mean age of patients was 45.1 (18–82) with a mean TBSA burn injury of 32.5 (15–42.5) In the first 24 hours patients (n=22) received a mean volume of 3.47 ml/kg/%TBSA (0.66 – 8.39) with a mean urine output of 0.95 mL/kg/hr (0.30 – 2.16 ml/kg/hr). For patients who remained on resuscitation during the second 24 hours (n = 16), they received a mean volume of 2.68ml/kg/%TBSA (0.56- 8.44) and had a mean urine output of 1.31 mL/kg/hr (0 .30–2.16). There were no complications related to fluid administration. Appropriate hourly fluid adjustments were made in 21 of the 22 patients. The one patient who did not have fluids titrated appropriately was attributed to resident physician education because the resident failed to provide the burn order set that includes the fluid resuscitation protocol. Conclusions 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. Applicability of Research to Practice The use of nurse-driven protocols can improve outcomes for burn patients.
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Guest, Julian F., Graham W. Fuller, and Jacky Edwards. "Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes." BMJ Open 10, no. 4 (April 2020): e035345. http://dx.doi.org/10.1136/bmjopen-2019-035345.
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ObjectiveTo evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK.DesignRetrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns.SettingPrimary and secondary care sectors in the UK.Primary and secondary outcome measuresPatients’ characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management.ResultsDiagnosis was incomplete in 63% of patients’ records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients’ wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients’ records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively.ConclusionsDue to incomplete documentation in the patients’ records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients’ records, integration of care between different providers, wound healing rates and reducing infection.
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Sahraian, A., A. Fazelzadeh, A. R. Mehdizadeh, and S. H. Toobaee. "Burnout in hospital nurses: a comparison of internal, surgery, psychiatry and burns wards." International Nursing Review 55, no. 1 (March 2008): 62–67. http://dx.doi.org/10.1111/j.1466-7657.2007.00582.x.
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Nagy, Sue. "Strategies used by burns nurses to cope with the infliction of pain on patients." Journal of Advanced Nursing 29, no. 6 (June 1999): 1427–33. http://dx.doi.org/10.1046/j.1365-2648.1999.01030.x.
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Burd, Andrew, K. W. Cheung, W. S. Ho, T. W. Wong, S. Y. Ying, and P. H. Cheng. "Before the paradigm shift: concepts and communication between doctors and nurses in a burns team." Burns 28, no. 7 (November 2002): 691–95. http://dx.doi.org/10.1016/s0305-4179(02)00095-5.
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Howarth, Michelle, and Liz Burns. "Social prescribing in practice: community-centred approaches." Practice Nursing 30, no. 7 (July 2, 2019): 338–41. http://dx.doi.org/10.12968/pnur.2019.30.7.338.
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More people are living longer with multimorbidities, many of which are handled in general practice. Michelle Howarth and Liz Burns highlight the contribution that general practice nurses can make to providing person-centred approaches to improving health and wellbeing The NHS Long Term Plan recognised the need to understand that ’what matters to someone’ is not the same as ‘what's the matter with someone’. Conversations that focus on what is the matter with someone typically draw out the patient's needs, with assessment and care planning based on classic principles of pathogenesis and accompanying clinical solutions. Conversations that consider what matters to someone draw out a person's individual assets and what is important to them, with personalised care and support planning based on principles of salutogenesis and non-medical solutions, such as social prescribing. This article explores the pivotal role that practice nurses have in maximising their impact on personalised care and population health for all, including for people living with long-term physical and mental health conditions. It highlights the unique contribution that practice nurses can make in strengthening community-centred approaches to health and wellbeing in primary care.
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Burns, Suzanne M., Sharon A. Fahey, David M. Barton, and Deborah Slack. "Weaning from Mechanical Ventilation: A Method for Assessment and Planning." AACN Advanced Critical Care 2, no. 3 (August 1, 1991): 372–87. http://dx.doi.org/10.4037/15597768-1991-3003.
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Weaning patients from mechanical ventilator assistance is difficult and often requires the input of experts. Though researchers have identified numerous factors that impede weaning and continue to develop criteria to determine ability to wean, no single factor or set of criteria have yet emerged to guide clinicians. In an effort to design a tool that assists critical care nurses in forwarding the wean process, the authors developed a comprehensive, integrated, computerized ventilator weaning program that stimulates the thinking and care planning strategies of experts. The Burns Wean Assessment Program also teaches complex concepts and tracks the progress of the weaning patient
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Hatmaker, Grace. "Development of a Skin Cancer Prevention Program." Journal of School Nursing 19, no. 2 (April 2003): 89–92. http://dx.doi.org/10.1177/10598405030190020501.
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The Centers for Disease Control and Prevention (CDC) now categorizes skin cancer as epidemic. Nearly 90% of these deadly cancers start from sun exposure during the childhood years. This makes sun exposure in school-age children a serious public health risk, also one that school nurses can address. Solar radiation is now classified as a “known human carcinogen,” with ultraviolet rays joining the ranks of other known cancer-causing elements such as tobacco, arsenic, and radon. Sun exposure to unprotected skin results in painful burns, premature aging, cataracts, and weakened immune systems. School nurses can use the new CDC guidelines along with other local and state resources to develop a specific skin cancer prevention program for their schools. They are in a pivotal position to partner with students, parents, administrators, teachers, and coaches to reduce the occurrence of skin cancer in children. The article describes one high school’s skin cancer prevention project.
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Hu, Yu, Ji-Eun Joo, Eunju Choi, Leeho Yoo, Dukyoo Jung, Juh-Hyun Shin, Jeong-Ho Kim, and Sung-Min Park. "Meal-Monitoring Systems Using Weight and Temperature Sensors for Elder Residents in Long-Term Care Facilities." International Journal of Environmental Research and Public Health 19, no. 2 (January 12, 2022): 808. http://dx.doi.org/10.3390/ijerph19020808.
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This paper presents a few meal-monitoring systems for elder residents (especially patients) in LTCFs by using electronic weight and temperature sensors. These monitoring systems enable to convey the information of the amount of meal taken by the patients in real-time via wireless communication networks onto the mobile phones of their nurses in charge or families. Thereby, the nurses can easily spot the most patients who need immediate assistance, while the families can have relief in seeing the crucial information for the well-being of their parents at least three times a day. Meanwhile, the patients tend to suffer burns of their tongues because they can hardly recognize the temperature of hot meals served. This situation can be avoided by utilizing the meal temperature-monitoring system, which displays an alarm to the patients when the meal temperature is above the reference. These meal-monitoring systems can be easily implemented by utilizing low-cost sensor chips and Arduino NANO boards so that elder-care hospitals and nursing homes can afford to exploit them with no additional cost. Hence, we believe that the proposed monitoring systems would be a potential solution to provide a great help and relief for the professional nurses working in elder-care hospitals and nursing homes.
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Farid, Mohammed, Yasser Al Omran, Darren Lewis, and Alan Kay. "Management of minor burns during the COVID-19 pandemic: A patient-centred approach." Scars, Burns & Healing 7 (January 2021): 205951312110205. http://dx.doi.org/10.1177/20595131211020566.
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Introduction: The UK government introduced lockdown measures on 23 March 2020 due to the first wave of the COVID-19 pandemic. A restructuring of clinical services was necessary to accommodate mandatory changes while also maintaining the best possible standards for patient care. The present study explored the initial management, follow-up and patient-reported outcomes of burn injuries <15% total body surface area (TBSA) during the height of the COVID-19 lockdown at a tertiary burns centre. Methods: A retrospective review of all adult patients with burns <15% TBSA during the national lockdown (23 March 2020 to 10 May 2020) was undertaken at The Queen Elizabeth Hospital Birmingham (QEHB), UK. All referrals from non-QEHB telemedicine (external) or QEHB emergency (internal) departments were reviewed for management, length of hospital stay and pattern of follow-up (ward attender, self-care, community or outreach nurses). A telephone survey based on a structured questionnaire was conducted to establish patients’ satisfaction. Results: A total of 84 burn patients were included in the study. The mean age was 39 years (age range = 19–91 years) and the male:female ratio was 4:1. Patients were managed non-operatively (n = 69, 82%) or operatively (n = 15, 18%). Patients attended the ward attender acute burns clinic only once (n = 36, 61%). The telephone survey captured 70% (n = 59) of the study population and 57 patients (97% of respondents) were pleased with the ongoing care and burn healing. Conclusion: The integration of patient led self-care, reduction in admissions, minimal clinics attendance and a telemedicine follow-up is an effective model for small burns management during the COVID-19 pandemic. A high degree of patient satisfaction was achieved with continuous and approachable communication channels with the burn multidisciplinary team. We continue to implement this effective model of burns management throughout the COVID-19 pandemic and the subsequent period. Lay Summary The lockdown measures due to the first wave of COVID-19 pandemic affected the way we manage all medical emergencies including burns. The initial management, follow-up and patient satisfaction for small burn injuries during lockdown has not been reported previously. The aim of this study is to examine the outcome in terms of small burn management, hospital stay, number of clinic reviews, healing and patient satisfaction during the lockdown period in a burn centre in the UK. This would look at the need for operations and whether patients stayed longer if they required an intervention. We reviewed adult patients with small burns during the national lockdown (23 March 2020 to 10 May 2020) at The Queen Elizabeth Hospital Birmingham (QEHB). All referrals from telemedicine, referral system (external) or QEHB (internal) were reviewed for management, length of hospital stay and pattern of follow-up. Patients were reviewed in the acute burns clinic and given advice for burn management and dressing for self-care. Follow-up was mostly via email (telemedicine) A telephone survey based on a structured questionnaire was conducted to find out patients’ satisfaction. Four times more men than women had small burns during the lockdown period. The average age was 39 years. The majority were managed conservatively with dressings (82%) and a small proportion required an operation (18%). Most patients attended the acute burns clinic only once (61%) for initial assessment and management. The telephone survey captured 70% of patient and 97% of respondents were pleased with the care and burn healing. The integration of patient-led self-care, reduction in admissions, minimal clinics attendance and a telemedicine follow-up is an effective model for burns management during the COVID-19 pandemic. A high degree of patient satisfaction was achieved with continuous and approachable communication channels with burn multidisciplinary team. We continue to implement this effective model of burns management throughout the COVID-19 pandemic and the subsequent period.
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Whittam, Alexander M., and Whitney Chow. "An educational board game for learning and teaching burn care: A preliminary evaluation." Scars, Burns & Healing 3 (January 1, 2017): 205951311769001. http://dx.doi.org/10.1177/2059513117690012.
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Timely and effective assessment, resuscitation and transfer of patients with severe burns has been demonstrated to improve outcome. A dedicated one-day course exists to equip all frontline emergency healthcare workers with the necessary knowledge and skills to manage severe burn injuries. More recently, a board game has been developed which aims to act as a learning and practice development tool for those managing burn injuries. We present the findings of our preliminary evaluation of this game. We played this game with a multidisciplinary group of staff including doctors, nurses and therapists. A proportion of these participants had previously completed the Emergency Management of Severe Burns (EMSB) course. We obtained subjective results from a questionnaire, using both Likert-type ratings and open-ended questions. The styling of the game and ease of instructions was rated from ‘average’ to ‘excellent’. The relevance of questions was rated from ‘good’ to ‘excellent’. The usefulness of the game to increase knowledge and stimulate discussion was rated between ‘good’ and ‘excellent’. All participants stated that they would recommend the game to other healthcare professionals. This is the only burns and plastic surgery-related educational game in the literature. Educational games adhere to principles of adult learning but there is insufficient evidence in the literature to either confirm or refute their utility. Our preliminary evaluation of this game has shown that it achieves its main aims, namely to increase knowledge in burn care and to stimulate discussion. Further work is required to assess the board game.
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Balan, Marli Aparecida Joaquim, William Campo Meschial, Rosangela Geritana Santana, Simone Mancini Liduário Suzuki, and Magda Lúcia Félix de Oliveira. "Validation of an instrument for investigating knowledge on the initial assistance to burns victims." Texto & Contexto - Enfermagem 23, no. 2 (June 2014): 373–81. http://dx.doi.org/10.1590/0104-07072014000380013.
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This study featured a methodological quantitative approach and its objective was to validate an instrument on the initial assistance given to burns victims, on medical and nursing knowledge, using the theoretical stage of Pasquali's model. The data were collected in June - August 2008, in two parts: analysis of face validity and content validity by 18 judges; and analysis of internal consistency, undertaken through Item Response Theory, by 42 doctors and nurses from a teaching hospital in the North-West region of the Brazilian state of Paraná. Following the judges' analysis, 35 questions regarding general, medical and nursing knowledge showed agreement above 80% for the concepts. Through the internal consistency analysis applied to the general knowledge questions, three were discarded due to not being correlated with the construct. The remaining seven questions (70%) presented low discrimination of the respondents, varying levels of difficulty, and similar probabilities of correct random guesses. The final instrument contains 32 questions and is available for use.
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Lucas, Christy, Kathryn R. Crowell, and Robert P. Olympia. "School Nurses on the Front Lines of Healthcare: Red Flags and Red Herrings: Improving the Recognition of Bruises and Burns Associated With Physical Abuse in School-Age Children." NASN School Nurse 36, no. 1 (August 1, 2020): 32–38. http://dx.doi.org/10.1177/1942602x20942922.
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Through a series of case scenarios, this article describes the assessment and management of suspected physical child abuse presenting as bruises and burns. Although it is not uncommon for school-age children to have accidental injuries, recognizing patterns associated with physical child abuse and understanding red flags for abuse is vital. Failure to recognize injury patterns suspicious for physical child abuse, and thus failure to intervene appropriately, may leave children at risk for more serious injury or death.
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Nagy, Sue. "A comparison of the effects of patients’ pain on nurses working in burns and neonatal intensive care units." Journal of Advanced Nursing 27, no. 2 (February 1998): 335–40. http://dx.doi.org/10.1046/j.1365-2648.1998.00514.x.
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Abir, Mahshid, Matthew M. Davis, Pratap Sankar, Andrew C. Wong, and Stewart C. Wang. "Design of a Model to Predict Surge Capacity Bottlenecks for Burn Mass Casualties at a Large Academic Medical Center." Prehospital and Disaster Medicine 28, no. 1 (October 23, 2012): 23–32. http://dx.doi.org/10.1017/s1049023x12001513.
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AbstractObjectivesTo design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims.MethodsUsing the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability—number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources—anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability.ResultsGiven base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type AB packed red blood cells (76 h), silver dressing/Acticoat (100 h), bismuth tribromophenate/Xeroform (102 h), and gauze bandage rolls/Kerlix (168 h). The following items do not precipitate a bottleneck: ventilators, topical epinephrine, staplers, foams, antimicrobial non-adherent dressing/Telfa types A, B, or O blood. Nurse, respiratory therapist, and physician staffing does not induce bottlenecks.ConclusionsThis model, and similar models for non-burn-related MCIs, can serve as a real-time estimation and management tool for hospital capacity in the setting of MCIs, and can inform supply decision support for disaster management.AbirM, DavisMM, SankarP, WongAC, WangSC. Design of a model to predict surge capacity bottlenecks for burn mass casualties at a large academic medical center. Prehosp Disaster Med. 2013;28(1):1-10.
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Kammin, Vitina M., Kristine Eckert, Paula Alem, Margaret A. Dimler, Vitina M. Kammin, and Michael Marano. "585 Preventing Occipital Pressure Injuries in Patients Admitted to the Burn ICU." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S134—S135. http://dx.doi.org/10.1093/jbcr/iraa024.211.
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Abstract Introduction Occipital pressure injuries (OPI) are categorized as pressure injuries on the occipital bone caused by pressure, shearing, or friction. Patients with significant burns are at a greater risk of developing these types of injuries due to increased fluid volume from resuscitation, decreased tissue perfusion, immobility, edema and length of stay. The rate of OPI in the BICU was 4.3 in 2016; this led to a comprehensive program to reduce/eliminate these injuries. Methods Early identification of at-risk patients and implementation of prevention strategies was conducted. Best practices were reviewed and the following interventions were put into place: on admission, all patients with facial burns, (intubated or not), were given a small size fluidized positioner pillow. The pillow was to be positioned with a defined divot in the center and not flattened (which is the way they were currently being utilized). The fluidized pillow must go into the hydrotherapy room with the patient and the patient’s head turned and repositioned every 2 hours. The use of a moisture-wicking fabric was utilized over the fluidized positioner pillow to prevent maceration. Nursing staff and burn technicians were educated as to practice changes; wound care nurses were available for educational support. In addition, in 2017, the Burn ICU instituted a 2 RN skin check daily for all patients in the hydrotherapy room once all dressings were removed. This tank room “time out” was instituted for early identification of areas of potential skin breakdown. Results Implementation of these protocols has significantly decreased the occurrence of OPI in the BICU. Since implementation, the rate of OPI in 2017, 2018 and Q1 and Q2 of 2019 has been 0%. The application of the fluidized positioner pillow, tank room “time-out” and staff education has greatly decreased the occurrence of OPI in the BICU. Conclusions Patients sustaining large surface area burns and/or full-thickness burns to the head and neck are susceptible to the development of OPI. The utilization of a fluidized positioner pillow in conjunction with improved assessment and identification using a 2 RN “time out” skin assessment daily, has led to a decrease in OPI in our BICU. Applicability of Research to Practice The utilization of the fluidized positioner pillow in conjunction with the described interventions can lead to a decrease in occipital HAPI and improve patient outcomes.
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Weinstock, Martin A., Graham A. Colditz, Walter C. Willett, Meir J. Stampfer, Ben A. Bronstein, Martin C. Mihm, and Frank E. Speizer. "Nonfamilial Cutaneous Melanoma Incidence in Women Associated With Sun Exposure Before 20 Years of Age." Pediatrics 84, no. 2 (August 1, 1989): 199–204. http://dx.doi.org/10.1542/peds.84.2.199.
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Despite strong evidence that sun exposure causes malignant melanoma, the details of this relation remain unclear. A nested case-control analysis was conducted within the Nurses' Health Study cohort to examine the relation between timing of severe sun exposure and incidence of melanoma. The subjects were 130 white women aged 38 to 65 years with confirmed cutaneous melanoma (other than acral lentigenous) who reported no history of melanoma in first-degree relatives. The control subjects were 300 women matched by race, date of birth, and cycle of questionnaire who also reported no history of melanoma in first-degree relatives. We used conditional logistic regression to evaluate the relation of sun damage after 30 years of age and sun damage from 15 to 20 years of age to the incidence of melanoma. Blistering sunburns between 15 to 20 years of age were associated with risk of melanoma (relative risk = 2.2 for five or more burns vs none, 95% confidence interval 1.2 to 3.8). This association persisted when a history of burns after 30 years of age was controlled in the analysis. No material association was found between blistering sunburns after 30 years of age and melanoma. Similarly, a more equatorial latitude of residence between 15 and 20 years of age was positively associated with melanoma; latitude after 30 years of age was less strongly and not significantly related to melanoma risk. Sun exposure prior to 20 years of age is more closely associated with melanoma risk than sun exposure after 30 years of age.
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Craig, Christopher K., James E. Johnson, James H. Holmes, Steven A. Kahn, and Jeffery E. Carter. "Results From an Evidenced-Based Curriculum Design With Innovative Simulators to Prepare Providers in Caring for Those With Burn Injuries." Journal of Burn Care & Research 41, no. 6 (June 9, 2020): 1267–70. http://dx.doi.org/10.1093/jbcr/iraa089.
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Abstract Burn care and medical education have undergone dramatic changes. Trauma has over seven courses covering fundamentals, whereas burns has one. Our goal was to develop a course to meet the needs of healthcare professionals requiring more advanced burn management training. A survey was distributed to burn physicians, nurses, therapists, administrators, and survivors, to assess the perceived proficiency of those managing adult and pediatric patients. Procedure simulators were developed, and a course was designed and delivered. An after-course survey of participants captured how this course filled identified knowledge gaps. A total of 188 initial surveys were sent to individuals involved in burn care. A diverse pool of 109 individuals participated (58% response rate). Survey results by providers demonstrated the lowest self-rated proficiency scores at managing large pediatric burns and frostbite. Nonphysicians reported low proficiency in developing wound treatment algorithms, performing escharotomies, and aftercare/reintegration. Following rigorous curriculum development, the course was conducted, and after-course surveys noted students’ improved understanding of managing burn injuries, ability to troubleshoot, confidence to manage patients, and their recommending the course to a peer. Providing quality care beyond the initial assessment and stabilization of a burn-injured patient requires additional skills and knowledge. Providers that are uncomfortable or challenged in providing this care may benefit from additional training. Initial data show that a course, such as this one, provides the education necessary to fill the most commonly reported gaps in knowledge and skills. Further work is being invested to develop disaster management skills, assessment components, and further determine course validity
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Starr, Nichole, Sarah Carpenter, Melissa Carvalho, Aileen Souza, Robin Chin, George Kasotakis, and Mengistu Worku. "Diagnosis and management of surgical disease at Ethiopian health centres: cross-sectional survey of resources and barriers to care." BMJ Open 9, no. 10 (October 2019): e031525. http://dx.doi.org/10.1136/bmjopen-2019-031525.
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ObjectivesThe aim of this study was to characterise the resources and challenges for surgical care and referrals at health centres (HCs) in South Wollo Zone, Ethiopia.SettingEight primary HCs in South Wollo Zone, Ethiopia.ParticipantsEight health officers and nurses staffing eight HCs completed a survey.DesignThe study was a survey-based, cross-sectional assessment of HCs in South Wollo Zone, Ethiopia and data were collected over a 30-day period from November 2014 to January 2015.Primary and secondary outcome measuresSurvey assessed human and material resources, diagnostic capabilities and challenges and patient-reported barriers to care.ResultsEight HCs had an average of 18 providers each, the majority of which were nurses (62.2%) and health officers (20.7%). HCs had intermittent availability of clean water, nasogastric tubes, rectal tubes and suturing materials, none of them had any form of imaging. A total of 168 surgical patients were seen at the 8 HCs; 58% were referred for surgery. Most common diagnoses were trauma/burns (42%) and need for caesarean section (9%). Of those who did not receive surgery, 32 patients reported specific barriers to obtaining care (91.4%). The most common specific barriers were patients not being decision makers to have surgery, lack of family/social support and inability to afford hospital fees.ConclusionsHCs in South Wollo Zone, Ethiopia are well-staffed with nurses and health officers, however they face a number of diagnostic and treatment challenges due to lack of material resources. Many patients requiring surgery receive initial diagnosis and care at HCs; sociocultural and financial factors commonly prohibit these patients from receiving surgery. Further study is needed to determine how such delays may impact patient outcomes. Improving material resources at HCs and exploring community and family perceptions of surgery may enable more streamlined access to surgical care and prevent delays.
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Hollen, Linda, Verity Bennett, Dianne Nuttall, Alan M. Emond, and Alison Kemp. "Evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children’s burns." BMJ Paediatrics Open 5, no. 1 (February 2021): e000796. http://dx.doi.org/10.1136/bmjpo-2020-000796.
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BackgroundAn estimated 10%–24% of children attending emergency departments with a burn are maltreated.ObjectiveTo test whether a clinical prediction tool (Burns Risk assessment for Neglect or abuse Tool; BuRN-Tool) improved the recognition of maltreatment and increased the referral of high-risk children to safeguarding services for assessment.MethodsA prospective study of children presenting with burns to four UK hospitals (2015–2018), each centre providing a minimum of 200 cases before and after the introduction of the BuRN-Tool. The proportions of children referred to safeguarding services were compared preintervention and postintervention, and the relationship between referral and the recommended cut-off for concern (BuRN-Tool score (BT-score) ≥3) was explored.ResultsThe sample was 2443 children (median age 2 years). Nurses and junior doctors mainly completed the BuRN-Tool, and a BT-score was available for 90.8% of cases. After intervention, 28.4% (334/1174) had a BT-score ≥3 and were nearly five times more likely to be discussed with a senior clinician than those with a BT-score <3 (65.3% vs 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals preintervention and postintervention. After intervention, the proportion of referrals for safeguarding concerns was greater when the BT-score was ≥3 (p=0.05) but not for scores <3 (p=0.60). A BT-score of 3 as a cut-off for referral had a sensitivity of 72.1, a specificity of 82.7 and a positive likelihood ratio of 4.2.ConclusionsA BT-score ≥3 encouraged discussion of cases of concern with senior colleagues and increased the referral of <5 year-olds with safeguarding concerns to children’s social care.
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Peterson, Abbey, Desiree Compton, Dana Y. Nakamura, Jeremy Landry, Aimee Keating, Nicole M. Kopari, Jeffrey E. Carter, and Herb A. Phelan. "543 Challenges in Burn Nurse and Therapy Staffing During and After a Category 4 Hurricane." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S106—S107. http://dx.doi.org/10.1093/jbcr/irac012.171.
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Abstract Introduction Burn nurse/therapy staffing has been stretched for months by the pandemic. Along the Gulf Coast, Hurricane Ida recently taxed these resources further as regional burn centers saw a weeks-long surge in serious burn injuries in the setting of prolonged power and water outages. We reviewed the execution of a plan for the provision of burn nurse/therapist staffing at an ABA-verified adult burn center that experienced a direct hit by a Category 4 storm. Methods Hospital leadership planned to activate Code Gray on 8/29/21 at which time the hospital would be placed on lockdown with no one allowed in or out until Code Gray was lifted. Our burn leadership subsequently designed a plan to have ten burn nurses and one Occupational Therapist (TEAM A) in house from the inception of Code Gray at 7am on 8/29 thru 7am on 9/1. If Code Gray conditions persisted, nine dedicated burn nurses (TEAM B) were to relieve TEAM A. TEAM B was planned to remain in-house until 7am on 9/4. If Code Gray conditions continued, the plan was to be reassessed at that time. The same burn therapist was planned to remain in-house throughout. Physician coverage was to be provided by the in-house trauma team during Code Gray. No housing or bedding was provided for in-house personnel, and the hospital generator system ostensibly had a 30-day fuel supply. Results TEAM A day/night staffing was 6/4 with the off crew sleeping in conference rooms and clinic spaces. An unexpected event occurred when a mission-critical tower for the city’s grid toppled into a river resulting in delays for restoration of the grid, and city-wide boil-water and burn-ban policies. As generators came into widespread use, our pre-storm census of 9 increased to a mean of 12.7 + 1.4. Due to this increase, on the morning of 9/1 six TEAM A nurses elected to stay and be absorbed into Team B with day/night staffing of 6/6. The rapid influx in number and complexity of burn patients made it clear a burn surgeon presence was needed during Code Gray. One burn attending was able to make it to the hospital at 7am on 8/30 and worked until being relieved at 7am on 9/5. An informal triage strategy was enacted in which only burns of >10% TBSA would be considered for admission. OR availability went down to 2 + 1 at the inception of Code Gray and 3 + 1 on 9/6. Eleven cases were done during this time with a mean TBSA of 20.2 + 10.7%. Hospital generators were found to consume fuel at a rate almost twice predicted. Due to prioritization, the hospital went back on city power on 9/2. Code Gray was lifted at 7am on 9/4 and normal operations resumed at 7am on 9/11. Conclusions The successful provision of care required a willingness for nurses and one therapist to remain in the hospital for six consecutive days and for hospital administration to approve the overtime.
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Eweas, Amany S., Sahar Y. Mohammad, Jehan S. A. Sayyed, Marwa M. Abd Elbaky, and Magda M. Bayoumi. "Application of Modified Ventilator Bundle and Its Effect on Weaning and Ventilation Days among Critical Ill Patients." Evidence-Based Nursing Research 2, no. 4 (January 12, 2021): 9. http://dx.doi.org/10.47104/ebnrojs3.v2i4.178.
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Context: Modified ventilator bundle is the group of interventions supported by evidence to prevent ventilator-associated pneumonia and other related complications that commonly occurred in mechanically ventilated patients. Furthermore, it helps in reducing the mortality rates and hospital length of stay.
Aim: The current study aimed to apply a modified ventilator bundle and evaluate its effect on weaning and ventilation days among critically ill patients.
Methods: A quasi-experimental research (study/control group) design was utilized. This study was conducted at the following critical care units (surgical, medical, and cardiac care units) affiliated to Bani Suief University Hospital in Bani Suief city, Egypt. A Purposive sample of 100 mechanically ventilated patients was divided into two groups. The study group included patients who received a modified ventilator bundle, while the control group included patients who received routine hospital nursing care. Data collection tools included two tools. The first tool is a patient assessment record, and the second tool is the weaning process assessment checklists using burns wean assessment program score.
Results: 68.0% of the study group, compared with only (40.0%) of the control group, had a shorter duration of mechanical ventilation support between (4- 6) days with mean ± SD of 6.1 ± 1.6 and 7.3 ± 1.9, respectively after modified bundle implementation with statistical significance differences (p-value 0.005). The study group of patients obtained higher weaning scores than the control group according to burns weaning scores.
Conclusion: The study group demonstrated higher weaning scores and shorter ventilation support duration than the control group. Developing a simplified and comprehensive training associated with demonstrative booklet, including information about ventilator-associated pneumonia, components of modified ventilator bundle, and its importance for ventilated patients to improve nurses' knowledge and practice. Furthermore, replicating the current study on a larger probability sample from different geographical locations to generalize results.
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Schmidt, Patricia, and Elizabeth A. Mann-Salinas. "Evolution of Burn Management in the U.S. Military: Impact on Nursing." Annual Review of Nursing Research 32, no. 1 (October 2014): 25–39. http://dx.doi.org/10.1891/0739-6686.32.25.
Повний текст джерелаАнотація:
As the only burn center in the Department of Defense, the U.S. Army Institute of Surgical Research is the primary location for care of service members with burn injuries. The combat operations in Iraq and Afghanistan during the past decade have caused an increase in burn patients. As a result of this increased need, advancements in care were developed. The speed and precision of transporting patients from the battlefield to the burn center has improved over previous conflicts. Technological advancements to support treating complications of burn wound healing were leveraged and are now integrated into daily practice. Clinical decision support systems were developed and deployed at the burn center as well as to combat support hospitals in combat zones. Technology advancements in rehabilitation have allowed more service members to return to active duty or live productive civilian lives. All of these advancements were developed in a patient-centered, interdisciplinary environment where the nurses are integrated throughout the research process and clinical practice with the end goal of healing combat burns in mind.
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Smith, Mallory B., Shelley A. Wiechman, Samuel P. Mandell, Nicole S. Gibran, Monica Vavilala, and Frederick P. Rivara. "91 Current Practices and Beliefs Regarding Screening Burn Patients for Acute Stress Disorder and Post-Traumatic Stress Disorder: A Survey of the American Burn Association." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S63. http://dx.doi.org/10.1093/jbcr/irab032.095.
Повний текст джерелаАнотація:
Abstract Introduction The prevalence of Acute Stress Disorder (ASD) after burn injury may be up to 30% and the prevalence of Post-Traumatic Stress Disorder (PTSD) is as much as 40% at six months post-burn injury. The American Burn Association (ABA) published a consensus statement in 2013 recommending screening for ASD and PTSD in all patients with a burn injury. To our knowledge, the current practices of screening for ASD and PTSD in patients with burns is not known. This study aims to describe the current screening practices and provider beliefs regarding screening for stress disorders in burn patients in the US. Methods Interviews with psychologists and clinicians from our regional burn and injury center were utilized to generate a 31-question survey to assess burn center screening practices and provider beliefs regarding screening for ASD/PTSD. The Survey was approved by the ABA and distributed to its US membership in July 2020. Percentages of responses were generated, and chi-square tests were used to compare answers by profession type. Results There were 121 respondents out of 1500 recipients. The respondents were surgeons (27%), psychologists (6%), therapists or social workers (16%), nurses (31%), and advanced practice providers (13%). About half of the respondents (47%) worked at institutions that admit over 300 adult burn patients a year and had over 10 years of experience (52%). Seventy-five respondents (62%) indicated their institution formally screens for ASD and/or PTSD, 35 do not formally screen, and 11 respondents were unsure. Of the 35 centers that did not screen, the most common reason was a lack of mental healthcare providers (46%), lack of funding (26%) and lack of time (20%). The timing of screening, person administering the screening, and method of screening varied greatly across centers for pediatric and adult patients. Most respondents thought screening pediatric (83%) and adult (87%) patients with burns for ASD/PTSD was important, and 87% thought it should be standard of care. However, only 32% of respondents were comfortable screening pediatric patients and 62% were comfortable screening adults. Conclusions Whereas screening for ASD and PTSD is recommended for patients with burns, our study indicates that, despite general consensus that it should be, screening is not a current standard of care. Lack of mental health providers, funding, and time are contributing factors. Among those institutions that screen, a uniform screening protocol does not exist for pediatric or adult patients.
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Short, Tracee. "661 Burns in the Time Of COVID: The Use Of a Poly Lactic Acid Polymer Skin Substitute Helped A Combined Adult/Pediatrics Burn Unit Change Clinical Practice During the Coronavirus Lockdown." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S186. http://dx.doi.org/10.1093/jbcr/irab032.307.
Повний текст джерелаАнотація:
Abstract Introduction As a verified burn center, we prepare for mass casualty & constantly strive to remain at the forefront of the burn technology & research. There was nothing that prepared us for a statewide stay-at-home order nor the hospital lockdown that would come with the coronavirus pandemic. The hospital lockdowns resulted in disheartening loneliness that would prohibit the visitation of family to the ill or injured patients. The difficulty of locking down well parents proved challenging. Our new hospital policy restricted parent movements & their anxiety of exposure also heightened the desire to discharge. We questioned whether the peds patient was better suited in the hospital or at home. This shifted our usual practice. During March-May, our hospital restricted parent movements out of the patient’s room, no visitors, no swap outs during the day. This resulted in early debridements, often at the bedside, & application of the polylactic acid polymer substitute. This allowed for a discharge within 24 hrs & return to clinic in 48 hrs. Methods We reviewed the charts of 10 pediatric patients that normally would have remained hospitalized pre-COVID & these patients were admitted underwent debridement & early application of a polylactic acid polymer skin substitute. The charts were reviewed to determine if there were any readmissions, ER visits, delays in wound healing, delays in OR time, if needed, opposition from parents or nurses from about readiness for discharge. Results The charts indicated there was one return admission. The readmit was from a planned split thickness skin graft & the polylactic acid polymer was used to stage the deeper area while allowing the majority to heal. Charts demonstrated satisfaction of the parents that didn’t want to be in the hospital during COVID. No nurses felt uncomfortable & all patients demonstrated stable vitals & good UOP at the time of discharge. This indicates several initial application on admission & was discharged within 24 hours. Conclusions This could at face value be a simple means to an end. The review of records indicates this was successful by most definitions of outcome. The limitation discovered was the ability to optimize outpatient therapy. Burns in the time of COVID, made use reexamine how we have cared for burns & whether there was room to perform more without an inpatient or a decreased inpatient stay. This change in practice also illustrated the ability to the wounds we initially thought may be deeper & possibly need excision actually healed well with no current development of hypertrophic scarring. Our institution will consider the early practice of debridement & lactic acid polymer application even when the restriction are eased. It also forced us to reevaluate how much we are grafting & reexamine what can heal on its own.
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Henry, Shana M., Nicole M. Kopari, and Mary Wolfe. "564 Managing California’s Creek Fire Mass Casualty’s Incident." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S132. http://dx.doi.org/10.1093/jbcr/irab032.214.
Повний текст джерелаАнотація:
Abstract Introduction California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned >300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night. Methods Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities. Results The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns < 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone. Conclusions Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.
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Quinn, Megan, Alexis Castro, and Nicole M. Kopari. "563 Therapy Dog Visits in a Burn Unit: The Positive Effects on Patients and Staff." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S122—S123. http://dx.doi.org/10.1093/jbcr/iraa024.191.
Повний текст джерелаАнотація:
Abstract Introduction Hospitalized burn patients encounter multiple stressors including pain, lack of sleep, concerns about outcomes, and unfamiliar environment that can impact their experience, well-being, and recovery. To help reduce these stressors, complementary therapies have been incorporated in their care. Burn Unit staff also carry emotional burdens from caring for patients and experience a high rate of “burnout.” A dog therapy program is one example of complementary interventions to help hospitalized burn patients cope, while helping nurses to focus on their patients in a unique and interactive way. Methods A therapy dog visitation protocol was developed which included recent literature supporting these visits and patient exclusion criteria. Exclusion criteria included: patients with burns >20% TBSA for adults and >15% for children, patients immediately recovering from conscious sedation/anesthesia, patients with Integra, and patients with allergies or fear of dogs. Post-visit surveys were recorded for patients and staff members. The surveys rated overall mood, enjoyment related to the visit, improvement in mood following the visit, importance of having activities such as dog therapy visits during the hospitalization, and recommendations for continued opportunities for other patients and staff to have dog therapy visits. A scaling system from 0–10 was utilized with 10 being the highest score. Results There were 15 patients and 24 staff members who completed the survey. All staff reported positive interactions with the dog therapy and responded that the therapy improved their mood. All patients answered that they enjoyed the therapy dog visit and 13/15 indicated improvement in their overall mood following a visit with the dog. All participants believed it is important to have activities such as dog therapy during hospitalization, with 32/39 rating the importance at 10/10. All participants recommended other patients and staff have the opportunity to have a therapy dog visit. Conclusions The dog therapy program allowed for positive interactions for both nurses and patients and improved patients’ moods. It also provided patients with an activity to look forward to during their hospitalization. Through this connection, nurses are able to help patients recover in a way that is different from the more traditional biomedical approach, which may also improve staff morale. Applicability of Research to Practice Complementary interventions such as therapy dogs may be utilized to improve morale within the Burn Unit.
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Fraser, S. J., S. Al Youha, P. J. Rasmussen, and J. G. Williams. "Medical Student Perception of Plastic Surgery and the Impact of Mainstream Media." Plastic Surgery 25, no. 1 (February 2017): 48–53. http://dx.doi.org/10.1177/2292550317694844.
Повний текст джерелаАнотація:
Background: Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students, and the public. These misconceptions affect the specialty in a number of ways, including referral patterns and recruitment of medical students into residency programs. The reason for these commonly held misconceptions has not yet been addressed in the plastic surgery literature. As such, we assessed medical students’ knowledge and perceptions of plastic surgery as a discipline and explored factors influencing these opinions. Methods: To assess medical students’ knowledge and perceptions of plastic surgery, we conducted an online survey. A total of 231 medical students responded. Interviews were then conducted with 2 focus groups, in which we explored the survey results and reasons behind these misconceptions. Results: As with previous studies, medical students showed a gap in knowledge with respect to plastic surgery. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand and craniofacial surgeries. Focus groups revealed that television plays a large role in shaping their ideas of plastic surgery. Conclusion: Medical students have a skewed perception of the discipline of plastic surgery, and this is largely influenced by television. Interventions aimed at educating medical students on the matter are recommended, including a greater presence in the preclerkship medical school curriculum.
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Werthman, Emily, Theresa Lynch, Linda Ware, and Julie Caffrey. "Evaluating pressure redistribution surfaces for the occiput." Journal of Wound Care 28, Sup9 (September 1, 2019): S38—S41. http://dx.doi.org/10.12968/jowc.2019.28.sup9.s38.
Повний текст джерелаАнотація:
Objective: Patients hospitalised in the Burn Intensive Care Unit are at increased risk of pressure ulcers (PU; also known as pressure injuries). While effective methods exist to offload pressure from other areas, offloading the head is difficult, especially with facial or head burns. An increase in occipital PUs prompted a review of practices for offloading the head in the Burn Intensive Care Unit. Method: A multidisciplinary team (MDT) of physicians, occupational therapists and nurses evaluated several devices used to prevent occipital PUs using a pressure mapping device. Pressure was measured using the SensorEdge Measure X device. The pressure mapping device provides a real-time graphic representation of pressure to the body area studied, in this case the occiput. In addition, the SensorEdge allows for numeric data to be exported to Excel format. Results: Our data showed that the occipital pressure was observed in our health volunteer using a fluidised gel positioner using pressure mapping. As a result of this we stopped using other pillows and went to exclusive use of the fluidised gel positioner. Reimplementation and consistent use of a fluidised gel positioner resulted in decreasing occipital PUs from nine to zero. Conclusion: The use of a fluidised gel positioner should be considered in other critical care environments to reduce the prevalence of hospital acquired occipital PUs.