A quantitative description of the current practice of managing burn wounds
AbstractObjectives: This article forms part of the findings of a thesis on the management of burn wounds by nurses. The aim of the study was to describe the current practice by nurses of managing burn wounds. Design: A mixed-method, quantitative and qualitative, nonexperimental, explanatory, sequential, descriptive design was used. Subjects and setting: The population was nurses providing care to adult patients with superficial- to partial-thickness burn wounds, admitted to a single burn unit in a tertiary academic hospital in Gauteng. Method: The quantitative data were collected initially through an integrative review, followed by the parallel collection of quantitative data through structured observations, and qualitative data through semi-structured interviews. This article presents the findings from the structured observations. Multiple dressing changes were observed, using a checklist as a data-collection tool. Data were collected from August to October 2012, and from April to June 2013. Descriptive statistics were used to summarise, categorise and order the data. The positivity index (PI) percentage was used for analysis. A total of 303 dressing changes were observed. Outcome measures: The outcome measure was a description of current practice according to the themes of the nursing process using a quantitative checklist. Results: The findings revealed that communication between nurses and patients was ineffective, with PIs of 18% for the nurses introducing themselves to patients, and 14% for giving an explanation of the procedure to be carried out to patients. Failing to heat the cleaning solution before applying it, and not washing their hands were also identified as areas needing improvement. On assessment and diagnosis, the nurses scored below the 70% mark required for a quality assessment. The lowest scores were observed for the use of the TIME (tissue management, control of infection and inflammation, moisture imbalance, and advancement of the epithelial edge of the wound) framework. This suggests that the framework had not been adopted as a frame of reference for the management of burn wounds in the observed setting. Satisfactory scores were obtained for certain elements of the dressing execution, namely the aseptic field being maintained, a logical sequence being followed throughout the procedure, and consideration being given to complaints by the patients about their pain. However, the way in which the environment was not adequately prepared prior to dressing execution, the way in which packages were not opened asceptically, the failure of the nurses to check the expiry dates of the cleaning materials, and the cleaning technique used were identified as gaps in competence. The need for a more structured approach to reporting was identified from lack of use of the TIME framework during documentation. A PI of 62% was obtained for the referral pathways, which is below the benchmarked score of 70% for quality. Conclusion: The results obtained from the structured observations in this study indicate that there is a need for guidelines on the management of burn wounds by nurses.
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