Burn Nurses Research Articles

400 Changing Course: A Comprehensive Approach to Ensuring Burn Nurse Competency

Our ABA verified burn center utilizes a ‘hybrid’ model to care for its patients. The burn center resides across mixed medical/ surgical trauma units within a large university hospital. This can present many challenges to the need for a cohesive, competent staff that consistently delivers expert care. Based on our hybrid model, nursing leadership recognized the need to enhance and further develop our annual competency and education plan for burn center nurses. This resulted in the addition of an annual skills assessment day. This is currently in its third year and, with the introduction of the ABA burn nurse competencies (BNC), our nursing team has begun the work of aligning our enhanced system of competency skills assessment and education with these standards to create a consistent, comprehensive education plan to ensure nursing competency throughout the burn center. A survey needs assessment was provided to all burn center nurses to determine content for the annual skills assessment day. The survey included a 5-point Likert Scale to assess the knowledge level of nurses in areas of burn care. This year we incorporated the eleven domains of ABA BNC in the questionnaire, and one question asking nurses what they would like included in the next skills day. The domains with the greatest knowledge gap will be addressed with this year’s skills day and online learning modules. The goal is to address each domain at a nursing skills day within the 3-year verification cycle. Routine ongoing education that is under development will address each domain annually. Nursing leadership for the burn center meets regularly to develop education for nursing. To align our current educational plan with the ABA BNCs, workgroups of interdisciplinary subject matter experts were formed to create comprehensive online learning modules consistent with BNC domains. Members of each group will include representation from all nursing units within the center. These learning modules will be assigned to all nurses annually and upon hire via an internet based learning platform. Orientation skills checklists will also be created to align with each competency domain’s performance criteria. The completed needs assessment identified the priorities for our annual skills day as felt by the nursing staff. A 3-year education plan is being developed to ensure nurses throughout the burn center receive education and skill practice that meets their needs and fulfills ABA BNC standards. Utilizing survey results, the competencies most needed by the nursing staff are recognized for immediate education. Providing a skills day for all burn center nurses builds relationships, encourages collaboration across burn units, and provides consistent education and information.

Observation on the effects of multidisciplinary comprehensive intervention in integrated treatment of patients with extremely severe burns

Objective: To explore the effects of multidisciplinary comprehensive intervention in integrated treatment of patients with extremely severe burns. Methods: One hundred and ten patients hospitalized in our center from July 2013 to August 2017 met the criteria for inclusion in this study, and their medical records were retrospectively analyzed. According to the medical model at that time, 56 patients hospitalized from July 2013 to July 2015 received routine comprehensive treatment led by doctors, and they were included in the conventional intervention group. From August 2015 to August 2017, 54 patients were treated with integrated multidisciplinary interventions performed by a team consisting of physicians, intensive care nurses, burn nurses, intravenous infusion nurses, wound stoma nurses, and rehabilitation therapists, and they were included in the integrated intervention group. Acute Physiological and Chronic Health Assessment Ⅱ (APACHE Ⅱ) scores on admission and 4 weeks after treatment, incidences of pressure injury, wound sepsis, lung infection, and catheter-related infection during hospitalization, length of stay in intensive care unit (ICU) and total length of hospital stay, and Abbreviated Burn Specific Health Scale (BSHS-A) scores at discharge and 3 months after discharge were analyzed. Data were processed with t-test and chi-square test. Results: The APACHE Ⅱ scores of patients in the two groups were close on admission (t=0.573, P>0.05). Four weeks after treatment, the APACHE Ⅱ scores of patients in the two groups were obviously lower than those on admission within the same group (t=5.697, 4.853, P<0.01), and the score of the integrated intervention group was obviously lower than that of the conventional intervention group (t=2.170, P<0.05). No pressure injury was observed in patients of any group during hospitalization. The incidences of wound sepsis, lung infection, and catheter-related infection of patients in the integrated intervention group were 18.5% (10/54), 3.7% (2/54), and 9.3% (5/54), respectively, significantly lower than 42.9% (24/56), 21.4% (12/56), and 26.8% (15/56) of the conventional intervention group, χ2=4.073, 6.075, 3.962, P<0.05. The length of stay in ICU of patients in the integrated intervention group was (50±5) d, obviously shorter than (62±4) d of the conventional intervention group (t=2.852, P<0.01). The total length of hospital stay of patients in the integrated intervention group was (115±8) d, obviously shorter than (140±7) d of the conventional intervention group (t=16.885, P<0.01). At discharge and 3 months after discharge, the scores of BSHS-A, physical function, psychological function, and general health status of 50 patients in the integrated intervention group were significantly higher than those of 48 patients in the conventional intervention group (t=2.886, 3.126, 2.416, 2.544, 2.033, 3.471, 2.588, 2.210, P<0.05 or P<0.01), while the scores of social function of patients in the two groups were close (t=1.570, 1.350, P>0.05). Conclusions: Integrative treatment of patients with extremely severe burns by multidisciplinary comprehensive intervention can significantly alleviate the severity of burns, reduce the incidences of wound sepsis, lung infection, and catheter-related infection, shorten the length of stay in ICU and total length of hospital stay, and improve the quality of life.

Improving the Precepting Experience in a Burn Intensive Care Unit.

Improving the Precepting Experience in a Burn Intensive Care Unit.

240 A Pilot Study on the Effects of Massage Therapy During the Workday to Combat Burn Nurse Burnout

240 A Pilot Study on the Effects of Massage Therapy During the Workday to Combat Burn Nurse Burnout

11 Clinical Evaluation of Burn Nursing Competency Domains

11 Clinical Evaluation of Burn Nursing Competency Domains

Burn Nurse Competencies: Developing Consensus Using E-Delphi Methodology.

Competency standards for nurses who specialize in the care of burn-injured patients are lacking. Currently, there are no nationally agreed on standards that define safe and competent burn nursing practice. In 2014, nurse members of the American Burn Association proposed the Burn Nurse Competency Initiative (BNCI) with the intent of establishing a core set of competency standards for burn nursing. The BNCI used the Delphi technique of consensus building with input from up to 178 registered nurse burn care experts. This article describes the multistaged consensus-building process used and provides a final list of competencies. These newly created competencies now define professional practice standards for burn nurses. Their creation completes one of the essential steps required for burn nursing to be recognized as a specialty.

Implementation and outcomes of an evidence-based precepting program for burn nurses

IntroductionThere is significant nationwide interest in transitioning new and new-to-specialty nurses into practice, especially in burn care. Lack of a structured transition program in our Burn Center was recognized as a contributing factor for nursing dissatisfaction and increased turnover compared to other hospital units. Employee evaluations exposed a need for more didactic instruction, hands-on learning, and preceptor support. The goal of this project was to implement an evidence-based transition to practice program specific to the burn specialty. Material and methodsThe Iowa Model of Evidence-based Practice served as the model for this project. A working group was formed consisting of nurse scientists, clinical nurse leaders, clinical nurse specialists, lead preceptors, staff nurse preceptors and wound care coordinators. A systematic review of the literature was conducted focusing on nurse transition; preceptor development and transitioning nurse training programs with competency assessment, ongoing multifaceted evaluation and retention strategies were created.The evidence-based Vermont Nurses in Partnership (VNIP) Clinical Transition Framework was selected and subsequent education was provided to all Burn Center leaders and staff. Benchmarks for basic knowledge assessment (BKAT) and burn wound care were established among current staff by work site and education level to help evaluate transitioning nurses. Policies were modified to count each preceptor/transitioning nurse dyad as half an employee on the schedule. Multiple high-fidelity simulation scenarios were created to expand hands-on opportunities. ResultsFrom September 2012–December 2013, 110 (57% acute care nursing) Burn Center staff attended the VNIP Clinical Coaching Course, to include 34 interdisciplinary staff (rehabilitation, education, respiratory therapy, and outpatient clinic staff) and 100% of identified preceptors (n=33). A total of 30 new nurses participated in the transition program: 26 (87%) completed, 3 (10%) did not complete, and 1 (3%) received exception (no patient care). Transitioning nurses achieved passing BKAT scores (n=22; 76%) and WC scores (n=24; 93%); individual remediation was provided for those failing to achieve unit benchmarks and transition training was modified to improve areas of weakness. Transitioning nurses’ weekly competency progression average initial ratings on a 10 point scale (10 most competent) were 5±2; final ratings averaged 9±1 (n=25) (p<0.0001). ConclusionsAn evidence-based team practice approach toward preceptorship created a standardized, comprehensive and flexible precepting program to assist and support transition to specialty burn practice for experienced nurses. Use of objective metrics enabled ongoing assessment and made training adaptable, individualized, and cost effective. Application of this standardized approach across our organization may improve consistency for all transitions in practice specialty.

Evaluating the Effectiveness of End-Tidal Carbon Dioxide Monitoring During Burn Wound Care in the Nonintubated Patient Population

Daily burn wound care for nonintubated patients involves administration of intravenous analgesic and sedation agents. Vital signs and oxygen saturation monitoring alone can result in late signs of oversedation and ineffective breathing. End-tidal carbon dioxide (EtCo2) monitoring provides immediate feedback of effective breathing during procedural sedation. The purpose of this study was to describe the nurse's sedation and analgesic therapy management of nonintubated patients during burn wound care when EtCo2 was used. This IRB approved study involved observing 22 burn nurses and 4 burn technicians during burn wound care of nonintubated patients. This descriptive, observational study compared adverse breathing/airway events, pain measurements, and sedation effectiveness, before and after introducing EtCo2 monitoring. Patients observed in this study were similar in age, type and size of burn, and use of recreational substances. Nurses and technicians also had similar burn experience. No statistically significant findings were found in this study; however, nurses in practice longer were found to apply oxygen sooner, which prevented decreased oxygen saturation events. When EtCo2 was used, less analgesia and sedation were required to maintain patient comfort. Time required for burn wound care was reduced by 22%, and 30% less overall analgesic and sedation agent dosages were administered after the introduction of EtCo2 monitoring. EtCo2 was found to enhance nurses' assessment of patients' response to intravenous analgesia and sedation effectiveness during burn wound care for nonintubated patients. Nurses with greater experience used oxygen sooner in the procedure, and patients had fewer decreases in SpO2.

Bibliometric analysis of scientific articles on evidence-based nursing of burn in the mainland of China

To analyze the current research status of evidence-based nursing of burn in the mainland of China, in order to provide basis for the improvement of scientificity of burn nursing practice. Chinese scientific articles on evidence-based nursing of burn in the mainland of China published from January 1997 to December 2015 were retrieved from Chinese Biology Medicine disc, Chinese Journals Full-text Database, Wanfang Database, and VIP Database. From the results retrieved, date with regard to publication year, region of affiliation of the first author, journal distribution, literature type, literature quality assessment, topic of evidence-based research, fund program support, implementation of evidence-based practice steps, and language and quantity of reference. Data were processed with Microsoft Excel software. A total of 50 articles conforming to the criteria were retrieved. (1) Articles about evidence-based nursing of burn arose in 2004. Compared with that in the previous year, there was no obvious increase in the number of relevant articles in each year from 2004 to 2011. The number of literature in 2012 was obviously increased than that in each year from 2004 to 2011, while the number of literature in each year from 2012 to 2015 was not obviously increased compared with that in the previous year. (2) The regions of affiliation of the first author were distributed in 13 provinces, 3 minority autonomous regions, and 3 municipalities, with the largest distribution in East China, and Northwest China and Southwest China in the follow. (3) The articles were published in 32 domestic journals, with 9 (28.12%) nursing journals, 5 (15.62%) burn medical related journals, and 18 (56.25%) other journals. Twenty (40%) articles were published in Source Journal for Chinese Scientific and Technical Papers. (4) Regarding the literature type, 31 (62%) articles dealt with clinical experiences, 17 (34%) articles dealt with scientific research, and 2 (4%) articles dealt with case report. (5) There were 21 quantitative study articles and 29 narrative study articles, all with low quality. (6) The topics of evidence-based research in these articles were mainly burn rehabilitation, burn nursing technology, pediatric burn, inhalation injury and airway management, and complications of burn injury. Only one study was supported by fund program. (7) Only one article described complete evidence-based practice steps. (8) The literature cited 57 English articles as references, with an average of 1.14, and 316 Chinese articles, with an average of 6.32. The concept of evidence-based nursing of burn has been initially formed in the mainland of China. The number of relevant articles is on the rise, but the quality needs to be further improved. There is an urgent need to improve nurses' understanding of evidence-based nursing and their command of the method of evidence-based practice through on-job training, so as to improve the scientificity and effectiveness of burn nursing.

Rescue, allocation and nursing of multiple-patient burn-blast combined injury in Kunshan explosive accident

Objective To discuss on nursing of patients multiple-patient burn-blast combined injury, the cooperation of processes and quality control. Methods For 35 cases of burn-blast combined injury, emergency plan was initiated immediately, including staffing allocation, supplies allocation, nursing quality control and monitoring the inpatient areas, etc. Results 35 cases of burn-blast combined injury acquired immediate treatment of burn shock and nursing. Rescue rate of multiple-patient burn blast arrived 77.14%(27/35), with no case of nursing complication. Conclusions Timely allocation of nursing staff, rational quantity and structure, forceful organization and coordination, complete and timely supplies, correct quality control of emergence nursing and beneficial solutions are keys to ensure successive nursing of intensive patients of burn-blast combined injury, and also reflection of nursing quality guarantee. Key words: Quality control; Multiple-patient; Burn-blast combined injury; Nursing cooperation

Development and Implementation of an Innovative Burn Nursing Handbook for Quality Improvement.

Evidence-based burn nursing literature is extremely limited and often nonexistent. As a result, there is a lack of standardization in burn nursing care. Our objective was to evaluate burn nursing knowledge at an academic medical center and to implement innovative educational tools to enhance staff competency and improve the quality of care. A collaboration of practicing clinical nurses developed a 24-question knowledge assessment survey (presurvey) to evaluate fundamental burn nursing knowledge (fluid management, burn pathophysiology, burn-related procedures, wound care, and infection control). Pre-education knowledge surveys were administered to 59 burn nurses electronically. A writing team of new and experienced nurses was established and a 51-page handbook focusing on areas of need identified in the survey developed. This book was disseminated to staff as required for reading. Post-educational surveys were sent to the same nurses who completed the initial survey. Forty-six nurses (46/59, 78.0%) completed the survey, with a mean (SD) of 55.9 (11.0)% of questions being answered correctly. Postsurveys sent to the same 46 nurses who completed the presurvey had a response rate of 78.3% (36/46). We observed a significant increase in correctly answered questions (mean [SD]: 69.6 [8.7]%, P < .001) in the postsurvey intervention. The handbook improved education and significantly improved overall fundamental burn knowledge of practicing nursing staff. The use of electronic surveys to drive development of targeted educational interventions provides evidence-based tools for establishing burn nursing standards and developing quality improvement metrics.

Burns nurses highlight fancy dress fire risk

Burns nurses highlight fancy dress fire risk

Burn Care Update

This issue of Nursing Clinics will include the following topics: History of Burn Care; Pathophysiology of Burns; Perioperative Considerations for the Burn Injured Patient; Surgical Procedures for the Burn Patient; Epicells; Reconstructive/Plastic Surgery; OR/PACU/ICU Hand Off; Pain; Infection Control; Surgical Care of Thermally Injured Patients on the Battlefield; Burn Pressure Ulcer Management in the Perioperative Burn Patient; Conducting Research in the Operating Room; High-Tech, High-Stress Environment for the Burn Nurse; Costs; and, Personal Experiences of a Perioperative Burn Nurse in the Military.

High-Tech, High-Stress Environment: Coping Strategies for the Perioperative Nurse

The operating room (OR) is among the most technologically advanced environments within the healthcare profession. This high-tech environment has a unique set of occupational demands that can cause increased stress for the nursing staff. Situations that lead nurses to experience pressure in the OR include the need to work quickly, to face higher medical dispute risks, to work uncertain shifts, to handle precision instruments, and to master complex techniques. Along with this, perioperative nurses are struggling with heavy workloads, high patient acuity, various instrument processing issues, low morale, and staff shortages. The nurse must killfully manage all of these tasks while keeping patient safety at the fulcrum of it all. nterestingly, the most intense stressor perceived by OR nurses was patient safety. In addition to the occupational stressors that are involved in the OR setting, there are a myriad of interpersonal stressors. The manner in which staff communicate can often times be unprofessional and lead to unresolved conflict and hostile working environments. Recent studies have found that OR nurses felt bullied by other nurses and perceived themselves to be victims of physician-perpetrated abuse. Undoubtedly, he culmination of daily stressors that the perioperative nurse encounters can have dverse effects on one’s personal and professional life. Like perioperative nurses, burn nurses at the US Army Institute of Surgical esearch experience increased amounts of occupational stress. Nurses in the Burn enter provide care for patients with inhalation injuries, circumferential extremity urns, and general burns of the body. This challenging patient population requires hat the nursing staff have the necessary skills to communication with the patient and heir families concerning issues such as complex wound care to include pain control long with death and dying. These are sensitive topics that normally elicit emotion

Behind the Redline: Personal Experiences of a Perioperative Burn Nurse in the Military

Behind the Redline: Personal Experiences of a Perioperative Burn Nurse in the Military

Nurses’ Practices Concerning Isolation Techniques for Patients with Burns At Baghdad Teaching Hospitals

Objective(s): The study aimed to evaluation of nurses’ practices concerning isolation techniques for patients with burns in burns ward, and to find out the relationship between the nurse’s practices and the demographic characteristics that includes (age, gender, level of education, years of experience in burns wards, and training session). Methodology: A descriptive study was carried out at the isolation rooms at burns wards in Baghdad Teaching Hospitals. A non-probability (purposive) sample of (50) nurses, was selected out of five teaching hospitals in Baghdad city. The study instrument consisted of two major parts was constructed. It is based on the review of literature. First it is concerned with demographic data for nurses; and the second part is observational tool (checklist) is composed of two sections in which there were (95) items. Reliability and validity of the observational checklist were determined through the analysis of a pilot study. Data were collected through the use of the observational tool. Starting from Nov. 14th 2013 up to the 16th of Apr. 2014.which analyzed through the use of two statistical approaches. They are descriptive statistical analysis (frequencies, percentage, SD, Range of scores, mean of scores and relative sufficiency; and inferential statistical analysis (correlation coefficient and chi- square test). Results: The finding of study reveals that the evaluation of relative sufficiency was low on 32 (33.7%) items, moderate on 25 (26.3%) items and high on 8 (8.4%) items, while 30 (31.6%) was out of comparison and there is no significant association between ages, gender, level of education and nurses’ practices scores, while there is significant association between years of experience in burns wards, training sessions and nurses’ practices scores. Conclusion: The study concluded that the more years of work with the nurses working in the field care of patients with isolated burns increased their excellent performance in the provision of care for burn patients isolated. Recommendations: the researcher recommends establishing new standard checklist suitable for nurses’ practices concerning isolation techniques for patients with burns and increase the educational level of the staffing nursing.

Enduring feelings of powerlessness as a burns nurse: A descriptive phenomenological inquiry

Feelings of powerlessness have been reported to affect nurses' perceived ability to provide competent quality care and have contributed to moral dilemmas and burnout among nurses. Burns nurses are a specific group of nurses who are more likely to experience feelings of powerlessness due to performing traumatic, painful and lengthy large dressing changes and procedures on a daily basis. Nevertheless, nurses' perception of powerlessness is under reported in the area of burn care. The purpose of this descriptive phenomenological study was to examine the feelings of powerlessness by nurses who care for severe burn injury patients. Data were analysed via Colaizzi's phenomenological method. Nurses' feelings of powerlessness were identified and organised into four cluster themes: inadequacy, apprehension, vulnerability and frustration. The findings clearly demonstrate the need to address issues of powerlessness experienced among burns nurses and nurses alike. Burn nurses are often left feeling inadequate during and after burns procedures, due to the level of pain and emotion experienced by patients with severe burn injuries. Emotional intelligence may offer nurses the ability to empower themselves in order to enhance their professional development and leadership capabilities.

Enduring feelings of powerlessness as a burns nurse: A descriptive phenomenological inquiry

Feelings of powerlessness have been reported to affect nurses’ perceived ability to provide competent quality care and have contributed to moral dilemmas and burnout among nurses. Burns nurses are a specific group of nurses who are more likely to experience feelings of powerlessness due to performing traumatic, painful and lengthy large dressing changes and procedures on a daily basis. Nevertheless, nurses’ perception of powerlessness is under reported in the area of burn care. The purpose of this descriptive phenomenological study was to examine the feelings of powerlessness by nurses who care for severe burn injury patients. Data were analysed via Colaizzi’s phenomenological method. Nurses’ feelings of powerlessness were identified and organised into four cluster themes: inadequacy, apprehension, vulnerability and frustration. The findings clearly demonstrate the need to address issues of powerlessness experienced among burns nurses and nurses alike. Burn nurses are often left feeling inadequate during and after burns procedures, due to the level of pain and emotion experienced by patients with severe burn injuries. Emotional intelligence may offer nurses the ability to empower themselves in order to enhance their professional development and leadership capabilities.

Allocating Scarce Resources in Disasters: Emergency Department Principles

Decisions about medical resource triage during disasters require a planned structured approach, with foundational elements of goals, ethical principles, concepts of operations for reactive and proactive triage, and decision tools understood by the physicians and staff before an incident. Though emergency physicians are often on the front lines of disaster situations, too often they have not considered how they should modify their decisionmaking or use of resources to allow the "greatest good for the greatest number" to be accomplished. This article reviews key concepts from the disaster literature, providing the emergency physician with a framework of ethical and operational principles on which medical interventions provided may be adjusted according to demand and the resources available. Incidents may require a range of responses from an institution and providers, from conventional (maximal use of usual space, staff, and supplies) to contingency (use of other patient care areas and resources to provide functionally equivalent care) and crisis (adjusting care provided to the resources available when usual care cannot be provided). This continuum is defined and may be helpful when determining the scope of response and assistance necessary in an incident. A range of strategies is reviewed that can be implemented when there is a resource shortfall. The resource and staff requirements of specific incident types (trauma, burn incidents) are briefly considered, providing additional preparedness and decisionmaking tactics to the emergency provider. It is difficult to think about delivering medical care under austere conditions. Preparation and understanding of the decisions required and the objectives, strategies, and tactics available can result in better-informed decisions during an event. In turn, adherence to such a response framework can yield thoughtful stewardship of resources and improved outcomes for a larger number of patients.

Building Resilience in Burns Nurses: A Descriptive Phenomenological Inquiry

The purpose of this qualitative study was to explore the concept of building resilience as a strategy for responding to adversity experienced by burns nurses. Nurses who care for patients with severe burn injury are often exposed to patients' pain and disfigurement, encountering emotional exhaustion, distress, reduced self-esteem, and desensitization to pain. Resilience has been identified as an essential characteristic for nurses in their work environment. Resilience assists nurses to bounce back and to cope in the face of adversity, sustaining them through difficult and challenging working environments. Nonetheless, there remains limited information that addresses the concept of building resilience in burns nurses. In 2009, seven burns nurses were recruited from a severe burn injury unit in New South Wales, Australia. A qualitative phenomenological methodology was used to construct themes depicting nurses' experiences. Participants were selected through purposeful sampling, and data were collected through in-depth individual semistructured interviews using open-ended questions. Data were analyzed with Colaizzi's phenomenological method of data analysis. The concept of building resilience as a strategy for coping with adversity was identified and organized into six categories: toughening up, natural selection, emotional toughness, coping with the challenges, regrouping and recharging, and emotional detachment. The findings clearly demonstrate that it is vital for burns nurses to build resilience to endure the emotional trauma of nursing patients with severe burn injury. Knowledge about building resilience could be incorporated into nursing education for both undergraduate and experienced nurses. Building resilience within the domain of burns nursing has the potential to retain nurses within the profession, having implications for staff development, orientation, and retention.