The management of burn wounds by nurses
Date
2015-09-18
Authors
Andrews, Ethel Althea
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Abstract
A standardised approach to wound care is vital if a positive outcome is expected. The positive outcomes of standardisation and evidence based wound care protocols have been well documented, yet nurses in South Africa do not have a standard that informs burn wound management. The purpose of this study is to describe the best available evidence for management of burn wounds and to explore nurses’ current practices in a single burns unit with the aim of developing guidelines to inform nursing practices.
A QUAN (quantitative dominant) QUAN+ QUAL (quantitative and quantitative concurrently), a non- experimental explanatory sequential descriptive design was used. The process was divided into three phases: Phase One involved the search for quality evidence through an integrative review. The main review question was: “What new knowledge or information related to non-surgical management of burn wounds has emerged in the literature between 2000 and 2014?” Eleven sub questions were used to guide the literature search according to the themes of the nursing process of: Assessment, Diagnosis, Intervention, Outcome and Evaluation. The review process included a problem identification stage, literature search stage, data evaluation stage, data analysis stage and presentation stage. The included literature was based on a hierarchy of evidence. The search strategy included: multiple electronic databases, hand searching, reference lists of relevant articles, comments of experts, textbook chapters compiled by experts and guidelines. The final sample consisted of n= 354 studies. A qualitative descriptive approach was used to synthesise the research findings. Phase Two involved the study of current practice through structured observation and semi-structured interviews.
The purpose of Phase Two was to obtain first-hand information in a naturally occurring situation to identify the strengths, weaknesses and gaps in current practices. Purposive sampling was undertaken and included all nurses providing care to patients with superficial to partial thickness burn wounds. A total of n= 303 dressings were observed and eight interviews were conducted.
Phase Three was the verification of findings from Phases One and Two by experts in the field using the AGREE II instrument. Conclusions drawn from observations and interviews were integrated and synthesised with the conclusions from the integrative review. These conclusions were used to develop guidelines for the management of burn wounds by nurses.
Description
A thesis submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in fulfilment of the requirements for the degree of
Doctor of Philosophy
Johannesburg, 2015