Critique the Evidence for the Provision of Family Cantered Nursing Care to Children with Burns

Introduction

An injury to the skin or any other bodily tissue that results from heat is often given the terminology of a burn. This type of injury occurs when the skin or any other bodily tissues are destroyed by hot liquids, to form scalds, hot solids, also known as contact burns, or even at times contact with flames resulting to flame burns. There are other forms of burns that result from emissions, electric current, abrasions, or contact with corrosive chemicals. Children by nature are curious to get to know and even understand the world they live in. This curiosity rises as they continue growing and even start moving (WHO &UNICEF. (2010).

This natural learning process means that they have to come in contact with different objects including those that can cause burns. In cases where children have been in contact with any of the factors that cause burns, it is important to note that both the family at home and nurses in the hospital have a role in caring for the said children. The family for instance is a child’s main source of strength and support. Parents are the experts on issues concerning their children and therefore they are in positions of offering information important in enhancing a child’s welfare. Nurses also have a responsibility of providing children with medical and emotional support (WHO & UNICEF, 2010). The main objective of this paper is to provide a critique to the evidence of the provision of family centred nursing care to children with burns.

Burns in children

When children are exposed to injuries on their skins or any other body tissue resulting from heat, it is commonly said that they are suffering from burns. There are different types of burns and they include; scalds, which are injuries to the skin or other body tissues caused by hot liquids. Another type is contact burns, resulting from hot solids, flame burns resulting from fires. There are also burns that result from contemporary factors such as emissions, electricity, contact with corrosive chemicals and radioactive agents. The factor that is considered when ranking burns is how deep they are on the skin (WHO & UNICEF, 2010). There are, for instance, first degree burns that are mostly minor. They cause the skin to be red but not blistered. Such burns include mild sunburns. There is the second degree burn that involve deep layers but not the entire skin, they blister the skin making it look red and raw and are too painful when touched. The third one is the third degree burn which is considered as the most harmful. This is because it completely burns the skin. It does not hurt when touched because the nerves on the skin are completely destroyed. In most cases such burns in children may require skin graft or at times special care when the burns are relatively large (Encyclopedia of Family Health, 2005).

The type of treatment or care that a child requires largely depends on the degree of the burn. First degree burns for instance can be treated at home by gently running cool water on the burn are for at least ten minutes, gently cleaning the area and patting it dry. Such burns require a doctor’s intervention if it is larger than the palm of the said baby’s hand. Second degree burns in most cases require a doctor’s intervention especially on how best to provide specific care for the child (Clark, et al, 2007). The parent or person concerned must clean and dress the burn as prescribed by the doctor. It is however important to note that while at home there are general guidelines that must be followed. These include; gently running cool water over the burn for at least ten minutes, avoiding the breaking of any blisters, careful observation for any kind of infection such as redness, swelling and green drainage. The caregiver must also ensure that the burn is always covered by sterilized bandage. For third degree burns, the caregiver must rely on the doctor to for information about specific care to the child. General guidelines include taking the child to the doctor to assess the burn no matter how small. The caregiver should always ensure that the child is returned for check-up or dressing-change as prescribed by the doctor (Delgado et al, 2002).

A major predisposing factor that places children in susceptible positions to burns is the fact that they are generally curious. Their curiosity heightens in the early stages of growth and development especially when they learn how to crawl and walk. The regular processes of learning more about their surrounding often make them want to play and explore the use of different objects. These activities often result in burns which cause intense pain with long-term consequences especially with regard to second and third degree burns (Encyclopedia of Family Health, 2005).

As the main agent of socialization, the family unlike the medical service providers have an essential role in providing necessary care to a child with burns. This is because the family provides a sense of togetherness and love which in themselves are essential in the healing process of a child. The presence or the involvement of the family in any child’s treatment provides the necessary emotional and psychological support to the said child. Nursing intervention is also a necessary ingredient in the healing process of a child suffering from burns. This is because, the nurses provide professional services such as the treatment of the wound as well as counselling services not only to the child but also to the family members. The professional care and counselling services offered by the nurses gives the ailing child together with his or her family the assurance that the patient’s wellbeing is a priority to the said medical facility (Delgado et al, 2002).

The risk factors associated with burns in children are varied both at the local level and international level. One major risk factor is fireworks. Fireworks are significant risks for children especially those at the adolescent stage. High income countries, for instance, have banned or in some cases instituted restrictions on their use. It is important to note that in some middle-income and low-income countries there are no laws restricting the use of fireworks. Flammable substances such as petroleum or even paraffin pose great risks when stored at home. It is important to note that burns are major causes of fatal injuries that occur more repeatedly among girls than boys in South East Asia, low-income countries and the western Pacific Regions (WHO & UNICEF, 2010).. Poverty is a risk factor since high mortality and morbidity rates in children have a strong association with poverty. This is because numerous burn incidences among children occur in low and middle-income economies. Cooking, lighting and heating objects also pose high risks of burns. This is especially common in societies that rely on fossil fuels for cooking. Such open fires that are at the ground level pose significant danger rot children. Socioeconomic factors have a tendency to increase the risk of child burns. These factors include high levels of illiteracy, overcrowded homes, and laziness in the supervision of children, lack of regulations that standardize building codes, smoke detectors and flammable clothing (WHO & UNICEF, 2010).

The bio psychosocial impact of burns on children and their families

Physical trauma such as burn injuries on children can be traumatizing for both the family and the child. This is because of the excruciating and indiscreet medical procedures that are required in the treatment of different degrees of burns (Bronson, 2012). After a burn the children are sometimes hospitalized. During this process, children have been observed to reveal apprehension and fear particularly those related to pain that is produced by the injuries and the treatment involved. On numerous occasions, the child’s emotional response is always in reaction to the amount of discomfort and previous psychopathology (Dickey, et al, 2006).

A number of studies have revealed that diverse family variables are associated with instances of child burns. For instance, the family’s emotional balance, parent psychopathology, dysfunctional families and adverse family environment are said to be the main determinants of the impact of burn injuries (Richard, 2012). This means that there is need to offer psychological support for parents whose children have suffered burns and the said children while they are hospitalized. In a study conducted by Philip and Rumsey (2008), the findings were that in the event of a child’s hospitalization as a result of burn injuries, the mother figure must be given special attention since such mothers, especially those with emotional alterations always express anxiety and depression including a manifestation of strong reproach and disbelief of the efficiency of medical treatment suggested and the health care practices espoused in the care of their children (Peden et al, 2008). The anxiety levels of families, especially mothers, whose children suffered third degree and second degree burns, remain high months after the incident (Kent et al, 2009). The normalization of family reactions characterized by family’s support of the children in face of possible education and social support accorded positively effects the bio psychological adjustment of the child and his or her family after the incident (Richard, 2012).

Emotional impact on the nurse when caring for a child with burns

Nurses experience a variety of emotions that range from satisfaction of their role to the children’s recovery to anxiety resulting from being unable to totally relive children of their pain. It is important to note that in most cases when nurses feel a sense of powerlessness it is always due to management encounters compounded by dressing-changes which aggravate pain in children. Nurses believe that the responsibility of relieving pain is an essential part of their job description and when they are unable to effectively relieve a patient’s pain, it brings with it a sense of helplessness and remorse. The feeling of guilt is further intensified by the insight among nurses that they have shattered children’s belief in their profession when performing dressing-changes (Hilliard & O’Neil, 2010).

Nurses also experience positive emotions such as the satisfaction they derive whenever they help children in relieving agony and distress. These emotions are further enhanced by the use of their knowledge and skills in the nursing profession which helps in the recovery of children (Hilliard & O’Neil, 2010). Positive patient results plays a vital role in nurses’ career gratification since whenever patients recover fully or show signs of recovery, nurses feel that they have met the patient’s expectations (Wise, 2000).

Distancing is one strategy that nurses use to as a means of protecting themselves from emotionally challenging situations. This they do by putting much of their focus on children’s needs while limiting social interaction with children and their parents. This strategy helps nurses in supressing their emotional responses especially when dressing -changes. This goes a long way in helping controlling their emotions to minimize chances of upsetting the children (Hilliard & O’Neil, 2010).

Evaluation of the family centred model of care as a positive approach in caring for children with burns

The family centred approach in the caring of children with burn injuries suggests the need for collaboration between therapists and the families of the patients. Collaborations would be in areas such as the assessment of the children’s needs, setting of common goals and intercessions which reflect the needs of the family and their significance in the success of the healing patient (Ackley et al, 2014). It further includes combined decision making and services made supple and adjustable to the family. One of the primary values in designing such an approach lies in its ability to involve parents in voicing their main concerns and priority on their child’s wellbeing. This will enable them to set goals and provide an enabling environment where they can find a perfect fit between their routine activities and their child’s therapeutic needs. This can only be made possible when parents are trained and educated on the benefits of the family centred approach in dealing with children with burn injuries (Knox & Menzies, 2005).

A family centred model recognizes and respects the unique nature of each family. These variances lie in their cultures, these differences unlike the therapist, are constant in a child’s life since they define how children relate to the society and the system beliefs. This means that the family- centred model designs a technique through which needs of family members are catered for including making adjustments to the healthcare environment to ensure that families operate according to their normal procedures. Another suggestion put forth by this model is that families are essential participants in taking care of their children despite the differences they may have on how to go about issues of caregiving. It therefore stresses on the need to allow families to choose their own roles and to make decisions on who to involve especially in the case of extended families (Knox & Menzies, 2005).

Despite its positive values and benefits, the implementation of this model may be hindered by among other factors; perceived difficulty by medical practitioners on how to incorporate expert knowledge and the family understanding of their child and the treatment needs, a possible conflict between a child’s needs and those of the family, insufficient time to listen to families’ concerns and the ability to work with the family in making judgements about the well-being of a child (Knox & Menzies, 2005).

Child safety strategies

The growing demand for knowledge of that which works is an ever-growing enterprise among those working to minimize the burden of unintentional burn injuries among children in different societies. The likelihood that a child will be injured or that he will die from burn injuries is closely related to variety of factors such as single parenthood, low education levels among parents, poor housing facilities, parental drug and substance abuse among other factors (European Association for Injury Prevention, 2006). There are strategies that have been developed to enhance child injury prevention and safety promotions. They include strategies such as environmental modification. This strategy is the view that children are particularly vulnerable to burn injuries among other injuries since they live in a world where they have no control over. This is associated to the fact that their surrounding is built to meet adults’ needs. Modification of the environment to makes it more children friendly enable the elimination of objects that may harm children. In the case of a child healing from burn injures such a modification will ensure that the patient stays in an environment with minimal possibilities of the harm reoccurring (Rankin, et al, 2005).

Community based intervention is also a strategy that endeavours to involve the family and the community at large in matters related to child protection. The main focus of this strategy is to alter community values to reduce the risk of injury. It is important to note that such an approach may have great relevance for children as interventions mostly target safety awareness attitudes including the conduct of children and parents. This strategy incorporates other numerous strategies such as education on behaviour change and environmental modification among other strategies. At a glance, this strategy aims at creating a danger free environment for the children through its restraint promotional campaigns (European Association for Injury Prevention, 2006).

The introduction of education and skill development programs also serve as proper strategies especially when they are well designed to work with other strategies and directed towards the targeted population, it can be effective (Karageorge & Kendall, 2008). These programmes may include parent skills training on how to handle different types and degrees of burns, training on how to develop and sustain a family based approach in the handling of children suffering from burns. The trainings can also incorporate safety precaution measures that parents can take to minimize burn injuries among their children and how to handle bio psychological impacts of burns (Rankin, et al, 2005).

Conclusion

Child burns have become a common occurrence in different societies especially those characterized by low income economies and low levels of education. However, it is important to note that burn injuries are caused by the contact of the skin of other boys tissues with heat. There are different degrees of burns depending on how deep into the skin the burn can be said to have gone. In cases where children experience these burns, there are always bio psychological effects that affect both the child patients and their families, these can however be rectified through proper guidance and counselling process. Nurses who take care of children face different emotional effects on the basis of their job description and this explains why it is necessary to develop a family-centred approach into dealing with burns among children. Other than that, safety strategies are also necessary to minimize the chances of burns or any other form of injuries to any child in all situations.

References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based

guide to planning care, pp. 285.

Bronson, M. (2012). Psychological and Emotional Impact of Buren Injury, Phoenix Society

for Burn Survivors, pp. 3-4.

Clark, R. E., Clark, J. F., & Adamec, C. A. (2007). The Encyclopedia of Child Abuse. New

York: Facts on File, pp. 45-50.

Delgado, J, Ramírez-Cardich, Gilman, H., Lavarello, R, Dahodwala, N, Rodríguez, B., Cama,

R, Tovar, M & Lescano, A. (2002). Risk Factors for Burns in Children: Crowding, Poverty, and Poor Maternal Education. Pp. 38-41.

Dickey, S. B., Greenberg, C. S., & Bowden, V. R. (2006). Children and their families: The

continuum of care. Philadelphia, PA: Lippincott Williams & Wilkins, pp. 1356.

Encyclopedia of family health. (2005). London: Marshall Cavendish, pp. 301-302.

European Association for Injury Prevention. (2006). Child safety, Good Practice Guide:

Good Investment in Unintentional Child Injury Prevention and Safety Promotion, pp. 4-5.

Hilliard, C & O’Neil, M. (2010). Nurses’ Emotional Experience of Caring For Children with

Burns, RCSI, pp. 19-21.

Karageorge, K & Kendall, R. (2008). The Role of Professional Child Caregivers in

Preventing and Responding to Child Abuse and Neglect. U.S Department of Health and Human Services, pp. 56-59.

Kent, L., King, H., Cochrane, R. (2000). Maternal and Child Psychological Sequelae in

Paediatric Burn Injuries. Burns, 26, 320- 322.

Knox, V and Menzies, S. (2005). Using the Measure of Processes of Care to Assess Parents’

Views of Paediatric Therapy Service. British Journal of Occupational Therapy, pp. 2-3.

Peden, M. M., UNICEF., & World Health Organization. (2008). World Report on Child

Injury Prevention. Geneva, Switzerland: World Health Organization.

Phillip, C., Rumsey, N. (2008). Considerations for the Provision of Psychosocial services for

Families Following Paediatric Burn Injury: A Quantitativ3e Study. Burns, 34, 59.

Rankin, S. H., London, F., & Stallings, K. D. (2005). Patient Education in Health and Illness.

Philadelphia [u.a.: Lippincott Williams & Wilkins, pp. 147

Richard, D. (2012). The Management of Burn Trauma in Children and Teens: A Guide For

Parents and Families. Montreal Children’s Hospital, pp. 20-24.

Wise, B. V. (2000). Nursing Care of the General Paediatric Surgical Patient. Gaithersburg:

Aspen., pp. 488.

World Health Organization (WHO) and UNICEF. (2010). Children and Burns.World Report

on Child Injury and Prevention. Pp. 1-2.