A burned child’s pain during treatment as assessed by the child, caregiver and the nurse

Abstract

Background: Burn injuries in children remain a significant public health concern in Tanzania, where research and interventions to decrease risk are lacking or inadequate. Pain is the most common symptom experienced in these children. The extent to which burn pain is undertreated in under-ten year old children with burn injuries is unknown in Tanzania. Purpose: The purpose of this study was to assess pain management in children with burn injuries admitted at KCMC hospital Methods: A descriptive cross-sectional study was conducted at KCMC hospital, in May and June, 2013. Information about the child was obtained from the caretakers by using semi-structured questionnaire. Also all 47 caretakers of recruited children were requested to rate the child’s pain. Interview by using unstructured questionnaire was conducted in 23 nurses caring for children with burn injuries and they were also requested to rate the child’s pain on a VAS scale. Pain was measured by using VAS for children 6 years and above, nurses and caretakers and FLACC for children below 6 years old. Data was analyzed using SPSS version 20 software. Results: Most children were under 4 years old, where 20(42.54%) were aged 1-2 years 3-4 years 10(21.3%) and 0-1 years 6(12.76%) years and most of them 30(63.8%) were males. A vast majority 40(85.1%) were from rural areas. All burns in these children were non-intentional and occurred at home mostly 33(70.2%) in the kitchen. Scald was the most common cause of burns in 33(70.2%). Burns between 10% and 20% constituted 29(61.7%) TBSA and above 20% constituted 18(38.3) TBSA. Most burns 31(66.0) were deep burns and 14(29.8) were full thickness burns. The most common agent of burn in these children 33(70.2%) were hot fluid or food. All children in the study were taken to hospital within 24 hours after sustained burn injury. A vast majority had local agents applied on the wound as a first aid treatment provided by parents or caretakers at home. Pain score in children ranged from 5 to 10 (mean = 8.83; SD 1.324). Most children 29(61.70%) were in worst pain during wound dressing. Severe pain was measured in 15(31.91%) of children and significant pain in 3(6.38%). More children with deep (mean = 9.00; SD = 1.00) and full thickness burns (mean = 9.00; SD = 2.00) experienced severe pain than those with superficial burn (mean = 7.00; SD = 1.00) during dressing changes. There was no significant difference between the mean pain score of children and caretaker (t=0.257; SD=1.599; df=92; p=0.8). The highly significant difference in pain score was observed between children and nurses (t=4.387; SD=1.799; df=92; p<0.0018). Result showed that there was no standard and common method used by nurses to assess child pain. Drugs administered orally and by injection were the main methods used to relief child’s pain. Non-pharmacological methods are not commonly used by nurses to relieve pain in children with burn injuries.

Conclusion: Burn injuries could be prevented by encouraging child supervision, improving the home environment, and living conditions and through educating parents and caretakers. Better pain management can be achieved encouraging nurses to trying to understand the child’s experience of pain and by providing appropriate pain relief drugs and non-pharmacological methods.