Factors influencing provision of care to hospitalized peadiatrics burn patients: a qualitative study among nurses in Muhimbili national hospital Dar es salaam, Tanzania

Abstract

Background The increase number of burn patients‘ admission in Muhimbili National Hospital indicated that burn injury is still a problem in our setting. In July 2011 up to June 2012 a total of 6135 paediatrics patients were admitted in MNH due to various diseases of which 319 patients were admitted due to burn injury. This is equal to 5.2% of all paediatrics admission (unpublished report). However hospital management made good coordination and availability of working equipments in order to archive optimal care for paediatric burn patients. Even though Health care providers especially nurse were facing some difficulties in provision of burn care. Objective The main objective of this study was to explore nurses‘ perceptions on factors influencing provision of care to pediatric burn patients among nurses at Muhimbili National Hospital. Methods Five in depth interviews were conducted in order to explore nurses‘ perception on factors that may influence provision of nursing care to hospitalized pediatric burn patients. This study was conducted from May 2012 to June 2012 in MNH. Simple observation method was used to complement data obtained through in-depth interviews. The study informants were sampled by using purposive sampling procedure. Data was analyzed by using content analysis approach. Findings The present study revealed two major categories which include motivating factors and barriers in provision of burn care. Participants described the use of closed method of wound dressing as an important skill that accelerates healing, decrease risk of wound contamination and decreased number of contractures. Presence of team work in burn care, facilitated patients recovery through reviewed and discussed management of patients as a team. Availability of equipments helped nurses to vi perform nursing care smoothly. Furthermore, participants felt gratified and increased work performance when they saw patients who sustained very severe burn injury recovering and going back home. Despite the fact that burn care was found somehow successfully in Muhimbili National Hospital (MNH), participants revealed several factors that hindered provision of care. These factors include limited resources, patient workload, and lack of standard skills. Participants described that there were limited human and non human resources, such as shortage of staffing which resulted into overworking, physical and emotional exhaustion among nurses, lack of water which is the mainstay of infection prevention control, lack of specimen equipment like pus swab. Since burn patient are at risk of infection therefore they need to take pus swab frequently. Nevertheless, participants expressed that they lack standard skills on burn care since there was no special training on burn care. Instead they were teaching themselves in the sense that experienced nurses in burn unit were teaching new nurses who came to work in burn unit. Conclusion The finding of this study revealed that there are both positively and negatively factors that influence provision of burn care. Positive factor (motivation) needed to be maintained but action is required to be taken in order to reduce negative factors. Recommendation More public health enlightenment is needed on prevention and initial intervention for burns in children. Community need to be aware that prevention of burn should be a priority since caring for burnt patient is very expensive. Further studies are needed in large population since this information is not conclusive to factors influence burn care in Tanzania.