Author Identifiers

Tania McWilliams
ORCID: 0000-0002-8290-9386

Date of Award

2020

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

First Advisor

Professor Di Twigg

Second Advisor

Adjunct Associate Professor Joyce Hendricks

Third Advisor

Professor Fiona Wood

Abstract

Introduction: Burns are a leading cause of injury worldwide, yet the initial assessment and management of patients following burn injury is often performed by non-burn specialist clinicians. Using the Gilbert Behaviour Engineering Model as a framework, strategies were introduced to support these clinicians. A better understanding was needed, however, of the effectiveness of these strategies, and the experiences of clinicians who provide this initial care.

Aims: This study aims to contribute new knowledge related to paediatric burn care through the evaluation of a state-wide burns telehealth program in Western Australia; specifically, develop a deeper and more relevant understanding of a state-wide burns infection control bundle; and elaborate upon existing knowledge of factors that influence clinical practice in acute burn management.

Method: A sequential explanatory mixed methods design was used. Phase 1 used quantitative data to explore the state-wide burns telehealth clinical and education program as well as the effectiveness of the state-wide burns infection control bundle. Phase 2 used qualitative data to explore factors that influence clinician practice in acute burn management. Results: The burns telehealth clinical program activity increased between 2005/6 and 2012/13. By providing real-time advice to non-burn specialist clinicians, unnecessary inpatient length of stay, transfers and admissions were reduced. The burns telehealth education program delivered to non-burn specialist clinicians demonstrated increased knowledge in most aspects of acute burn care following attendance at the education sessions. Building on these strategies, the implementation of a state-wide burns infection control bundle was effective in reducing burn wound infection and sepsis rates to zero, but was not able to demonstrate the same effectiveness in reducing upper respiratory or urinary tract infections in this population. Following integration of these strategies within the state-wide model of care, an exploration of factors which influence the clinical practice of the non-burn specialist clinicians providing this initial care demonstrated a number of common themes, in particular, that telehealth services support these clinicians, but IT issues remain a barrier.

Conclusion: The integration of state-wide clinical and educational paediatric burn telehealth services enabled the introduction of a state-wide infection control bundle which has resulted in increased non-burn specialist clinician knowledge and access to real-time advice which has reduced unnecessary transfers and admissions, while also reducing the risk of infection for those burns patients who do require transfer and admission. Clinicians providing this initial care reported that this telehealth service was a major support in their care of paediatric patients following burn injury, demonstrating its importance now and in the future.

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