Simons Megan, De Young Alexandra, McPhail Steven M, Harvey Gillian, Kenardy Justin, Kularatna Sanjeewa, Kimble Roy, Tyack Zephanie
Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland 4101 Australia.
Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia.
Pilot Feasibility Stud. 2020 Aug 19;6:118. doi: 10.1186/s40814-020-00636-8. eCollection 2020.
Adoption of responsive trauma-informed practices by staff in hospital-based paediatric care may help mitigate downstream costs associated with treatment delivery due to reduced pain and distress for children and care providers, improved health-related quality of life and increased satisfaction with care. A web-based education intervention (termed Responsive CARE) was developed to build self-efficacy of staff in a paediatric medical setting. This protocol paper describes a feasibility study (including preliminary effectiveness) of the implementation of Responsive CARE in a tertiary, outpatient burn clinical setting.
A pre-post, mixed methods design will be employed. Children and caregivers attending hospital for change of burn wound dressings or burn scar management during the 3-month control or 3-month intervention period will be eligible, with follow-up to 6-months post-baseline. All children and caregiver/s will receive "standard care" including burn interventions focused on wound healing, scar management, itch management (both pharmacological and non-pharmacological), counselling, age-appropriate procedural support and burn rehabilitation. Health professional participants will be those involved in the management of children with burns during the study period or their senior managers. Health professional participants who attend a weekly educational clinical meeting will be invited to complete the intervention during a 1-month timeframe between the control and intervention period (or upon their commencement in burn outpatients during the intervention period) using an individualised log-in process. A purposive sample of caregivers and health professionals will be sought for participation in semi-structured interviews. Qualitative data will be analysed using Framework analysis. Feasibility will be evaluated via interviews, digital records of intervention usage and technical assistance logs. The primary outcome measures of effectiveness (pain, itch and distress) will be measured using self-report or behavioural observation. Quantitative data will primarily be analysed descriptively and using generalised linear models.
This study will provide insights into factors that impact upon the feasibility of a web-based trauma-informed care education intervention in a clinical practice setting. This knowledge may support other education approaches within healthcare settings related to improving and supporting patients to reduce the risk of healthcare interactions that result in paediatric medical traumatic stress.
医院儿科护理人员采用以创伤为导向的应对性措施，可能有助于降低因儿童和护理人员疼痛与痛苦减轻、健康相关生活质量改善以及护理满意度提高而产生的下游治疗成本。开发了一种基于网络的教育干预措施（称为应对性护理），以增强儿科医疗环境中工作人员的自我效能感。本方案文件描述了在三级门诊烧伤临床环境中实施应对性护理的可行性研究（包括初步有效性）。
将采用前后混合方法设计。在3个月的对照期或3个月的干预期内，因烧伤伤口换药或烧伤瘢痕管理而住院的儿童及其照料者符合条件，基线后随访6个月。所有儿童及其照料者将接受“标准护理”，包括侧重于伤口愈合、瘢痕管理、瘙痒管理（药物和非药物）、咨询、适合年龄的操作支持和烧伤康复的烧伤干预措施。卫生专业参与者将是研究期间参与烧伤儿童管理的人员或其高级管理人员。参加每周教育临床会议的卫生专业参与者将被邀请在对照期和干预期之间的1个月时间内（或在干预期开始在烧伤门诊工作时）使用个性化登录流程完成干预。将寻求有目的的照料者和卫生专业人员样本参与半结构化访谈。定性数据将采用框架分析法进行分析。将通过访谈、干预使用的数字记录和技术援助日志评估可行性。有效性的主要结局指标（疼痛、瘙痒和痛苦）将采用自我报告或行为观察进行测量。定量数据将主要进行描述性分析并使用广义线性模型。
本研究将深入了解影响基于网络的创伤知情护理教育干预在临床实践环境中可行性的因素。这些知识可能支持医疗保健环境中与改善和支持患者以降低导致儿科医疗创伤性应激的医疗保健互动风险相关的其他教育方法。
