Clinical guidance in the UK on treating minor burns can be contradictory. Some researchers argue blister fluid can help wound healing and blisters should be left intact while others say blisters need to be removed to avoid infection. A study has found non-burns specialist nurses, who treat minor burns patients in accident and emergency and urgent care units rely on on experience rather than evidence for treatment. The study authors call for a national audit and evidence-based guidelines.
A&E nurses treating patients with minor burns rely on their experience or the opinion of colleagues because of a lack of evidence to guide them, according to a study published in the journal Emergency Nurse.
Nurses often say they are basing treatment decisions on current evidence but that evidence is inadequate and ambiguous, according to the study.
The authors undertook a study of clinical decision-making by non-specialist burns nurses in emergency and unscheduled care who routinely treat patients with burns and manage acute partial-thickness burn blisters (APTBBs).
Some researchers say burn blister fluid can stimulate wound healing and therefore the blister should be left intact, while others claim de-roofing the blister reduces incidence of infection.
As a result, nurses chose to either rely on their own experience or seek the advice of colleagues such as trainee doctors.
'Experts were regarded by the participants as the most accessible resource for advice or referral. However, participants' approach to managing patients with APTBBs did not reflect the advice or practice of the experts they consulted,' it was reported.
The authors Sarah Payne, a nurse practitioner from Essex, England, and Elaine Cole, a senior lecturer in trauma care at City University London, found clinical experience does not always translate into in-depth knowledge, even among senior nurses who may be assumed to have a good understanding of the pathophysiology of burn wounds.
They have called for a UK audit led by burn experts to determine infection rates, cosmesis, function and patient satisfaction after APTBB management by non-specialist nurses.
- Payne S, Cole E. Treatment of acute burn blisters in unscheduled care settings. Emergency Nurse, 20, 5, 32-37
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