A randomized single-blind evaluation of a discharge teaching book for pediatric patients with burns

Abstract

To evaluate the influence of a modular, multidisciplinary, pediatric burn discharge book on burn-care-related knowledge and satisfaction of caregivers, we studied children less than 17 years of age admitted with an acute thermal injury to the pediatric burn unit of a large, tertiary care hospital in Winnipeg, Canada over a 32 month period. Demographic characteristics of the population are similar to published profiles of other pediatric burn units with the exception that North American Indian (NAI) families were disproportionately admitted, with 59 out of the 123 (48%) admissions from a geographic area that has less than 15% NAIs. We randomly assigned the families to receive discharge instructions with the book (intervention group) or routine discharge teaching without the book (comparison group). Knowledge levels of burn care and satisfaction with discharge teaching of caregivers were evaluated with a questionnaire administered in single-blind fashion at the first outpatient follow-up visit. Sixty-two families received the book and 61 families received standard discharge teaching. Bivariate analysis showed greater knowledge in the intervention group, with an average score (range, 0.0 to 1.0) of 0.79 +/- 0.15 versus 0.73 +/- 0.15 in the comparison group (p < 0.05). We did not observe this positive effect of the book when we analyzed NAI families separately: 28 families instructed with the book scored 0.68 +/- 0.14 versus 0.63 +/- 0.13 in 31 families provided with routine teaching (p = 0.18). Stepwise multiple-regression analysis found that the influence of the book was limited to families with children who sustained scald burns (p < 0.05). Factors negatively related to the knowledge levels of caregivers (p < 0.05) were being of NAI origin and being NAI with no safety devices in the home. A positive correlation (p < 0.05) was found with having English as the first language, having a child with more extensive burns, having a younger age of the child with burns, and having fewer children in the home. In conclusion, we found that the discharge book improved the burn-care-related knowledge of caregivers. However, other factors, particularly ethnic and language background, were of greater influence.