Descripción de requisitos del sistema

The emergent theme `Limited Empowerment´ related to feelings of inadequacy with regard to knowledge and skills for burns care. This was expressed with regard to preparation for technical competency and decision making regarding caring for patients with burn injuries in the unit. This is what one participant had this to say regarding technical preparation for the burns care work in the unit:

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`Just look at how critically ill these patients are and the surrounding technology in this room like these monitoring machines (points to a cardiac monitoring machine). I was only trained to use these machines and care for these critically ill patients on the job.`

The participants lamented for training that would adequately prepare them for caring for patients with burn injuries in totality, just as this participant expressed:

`...so we need on-going in-service education-more on aspects of burns care from critical to rehabilitation...,and trainings for knowledge and skill development in the field of burn care.`

With regard to specific training packages, the nurses alluded to Intensive Care training as one educational opportunity which would empower them on the job, just as this participant expressed:

`..., you see, nurses in this unit need to be upgraded so that they become equipped with knowledge. Things like that...I think we just need more of professional nurses in this unit but also with post-basic trainings in ICU and care of the trauma individuals.., something like that, I don’t know...,`

The need for proper training and certification for recognition in burns care was highly expressed, as stated by this participant:

`...it is all about going for these specialisation courses like critical care nursing.

You become certified and come to work in this unit; perhaps that can make one feel empowered.`

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Another participant had this to say with regard to training for recognition:

`...and of course after such trainings we need to be well certified and to be recognised, you see, making this burn nursing a speciality field can make us feel empowered...`

The participants expressed they only received training when they were allocated to the unit, as one participant described:

`Ahh, hmm, I was just trained on the job for this burns care,...`

Another participant also said:

`Hmmm, I did not have any formal training at all! But we do go for workshops where we are orientated on some aspects of burns care, you see.`

It was noted these on-the-job trainings were not without some hurdles, as this participant expressed:

`Ahh, hmm, I was just trained on the job for this burns care,...but frankly speaking what I saw when I came here was really too much,`

Another nurse had this to say when expressing how new nurses acquire burns nursing experience in the unit:

`Eh... Sister, some of the new nurses really needed a lot of support to learn and get used to this work environment, you see... I have seen some actually quitting saying `hey,..I cannot cope` and they would really leave.´

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It is worth noting that the need for special training on burns care was commonly expressed by those participants between the ages of 25 and 36 and with less than five years of experience in the unit. Those participants with more than five years of experience and aged over 45 years expressed that long exposure in the unit helped them get used to the work environment. One participant had this to say:

`And we also use our experiences, that is, the long exposure in this unit. You know, with that experience, you can come across a burn wound and straight away you would know exactly how to manage it...yah.`

It was evident that nurses in the unit were mainly trained on-the-job, however one nurse had this to say:

`You know, people tend to be recognised and appreciated basing on the certified qualification that they possess. These trainings on the job do not place so much power on us nurses that we can effectively influence patient-centred care in the clinical settings..,`

In this study, nurses expressed some level of inadequacy to exert influence in the burns care team for the benefit of patients, which they attributed to limited empowerment just as this participant explained:

` ....But you know, my decisions sometimes may not be appreciated in this unit because I do not have that power- I mean that empowerment via knowledge and skills acquired through proper certification.`

87 The same nurse expressed:

`...you see this green stained dressings (points to green-stained swabs used on the wound), this room needs to be well aerated before getting in another fresh burn. But people here will only be looking at the urgency of the situation. As a nurse, I may not have much influence on immediate transferring in of patients in this room. Sister, this sometimes frustrates me - I cannot just be doing delegated work on and on. My views based on what I am certified with concerning my work needs to be recognised...(makes another pause)`

It was apparent that nurses in this study demonstrated minimal influence in the burns care multidisciplinary team which prevented them manipulating the patients` environment to enhance wound healing, as this participant also stated:

`You know...., I think we have a challenge on controlling infections. There are times when we experience many deaths due to infections...., but I don`t know....

(pauses), Well...., I do not know exactly but I think it is due to non-compliance to adhering to infection prevention practices by the staff..., and I feel this contribute greatly...,Mhhh...,I think....,(hesitates) you know, I just become strong and tell them to follow infection prevention practices in the unit especially when they are performing procedures on the patients..`

Another nurse`s response on the same issue of influence in the burns care team was as follows:

` Sometimes the nurses can have good ideas but you know, they may not feel all that strong to say it out although it can be the right thing ...Mhhh,... (hesitates). I really do not know but perhaps it can be the issues of trainings,`

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However, one out of the 13 participants expressed some level of confidence in advocating for the patients. When expressing how it felt like to be the primary contact of the patients, below is what was described:

`(Smiles).... You know, this alone really makes me feel that I actually own the patients under my care, ne, and the patients really belong to me. The others just come for a while and they go. This makes me really to feel so responsible for all the care of the patients and of course I know that I am the patients` advocate so I would call in others depending on my patients` needs..,`