Burn care for Aboriginal and Torres Strait Islander children in Australia – guidance and enactment of care

Background: Burn injury is a significant burden for children across Australia; especially for Aboriginal and Torres Strait Islander children. Gaps concerning the safety and quality of existing models of care that prescribe best practice are evident. Furthermore, it is not clear if there are standardised guidelines to inform practice, nor whether these are relevant and appropriate for the care of Aboriginal and Torres Strait Islander children.
Aim: This study aimed to explore and describe whether clinicians in multidisciplinary paediatric burn teams around Australia use guidance documents and if so whether they are appropriate and useful for care of Aboriginal and Torres Strait Islander children.
Methods: Interface research methodology incorporating both Indigenous and Western biomedical research approaches was used to guide this research. Semi-structured interviews we conducted with eighty clinicians from multidisciplinary paediatric burn teams across six sites in Australia. Interviews were audio recorded and transcribed verbatim. Data were thematically analysed by Aboriginal and non-Indigenous researchers.
Results: Results revealed significant diversity in use of guidance documents, with some clinicians reporting their practice is informed by formal guidelines while others report being guided by their personal clinical experiences. For particular disciplines, for example social workers, burn care provision was guided by theoretical frameworks. In some burn services, burn care for Aboriginal and Torres Strait Islander children was guided by overarching policy documents that reportedly made provision of culturally competent care easier. This was not the case for all services. Differences exist in awareness of applicable jurisdictional or service models of care, and some clinicians recognised the need for the development of an overarching model of care.
Discussion: The findings demonstrate the need for clarification on what constitutes best practice guidance for burn care and development of clear clinical models of care or guidelines. Attributing importance to cultural competence with explicit guidance in the documents that do guide burn care may help facilitate service and clinician cultural competence.