N Zwaard, I Brosky, JK Zuiker, SA van Ingen Schenau-Veldman, M Baartmans, K Lamberts N Trommel, E Middelkoop, MK Nieuwenhuis, ME van Baar 

Burn Centre, Maasstad Hospital 
Burn centre, Martini Hospital
Paediatric Dept. Maasstad Hospital
Psychology department, Martini Hospital
Association of Dutch Burn Centres
Association of Dutch Burn Centres

Video interaction guidance in Dutch burn care: proof of the pudding

Objectives
Burn injuries and their care are punishing experiences for hospitalized children. It is thought that if nurses have more skills to interact with children during recurring medical events, like wound dressing changes, these would be less distressing and painful. To modify interactional behaviour, video interaction guidance (VIG) can be used. With VIG, adult-child interactions are filmed and edited to produce a short film. In subsequent video review sessions, the interaction is discussed and, focussing on the positive, feedback is given. A recent pilot study showed that interactional behaviour during wound dressing changes did change as a result of VIG and was associated with the (dis)comfort of the child. To gain further evidence on the effect of VIG, it was introduced in a different Burn Centre.
Methods
At the burn centre Rotterdam eleven nurses were randomly selected and allocated to receive VIG (4 nurses) or not (7 nurses). Of the nurses receiving VIG, 3 wound dressing chances were videotaped before they received VIG and three after. 
Results
A total of 74 dressing changes were videotaped of 11 nurses. All 4 nurses have completed their VIG training. They learned to look for the initiatives of the child, for the reaction of the nurse and what this reaction meant for the child. By recognizing this pattern, the consciousness of the nurse was triggered: what does the child tell you and what does it mean for the child to be heard. Questionnaires showed that trained nurses are unanimously positive about VIG. In addition, two persons working in Rotterdam became certified VIG trainer. 

Conclusions
The implementation of VIG in Burn centre Rotterdam was successful. The formal study regarding its effects on the interaction between nurse and child (process) and the distress of a child during wound care procedures (outcome) will be completed this summer.

Video interaction guidance in Dutch burn care; the implementation in burn centre Rotterdam.