- Email: [email protected]
Nursing students practice primary fire prevention
burns 39 (2013) 1277–1284
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Nursing students practice primary fire prevention Carlee Lehna *, Julie A. Todd, Rachel Keller, Lynn Presley, Jessica Jackson, Stephanie Davis, Kristi Hockman, Charles Phillips-Payne, Sarah Sauer, Sarah Wessemeier University of Louisville School of Nursing, 555 S. Floyd St., K-4060, University of Louisville, Louisville, KY 40292, USA
article info
abstract
Article history:
The purpose of this project was to evaluate a standardized, interactive, home fire safety
Accepted 22 January 2013
program for elementary school students. Background: Senior baccalaureate nursing students in their pediatric clinical rotation taught
Keywords:
burn prevention techniques using Hazard House, a model house filled with common
School-based education
household fire hazards (Hazard House, 2006, Ref. 1). Elementary school students were
Fire injury prevention
encouraged to identify the hazards and discuss ways in which the house could be made
Pediatric
safer. Local firemen then briefly presented what to do if a fire occurred, how firemen may look during a rescue, and the importance of working smoke alarms in the home. Methods: A pretest–posttest design was used to examine the effectiveness of an educational intervention. The three groups of participants included 128 kindergarten students, 311 students in grades 1–2, and 61 students in grades 3–4. The tests and interventions were tailored appropriately for each age group. Results: There was no difference in pre- and post-test scores for the students in kindergarten and grades 3–4 ( p > 0.05). However, there was a significant difference for students in grades 1–2 ( p < 0.001). Conclusion: It is important for nurses to assess for and teach about fire injury prevention to prevent potentially devastating irreversible injuries. The results suggest that the educational intervention was effective in improving the understanding of fire safety for students in grades 1–2. Future studies may need to include a larger sample of students for the other grades. # 2013 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
The purpose of this project was to evaluate a standardized, interactive, home fire safety program in elementary school students [1]. In 2008, there were approximately 403,000 residential structure fires in the United States [2]. In the same year, of the 403,000 residential fires, 2780 deaths and 13,560 injuries resulted [2,3]. For children less than 14 years of age, 509 children died which accounted for 13% of the fire deaths [3,4]. During the last two years, 595 children with burn injuries
were treated at one north central Kentucky children’s hospital [5]. Thus, there is a need to decrease burn injuries among children in this community. Children are at risk for burn injuries for many reasons. Young children and older adults are more susceptible to being seriously burned because they have thinner skin. Young children are more curious and will play with items left within their reach [3,4]. School-aged children after participating in fire injury prevention programs are then able to share their learning with family members at home (e.g., parents, younger siblings, and grandparents).
* Corresponding author. Tel.: +1 502 852 3913, fax: +1 502 852 8783. E-mail addresses: [email protected], [email protected], [email protected] (C. Lehna). 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.01.016
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burns 39 (2013) 1277–1284
Primary fire injury prevention with adults has been shown to reduce fire fatalities [6,7]. Living in urban, poorer neighborhoods is a risk factor for home fire related injuries [7–9]. Community-based prevention programs (e.g., to install smoke alarms, review escape plans, and/or other fire prevention activities) delivered in the home by fire department personnel improved fire safety behavior of adults [10–12]. There is a lack of research demonstrating the effectiveness of school-based fire safety prevention programs for children. Children under 14 years of age, especially school-age children are at a high risk of burn related injury. They are easily accessible in the school setting and are more willing to participate in interactive burn prevention programs. The fire injury prevention program used in the current study is a standardized, interactive home fire safety model [1]. This program was the first step in the development of a comprehensive community-based fire injury prevention program.
2.
Methods
2.1.
Design
This study used a pre-test/post-test design to examine the effect of Hazard House, a standardized educational intervention, on children’s knowledge of fire injury prevention [1].
2.2.
Sample
A total of 500 elementary school children participated in the study: 128 kindergarten students, 311 students in first or second grades, and 61 students in grades third or fourth. Ages of 128 kindergarteners, ranged from 5 to 7 years with M = 5.48 0.62. The 311 children in first and second grades ranged from age 5 to 13 years (one child had repeated multiple
Table 1 – Grade 1 and 2 Teacher Instructions and Student Answer Form.
Hazard House Quiz for 1st and 2nd Graders – TEACHER INSTRUCTIONS Work with children in small groups or individually. Have children point to the number. Read the queson and have children respond by wring the answer in the space provided or circling the best answer. Correct answers are in bold. 1. If there is a fire or medical emergency, what telephone number would you call? (Teacher: Write in your local emergency response number or 911.) ________________ 2. What would you do if you found matches lying on a table? Would you play with the matches or tell a grown-up? The first word says “play.” The second word says “give.” Circle the word that says what you would do if you found matches. play
give
3. How would you keep the stairs in your home safe? Would you keep them clean or leave your toys on them? The first word says “clean.” The second words say “leave toys.” Circle the answer that says how you would keep the stairs in your home safe. clean
leave toys
4. Is it okay to leave the dryer running when you and your family leave the house? The first word says “yes.” The second word says “no.” Circle “yes” if it is okay to leave the dryer running. Circle “no” if it is not okay to leave the dryer running. yes
no
5. What is the name of the item in your home that is used to protect you and your family from fire? The first words say “smoke alarm.” The second word says “stove.” Circle the answer that is the name of the item used to protect you from fire. smoke alarm
stove
6. If the smoke alarm sounds, what would you do? Would you hide or get out of the house? The first words say “get out.” The second word says “hide.” Circle the answer that says what you would do if the smoke alarm sounds. get out
hide
7. If you and your family are leaving the house and you see a candle burning, would you leave it burning and not tell your parents or would you tell your parents so they can blow it out? The
burns 39 (2013) 1277–1284
first words say “leave burning.” The second words say “tell parents.” Circle the answer that says what you would do if you saw that a candle was burning. leave burning
tell parents
8. If you are awakened by a smoke alarm, you should feel the door to your room to see if the door is hot. If the door is hot, would you open the door or keep it closed? The first words say “open door.” The second words say “keep closed.” Circle the answer that says what you would do if the door was hot. open door
keep closed
9. What can happen if someone smokes a cigaree, cigar, or pipe inside the house? The first word says “fire.” The second word says “tornado.” Circle the word that says what can happen is someone smokes in the home. tornado
fire
10. Can hot things such as a toaster, iron, and hot water hurt you? The first word says “yes.” The second word says “no.” Circle your answer.
no
yes
11. What would you do if you saw water on the floor of the bathroom? Would you leave it there because it will dry on its own, or would you wipe it up wit h a towel because it could make someone slip and fall? The first words say “leave it.” The second words say “wipe up.” Circle the answer that says what you would do.
wipe up
leave it
12. If you see a power line down in the street in front of your house, what would you do? Would you tell a grown-up so they can call the power company, or would you go ahead and play outside as long as you don’t touch the power line? The first word says “tell.” The second word says “play.” Circle the word that says what you would do if you see a power line in the street.
play
tell
Hazard House Quiz for 1st and 2nd Graders
Name: _______________________________ Age: Grade: Pretest: Posest: Teacher: Boy: _____ or Girl: ______ Write the answer in the space provided. 1.___________________________________ Circle the best answer. 2. play give 3.
smoke alarm
stove
4.
get out
hide
5.
open door
keep closed
6.
fire
tornado
7.
yes
no
8.
tell
play
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grades) with M = 6.94 0.85, and the 61 third and fourth graders ranged in age from 6 to 9 years with M = 7.98 0.77.
2.3.
Statistical analysis
Change in group means between pre- and post-tests for the three grades (kindergarten, 1st–2nd grade, and 3rd–4th grades) were compared using Paired T-tests with alpha set at 0.05 (see Table 4). Pre- and post-test score means, standard deviations, and ranges were described by grade (see Table 3).
2.4.
Intervention
The educational intervention included a model house, a portable 3-D unit with lights which could simulate fire and
smoke [1]. Nursing students used a remote to highlight the room-by-room fire hazards and had the elementary school children suggest ways to make corrections. The lights and sounds helped keep the students interested in and excited about what was being discussed. Some of the key points were to never play with matches, never overload power switches, never use electrical items near water, and ensure smoke alarms are on each floor and working properly. Ten senior baccalaureate nursing students in their pediatric clinical rotation in each of two semesters signed up for project roles on their first clinical day (e.g., administration of pre- and post-tests in the classroom, presenting the interactive program, grading tests, and data entry). Three of the nursing students were trained to present the intervention by studying the script, watching a training DVD, and presenting
Table 2 – Grade 3 and 4 Teacher Instructions and Student Answer Form.
Hazard House Quiz for 3rd and 4th Graders – Teacher Instrucons Name: ______________________________________________________________________________ Quesons 1 and 2. Write the answers in the space provided. 1. When your clothes catch fire, what are the three things you should do to put out the fire? _____________________________________________________________________________________ _____________________________________________________________________________________ 2. What is the phone number you dial when there is an emergency? _____________________________________________________________________________________ Quesons 3-12. Please circle the best answer. 3. What is the number one cause of house fires? A. Candles B. Curling irons C. Cigarees, cigars, and pipes 4. Is it okay to leave the dryer running when you and your family leave the house? A. Yes B. No 5. Which of the following is a fire hazard? A. A window with security bars B. Matches and lighters C. Both of the above 6. When is it okay to use matches? A. If someone has showed you how B. Whenever you want C. Only with parental permission and supervision D. When camping 7. When trying to escape a fire, should you feel all doors before opening them to see if they are hot? A. Yes. Hot doors have fire behind them, so are unsafe to open B. False. Open the doors closest to you regardless of temperature, get out fast! 8. What should you do if you cannot get out of the room because the only door is hot? A. Hide in the closet B. Make yourself visible so the firemen can see where you are. 9. What should every house have to protect families from fire? A. Smoke detectors B. Matches C. Candles 10. Once a power line is down, it is safe because it no longer has electricity running through it. A. True: power lines are only dangerous when they run pole to pole. B. False: loose dangling or down power lines should be avoided and immediately reported to the power company; they may sll be “hot” with electricity.
burns 39 (2013) 1277–1284
Hazard House Quiz for 3rd and 4th Graders Name: _____________________________________________PreTest________or Posest: _________ Grade:
Teacher:
Age: _______ Boy: ______ or Girl: _______ Quesons 1 and 2. Write the answers in the space provided. 1. When your clothes catch fire, what are the three things you should do to put out the fire? _____________________________________________________________________________________ 2. What is the phone number you dial when there is an emergency? _______________________ Quesons 3-12. Please circle the best answer. 3. What is the number one cause of house fires? D. Candles E. Curling irons F. Cigarees, cigars, and pipes 4. Is it okay to leave the dryer running when you and your family leave the house? C. Yes D. No 5. Which of the following is a fire hazard? D. A window with security bars E. Matches and lighters F. Both of the above 6. When is it okay to use matches? E. If someone has showed you how F. Whenever you want G. Only with parental permission and supervision H. When camping 7. When trying to escape a fire, should you feel all doors before opening them to see if they are hot? C. Yes. Hot doors have fire behind them, so are unsafe to open D. False. Open the doors closest to you regardless of temperature, get out fast! 8. What should you do if you cannot get out of the room because the only door is hot? C. Hide in the closet D. Make yourself visible so the firemen can see where you are. 9. What should every house have to protect families from fire? D. Smoke detectors E. Matches F. Candles 10. Once a power line is down, it is safe because it no longer has electricity running through it. C. True: power lines are only dangerous when they run pole to pole. D. False: loose dangling or down power lines should be avoided and immediately reported to the power company; they may sll be “hot” with electricity.
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to classmates before delivery of the intervention to the elementary school children.
Table 3 – Hazard House test scores by grade, mean (M), standard deviation (SD), and range. Grade
2.5.
Measures
Three grade specific knowledge evaluation tests were designed. The tests were adapted from existing tests on general injury prevention topics. Drafts of the burn prevention tests were reviewed by children’s injury prevention experts, each with over 20 years in injury prevention education with children, from the local Safe Kids Coalition. Modifications were made per the experts’ suggestions. For each burn prevention test, there were teacher instructions. The same tests were given as pre- and post-test. For the 10-item kindergarten test, the nursing student tester would ask a question and then the children would circle one of two pictures. One question example was ‘‘Circle the picture that shows what children should do with matches.’’ The two choices were: a child lighting a camp fire or a child giving matches to an adult. For the 12-item first and second grade test, the students were asked a question by the nursing student tester, and two possible answers were read. The students circled their answer (see Table 1). For the third and fourth grade 12-item test, the students independently read the questions and either wrote an answer or circled a letter indicating their response. Examples of questions on this test were ‘‘When your clothes catch fire, what are the three things you should do to put out the fire? Is it okay to leave the dryer running when you and your family leave the house (yes/no)?’’ One point was awarded for each correct answer in all of the three tests (see Table 2).
2.6.
Procedure
The study was considered exempt by the university institutional review board and permission was granted to evaluate the educational intervention by the county school system. Groups of 25–50 elementary students attended the presentation in the all-purpose room of their school. Additional presentations were scheduled each half hour until all participated. As the nursing students presented the educational intervention, elementary students were encouraged to identify fire hazards within each room of the house. Discussion regarding how to remedy the hazards was promoted. Participants were given a fire safety checklist which included the major points of the demonstration to take and use at home. Local firefighters presented on fire safety and the importance of working smoke alarms. The post-test was conducted in the classrooms by the nursing students immediately after program participation.
3.
Results
Elementary students in all three age groups loved the Hazard House program. They attentively listened to the nursing students’ presentation, and tried to find and then fix the fire safety hazards for each room. Some of the younger
Kindergarten (n = 128) Pre-test score Post-test score Grades 1–2 (n = 311) Pre-test score Post-test score Grades 3–4 (n = 61) Pre-test score Post-test score
M (SD)
Range
8.33 (1.44) 8.5 (1.61)
3–10 2–10
11.45 (1.21) 11.83 (0.63)
2–12 5–12
9.31 (1.21) 9.39 (0.63)
3–12 1–12
students did become frightened when the firefighter donned all his gear. Older students attentively looked on and answered questions. For major concepts such as dialing 911 for a fire emergency and Stop, Drop, and Roll, all the elementary students knew the answers. Older students, after participating in the presentation, knew that the dryer should be turned off prior to leaving home but said often it did not happen at their house. On the 10-question pretest, the kindergarten group’s scores ranged from 3 to 10 correct answers with M = 8.33 2.17 (see Table 3). The posttest scores ranged from 2 to 10 correct answers with M = 8.5 2.67 (see Table 3). Mean scores on the pre- and post-test did not differ (t = 0.833, df = 127, p = 0.406; see Table 4). The first and second grade group received a 12-question test. On pre-test, scores ranged from 2 to 12 correct answers with M = 11.45 0.15 (see Table 3). The posttest scores in this group ranged from 5 to 12 correct answers with M = 11.83 2.22 (see Table 3). There was a statistically significant improvement in post–test scores over pre-test scores (t = 6.25, df = 310, p < 0.001; see Table 4). The participants in grades three and four also took a 12question test. Scores on the pretest ranged from 3 to 12 correct answers with M = 9.31 1.78 (see Table 3). The posttest scores ranged from 1 to 12 correct answers with M = 9.39 1.98 (see Table 3). There was no significant difference from pre- to posttest (t = 0.476, df = 60, p = 0.636; see Table 4).
4.
Discussion
The Hazard House program only demonstrated a statistically significant change in the first and second graders’ scores [1]. Lack of improvement in test scores for the fourth graders could
Table 4 – Differences between pre- and post-test scores by grade. Grade Kindergarten Grade 1–2 Grade 3–4
Paired T-test
df
p-Value
0.833 6.25 0.476
127 310 60
0.406 NS 0.001*** 0.636 NS
NS, non-significant. Significant at the 0.05 level.
***
burns 39 (2013) 1277–1284
be due to the tests not being sensitive. This may not have been the first fire prevention education these children had received. They may have had education via the annual county-wide Children in Hospitals Week, watching educational television, or education on the topic by previous teachers. The kindergarteners may have been too young developmentally to understand the content or test questions. Other reasons for non-significant results could be because there were lower student numbers in the youngest and oldest groups when compared to the first and second graders where there were 311 participants. Conversely, a potential reason for significant results in the first and second graders was that they were at an ideal age developmentally for children to internalize and understand the fire safety education. Hopefully, the knowledge from this intervention will remain with the students in order to protect them and be passed on to those they come in contact with throughout their lives. Changes to the kindergartner test might involve piloting different pictures to choose from which were specially drawn to answer the questions versus finding clip art illustrations from the web. Using item analysis technique would be helpful in seeing which questions for the kindergarten and 3–4 grade tests were not sensitive in evaluating burn prevention educational content. Then changing items through rewording, deleting others, or adding new ones would be important. There were many positive aspects to this project, the most important being that the elementary students were presented with strategies for home fire safety. Elementary student participants increased their knowledge, attitudes, and behavior toward fire prevention. The nursing students and clinical instructor found this project to be rewarding too. By implementing the Hazard House fire safety and prevention program, the baccalaureate nursing students became actively involved in an evidence-based research project [1]. This fostered the development of research skills through working in groups to gather data, to analyze data, and to present the findings orally, in poster format, and through journal article development. Future studies should evaluate previous elementary student burn prevention education. Another change would be to revise the pre/post-test questions to focus more on fire safety and then pilot the revisions in a smaller sample. Lack of follow-up with families at home to determine if classroom education resulted in changes at home would be an important objective for future research.
5.
Conclusion
The objective of teaching and evaluating primary burn prevention education in school-aged children from kindergarten to fourth grade was partially achieved. All three age groups were taught; however, significant knowledge changes were only evidenced in the first and second graders. With close to 300 pediatric burn injuries a year in this north central Kentucky community, it is critical that pediatric nurses teach burn prevention strategies to families in the community or hospital setting to decrease these devastating injuries. Teaching about primary home fire safety should be considered by nurses during patient hospitalization or when discharging children and adults. A quick assessment regarding home hot
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water heater temperature, frequency of battery checks in home smoke alarms, whether young children have access to play with matches, lighters, or candles, or if an older adult in the home smokes while on home oxygen, could prevent costly, painful, irreversible, and potentially life-threatening injuries.
Conflict of interest statement All the authors have no actual or potential conflict of interests to disclose.
Acknowledgments Safe Kids Coalition Louisville and Jefferson County led by Kosair Children’s Hospital members Erika Janes, R.N., (Coordinator), Sharon Rengers, R.N (Child advocate), and Jackie Graviss, Sergeant (Fire Prevention Inspector 1, Louisville Fire Department). Louisville Fire Department: Daryell Hudson (Firefighter), Briane Hume (Firefighter), Toby Mathes (Sergeant), and Andrew Tilford (Sergeant). Jefferson County Public Schools.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.burns.2013.01.016.
references
[1] Hazard House. Safety education through simulation; 2006. Retrieved 21 December 2011 from Modeltech International Incorporated. Available from: http://www.modeltech.com/ fhh-original.htm. [2] US Fire Administration (USFA). Residential Structure Fires; 2009. Retrieved 21 July 2012 from US Fire Administration. Available from: http://www.usfa.dhs.gov/statistics/ national/residential.shtm. [3] Safe Kids USA. Burn and Scald Prevention Fact Sheet; 2011. Retrieved 21 July 2012 from http://www.safekids.org/ourwork/research/fact-sheets/burn-and-scald-preventionfact-sheet.html. [4] USFA. Fire risk to children in 2007. Topical fire report series; 2007, 11(9). Retrieved 21 July 2012 from USFA, Available from: http://www.usfa.dhs.gov/media/press/2011releases/ 030911.shtm. [5] Kosair Children’s Hospital (KCH). Burn injury statistics. Louisville, KY: Author; 2011. [6] Barillo DJ, Goode R. Fire fatality study: demographics of fire victims. Burns 1996;22(2):85–8. [7] Istre G, McCoy M, Carlin D, McClain J. Residential fire related deaths and injuries among children: fire play, smoke alarms, and prevention. Inj Prev 2002;8:128–32. http://dx.doi.org/10.1136/ip.8.2.128. [8] Klein MB, Mack CD, Kramer CB, Heimbach DM, Gibran NS, Rivara FP. Influence of injury characteristics and payer status on burn treatment location in Washington state. JBCR 2008;26(3):435–40.
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[9] Scholer SJ, Hickson GB, Mitchel Jr EF, Ray WA. Predictors of mortality from fires in young children. Pediatrics 1998;101(5):E12. http://dx.doi.org/10.1542/peds. 101.5.e12. [10] Azerdo R, Stephens-Stidham S. Design and implementation of injury prevention curricula for elementary schools: lessons learned. Inj Prev 2003;9:274–8. http://dx.doi.org/ 10.1136/ip.9.3.274.
[11] Hwang V, Duchossois GP, Garcia-Espana JF, Durbin DR. Impact of a community based fire prevention intervention in fire safety knowledge and behavior in elementary school children. Inj Prev 2006;12:344–6. http://dx.doi.org/10.1136/ ip.2005.011197. [12] King WJ, Klassen TP, LeBlanc J, Bernard-Bonnin AC, Robitaille Y, Pham B, et al. The effectiveness of a home visit to prevent childhood injury. Pediatrics 2001;108(2):382–8.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Nursing students practice primary fire prevention Carlee Lehna *, Julie A. Todd, Rachel Keller, Lynn Presley, Jessica Jackson, Stephanie Davis, Kristi Hockman, Charles Phillips-Payne, Sarah Sauer, Sarah Wessemeier University of Louisville School of Nursing, 555 S. Floyd St., K-4060, University of Louisville, Louisville, KY 40292, USA
article info
abstract
Article history:
The purpose of this project was to evaluate a standardized, interactive, home fire safety
Accepted 22 January 2013
program for elementary school students. Background: Senior baccalaureate nursing students in their pediatric clinical rotation taught
Keywords:
burn prevention techniques using Hazard House, a model house filled with common
School-based education
household fire hazards (Hazard House, 2006, Ref. 1). Elementary school students were
Fire injury prevention
encouraged to identify the hazards and discuss ways in which the house could be made
Pediatric
safer. Local firemen then briefly presented what to do if a fire occurred, how firemen may look during a rescue, and the importance of working smoke alarms in the home. Methods: A pretest–posttest design was used to examine the effectiveness of an educational intervention. The three groups of participants included 128 kindergarten students, 311 students in grades 1–2, and 61 students in grades 3–4. The tests and interventions were tailored appropriately for each age group. Results: There was no difference in pre- and post-test scores for the students in kindergarten and grades 3–4 ( p > 0.05). However, there was a significant difference for students in grades 1–2 ( p < 0.001). Conclusion: It is important for nurses to assess for and teach about fire injury prevention to prevent potentially devastating irreversible injuries. The results suggest that the educational intervention was effective in improving the understanding of fire safety for students in grades 1–2. Future studies may need to include a larger sample of students for the other grades. # 2013 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
The purpose of this project was to evaluate a standardized, interactive, home fire safety program in elementary school students [1]. In 2008, there were approximately 403,000 residential structure fires in the United States [2]. In the same year, of the 403,000 residential fires, 2780 deaths and 13,560 injuries resulted [2,3]. For children less than 14 years of age, 509 children died which accounted for 13% of the fire deaths [3,4]. During the last two years, 595 children with burn injuries
were treated at one north central Kentucky children’s hospital [5]. Thus, there is a need to decrease burn injuries among children in this community. Children are at risk for burn injuries for many reasons. Young children and older adults are more susceptible to being seriously burned because they have thinner skin. Young children are more curious and will play with items left within their reach [3,4]. School-aged children after participating in fire injury prevention programs are then able to share their learning with family members at home (e.g., parents, younger siblings, and grandparents).
* Corresponding author. Tel.: +1 502 852 3913, fax: +1 502 852 8783. E-mail addresses: [email protected], [email protected], [email protected] (C. Lehna). 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.01.016
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burns 39 (2013) 1277–1284
Primary fire injury prevention with adults has been shown to reduce fire fatalities [6,7]. Living in urban, poorer neighborhoods is a risk factor for home fire related injuries [7–9]. Community-based prevention programs (e.g., to install smoke alarms, review escape plans, and/or other fire prevention activities) delivered in the home by fire department personnel improved fire safety behavior of adults [10–12]. There is a lack of research demonstrating the effectiveness of school-based fire safety prevention programs for children. Children under 14 years of age, especially school-age children are at a high risk of burn related injury. They are easily accessible in the school setting and are more willing to participate in interactive burn prevention programs. The fire injury prevention program used in the current study is a standardized, interactive home fire safety model [1]. This program was the first step in the development of a comprehensive community-based fire injury prevention program.
2.
Methods
2.1.
Design
This study used a pre-test/post-test design to examine the effect of Hazard House, a standardized educational intervention, on children’s knowledge of fire injury prevention [1].
2.2.
Sample
A total of 500 elementary school children participated in the study: 128 kindergarten students, 311 students in first or second grades, and 61 students in grades third or fourth. Ages of 128 kindergarteners, ranged from 5 to 7 years with M = 5.48 0.62. The 311 children in first and second grades ranged from age 5 to 13 years (one child had repeated multiple
Table 1 – Grade 1 and 2 Teacher Instructions and Student Answer Form.
Hazard House Quiz for 1st and 2nd Graders – TEACHER INSTRUCTIONS Work with children in small groups or individually. Have children point to the number. Read the queson and have children respond by wring the answer in the space provided or circling the best answer. Correct answers are in bold. 1. If there is a fire or medical emergency, what telephone number would you call? (Teacher: Write in your local emergency response number or 911.) ________________ 2. What would you do if you found matches lying on a table? Would you play with the matches or tell a grown-up? The first word says “play.” The second word says “give.” Circle the word that says what you would do if you found matches. play
give
3. How would you keep the stairs in your home safe? Would you keep them clean or leave your toys on them? The first word says “clean.” The second words say “leave toys.” Circle the answer that says how you would keep the stairs in your home safe. clean
leave toys
4. Is it okay to leave the dryer running when you and your family leave the house? The first word says “yes.” The second word says “no.” Circle “yes” if it is okay to leave the dryer running. Circle “no” if it is not okay to leave the dryer running. yes
no
5. What is the name of the item in your home that is used to protect you and your family from fire? The first words say “smoke alarm.” The second word says “stove.” Circle the answer that is the name of the item used to protect you from fire. smoke alarm
stove
6. If the smoke alarm sounds, what would you do? Would you hide or get out of the house? The first words say “get out.” The second word says “hide.” Circle the answer that says what you would do if the smoke alarm sounds. get out
hide
7. If you and your family are leaving the house and you see a candle burning, would you leave it burning and not tell your parents or would you tell your parents so they can blow it out? The
burns 39 (2013) 1277–1284
first words say “leave burning.” The second words say “tell parents.” Circle the answer that says what you would do if you saw that a candle was burning. leave burning
tell parents
8. If you are awakened by a smoke alarm, you should feel the door to your room to see if the door is hot. If the door is hot, would you open the door or keep it closed? The first words say “open door.” The second words say “keep closed.” Circle the answer that says what you would do if the door was hot. open door
keep closed
9. What can happen if someone smokes a cigaree, cigar, or pipe inside the house? The first word says “fire.” The second word says “tornado.” Circle the word that says what can happen is someone smokes in the home. tornado
fire
10. Can hot things such as a toaster, iron, and hot water hurt you? The first word says “yes.” The second word says “no.” Circle your answer.
no
yes
11. What would you do if you saw water on the floor of the bathroom? Would you leave it there because it will dry on its own, or would you wipe it up wit h a towel because it could make someone slip and fall? The first words say “leave it.” The second words say “wipe up.” Circle the answer that says what you would do.
wipe up
leave it
12. If you see a power line down in the street in front of your house, what would you do? Would you tell a grown-up so they can call the power company, or would you go ahead and play outside as long as you don’t touch the power line? The first word says “tell.” The second word says “play.” Circle the word that says what you would do if you see a power line in the street.
play
tell
Hazard House Quiz for 1st and 2nd Graders
Name: _______________________________ Age: Grade: Pretest: Posest: Teacher: Boy: _____ or Girl: ______ Write the answer in the space provided. 1.___________________________________ Circle the best answer. 2. play give 3.
smoke alarm
stove
4.
get out
hide
5.
open door
keep closed
6.
fire
tornado
7.
yes
no
8.
tell
play
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grades) with M = 6.94 0.85, and the 61 third and fourth graders ranged in age from 6 to 9 years with M = 7.98 0.77.
2.3.
Statistical analysis
Change in group means between pre- and post-tests for the three grades (kindergarten, 1st–2nd grade, and 3rd–4th grades) were compared using Paired T-tests with alpha set at 0.05 (see Table 4). Pre- and post-test score means, standard deviations, and ranges were described by grade (see Table 3).
2.4.
Intervention
The educational intervention included a model house, a portable 3-D unit with lights which could simulate fire and
smoke [1]. Nursing students used a remote to highlight the room-by-room fire hazards and had the elementary school children suggest ways to make corrections. The lights and sounds helped keep the students interested in and excited about what was being discussed. Some of the key points were to never play with matches, never overload power switches, never use electrical items near water, and ensure smoke alarms are on each floor and working properly. Ten senior baccalaureate nursing students in their pediatric clinical rotation in each of two semesters signed up for project roles on their first clinical day (e.g., administration of pre- and post-tests in the classroom, presenting the interactive program, grading tests, and data entry). Three of the nursing students were trained to present the intervention by studying the script, watching a training DVD, and presenting
Table 2 – Grade 3 and 4 Teacher Instructions and Student Answer Form.
Hazard House Quiz for 3rd and 4th Graders – Teacher Instrucons Name: ______________________________________________________________________________ Quesons 1 and 2. Write the answers in the space provided. 1. When your clothes catch fire, what are the three things you should do to put out the fire? _____________________________________________________________________________________ _____________________________________________________________________________________ 2. What is the phone number you dial when there is an emergency? _____________________________________________________________________________________ Quesons 3-12. Please circle the best answer. 3. What is the number one cause of house fires? A. Candles B. Curling irons C. Cigarees, cigars, and pipes 4. Is it okay to leave the dryer running when you and your family leave the house? A. Yes B. No 5. Which of the following is a fire hazard? A. A window with security bars B. Matches and lighters C. Both of the above 6. When is it okay to use matches? A. If someone has showed you how B. Whenever you want C. Only with parental permission and supervision D. When camping 7. When trying to escape a fire, should you feel all doors before opening them to see if they are hot? A. Yes. Hot doors have fire behind them, so are unsafe to open B. False. Open the doors closest to you regardless of temperature, get out fast! 8. What should you do if you cannot get out of the room because the only door is hot? A. Hide in the closet B. Make yourself visible so the firemen can see where you are. 9. What should every house have to protect families from fire? A. Smoke detectors B. Matches C. Candles 10. Once a power line is down, it is safe because it no longer has electricity running through it. A. True: power lines are only dangerous when they run pole to pole. B. False: loose dangling or down power lines should be avoided and immediately reported to the power company; they may sll be “hot” with electricity.
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Hazard House Quiz for 3rd and 4th Graders Name: _____________________________________________PreTest________or Posest: _________ Grade:
Teacher:
Age: _______ Boy: ______ or Girl: _______ Quesons 1 and 2. Write the answers in the space provided. 1. When your clothes catch fire, what are the three things you should do to put out the fire? _____________________________________________________________________________________ 2. What is the phone number you dial when there is an emergency? _______________________ Quesons 3-12. Please circle the best answer. 3. What is the number one cause of house fires? D. Candles E. Curling irons F. Cigarees, cigars, and pipes 4. Is it okay to leave the dryer running when you and your family leave the house? C. Yes D. No 5. Which of the following is a fire hazard? D. A window with security bars E. Matches and lighters F. Both of the above 6. When is it okay to use matches? E. If someone has showed you how F. Whenever you want G. Only with parental permission and supervision H. When camping 7. When trying to escape a fire, should you feel all doors before opening them to see if they are hot? C. Yes. Hot doors have fire behind them, so are unsafe to open D. False. Open the doors closest to you regardless of temperature, get out fast! 8. What should you do if you cannot get out of the room because the only door is hot? C. Hide in the closet D. Make yourself visible so the firemen can see where you are. 9. What should every house have to protect families from fire? D. Smoke detectors E. Matches F. Candles 10. Once a power line is down, it is safe because it no longer has electricity running through it. C. True: power lines are only dangerous when they run pole to pole. D. False: loose dangling or down power lines should be avoided and immediately reported to the power company; they may sll be “hot” with electricity.
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to classmates before delivery of the intervention to the elementary school children.
Table 3 – Hazard House test scores by grade, mean (M), standard deviation (SD), and range. Grade
2.5.
Measures
Three grade specific knowledge evaluation tests were designed. The tests were adapted from existing tests on general injury prevention topics. Drafts of the burn prevention tests were reviewed by children’s injury prevention experts, each with over 20 years in injury prevention education with children, from the local Safe Kids Coalition. Modifications were made per the experts’ suggestions. For each burn prevention test, there were teacher instructions. The same tests were given as pre- and post-test. For the 10-item kindergarten test, the nursing student tester would ask a question and then the children would circle one of two pictures. One question example was ‘‘Circle the picture that shows what children should do with matches.’’ The two choices were: a child lighting a camp fire or a child giving matches to an adult. For the 12-item first and second grade test, the students were asked a question by the nursing student tester, and two possible answers were read. The students circled their answer (see Table 1). For the third and fourth grade 12-item test, the students independently read the questions and either wrote an answer or circled a letter indicating their response. Examples of questions on this test were ‘‘When your clothes catch fire, what are the three things you should do to put out the fire? Is it okay to leave the dryer running when you and your family leave the house (yes/no)?’’ One point was awarded for each correct answer in all of the three tests (see Table 2).
2.6.
Procedure
The study was considered exempt by the university institutional review board and permission was granted to evaluate the educational intervention by the county school system. Groups of 25–50 elementary students attended the presentation in the all-purpose room of their school. Additional presentations were scheduled each half hour until all participated. As the nursing students presented the educational intervention, elementary students were encouraged to identify fire hazards within each room of the house. Discussion regarding how to remedy the hazards was promoted. Participants were given a fire safety checklist which included the major points of the demonstration to take and use at home. Local firefighters presented on fire safety and the importance of working smoke alarms. The post-test was conducted in the classrooms by the nursing students immediately after program participation.
3.
Results
Elementary students in all three age groups loved the Hazard House program. They attentively listened to the nursing students’ presentation, and tried to find and then fix the fire safety hazards for each room. Some of the younger
Kindergarten (n = 128) Pre-test score Post-test score Grades 1–2 (n = 311) Pre-test score Post-test score Grades 3–4 (n = 61) Pre-test score Post-test score
M (SD)
Range
8.33 (1.44) 8.5 (1.61)
3–10 2–10
11.45 (1.21) 11.83 (0.63)
2–12 5–12
9.31 (1.21) 9.39 (0.63)
3–12 1–12
students did become frightened when the firefighter donned all his gear. Older students attentively looked on and answered questions. For major concepts such as dialing 911 for a fire emergency and Stop, Drop, and Roll, all the elementary students knew the answers. Older students, after participating in the presentation, knew that the dryer should be turned off prior to leaving home but said often it did not happen at their house. On the 10-question pretest, the kindergarten group’s scores ranged from 3 to 10 correct answers with M = 8.33 2.17 (see Table 3). The posttest scores ranged from 2 to 10 correct answers with M = 8.5 2.67 (see Table 3). Mean scores on the pre- and post-test did not differ (t = 0.833, df = 127, p = 0.406; see Table 4). The first and second grade group received a 12-question test. On pre-test, scores ranged from 2 to 12 correct answers with M = 11.45 0.15 (see Table 3). The posttest scores in this group ranged from 5 to 12 correct answers with M = 11.83 2.22 (see Table 3). There was a statistically significant improvement in post–test scores over pre-test scores (t = 6.25, df = 310, p < 0.001; see Table 4). The participants in grades three and four also took a 12question test. Scores on the pretest ranged from 3 to 12 correct answers with M = 9.31 1.78 (see Table 3). The posttest scores ranged from 1 to 12 correct answers with M = 9.39 1.98 (see Table 3). There was no significant difference from pre- to posttest (t = 0.476, df = 60, p = 0.636; see Table 4).
4.
Discussion
The Hazard House program only demonstrated a statistically significant change in the first and second graders’ scores [1]. Lack of improvement in test scores for the fourth graders could
Table 4 – Differences between pre- and post-test scores by grade. Grade Kindergarten Grade 1–2 Grade 3–4
Paired T-test
df
p-Value
0.833 6.25 0.476
127 310 60
0.406 NS 0.001*** 0.636 NS
NS, non-significant. Significant at the 0.05 level.
***
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be due to the tests not being sensitive. This may not have been the first fire prevention education these children had received. They may have had education via the annual county-wide Children in Hospitals Week, watching educational television, or education on the topic by previous teachers. The kindergarteners may have been too young developmentally to understand the content or test questions. Other reasons for non-significant results could be because there were lower student numbers in the youngest and oldest groups when compared to the first and second graders where there were 311 participants. Conversely, a potential reason for significant results in the first and second graders was that they were at an ideal age developmentally for children to internalize and understand the fire safety education. Hopefully, the knowledge from this intervention will remain with the students in order to protect them and be passed on to those they come in contact with throughout their lives. Changes to the kindergartner test might involve piloting different pictures to choose from which were specially drawn to answer the questions versus finding clip art illustrations from the web. Using item analysis technique would be helpful in seeing which questions for the kindergarten and 3–4 grade tests were not sensitive in evaluating burn prevention educational content. Then changing items through rewording, deleting others, or adding new ones would be important. There were many positive aspects to this project, the most important being that the elementary students were presented with strategies for home fire safety. Elementary student participants increased their knowledge, attitudes, and behavior toward fire prevention. The nursing students and clinical instructor found this project to be rewarding too. By implementing the Hazard House fire safety and prevention program, the baccalaureate nursing students became actively involved in an evidence-based research project [1]. This fostered the development of research skills through working in groups to gather data, to analyze data, and to present the findings orally, in poster format, and through journal article development. Future studies should evaluate previous elementary student burn prevention education. Another change would be to revise the pre/post-test questions to focus more on fire safety and then pilot the revisions in a smaller sample. Lack of follow-up with families at home to determine if classroom education resulted in changes at home would be an important objective for future research.
5.
Conclusion
The objective of teaching and evaluating primary burn prevention education in school-aged children from kindergarten to fourth grade was partially achieved. All three age groups were taught; however, significant knowledge changes were only evidenced in the first and second graders. With close to 300 pediatric burn injuries a year in this north central Kentucky community, it is critical that pediatric nurses teach burn prevention strategies to families in the community or hospital setting to decrease these devastating injuries. Teaching about primary home fire safety should be considered by nurses during patient hospitalization or when discharging children and adults. A quick assessment regarding home hot
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water heater temperature, frequency of battery checks in home smoke alarms, whether young children have access to play with matches, lighters, or candles, or if an older adult in the home smokes while on home oxygen, could prevent costly, painful, irreversible, and potentially life-threatening injuries.
Conflict of interest statement All the authors have no actual or potential conflict of interests to disclose.
Acknowledgments Safe Kids Coalition Louisville and Jefferson County led by Kosair Children’s Hospital members Erika Janes, R.N., (Coordinator), Sharon Rengers, R.N (Child advocate), and Jackie Graviss, Sergeant (Fire Prevention Inspector 1, Louisville Fire Department). Louisville Fire Department: Daryell Hudson (Firefighter), Briane Hume (Firefighter), Toby Mathes (Sergeant), and Andrew Tilford (Sergeant). Jefferson County Public Schools.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.burns.2013.01.016.
references
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[9] Scholer SJ, Hickson GB, Mitchel Jr EF, Ray WA. Predictors of mortality from fires in young children. Pediatrics 1998;101(5):E12. http://dx.doi.org/10.1542/peds. 101.5.e12. [10] Azerdo R, Stephens-Stidham S. Design and implementation of injury prevention curricula for elementary schools: lessons learned. Inj Prev 2003;9:274–8. http://dx.doi.org/ 10.1136/ip.9.3.274.
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