For the 120,000 Americans hospitalized with burn injury yearly, standard care consists of periodic washing, debridement and redressing of their wounds, characterized by patients as moderately to excruciatingly painful. Because clinical and research data indicate that patient-performed washing (PPW) during the burn dressing change may be less painful than nurse-performed washing (NPW), a study using a single-subject repeated reversal design was implemented in which numerical pain intensity scores were obtained intraprocedurally under conditions of both PPW and NPW, for ten adult subjects with burns. Measurements of retrospective pain quality, health locus of control, mood state, adequacy of washing and quantity of medication administered were also obtained. Interviews with subjects provided qualitative data and subject preference of PPW versus NPW.

For all ten subjects, pain was significantly less intense under conditions of PPW, as compared with NPW, by repeated-measures ANOVA with secondary Scheffe analysis (p $<$.001 through p $<$.05). Adequacy of washing, as evaluated by blind raters, and opioid medication administration did not differ significantly between PPW and NPW (p $<$.05). Descriptors selected by subjects characterized procedural pain in general as exhausting, stinging, sharp, tender and piercing in quality, PPW pain as exhausting, jumping and tender, and NPW pain as stinging, exhausting, piercing, shooting, sharp, wrenching, searing, hurting, sickening, fearful and tearing.

Seven subjects preferred PPW. Two preferred NPW, and one indicated a divided preference. Statistically, subject preference of PPW over NPW most clearly associated with the number of times the subject performed NPW, with an internal health locus of control, with a more negative score on the vigor-activity subscale of the POMS and with a low score on the evaluative subscale of the McGill Pain Questionnaire. Reasons given by subjects for preferring NPW were doubts of their own expertise, compression of legs in stretching to wash calf burns, and inability to self-inflict severe pain. Reasons given by subjects for preference of PPW were decreased pain and enhanced feelings of control.